Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?
Abstract Background/purpose Impaired 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 f...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06539-y |
| _version_ | 1797823114801840128 |
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| author | Sascha Halvachizadeh David Paul Martin Roman Pfeifer Gerrolt Nico Jukema Boyko Gueorguiev Hans-Christoph Pape Till Berk |
| author_facet | Sascha Halvachizadeh David Paul Martin Roman Pfeifer Gerrolt Nico Jukema Boyko Gueorguiev Hans-Christoph Pape Till Berk |
| author_sort | Sascha Halvachizadeh |
| collection | DOAJ |
| description | Abstract Background/purpose Impaired 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. Methods This 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. Results This 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. Conclusion Increasing 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. |
| first_indexed | 2024-03-13T10:18:15Z |
| format | Article |
| id | doaj.art-deafa97b90204fa4976e072dfefc89d4 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-13T10:18:15Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-deafa97b90204fa4976e072dfefc89d42023-05-21T11:05:16ZengBMCBMC Musculoskeletal Disorders1471-24742023-05-012411810.1186/s12891-023-06539-yWhich non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?Sascha Halvachizadeh0David Paul Martin1Roman Pfeifer2Gerrolt Nico Jukema3Boyko Gueorguiev4Hans-Christoph Pape5Till Berk6Department of Trauma, University Hospital ZurichDepartment of Orthopedics and Rehabilitation, University of WisconsinDepartment of Trauma, University Hospital ZurichDepartment of Trauma, University Hospital ZurichAO Research Institute DavosDepartment of Trauma, University Hospital ZurichDepartment of Trauma, University Hospital ZurichAbstract Background/purpose Impaired 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. Methods This 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. Results This 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. Conclusion Increasing 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.https://doi.org/10.1186/s12891-023-06539-yTraumatic proximal femur fracturesPolytraumaNonunionDelayed unionRisk factorsNon-geriatric |
| spellingShingle | Sascha Halvachizadeh David Paul Martin Roman Pfeifer Gerrolt Nico Jukema Boyko Gueorguiev Hans-Christoph Pape Till Berk 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 Traumatic proximal femur fractures Polytrauma Nonunion Delayed union Risk factors Non-geriatric |
| title | Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? |
| title_full | Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? |
| title_fullStr | Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? |
| title_full_unstemmed | Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? |
| title_short | Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? |
| title_sort | which non infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years |
| topic | Traumatic proximal femur fractures Polytrauma Nonunion Delayed union Risk factors Non-geriatric |
| url | https://doi.org/10.1186/s12891-023-06539-y |
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