Abstract
Introduction
Fracture non-union is a devastating cause of patient morbidity. The cost of NU treatment ranges from £7,000 to £79,000. With an estimated 11,700 cases in the UK pa the financial implications are huge, potentially costing several hundreds of million of pounds annually.
Successful outcome in the management of non-union is based upon correctly identifying the underlying cause(s) and addressing them appropriately.
Aim
The aim of this study was to assess the causative factors in non-union in order to optimize the management of non-union. The causes of NU were categorized into 4 groups (infection, dead bone/gap, host factors, mechanical).
Method
100 consecutive patients who had surgery for long bone non-union were analysed. Information was obtained from the patient clinic visits, notes, radiographs and laboratory results. The cause(s) of the non-union were identified, recorded and divided into 4 groups; host, mechanical, dead bone/gap at NU site and infection.
Results
The mean age at time of injury was 41.4(±16.7)years; male/female ratio was 3:1, 80% were lower limb (52% of all cases were tibial). 69% were high energy, 38% were open.
26% of patients had a single attributable cause, 59% had two causes, 14% had three causes and one had all four.
Mechanical causation was found in 56% of cases, dead bone/gap in 50%, host factors in 44%, infection in 40% of patients.
5.7% of the infections were unexpected new/occult positive findings.
73% of patients with previously treated infection but without ongoing infection had multiple positive cultures.
Conclusion/discussion
Surgical procedures for non-union often address a single aspect yet 74% had more than one attributable cause. With a 6% occult infection rate multiple tissue samples for microbiology and pathology investigation should be carried out routinely in every patient with non-union.
The multi-factorial nature of non-union makes meticulous patient assessment vital to maximise the chance of treatment success.
