Do successful surgical results after operative treatment of long-bone nonunions correlate with outcomes?
There has been increased emphasis on validated, patient-reported functional outcomes after orthopaedic interventions for various conditions. The few reports on these types of outcomes after treatment of fracture nonunions are limited to specific anatomic sites, limited by small numbers, and retrospective. To determine whether successful healing of established long-bone nonunions resulted in improved functional outcomes and reduction in patient-reported pain scores, we prospectively followed 80 patients. These patients had a mean of 1.4 surgical procedures before enrollment and a mean of 18 months had elapsed from previous surgery until enrollment. Baseline data and functional scores were obtained before intervention. Seventeen of the 80 patients (21%) had positive intraoperative cultures. At a mean of 18.7 months (range, 12-36 months), 72 (90%) nonunions had healed. Patients with healed nonunions scored better on the Short Musculoskeletal Functional Assessment. Pain scores among all patients improved compared with baseline, but to a greater degree in patients who achieved healing by final followup. Our data suggest improvement in pain scores is seen in all patients after surgery, whereas successful internal fixation leads to improved function.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Egol
Kenneth A
KA
NYU Hospital for Joint Diseases, 301 E 17th Street 1402, New York, NY, 10003, USA. Kenneth.egol@nyumc.org
Gruson
Konrad
K
Spitzer
Allison B
AB
Walsh
Michael
M
Tejwani
Nirmal C
NC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012044:Regression Analysis; D012086:Reoperation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult