title: Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures.
abstract: BACKGROUND
  Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union.
  
  
  METHODS
  An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury.
  
  
  RESULTS
  285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant.
  
  
  CONCLUSIONS
  Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion.
  
  
  CONCLUSIONS
  Despite modern treatment, the patient-reported outcomes of lower limb long bone shaft fractures do not return to normal at one year. Patients with delayed union or nonunion can expect poorer outcomes.
authors: Department of Orthopaedic Surgery, John Hunter Hospital, New South Wales, Australia.
authors: Wei-Han
authors: WH
authors: Tay
authors: Department of Surgery, Epworth HealthCare, University of Melbourne, Victoria, Australia.
authors: Richard
authors: R
authors: de Steiger
authors: Department of Surgery, Epworth HealthCare, University of Melbourne, Victoria, Australia.
authors: Martin
authors: M
authors: Richardson
authors: Department of Surgery, National Trauma Research Institute, The Alfred, Monash University, Victoria, Australia.
authors: Russell
authors: R
authors: Gruen
authors: Department of Traumatology, John Hunter Hospital, University of Newcastle, New South Wales, Australia. Electronic address: zsolt.balogh@hnehealth.nsw.gov.au.
authors: Zsolt J
authors: ZJ
authors: Balogh
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D037001:Directive Counseling; D004185:Disability Evaluation; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data; D013978:Tibial Fractures / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Delayed union; Femur; Fracture; Nonunion; Outcomes; Tibia; Trauma