Risk factors for nonunion following open reduction and internal fixation for proximal humerus fractures

Sanchez, Giovanni; Vargas, Marcos; Gordon, Adam M.; Golub, Ivan J; Ashraf, Asad; Diamond, Keith B.; Kang, Kevin; Razi, Afshin E.

doi:10.1007/s00590-022-03221-2

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Prior studies have linked patient factors such as smoking, diabetes, chronic kidney disease, and obesity as risk factors for impaired fracture healing, 4,16,19,20 but our data did not share these findings. Chronic anemia has recently been identified as a risk factor for nonunion in proximal humerus fractures 21 and was identified as an independent risk factor for distal femoral nonunion in our study. Although the causative mechanism by which anemia affects bone healing is not well defined, all of our patients with chronic anemia suffered from multiple comorbidities.…”

Section: Discussionsupporting

confidence: 61%

Risk Factors for Nonunion of Distal Femur Fractures

Cone

Roszman

Conway

et al. 2023

Journal of Orthopaedic Trauma

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Participants: Patients 18 years and older presenting with OTA/AO 33A and 33C distal femur fractures from 2004 to 2020. A minimum follow-up of 6 months was required for inclusion. OTA/AO 33B and periprosthetic fractures were excluded, 438 patients met inclusion criteria for the study. Main Outcomes:The primary outcome of the study was fracture nonunion defined as a return to the OR for management of inadequate bony healing. Patient demographics, comorbidities, injury characteristics, fixation type, and construct variables were assessed for association with distal femur fracture nonunion. Secondary outcomes include conversion to total knee arthroplasty, surgical site infection, and other reoperation. Results:The overall nonunion rate was 13.8% (61/438). The nonunion group was compared directly with the fracture union group for statistical analysis. There were no differences in age, sex, mechanism of injury, Injury Severity Score, and time to surgery between the groups. Lateral locked plating characteristics including length of plate, plate metallurgy, screw density, and working length were not significantly different between groups. Increased body mass index [odds ratio (OR), 1.05], chronic anemia (OR, 5.4), open fracture (OR, 3.74), and segmental bone loss (OR, 2.99) were independently associated with nonunion. Conversion to total knee arthroplasty (TKA) (P = 0.005) and surgical site infection (P , 0001) were significantly more common in the nonunion group. Conclusion:Segmental bone loss, open fractures, chronic anemia, and increasing body mass index are significant risk factors in the occurrence of distal femoral nonunion. Lateral locked plating characteristics did not seem to affect nonunion rates. Further investigation into the prevention of nonunion should focus on fracture fixation constructs and infection prevention.

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Section: Discussionsupporting

confidence: 61%

Risk Factors for Nonunion of Distal Femur Fractures

Cone

Roszman

Conway

et al. 2023

Journal of Orthopaedic Trauma

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“…The factors that contributed to the initial non-union could potentially lead to a treatment failure when addressing the non-union with open reduction and initial fixation (ORIF). Smoking is a well-known risk factor for PHN [ 2 , 25 , 26 ]. Sanchez described those younger patients who developed non-union usually and had higher Elixhauser-Comorbidity Index scores [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Smoking is a well-known risk factor for PHN [ 2 , 25 , 26 ]. Sanchez described those younger patients who developed non-union usually and had higher Elixhauser-Comorbidity Index scores [ 25 ]. Two (33%) patients were smokers in this study.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Mukhopadhaya,

Singh,

Gupta

et al. 2024

jocr

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Introduction: It can be challenging to treat proximal humeral non-union (PHN). The challenge gets compounded when they are presented either late or after previous surgery. The challenges are far greater due to small proximal fragments, scalloping of the head, medial bone defect, osteoporosis, soft tissue contractures, and problems related to the previous implants. Materials and Methods:In this retro-prospective study (2007–2020), we report on six cases of PHN which were presented to us more than 5 years after the original injury and managed using an intra-medullary autologous fibular strut graft (FSG) along with fixation with a proximal humeral locking plate and cancellous bone grafting. We quantified shoulder function based on constant score and disabilities of the arm, shoulder and hand (DASH) score. Results: The mean age of patients is found to be 54.3 years (range, 22–74 years) with females dominating our study. The mean pre-operative constant score is 26.33 which improved to 71.83 in the post-operative period. The mean DASH score is 77.98 preoperatively, which improved to 19.5 postoperatively. The paired sample t-test compared the difference in mean of the pre-operative and post-operative scores, which shows significant improvement in outcome. Conclusion: Even in very late PHN in poor-quality bone, the additional use of intramedullary strut grafts provides structural support to the fixation and further enhances the ability to withstand the load-start early motion and have a satisfactory functional outcome. Keywords: Non-union, proximal humerus non-union, proximal humerus fracture, proximal humerus internal locking system, locking plate, autogenous fibular strut graft.

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“…Another meta-analysis of 13 studies by Wu et al 34 demonstrated that a diagnosis of depression was independently associated with an increased risk of fractures (relative risk = 1.74). Furthermore, a recent retrospective cohort study by Sanchez et al 35 demonstrated that a diagnosis of depression was associated with increased rates of nonunion after open reduction and internal fixation for humeral fractures (OR = 1.28).…”

Section: Pseudarthrosismentioning

confidence: 99%

Poor Mental Health Negatively Impacts Outcomes After Spinal Surgery: A Narrative Review

Heard,

Yeung,

Ezeonu

et al. 2024

Contemporary Spine Surgery

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Risk factors for nonunion following open reduction and internal fixation for proximal humerus fractures

Cited by 5 publications

References 17 publications

Risk Factors for Nonunion of Distal Femur Fractures

Risk Factors for Nonunion of Distal Femur Fractures

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Poor Mental Health Negatively Impacts Outcomes After Spinal Surgery: A Narrative Review

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