title: Can a combination of different risk factors be correlated with leg fracture healing time?
abstract: BACKGROUND
  A multicenter retrospective analysis of patients treated for leg fractures was conducted to develop a score that correlates with fracture healing time and to identify the risk gradient for delayed healing.
  
  
  METHODS
  Fifty-three patients were analyzed and considered healed when full weight bearing was possible. Patients were divided into those who healed within 180 days and those who took longer to heal. Risk factors associated with delayed healing, fracture morphology, and orthopedic treatments were recorded. The available literature was used to weight the relative risk associated with each factor; values were combined into a score evaluating the risk of delayed healing: L-ARRCO (a literature-based score where the risk of delayed bone healing is calculated using a specific algorithm). Other risk factors associated with delayed healing were then considered in order to calculate a new score, ARRCO. Continuous variables were compared between groups using Student's heteroschedastic two-tail t test. Receiver operating characteristic (ROC) curves and the areas under the curves were calculated to determine the ability of this score to discriminate subjects with delayed healing.
  
  
  RESULTS
  The mean L-ARRCO scores of the patients who healed within and after 180 days were significantly different (5.78 ± 1.59 and 7.05 ± 2.46, respectively). The mean ARRCO scores of the patients who healed within and after 180 days were also significantly different (5.92 ± 1.78 and 9.03 ± 2.79, respectively). However, the area under the ROC curve was significantly smaller for L-ARRCO than for ARRCO (0.62 ± 0.09 versus 0.82 ± 0.07).
  
  
  CONCLUSIONS
  The ARRCO score is significantly associated with fracture healing time and could be used to identify "fractures at risk," allowing early intervention to stimulate osteogenesis.
authors.affiliation: Orthopaedic and Traumatology Department, Sant'Anna Hospital, University of Ferrara, Via Savonarola 9, 44121, Ferrara, Italy.
authors.forename: Leo
authors.initials: L
authors.lastname: Massari
authors.forename: Francesco
authors.initials: F
authors.lastname: Falez
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lorusso
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanon
authors.forename: Luigi
authors.initials: L
authors.lastname: Ciolli
authors.forename: Filippo
authors.initials: F
authors.lastname: La Cava
authors.forename: Matteo
authors.initials: M
authors.lastname: Cadossi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Chiarello
authors.forename: Francesca
authors.initials: F
authors.lastname: De Terlizzi
authors.forename: Stefania
authors.initials: S
authors.lastname: Setti
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Benazzo
mesh_terms: D000328:Adult; D005264:Femoral Fractures / Q000453:epidemiology / Q000503:physiopathology*; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013978:Tibial Fractures / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome