IS FRACTURE HEALING DELAYED IN OSTEOPOROTIC PATIENTS?

Abstract

Purpose: To evaluate the effect of osteoporosis on healing time of long bone fractures.

Methods: Between January 2002 to January 2004 patients with femoral shaft fracture treated in our institution by locked reamed IM nailing were eligible for inclusion in this study. Patients were divided in two age groups; Group A, consisting of patients between 18 and 41 years of age and group B consisting of patients over 65 years old with radiological evidence of osteoporosis. Exclusion criteria were open fractures, pathological fractures, patients with head injuries and patients with systematic inflammatory diseases. In addition to the demographic details such parameters were documented as fracture classification, Injury Severity Score, mode of mobilization, time to clinical and radiological union, complications, and length of hospital stay. In all patients the Singh Index Score for osteoporosis was assigned. Following discharge from the hospital, all patients were followed up at regular intervals for clinical and radiological assessment in the trauma clinics. The minimum follow up was 12 months.

Results: Out of 112 patients, 90 met the inclusion criteria. Group A consisted of 48 and group B of 42 patients. The mean age in group A was 24.5 years (18 – 41) and in group B 78.3 years (65 – 93). The mean ISS was 13.3 (9 – 32) and 9.07 (9–10) respectively, (p> 0.05). According to OTA fracture classification in group A there were 16 type 32A, 19 type 32B and 13 type 32C fractures, whereas in group B there were 25 type 32A, 15 type 32B and 2 type 32C fractures respectively. In 96% of patients in group A, a Singh score of 5 or 6 was assigned, whereas 85.5% of group B patients had a Singh score of 4 or less, indicating the presence of installed osteoporosis. Overall, the incidence of complications was similar among the studied groups. Delayed union occurred in 6 patients of group B and in 1 patient of group A (P=0.113). All fractures eventually progressed to union without further intervention. In group A the mean time to union was 15.73±0.52 weeks (7–22) and in group B 19.45±1.5 weeks (10–52) from surgery (P=0.0156).

Conclusion and Significance: This study indicates that fracture healing of nailed femoral shaft fractures is significantly delayed in older osteoporotic patients. Further studies are mandatory to clarify the exact mechanism of osteoporosis in the fracture healing response and the possible future therapeutic strategies.