Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects
OBJECTIVES:To determine factors associated with developing nonunion or delayed healing after open fracture. DESIGN:Prospective cohort between 2001 and 2009. SETTING:Three level 1 Canadian trauma centers. PARTICIPANTS:Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty...
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| Veröffentlicht in: | Journal of orthopaedic trauma 2016-03, Vol.30 (3), p.149-155 |
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| creator | Westgeest, Joseph Weber, Donald Dulai, Sukhdeep K Bergman, Joseph W Buckley, Richard Beaupre, Lauren A |
| description | OBJECTIVES:To determine factors associated with developing nonunion or delayed healing after open fracture.
DESIGN:Prospective cohort between 2001 and 2009.
SETTING:Three level 1 Canadian trauma centers.
PARTICIPANTS:Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty-nine (94%) subjects (739 fractures) provided adequate outcome data.
INTERVENTION:Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted 1 year after fracture. Patient, fracture, and injury information, and time to surgery and antibiotics were recorded during hospitalization.
MAIN OUTCOME MEASUREMENTS:Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year.
RESULTS:There were 413 (52%) tibia/fibular, 285 (36%) upper extremity, and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. The median time to surgery was not different for fractures that developed nonunion compared with those who did not (P = 0.36). Deep infection [Odd ratio (OR) 12.75; 95% confidence interval (CI) 6.07–26.8], grade 3A fractures (OR 2.49; 95% CI, 1.30–4.78), and smoking (OR 1.73; 95% CI, 1.09–2.76) were significantly associated with developing a nonunion. Delayed healing was also significantly associated with deep infection (OR 4.34; 95% CI, 1.22–15.48) and grade 3B/C fractures (OR 3.69; 95% CI, 1.44–9.44). Multivariate regression found no association between nonunion and time to surgery (P = 0.15) or antibiotics (P = 0.70).
CONCLUSIONS:Deep infection and higher Gustilo grade fractures were associated with nonunion and delayed healing.
LEVEL OF EVIDENCE:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.1097/BOT.0000000000000488 |
| format | Article |
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DESIGN:Prospective cohort between 2001 and 2009.
SETTING:Three level 1 Canadian trauma centers.
PARTICIPANTS:Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty-nine (94%) subjects (739 fractures) provided adequate outcome data.
INTERVENTION:Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted 1 year after fracture. Patient, fracture, and injury information, and time to surgery and antibiotics were recorded during hospitalization.
MAIN OUTCOME MEASUREMENTS:Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year.
RESULTS:There were 413 (52%) tibia/fibular, 285 (36%) upper extremity, and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. The median time to surgery was not different for fractures that developed nonunion compared with those who did not (P = 0.36). Deep infection [Odd ratio (OR) 12.75; 95% confidence interval (CI) 6.07–26.8], grade 3A fractures (OR 2.49; 95% CI, 1.30–4.78), and smoking (OR 1.73; 95% CI, 1.09–2.76) were significantly associated with developing a nonunion. Delayed healing was also significantly associated with deep infection (OR 4.34; 95% CI, 1.22–15.48) and grade 3B/C fractures (OR 3.69; 95% CI, 1.44–9.44). Multivariate regression found no association between nonunion and time to surgery (P = 0.15) or antibiotics (P = 0.70).
CONCLUSIONS:Deep infection and higher Gustilo grade fractures were associated with nonunion and delayed healing.
LEVEL OF EVIDENCE:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/BOT.0000000000000488</identifier><identifier>PMID: 26544953</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alberta - epidemiology ; Cohort Studies ; Female ; Fracture Fixation, Internal - statistics & numerical data ; Fracture Healing ; Fractures, Bone - epidemiology ; Fractures, Bone - surgery ; Fractures, Malunited - epidemiology ; Fractures, Malunited - surgery ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Reoperation - utilization ; Risk Factors ; Time Factors ; Treatment Outcome ; Young Adult</subject><ispartof>Journal of orthopaedic trauma, 2016-03, Vol.30 (3), p.149-155</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3758-342521e9ed44816c38fe0f4e26a79d141758c6f8323ebc96cf808dcb816b31813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26544953$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Westgeest, Joseph</creatorcontrib><creatorcontrib>Weber, Donald</creatorcontrib><creatorcontrib>Dulai, Sukhdeep K</creatorcontrib><creatorcontrib>Bergman, Joseph W</creatorcontrib><creatorcontrib>Buckley, Richard</creatorcontrib><creatorcontrib>Beaupre, Lauren A</creatorcontrib><title>Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVES:To determine factors associated with developing nonunion or delayed healing after open fracture.
DESIGN:Prospective cohort between 2001 and 2009.
SETTING:Three level 1 Canadian trauma centers.
PARTICIPANTS:Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty-nine (94%) subjects (739 fractures) provided adequate outcome data.
INTERVENTION:Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted 1 year after fracture. Patient, fracture, and injury information, and time to surgery and antibiotics were recorded during hospitalization.
MAIN OUTCOME MEASUREMENTS:Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year.
RESULTS:There were 413 (52%) tibia/fibular, 285 (36%) upper extremity, and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. The median time to surgery was not different for fractures that developed nonunion compared with those who did not (P = 0.36). Deep infection [Odd ratio (OR) 12.75; 95% confidence interval (CI) 6.07–26.8], grade 3A fractures (OR 2.49; 95% CI, 1.30–4.78), and smoking (OR 1.73; 95% CI, 1.09–2.76) were significantly associated with developing a nonunion. Delayed healing was also significantly associated with deep infection (OR 4.34; 95% CI, 1.22–15.48) and grade 3B/C fractures (OR 3.69; 95% CI, 1.44–9.44). Multivariate regression found no association between nonunion and time to surgery (P = 0.15) or antibiotics (P = 0.70).
CONCLUSIONS:Deep infection and higher Gustilo grade fractures were associated with nonunion and delayed healing.
LEVEL OF EVIDENCE:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alberta - epidemiology</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fracture Fixation, Internal - statistics & numerical data</subject><subject>Fracture Healing</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - surgery</subject><subject>Fractures, Malunited - epidemiology</subject><subject>Fractures, Malunited - surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Reoperation - utilization</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9O4zAQxq0VaOmWfYMV8pFLwP-SONxK2QJSRZEK4hg5zoQGUjvYDqhPwStjVHaFODAXSzO_-Ub-PoT-UHJESZEfny5ujsjnElL-QCOacpowVtAdNCKyIEnKebGHfnn_EBlJGPuJ9liWClGkfIReZ0oH6zyeeG91qwLU-K4NK3wGz9DZfg0mYNvgK2sG01qDrYujTm0idwGqa809njQBHFYGL3oweG5j69QawDMXtQcHJ3iCr531PejQPgOe2pV1AS_DUG_etXOe4eVQPcSx30e7jeo8_P54x-h29vdmepHMF-eX08k80TxPZcIFSxmFAmohJM00lw2QRgDLVF7UVNAI6ayRnHGodJHpRhJZ6yqyFaeS8jE63Or2zj4N4EO5br2GrlMG7OBLmmc5yXIpZETFFtXxD95BU_auXSu3KSkp36MoYxTl1yji2sHHhaFaQ_1_6Z_3EZBb4MV20UD_2A0v4MpVdDWsvtd-A1RklM8</recordid><startdate>201603</startdate><enddate>201603</enddate><creator>Westgeest, Joseph</creator><creator>Weber, Donald</creator><creator>Dulai, Sukhdeep K</creator><creator>Bergman, Joseph W</creator><creator>Buckley, Richard</creator><creator>Beaupre, Lauren A</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201603</creationdate><title>Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects</title><author>Westgeest, Joseph ; Weber, Donald ; Dulai, Sukhdeep K ; Bergman, Joseph W ; Buckley, Richard ; Beaupre, Lauren A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3758-342521e9ed44816c38fe0f4e26a79d141758c6f8323ebc96cf808dcb816b31813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alberta - epidemiology</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fracture Fixation, Internal - statistics & numerical data</topic><topic>Fracture Healing</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - surgery</topic><topic>Fractures, Malunited - epidemiology</topic><topic>Fractures, Malunited - surgery</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Reoperation - utilization</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Westgeest, Joseph</creatorcontrib><creatorcontrib>Weber, Donald</creatorcontrib><creatorcontrib>Dulai, Sukhdeep K</creatorcontrib><creatorcontrib>Bergman, Joseph W</creatorcontrib><creatorcontrib>Buckley, Richard</creatorcontrib><creatorcontrib>Beaupre, Lauren A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Westgeest, Joseph</au><au>Weber, Donald</au><au>Dulai, Sukhdeep K</au><au>Bergman, Joseph W</au><au>Buckley, Richard</au><au>Beaupre, Lauren A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2016-03</date><risdate>2016</risdate><volume>30</volume><issue>3</issue><spage>149</spage><epage>155</epage><pages>149-155</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVES:To determine factors associated with developing nonunion or delayed healing after open fracture.
DESIGN:Prospective cohort between 2001 and 2009.
SETTING:Three level 1 Canadian trauma centers.
PARTICIPANTS:Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty-nine (94%) subjects (739 fractures) provided adequate outcome data.
INTERVENTION:Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted 1 year after fracture. Patient, fracture, and injury information, and time to surgery and antibiotics were recorded during hospitalization.
MAIN OUTCOME MEASUREMENTS:Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year.
RESULTS:There were 413 (52%) tibia/fibular, 285 (36%) upper extremity, and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. The median time to surgery was not different for fractures that developed nonunion compared with those who did not (P = 0.36). Deep infection [Odd ratio (OR) 12.75; 95% confidence interval (CI) 6.07–26.8], grade 3A fractures (OR 2.49; 95% CI, 1.30–4.78), and smoking (OR 1.73; 95% CI, 1.09–2.76) were significantly associated with developing a nonunion. Delayed healing was also significantly associated with deep infection (OR 4.34; 95% CI, 1.22–15.48) and grade 3B/C fractures (OR 3.69; 95% CI, 1.44–9.44). Multivariate regression found no association between nonunion and time to surgery (P = 0.15) or antibiotics (P = 0.70).
CONCLUSIONS:Deep infection and higher Gustilo grade fractures were associated with nonunion and delayed healing.
LEVEL OF EVIDENCE:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26544953</pmid><doi>10.1097/BOT.0000000000000488</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of orthopaedic trauma, 2016-03, Vol.30 (3), p.149-155 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Alberta - epidemiology Cohort Studies Female Fracture Fixation, Internal - statistics & numerical data Fracture Healing Fractures, Bone - epidemiology Fractures, Bone - surgery Fractures, Malunited - epidemiology Fractures, Malunited - surgery Humans Incidence Male Middle Aged Prevalence Prospective Studies Reoperation - utilization Risk Factors Time Factors Treatment Outcome Young Adult |
| title | Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects |
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