Physical Health and Psychological Outcomes in Adult Patients with Long-Bone Fracture Non-Unions: Evidence Today

Abstract

Background: Research has suggested that bone fractures can hinder the health status of patients’ life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes. Methods: Electronic databases ‘PubMed’, ‘Cochrane’, ‘PsycInfo’, ‘Medline’, ‘Embase’, ‘Web of Science’, and ‘CINAHL’ were used. Search terms used were nonunion OR non-union OR “non union” OR “long bone” OR “delayed union” AND “quality of life” OR qol OR depression OR anxiety OR psycholog* OR PTSD OR “post-traumatic stress disorder”. Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The “non-union” group to a normative, matched population and (2) the “non-union group” to the same group after union was achieved. However, studies that did not use comparison groups were also included. Results: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery. Conclusions: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.

Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail—clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating

“…These finding are in line with other studies providing first insights into the serious consequences following fractures, non-unions, and fracture-related infections on patients’ physical and mental wellbeing [ 31 – 33 ]. For instance, Brinker et al assessed the quality of life in 237 patients with tibial shaft fracture non-unions (14.8% infected) and report a mean SF-12 mental health component score of 42.3 ± 7.1 and a mean SF-12 physical health component score of 27.4 ± 6.7.…”

Do the Successful Revision Surgery for Humeral Nonunion Solve all the Effects on Health-Related Quality of life? A Retrospective Cohort Study

“…The possible reasons for this phenomenon could be as follows. First, humeral nonunion due to failure of internal xation often leads to severe appearance deformities or pseudo-articular formation, causing patients to fall into serious psychological obstacles 44 . Second, patients with nonunion of the lower extremities can travel by wheelchair and crutches, but there is no alternative for upper limb nonunion patients to perform some ne motor skills.…”

Do the successful revision surgery for humeral nonunion solve all the effects on health‐related quality of life? A retrospective cohort study

“…The possible reasons for this phenomenon could be as follows. First, humeral nonunion due to failure of internal fixation often leads to severe appearance deformities or pseudo-articular formation, causing patients to fall into serious psychological obstacles [ 42 ]. Second, patients with nonunion of the lower extremities can travel by wheelchair and crutches, but there is no alternative for upper limb nonunion patients to perform some fine motor skills.…”