RESULTS: In patients who were eighteen years of age or older, 125 (13.3%) of the fractures had clinical and radiographic evidence of nonunion. Factors significantly associated with nonunion on bivariate analysis were sex, smoking status, overall fracture displacement, overlap, translation, and comminution. The factors that maintained significance on multivariate analysis were smoking (odds ratio, 3.76), comminution (odds ratio, 1.75), and fracture displacement (odds ratio, 1.17). If all displaced midshaft fractures were managed operatively, 7.5 procedures would need to be undertaken to prevent a single nonunion. If only fractures with a predicted probability of ≥40% were managed operatively, the number of patients managed operatively to prevent a single nonunion would fall to 1.7.
CONCLUSIONS: Thirteen percent of displaced diaphyseal fractures in patients who were at least eighteen years of age did not heal. Smoking was the strongest risk factor, and smoking cessation should be an integral part of treatment. The probability of nonunion in a particular individual can be estimated with use of a statistical model based on known risk factors. This information can be useful when counseling the patient even though nonunion remains difficult to predict accurately in that individual. The number who would need to be treated to prevent a single nonunion can be reduced by identifying those at higher risk.
LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
PMID: 23824382 [PubMed - in process]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23824382?dopt=Abstract
