Do Successful Surgical Results after Operative Treatment of Long-bone Nonunions Correlate with Outcomes?

Egol, Kenneth A; Gruson, Konrad I.; Spitzer, Allison B.; Walsh, Michael; Tejwani, Nirmal C.

doi:10.1007/s11999-009-0883-x

Cited by 26 publications

(12 citation statements)

References 38 publications

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“…Patient-reported pain has been demonstrated to be greatly affected by fracture healing, and the vast majority of our cohort was likely healed by the 3-month time point. 15 There was no difference between groups in regard to distribution of genders, polytrauma status, or age. Albuquerque et al 16 reported on their cohort of 249 patients with tibial plateau fracture treated at an urban level 1 trauma center and similarly demonstrated no difference in age, gender, or polytrauma status between a lateral tibial plateau fracture group and a medial or bicondylar plateau fracture group.…”

Section: Discussionmentioning

confidence: 84%

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures

et al. 2019

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The purpose of this study is to determine when functional outcome no longer improves following tibial plateau fracture. A patient series of operatively treated tibial plateau fractures was reviewed. Patients were evaluated using the short musculoskeletal function assessment (SMFA), range of motion (ROM) assessment, and pain levels at visual analog scale (VAS) at 3, 6, and 12 months postoperatively. Fractures were classified by the Schatzker's classification using preoperative imaging. The case series was divided into two groups based on fracture patterns. Friedman's tests were conducted to determine if there were differences in SMFA, ROM, or VAS throughout the postoperative course. A total of 117 patients with tibial plateau fractures treated operatively, with complete follow-up and without complication, were identified. Seventy-seven patients (65.8%) sustained lateral tibial plateau fractures (Schatzker's I–III). Friedman's test demonstrated significant differences in SMFA (p < 0.0005) and ROM (p < 0.0005) at the three time points. Post hoc analysis demonstrated a significant difference in SMFA (p < 0.0005) and ROM (p = 0.003) between 3 and 6 months postoperatively but no significant difference in either metric between 6 and 12 months postoperatively. Friedman's test demonstrated no significant difference in VAS postoperatively (p = 0.210). Forty patients (34.2%) sustained medial or bicondylar tibial plateau fractures (Schatzker's IV–VI). Friedman's test demonstrated significant differences in SMFA (p < 0.0005) and ROM (p < 0.0005) at the three time points. Post hoc analysis demonstrated a strong trend toward significance in SMFA between 3 and 6 months postoperatively (p = 0.088), and demonstrated a significant difference between 6 and 12 months postoperatively (p = 0.013). ROM was found to be significantly different between 3 and 6 months postoperatively (p = 0.010), but no difference was found between 6 and 12 months postoperatively (p = 0.929). Friedman's test demonstrated no significant difference in VAS postoperatively (p = 0.941). In this cohort, no significant difference in function, ROM, or pain level exists between 6 and 12 months after treatment of lateral tibial plateau fractures. However, there are significant improvements in function for at least 1 year following medial or bicondylar tibial plateau fractures.

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Section: Discussionmentioning

confidence: 84%

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures

et al. 2019

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“…In situations where a determination could not be made, a CT scan was obtained to confirm union. 2,10,11,13 Intraoperative culture results and complications with wound infection identified during follow-up visits were recorded. Other follow-up complications, such as development of iliac crest graft site and surgical wound hematoma, wound dehiscence, wound breakdown, and malunion following revision, were also noted.…”

Section: Methodsmentioning

confidence: 99%

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Taormina

Shulman

Karia

et al. 2014

Geriatr Orthop Surg Rehabil

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Introduction: Elderly patients are at risk of fracture nonunion, given the potential setting of osteopenia, poorer fracture biology, and comorbid medical conditions. Risk factors predicting fracture nonunion may compromise the success of fracture nonunion surgery. The purpose of this study was to investigate the effect of patient age on clinical and functional outcome following long bone fracture nonunion surgery. Materials and Methods: A retrospective analysis of prospectively collected data identified 288 patients (aged 18-91) who were indicated for long bone nonunion surgery. Two-hundred and seventy-two patients satisfied study inclusion criteria and analyses were performed comparing elderly patients aged !65 years (n ¼ 48) with patients <65 years (n ¼ 224) for postoperative wound complications, Short Musculoskeletal Functional Assessment (SMFA) functional status, healing, and surgical revision. Regression analyses were performed to look for associations between age, smoking status, and history of previous nonunion surgery with healing and functional outcome. Twelve-month follow-up was obtained on 91.5% (249 of 272) of patients. Results: Despite demographic differences in the aged population, including a predominance of medical comorbidities (P < .01) and osteopenia (P ¼ .02), there was no statistical differences in the healing rate of elderly patients (95.8% vs 95.1%, P ¼ .6) or time to union (6.2 + 4.1 months vs. 7.2 + 6.6, P ¼ .3). Rates of postoperative wound complications and surgical revision did not statistically differ. Elderly patients reported similar levels of function up to 12 months after surgery. Regression analyses failed to show any significant association between age and final union or time to union. There was a strong positive association between smoking and history of previous nonunion surgery with time to union. Age was associated (positively) with 12-month SMFA activity score. Conclusions: Smoking and failure of previous surgical intervention were associated with nonunion surgery outcomes. Patient's age at the time of surgery was not associated with achieving union. Advanced age was generally not associated with poorer nonunion surgery outcomes.

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“…Nonunion is a devastating complication of a fracture, and can cause considerable patient morbidity. 1 The management of fracture nonunion is expensive with the estimated cost per case between £7000 and £79 000 ($10 000 to $114 000). [2][3][4][5] For every million people there are approximately 200 long-bone nonunions per year.…”

Section: Cite This Article: Bone Joint J 2016;98-b:534-41mentioning

confidence: 99%

Exchange nailing for nonunion of diaphyseal fractures of the tibia

Tsang

Mills

Frantzias

et al. 2016

The Bone & Joint Journal

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Do Successful Surgical Results after Operative Treatment of Long-bone Nonunions Correlate with Outcomes?

Abstract: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 26 publications

References 38 publications

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Exchange nailing for nonunion of diaphyseal fractures of the tibia

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