Delayed union and non-union are complications of fracture healing associated with pain and with functional and psychosocial disability. This study compares the effect on self-reported health outcomes of delayed union or non-union of femoral and tibial shaft fractures treated at two major metropolitan trauma centres in Victoria.

Patients admitted to the Royal Melbourne Hospital and The Alfred with extra- articular femoral and tibial shaft fractures during 2003-2004 and 2005-2006, and followed up by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included. Hospital medical records were reviewed to identify the outcome of each fracture. Fracture healing was assessed by the need for unplanned revision surgery for delayed union or nonunion, and clinical and radiological evidence of union. Prospectively-gathered VOTOR health outcome measurements included the Short Form 12-Item Health Survey (SF-12), and return to work and pain status at 6 and 12 months post injury.

Of the 520 patients, 260 femoral and 282 tibial shaft fractures were included. In total, 285 fractures progressed to union, 138 fractures developed delayed union or non-union and 119 fractures had an unknown outcome. Factors that were significantly different between the union and delayed union or non-union groups included: fund source, mechanism of injury, other injuries, wound and Gustilo type, and fixation method. On linear regression modelling, an inverse relationship was demonstrated between delayed union or nonunion and the Physical and Mental Component Summary scores of the SF-12. This was statistically significant at both 6 and 12 months post injury unadjusted and adjusted for age, gender and other injuries. On logistic regression modelling, patients with delayed union or non-union showed unadjusted and adjusted risk ratios of 0.85 and 0.82, respectively at 6 months, and 0.82 and 0.76, respectively at 12 months to return to work. Similarly, patients with delayed union or nonunion had unadjusted and adjusted risk ratios of 1.09 and 1.11, respectively at 6 months, and 1.33 and 1.37, respectively at 12 months to have pain. Both were statistically significant at 12 months post injury unadjusted and adjusted for age, gender and other injuries.

Patients with delayed union or non-union of femoral and tibial shaft fractures have poorer physical and mental health at 6 and 12 months post injury. In addition, they are less likely to have returned to work and more likely to still have pain at 12 months post injury.

Background: Hip fractures are a common cause of hospitalisation amongst elderly patients, imposing a burden on resources and resulting in significant morbidity and mortality. Despite the high incidence questions remain surrounding the efficacy of current treatment protocols. There has also been relative neglect, within current literature, of the ‘young’ hip fracture patient.

Objectives: To analyse clinical and patient-reported outcomes for patients with hip fractures treated at two Australian level-1 trauma centres, and, to highlight key differences between the ‘typical’ patient (age> 60 years) and those aged 60 years or less.

Methods: Patients with traumatic proximal femoral fractures treated at The Royal Melbourne and Alfred hospitals between 2003 and 2006 were identified via the Victorian Orthopaedic Trauma Outcomes Registry. Patient-reported outcomes were prospectively measured at 6 and 12 months post-injury using the 12-Item Short-Form Health Survey (SF-12) and a Numerical Pain Scale. A priori defined clinical outcomes were also determined by reviewing medical records and X-rays.

Results: A total of 695 patients were identified with similar distribution between institutions. The male: female ratio was 1:2 and 13.8% were aged 60 years or less at presentation. ‘Community-dwellers’ accounted for 69.9% with 25.6% presenting from an institutional setting. Displaced subcaptial fractures (AO-31B3) occurred most commonly.

Median hospital length of stay was 12 days. Inpatient mortality reached 5.5% whilst mortality at 6 and 12 months post-injury was 17.1% and 22.6% respectively. Upon discharge 16.1% returned to the community and 60.5% required rehabilitation. At 6 months 48.0% were residing at home and 30.5% at an institutional setting. Institutionalisation decreased to 27.7% at 12 months, approaching pre-injury levels. Mean physical SF-12 scores remained well below population norms at 12 months (36.4 vs 48.9). Younger patients demonstrated significantly different results with reference to presentation, management and outcomes. Several factors were highlighted as predictors of mortality and/or functional recovery.

Conclusions: Mortality following hip fracture treatment at an Australian level-1 trauma centre is comparable to statistics achieved by similar international institutions. The rise in mortality is greatest within the initial 6 months representing a period during which close medical attention is paramount. The Mortality predictors highlighted may be useful in guiding this resource allocation. Patient-reported health status also plateaus following the initial 6 months, warranting a review of current protocols to ascertain whether this represents a golden ‘window-period’ for successful rehabilitation or whether appropriate care is not being provided beyond 6 months. Patients aged 60 years or younger represent a significant and unique group. Approach to management and goals of treatment should be tailored accordingly.