Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?

BMC Musculoskeletal Disorders

Research

Boyko Gueorguiev¹  David Paul Martin²  Gerrolt Nico Jukema³  Hans-Christoph Pape³  Till Berk³  Sascha Halvachizadeh³  Roman Pfeifer³ 

[1] AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland;Department of Orthopedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave, 53705, Madison, WI, USA;Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland;Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland;

关键词: Traumatic proximal femur fractures;    Polytrauma;    Nonunion;    Delayed union;    Risk factors;    Non-geriatric;   

DOI  :  10.1186/s12891-023-06539-y

 received in 2022-08-26, accepted in 2023-05-16,  发布年份 2023

来源: Springer

【 摘 要 】

Background/purposeImpaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed. Therefore, this study aimed to identify non-infection related risk factors for impaired fracture healing of proximal femur fractures in non-geriatric trauma patients.MethodsThis study included non-geriatric patients (aged 69 years and younger) who were treated between 2013 and 2020 at one academic Level 1 trauma center due to a proximal femur fracture (PFF). Patients were stratified according to AO/OTA classification. Delayed union was defined as failed callus formation on 3 out of 4 cortices after 3 to 6 months. Nonunion was defined as lack of callus-formation after 6 months, material breakage, or requirement of revision surgery. Patient follow up was 12 months.ResultsThis study included 150 patients. Delayed union was observed in 32 (21.3%) patients and nonunion with subsequent revision surgery occurred in 14 (9.3%). With an increasing fracture classification (31 A1 up to 31 A3 type fractures), there was a significantly higher rate of delayed union. Additionally, open reduction and internal fixation (ORIF) (OR 6.17, (95% CI 1.54 to 24.70, p ≤ 0.01)) and diabetes mellitus type II (DM) (OR 5.74, (95% CI 1.39 to 23.72, p = 0.016)), were independent risk factors for delayed union. The rate of nonunion was independent of fracture morphology, patient’s characteristics or comorbidities.ConclusionIncreasing fracture complexity, ORIF and diabetes were found to be associated with delayed union of intertrochanteric femur fractures in non-geriatric patients. However, these factors were not associated with the development of nonunion.

【 授权许可】

CC BY   
© The Author(s) 2023