Westgeest Joseph, Weber Donald, Dulai Sukhdeep K, Bergman Joseph W, Buckley Richard, Beaupre Lauren A
*Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; †Department of Surgery, University of Calgary, Calgary, Alberta, Canada; and ‡Departments of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
J Orthop Trauma. 2016 Mar;30(3):149-55. doi: 10.1097/BOT.0000000000000488.
To determine factors associated with developing nonunion or delayed healing after open fracture.
Prospective cohort between 2001 and 2009.
Three level 1 Canadian trauma centers.
Seven hundred thirty-six (791 fractures) subjects were enrolled. Six hundred eighty-nine (94%) subjects (739 fractures) provided adequate outcome data.
Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted 1 year after fracture. Patient, fracture, and injury information, and time to surgery and antibiotics were recorded during hospitalization.
Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year.
There were 413 (52%) tibia/fibular, 285 (36%) upper extremity, and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. The median time to surgery was not different for fractures that developed nonunion compared with those who did not (P = 0.36). Deep infection [Odd ratio (OR) 12.75; 95% confidence interval (CI) 6.07-26.8], grade 3A fractures (OR 2.49; 95% CI, 1.30-4.78), and smoking (OR 1.73; 95% CI, 1.09-2.76) were significantly associated with developing a nonunion. Delayed healing was also significantly associated with deep infection (OR 4.34; 95% CI, 1.22-15.48) and grade 3B/C fractures (OR 3.69; 95% CI, 1.44-9.44). Multivariate regression found no association between nonunion and time to surgery (P = 0.15) or antibiotics (P = 0.70).
Deep infection and higher Gustilo grade fractures were associated with nonunion and delayed healing.
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
确定开放性骨折后发生骨不连或延迟愈合的相关因素。
2001年至2009年的前瞻性队列研究。
加拿大的三家一级创伤中心。
共纳入736名受试者（791处骨折）。689名受试者（94%）（739处骨折）提供了充分的结局数据。
对受试者进行随访直至骨折愈合；骨折后1年进行电话访谈和病历审查。住院期间记录患者、骨折及损伤信息，以及手术时间和使用抗生素情况。
骨不连定义为伤口最终闭合后进行的非计划性手术干预或1年时影像学愈合不完全；延迟愈合定义为连续2次临床评估显示在6个月至1年期间影像学无进展或影像学愈合不完全。
共有413处（52%）胫腓骨骨折、285处（36%）上肢骨折和93处（13%）股骨骨折。124处（17%）骨折发生骨不连，63处（8%）骨折发生延迟愈合。发生骨不连的骨折与未发生骨不连的骨折相比，手术中位时间无差异（P = 0.36）。深部感染[比值比（OR）12.75；95%置信区间（CI）6.07 - 26.8]、3A级骨折（OR 2.49；95% CI，1.30 - 4.78）和吸烟（OR 1.73；95% CI，1.09 - 2.76）与骨不连的发生显著相关。延迟愈合也与深部感染（OR 4.34；95% CI，1.22 - 15.48）和3B/C级骨折（OR 3.69；95% CI，1.44 - 9.44）显著相关。多因素回归分析发现骨不连与手术时间（P = 0.15）或抗生素使用（P = 0.70）之间无关联。
深部感染和较高的 Gustilo 分级骨折与骨不连和延迟愈合相关。
预后性一级。有关证据级别的完整描述，请参阅作者指南。
