Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?

• Published in: BMC musculoskeletal disorders 2023-05, Vol.24 (1), p.405-405, Article 405
• Main Authors: Halvachizadeh, Sascha, Martin, David Paul, Pfeifer, Roman, Jukema, Gerrolt Nico, Gueorguiev, Boyko, Pape, Hans-Christoph, Berk, Till
• Format: Article
• Language: English
• Subjects: Adult; Age; Bone healing; Bones; Callus; Care and treatment; Classification; Comorbidity; Delayed union; Diabetes; Diabetes mellitus; Diabetics; Femoral Fractures - diagnostic imaging; Femoral Fractures - epidemiology; Femoral Fractures - surgery; Femur; Fracture Fixation, Internal - adverse effects; Fracture Healing; Fractures; Graft rejection; Humans; Infections; Injuries; Interdisciplinary aspects; Internal fixation in fractures; Leg; Morphology; Mortality; Musculoskeletal diseases; Necrosis; Non-geriatric; Nonunion; Osteoporosis; Patient outcomes; Patients; Physical characteristics; Polytrauma; Prevention; Proximal Femoral Fractures; Regression analysis; Retrospective Studies; Risk Factors; Surgeons; Surgery; Transplants & implants; Trauma; Traumatic proximal femur fractures; Treatment Outcome
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06539-y

Impaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed. Therefore, this study aimed to identify non-infection related risk factors for impaired fracture healing of proximal femur fractures in non-geriatric trauma patients. This study included non-geriatric patients (aged 69 years and younger) who were treated between 2013 and 2020 at one academic Level 1 trauma center due to a proximal femur fracture (PFF). Patients were stratified according to AO/OTA classification. Delayed union was defined as failed callus formation on 3 out of 4 cortices after 3 to 6 months. Nonunion was defined as lack of callus-formation after 6 months, material breakage, or requirement of revision surgery. Patient follow up was 12 months. This study included 150 patients. Delayed union was observed in 32 (21.3%) patients and nonunion with subsequent revision surgery occurred in 14 (9.3%). With an increasing fracture classification (31 A1 up to 31 A3 type fractures), there was a significantly higher rate of delayed union. Additionally, open reduction and internal fixation (ORIF) (OR 6.17, (95% CI 1.54 to 24.70, p ≤ 0.01)) and diabetes mellitus type II (DM) (OR 5.74, (95% CI 1.39 to 23.72, p = 0.016)), were independent risk factors for delayed union. The rate of nonunion was independent of fracture morphology, patient's characteristics or comorbidities. Increasing fracture complexity, ORIF and diabetes were found to be associated with delayed union of intertrochanteric femur fractures in non-geriatric patients. However, these factors were not associated with the development of nonunion.