Abstract
PurposeConcomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union.MethodsPatients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS).ResultsThe total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development.ConclusionOur results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
Highlights
Fracture healing depends on the interactions of many biomechanical and biological factors [1]
Independent from the already well-known risk factors for non-union development, we aimed to focus on the impact of fracture stabilisation strategy, chest injury and traumatic brain injury (TBI) on the occurrence of non-unions in diaphyseal long bone fractures
damage control orthopaedics (DCO) treatment is well accepted to be beneficial in certain subgroups of trauma patients, we found that this treatment strategy is associated with a higher risk of nonunion
Summary
Fracture healing depends on the interactions of many biomechanical and biological factors [1]. Disturbances in this process might result in non-union with an overall incidence of 1.5–10%, increasing up to 40% in case of open fractures. Interactions between local and systemic inflammatory responses have been considered as the potential reasons for delayed fracture healing in chest trauma [6]. TBI seems to be positively correlated with osteogenesis [7,8,9]. This association has not been found in all studies [10, 11]. Potential pathophysiological mechanisms for TBI-related impact on osteogenesis seem to be multifactorial (humoral, hormonal and cellular) and are far from clear [7, 12, 13]
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