*Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY; and †Jamaica Hospital Medical Center, Jamaica, NY.
J Orthop Trauma. 2017 May;31(5):e143-e147. doi: 10.1097/BOT.0000000000000816.
The purpose of this study was to determine whether the finding of failed fracture implants in association with lower extremity long bone fracture nonunion portends worse clinical or functional outcome after surgical nonunion repair.
Retrospective analysis of prospectively collected data.
Academic Medical Center.
One hundred eighty-one patients who presented to our institution over a 10-year period and underwent surgical repair of a lower extremity fracture nonunion.
Surgical repair of lower extremity fracture nonunion.
Time to union, postoperative complications, visual analog scale pain scores, and Short Musculoskeletal Function Assessment scores after lower extremity nonunion repair. Data were analyzed to assess for differences in postoperative outcomes based on the integrity of fracture implants at the time of nonunion diagnosis. Implant integrity was defined using 3 groups: broken implants (BI), implants intact (II), and no implants (NI).
There was no significant difference in time to union after surgery between the BI, II, or NI groups (mean 8.1 months vs. 7.6 months vs. 6.2 months, respectively). Fourteen patients (7.7%) failed to heal, including 5 BI patients, 7 II patients, and 2 NI patients. One tibial nonunion patient in each of the 3 groups underwent amputation for persistent nonunion after multiple failed revision attempts at a mean of 4.8 years after initial injury. There was no difference in postoperative pain scores, the rate of postoperative complications, or functional outcome scores identified between the 3 groups.
The finding of failed fracture implants at the time of lower extremity long bone nonunion diagnosis does not portend worse clinical or functional outcome after surgical nonunion repair. Patients who present with failed fracture implants at the time of nonunion diagnosis can anticipate similar time to union, complication rates, and functional outcomes when compared with patients who present with intact implants or those with history of nonoperative management.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在确定下肢长骨骨折不愈合时发现骨折内固定失败是否预示着手术治疗后骨折不愈合的临床或功能结果更差。
前瞻性收集数据的回顾性分析。
学术医疗中心。
181 例患者在 10 年期间就诊于我院并接受下肢骨折不愈合手术修复。
下肢骨折不愈合手术修复。
骨折愈合时间、术后并发症、视觉模拟评分（VAS）疼痛评分以及下肢非愈合修复后的短肌肉骨骼功能评估（SMFA）评分。分析数据以评估骨折内固定在非愈合诊断时的完整性对术后结果的差异。使用 3 组定义内固定完整性：骨折内固定断裂（BI）、内固定完整（II）和无内固定（NI）。
BI、II 和 NI 组之间手术后愈合时间无显著差异（分别为 8.1 个月、7.6 个月和 6.2 个月）。14 例患者（7.7%）未愈合，包括 5 例 BI 患者、7 例 II 患者和 2 例 NI 患者。在 3 组中，各有 1 例胫骨不愈合患者在经历多次失败的翻修尝试后因持续性不愈合而接受截肢，平均在初次损伤后 4.8 年。3 组之间术后疼痛评分、术后并发症发生率或功能结果评分均无差异。
下肢长骨骨折不愈合时发现骨折内固定失败并不预示着手术治疗后骨折不愈合的临床或功能结果更差。与内固定完整或非手术治疗病史的患者相比，不愈合时出现骨折内固定失败的患者可预期具有相似的愈合时间、并发症发生率和功能结果。
预后 IV 级。有关证据水平的完整描述，请参见作者说明。
