Hak David J, Fitzpatrick Daniel, Bishop Julius A, Marsh J Lawrence, Tilp Susanne, Schnettler Reinhard, Simpson Hamish, Alt Volker
Department of Orthopaedics Denver Health/University of Colorado, 777 Bannock Street, MC 0188, Denver, CO 80204, USA.
Slocum Center for Orthopedics and Sports Medicine, Eugene, OR, USA.
Injury. 2014 Jun;45 Suppl 2:S3-7. doi: 10.1016/j.injury.2014.04.002.
Fracture healing is a critically important clinical event for fracture patients and for clinicians who take care of them. The clinical evaluation of fracture healing is based on both radiographic findings and clinical findings. Risk factors for delayed union and nonunion include patient dependent factors such as advanced age, medical comorbidities, smoking, non-steroidal anti-inflammatory use, various genetic disorders, metabolic disease and nutritional deficiency. Patient independent factors include fracture pattern, location, and displacement, severity of soft tissue injury, degree of bone loss, quality of surgical treatment and presence of infection. Established nonunions can be characterised in terms of biologic capacity, deformity, presence or absence of infection, and host status. Hypertrophic, oligotrophic and atrophic radiographic appearances allow the clinician to make inferences about the degree of fracture stability and the biologic viability of the fracture fragments while developing a treatment plan. Non-unions are difficult to treat and have a high financial impact. Indirect costs, such as productivity losses, are the key driver for the overall costs in fracture and non-union patients. Therefore, all strategies that help to reduce healing time with faster resumption of work and activities not only improve medical outcome for the patient, they also help reduce the financial burden in fracture and non-union patients.
骨折愈合对于骨折患者以及照料他们的临床医生而言是极为重要的临床事件。骨折愈合的临床评估基于影像学检查结果和临床检查结果。延迟愈合和不愈合的风险因素包括患者相关因素，如高龄、内科合并症、吸烟、使用非甾体抗炎药、各种遗传性疾病、代谢性疾病和营养缺乏。与患者无关的因素包括骨折类型、部位、移位情况、软组织损伤的严重程度、骨丢失程度、手术治疗质量以及是否存在感染。已确诊的不愈合可根据生物学能力、畸形情况、有无感染以及宿主状态进行分类。肥大性、营养不良性和萎缩性影像学表现可使临床医生在制定治疗方案时推断骨折稳定性程度以及骨折碎片的生物学活性。不愈合难以治疗且经济负担高昂。间接成本，如生产力损失，是骨折和不愈合患者总体费用的主要驱动因素。因此，所有有助于缩短愈合时间、更快恢复工作和活动的策略不仅能改善患者的医疗结局，还能减轻骨折和不愈合患者的经济负担。
