title: Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life.
abstract: OBJECTIVE
  The purpose of this study was to report the extent of the effects of femoral nonunion on health-related quality of life.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  One hundred eighty-seven consecutive patients (85 women, age 55.9 ± 16.9 years; 102 men, age 42.8 ± 16.1 years) with 188 nonunions of the femur, excluding those involving the hip or knee articular surfaces.
  
  
  METHODS
  Average nonunion duration was 28.5 months. 5.7% of the nonunions were infected, and the distal third was the most frequently involved segment.
  
  
  METHODS
  SF-12 Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, Brief Pain Inventory (BPI), American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), and Time Trade-Off (TTO) reported at the time of initial clinical evaluation at our center.
  
  
  RESULTS
  The MCS scores averaged 43 ± 6.5, and the PCS scores averaged 26.3 ± 6.5, indicating the large adverse impact of femoral nonunion on mental and physical health, respectively. The BPI average intensity score averaged 5.1 ± 2.5, indicating moderate to severe pain. The LLCS averaged 53.9 ± 20.0, indicating substantial lower extremity-specific disability. The TTO questionnaire responses indicated that these patients were willing to trade an average of 38.3% of their remaining years of life to regain health.
  
  
  CONCLUSIONS
  The impact of femoral shaft nonunion on physical health was comparable to end-stage hip arthrosis and tibial nonunion and worse than many other medical conditions. Femoral shaft nonunion is a debilitating chronic medical condition with substantial negative effects on health.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX; †Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX; and ‡Department of Health and Human Performance, University of Houston, Houston, TX.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Brinker
authors.forename: Akash
authors.initials: A
authors.lastname: Trivedi
authors.forename: Daniel P
authors.initials: DP
authors.lastname: OʼConnor
mesh_terms: D000328:Adult; D017677:Age Distribution; D018771:Arthralgia / Q000453:epidemiology* / Q000523:psychology; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005264:Femoral Fractures; D005599:Fractures, Ununited / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013781:Texas / Q000453:epidemiology