Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Westgeest, Joseph; Weber, Donald; Dulai, Sukhdeep K.; Bergman, Joseph W.; Buckley, Richard; Beaupre, Lauren A.
• Is Part Of: Journal of orthopaedic trauma. Volume 30:Issue 3(2016)
• Publication Date: 2016-03
• Subjects: open fracture -- nonunion -- delayed healing; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000488
• Languages: English
• ISSNs: 0890-5339

Abstract

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.