Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture.

Christina Ekegren,Richard De Steiger,Belinda Gabbe,Elton Edwards

doi:10.3390/ijerph15122845

Abstract

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

Highlights

Fractures are the most common form of hospitalised trauma, contributing to over 150,000 hospitalisations and almost one million bed-days in Australia each year [1]
Of the 3886 patients included in the study, 8% were admitted to hospital for fracture healing complications within two years of their index fracture
Factors that predicted the development of complications requiring readmission, included being older, receiving compensation and having any fracture type other than a proximal humerus fracture, with shaft of femur and shaft of tibia fractures having the greatest odds of readmission

Summary

Introduction

Fractures are the most common form of hospitalised trauma, contributing to over 150,000 hospitalisations and almost one million bed-days in Australia each year [1]. Fractures of the femoral shaft, humerus and tibia account for 3%, 14% and 24% of fractures in working-age adults, respectively, and are commonly the result of hi-energy trauma such as a fall from height and transport accidents [3]. The management of these long bone fractures is complex, and the risk of mal-union, delayed union and non-union remains high, contributing to considerable patient disability, reduced quality of life and significant treatment costs [4,5].

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