Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

Abstract

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

Dynamics of Early Signalling Events during Fracture Healing and Potential Serum Biomarkers of Fracture Non-Union in Humans

“…Delayed bone healing and non-union fortunately is an infrequent event occurring in approximately 5%−10% of long bone fracture cases [4]. Fracture non-union represents a serious health care burden for society, the National Health System (NHS) and patients.…”

“…Prolonged non-union treatment is associated with significant loss of working days and economic effects and also carries the risk of permanent disabilities related to a dysfunctional limb, joint stiffness, muscular atrophy or reflex sympathetic dystrophy [5]. Cases where fractures fail to heal frequently result in further complications, additional surgery and may be even fatal [4].…”

Highly filled poly(l‐lactic acid)/hydroxyapatite composite for 3D printing of personalized bone tissue engineering scaffolds

“…Surgical treatment of polytrauma and congenital diseases accompanied by massive bone tissue lose is still one of the most challenging issues for modern orthopedics and traumatology. Consolidation of bone fragments during the treatment of such diseases even with the use of external fixation devices is often accompanied by complications leading to the increase in the time of osteosynthesis and, in some cases, to the additional surgical intervention 4–6 . With conservative treatment, prolonged limb immobilization leads to deterioration in blood supply and atrophy of muscle tissue, thereby limiting joint mobility and leading to the need for subsequent long‐term rehabilitation 7 .…”

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

“…Type B1 fractures represent 30% and type C fractures represent 10% of all PFFs, and their treatment can be associated to a higher risk of complication than other PFFs types and high risk of failure due to nonunion with implant loosening and/or re-fracture [8,[25][26][27][28][29][30][31]. Clearly, this entails an important economic expense [32][33][34] and a high rate of morbidity and disability for these patients; moreover, mortality after PFFs and their treatment varies with patient age and concomitant disease between 4.5% and 22% [29,[35][36][37][38][39].…”