title: Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database.
abstract: OBJECTIVE
  A variety of risk factors have been hypothesized to contribute to the development of fracture-healing complications; however, population-based estimates of the strength of these risk factors are limited. In this case-control study, we evaluated patient-related risk factors for fracture-healing complications.
  
  
  METHODS
  Using the United Kingdom General Practice Research Database, we identified patients with a fracture-healing complication (delayed union, nonunion, or malunion) between 1988 and 2008. 4 controls (i.e. patients with normal healing) were matched to each case on general practice, fracture site, fracture date, and length of history in the database. We used conditional logistic regression to estimate odds ratios (ORs) of various risk factors, including demographics, comorbidities, and medication use.
  
  
  RESULTS
  Diabetes and use of non-steroidal anti-inflammatory drugs (NSAIDs) within 12 months before the initial fracture were associated with a higher odds of a fracture-healing complication (type-I diabetes: adjusted OR = 2.3, 95% CI: 1.3-3.8; type-II diabetes: adjusted OR = 2.3, CI: 1.4-3.7; NSAIDs: adjusted OR = 2.6, CI: 2.1-3.2). Patients who had a motor vehicle accident recorded within 1 month before their initial fracture were also at increased odds of a fracture-healing complication (adjusted OR = 2.6, CI: 1.2-5.4).
  
  
  CONCLUSIONS
  Diabetes, NSAID use, and a recent motor vehicle accident were most consistently associated with an increased risk of a fracture-healing complication, regardless of fracture site or specific fracture-healing complication. This analysis suggests that certain patient-related characteristics influence the development of fracture-healing complications in general, even though specific healing complications may differ by their mechanism.
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Rohini K
authors.initials: RK
authors.lastname: Hernandez
authors.forename: Thy P
authors.initials: TP
authors.lastname: Do
authors.forename: Cathy W
authors.initials: CW
authors.lastname: Critchlow
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Dent
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011859:Radiography; D018570:Risk Assessment; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal