The Aseptic Femoral and Tibial Shaft Non-union in Healthy Patients - an Analysis of the Health-related Quality of Life and the Socioeconomic Outcome

Overview

Journal Open Orthop J

Publisher Bentham Open

Specialty Orthopedics

Date 2011 Jun 21

PMID 21686321

Citations 17

Authors

Christian Zeckey

Philipp Mommsen

Hagen Andruszkow

Christian Macke

Michael Frink

Timo Stubig

Tobias Hufner

Christian Krettek

Frank Hildebrand

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Long bone non-unions may lead to recurrent surgical procedures and in-hospital stays. Thus, restrictions of the health-related quality of life and of socioeconomic parameters might be expected. Knowledge of the impact on several parameters of professional life is sparse. Therefore, we analyzed the outcome in patients following non-unions of the tibial and femoral shaft after fracture compared to patients with uneventful healing.

Material And Methodology: 51 patients following non-unions of the the femoral (FNU) or tibial shaft (TNU) were compared to 51 patients (groups FH and TH) with uneventful fracture healing. Physical and mental health was assessed using the Short-Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). We also analyzed employment status and the usage of medical aids.

Results: Scores of the SF-12 physical and psychological were lower in group TNU compared to group TH, the score of SF-12 physical but not psychological was significantly lower in group FNU compared to FH. Compared to uneventful healing, a significantly more frequent usage of medical aids was found in both non-union groups. A higher incidence of early retirement and unemployment was found in group FNU but not in group TNU.

Conclusions: There is a profound influence on the quality of life following femoral or tibial non-unions after trauma. Compared to patients with uneventful fracture healing, patients with tibial and even more so femoral non-union show worse scores of the SF-12. Medical aids are frequently used following both, femoral and tibial non-unions. Not tibial, but femoral non-unions frequently lead to severe restrictions in professional life such as early retirement and unemployment.

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References

McKee M, Yoo D, Schemitsch E . Health status after Ilizarov reconstruction of post-traumatic lower-limb deformity. J Bone Joint Surg Br. 1998; 80(2):360-4. DOI: 10.1302/0301-620x.80b2.8192. View

Soucacos P, Dailiana Z, Beris A, Johnson E . Vascularised bone grafts for the management of non-union. Injury. 2006; 37 Suppl 1:S41-50. DOI: 10.1016/j.injury.2006.02.040. View

Zlowodzki M, Obremskey W, Thomison J, Kregor P . Functional outcome after treatment of lower-extremity nonunions. J Trauma. 2005; 58(2):312-7. DOI: 10.1097/01.ta.0000154302.23143.63. View

Zelle B, Gruen G, Klatt B, Haemmerle M, Rosenblum W, Prayson M . Exchange reamed nailing for aseptic nonunion of the tibia. J Trauma. 2004; 57(5):1053-9. DOI: 10.1097/01.ta.0000100380.50031.dc. View

Lerner R, Esterhai Jr J, Polomano R, Cheatle M, Heppenstall R . Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation. Clin Orthop Relat Res. 1993; (295):28-36. View

Georgiadis G, Behrens F, Joyce M, EARLE A, Simmons A . Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am. 1993; 75(10):1431-41. DOI: 10.2106/00004623-199310000-00003. View

Bullinger M . German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995; 41(10):1359-66. DOI: 10.1016/0277-9536(95)00115-n. View

Horowitz M, WILNER N, Alvarez W . Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41(3):209-18. DOI: 10.1097/00006842-197905000-00004. View

Devnani A . Simple approach to the management of aseptic non-union of the shaft of long bones. Singapore Med J. 2001; 42(1):20-5. View

10.

Holtslag H, Post M, van der Werken C, Lindeman E . Return to work after major trauma. Clin Rehabil. 2007; 21(4):373-83. DOI: 10.1177/0269215507072084. View

11.

Brinker M, OConnor D . Outcomes of tibial nonunion in older adults following treatment using the Ilizarov method. J Orthop Trauma. 2007; 21(9):634-42. DOI: 10.1097/BOT.0b013e318156c2a2. View

12.

Alonso J, GEISSLER W, Hughes J . External fixation of femoral fractures. Indications and limitations. Clin Orthop Relat Res. 1989; (241):83-8. View

13.

Harvey E, Agel J, Selznick H, Chapman J, Henley M . Deleterious effect of smoking on healing of open tibia-shaft fractures. Am J Orthop (Belle Mead NJ). 2003; 31(9):518-21. View

14.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

15.

Pountos I, Georgouli T, Blokhuis T, Pape H, Giannoudis P . Pharmacological agents and impairment of fracture healing: what is the evidence?. Injury. 2008; 39(4):384-94. DOI: 10.1016/j.injury.2007.10.035. View

16.

Keating J, OBrien P, Blachut P, Meek R, Broekhuyse H . Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997; 79(3):334-41. DOI: 10.2106/00004623-199703000-00003. View

17.

Starr A, Smith W, Frawley W, Borer D, Morgan S, Reinert C . Symptoms of posttraumatic stress disorder after orthopaedic trauma. J Bone Joint Surg Am. 2004; 86(6):1115-21. DOI: 10.2106/00004623-200406000-00001. View

18.

Kayal R, Tsatsas D, Bauer M, Allen B, Al-Sebaei M, Kakar S . Diminished bone formation during diabetic fracture healing is related to the premature resorption of cartilage associated with increased osteoclast activity. J Bone Miner Res. 2007; 22(4):560-8. PMC: 3109431. DOI: 10.1359/jbmr.070115. View

19.

Griffin X, Warner F, Costa M . The role of electromagnetic stimulation in the management of established non-union of long bone fractures: what is the evidence?. Injury. 2008; 39(4):419-29. DOI: 10.1016/j.injury.2007.12.014. View

20.

Grigoryan M, Lynch J, Fierlinger A, Guermazi A, Fan B, MacLean D . Quantitative and qualitative assessment of closed fracture healing using computed tomography and conventional radiography. Acad Radiol. 2003; 10(11):1267-73. DOI: 10.1016/s1076-6332(03)00467-7. View