The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National dat...

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Veröffentlicht in:	Acta orthopaedica Jg. 88; H. 4; S. 434 - 439
Hauptverfasser:	Mills, Leanora A, Aitken, Stuart A, Simpson, A Hamish R W
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England Taylor & Francis 04.07.2017 Medical Journals Sweden
Schlagworte:	Adolescent Adult Age Factors Aged Aged, 80 and over Female Fracture Fractures, Ununited - epidemiology Fractures, Ununited - etiology Humans Incidence Male Middle Aged Risk Factors Scotland - epidemiology Sex Factors Young Adult
ISSN:	1745-3674, 1745-3682, 1745-3682
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Abstract	Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.
AbstractList	Background and purpose — Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods — National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation — The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but—less expectedly—it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted. Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted. Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.
Author	Mills, Leanora A Aitken, Stuart A Simpson, A Hamish R W
AuthorAffiliation	1 Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh 2 Orthopaedics and Trauma, Royal Aberdeen Children’s Hospital, Aberdeen, UK 3 Orthopaedic Trauma Center, Maine General Medical Center, Augusta, ME, USA
AuthorAffiliation_xml	– name: 3 Orthopaedic Trauma Center, Maine General Medical Center, Augusta, ME, USA – name: 1 Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh – name: 2 Orthopaedics and Trauma, Royal Aberdeen Children’s Hospital, Aberdeen, UK
Author_xml	– sequence: 1 givenname: Leanora A surname: Mills fullname: Mills, Leanora A email: leanora.mills@nhs.net organization: Orthopaedics and Trauma, Royal Aberdeen Children's Hospital – sequence: 2 givenname: Stuart A surname: Aitken fullname: Aitken, Stuart A organization: Orthopaedic Trauma Center, Maine General Medical Center – sequence: 3 givenname: A Hamish R W surname: Simpson fullname: Simpson, A Hamish R W organization: Department of Orthopaedics and Trauma, University of Edinburgh
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/28508682$$D View this record in MEDLINE/PubMed
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References_xml	– ident: CIT0011 doi: 10.2106/00004623-199506000-00016 – ident: CIT0020 doi: 10.1016/S0020-1383(99)00312-5 – ident: CIT0004 doi: 10.1097/00005131-200305000-00006 – ident: CIT0024 doi: 10.1302/0301-620X.80B3.8079 – ident: CIT0008 doi: 10.1016/j.injury.2006.08.055 – volume-title: American Academy of Orthopaedic Surgeons. Musculoskeletal conditions in the United States year: 1992 ident: CIT0022 – volume-title: Musculoskeletal conditions in the United States year: 1999 ident: CIT0023 – ident: CIT0014 doi: 10.1016/S0020-1383(07)80012-X – ident: CIT0005 doi: 10.1016/S0020-1383(08)70016-0 – ident: CIT0021 doi: 10.1302/0301-620X.88B7.17639 – ident: CIT0027 doi: 10.1016/S0020-1383(07)80003-9 – ident: CIT0002 doi: 10.1007/s00264-012-1556-z – ident: CIT0013 doi: 10.1016/S0020-1383(08)70003-2 – volume-title: Department of Trauma and Orthopaedics year: 2013 ident: CIT0001 – ident: CIT0003 doi: 10.1097/00005131-200209000-00004 – start-page: 53 volume-title: Rockwood and Green’s fractures in adults year: 2009 ident: CIT0007 – ident: CIT0028 doi: 10.1302/0301-620X.86B7.15047 – ident: CIT0012 doi: 10.1097/TA.0b013e31828c3dc9 – volume-title: Guidelines for essentail trauma care year: 2004 ident: CIT0019 – ident: CIT0029 doi: 10.1016/j.injury.2011.08.019 – ident: CIT0009 doi: 10.1007/s00264-008-0709-6 – volume-title: Trauma year: 2006 ident: CIT0006 – volume-title: College of Medicine and vetinary Medicine year: 2016 ident: CIT0016 – ident: CIT0010 doi: 10.1016/j.injury.2004.05.023 – ident: CIT0026 doi: 10.2106/JBJS.J.01418 – volume: 3 start-page: e002276 year: 2012 ident: CIT0017 publication-title: BMJ Open doi: 10.1136/bmjopen-2012-002276 – ident: CIT0025 doi: 10.2106/JBJS.K.00188 – ident: CIT0018 doi: 10.1007/s11832-013-0521-8 – ident: CIT0015 doi: 10.1007/s11999-008-0651-3 – reference: 9619941 - J Bone Joint Surg Br. 1998 May;80(3):476-84 – reference: 24432093 - J Child Orthop. 2013 Oct;7(4):317-22 – reference: 19082865 - Clin Orthop Relat Res. 2009 May;467(5):1370-6 – reference: 18804575 - Injury. 2008 Sep;39 Suppl 2:S59-63 – reference: 12352564 - J Orthop Trauma. 2002 Sep;16(8):562-6 – reference: 19052743 - Int Orthop. 2009 Oct;33(5):1407-14 – reference: 23396560 - BMJ Open. 2013 Feb 08;3(2):null – reference: 12759640 - J Orthop Trauma. 2003 May;17(5):353-61 – reference: 17920421 - Injury. 2007 May;38 Suppl 2:S77-84 – reference: 23694881 - J Trauma Acute Care Surg. 2013 Jun;74(6):1516-20 – reference: 15589931 - Injury. 2005 Jan;36(1):131-41 – reference: 23032589 - J Bone Joint Surg Am. 2012 Oct 3;94(19):1786-93 – reference: 17920415 - Injury. 2007 May;38 Suppl 2:S3-9 – reference: 7782368 - J Bone Joint Surg Am. 1995 Jun;77(6):940-56 – reference: 16798998 - J Bone Joint Surg Br. 2006 Jul;88(7):928-32 – reference: 22488624 - J Bone Joint Surg Am. 2012 Apr 4;94(7):e40 – reference: 18224731 - Injury. 2007 Sep;38 Suppl 4:S3-6 – reference: 10775691 - Injury. 2000 Jun;31(5):353-8 – reference: 15446534 - J Bone Joint Surg Br. 2004 Sep;86(7):1035-40 – reference: 21907987 - Injury. 2011 Dec;42(12):1491-4 – reference: 17070526 - Injury. 2007 Mar;38(3):371-7 – reference: 22643795 - Int Orthop. 2012 Sep;36(9):1757-65
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Snippet	Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures... Background and purpose — Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures...
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StartPage	434
SubjectTerms	Adolescent Adult Age Factors Aged Aged, 80 and over Female Fracture Fractures, Ununited - epidemiology Fractures, Ununited - etiology Humans Incidence Male Middle Aged Risk Factors Scotland - epidemiology Sex Factors Young Adult
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Title	The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults
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