Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY.
J Orthop Trauma. 2019 Aug;33(8):e296-e302. doi: 10.1097/BOT.0000000000001476.
To evaluate the clinical and functional outcomes after operative repair of nonunited lower extremity fractures initially repaired outside the developed Western world.
Retrospective analysis of prospectively collected data.
Academic medical center.
PATIENTS/PARTICIPANTS: From September 2004 through February 2017, 227 patients who underwent operative repair of a lower extremity fracture nonunion were prospectively enrolled in a research registry. All patients underwent previous fracture surgery and had at least 12 months of postoperative follow-up.
Repair of lower extremity fracture nonunion.
Postoperative complications, reoperation rate, time to union, and functional outcomes were assessed using the Short Musculoskeletal Function Assessment and Visual Analog Scale pain scores. Univariate and multivariate analyses were performed to evaluate the differences in patients who underwent initial fracture repair outside the developed Western world as opposed to within the United States.
Twenty-one patients (9.3%) underwent initial fracture repair outside the developed Western world. These patients had a greater incidence of infected nonunions (47.6% vs. 23.3%; P = 0.015) and failure of a previous implant at the time of presentation (52.4% vs. 22.8%; P = 0.003) than those initially managed within the United States. This cohort also experienced a greater rate of postoperative complications after nonunion repair (23.8% vs. 6.3%; P = 0.016). The geographic location of initial fracture repair was not associated with postoperative Short Musculoskeletal Function Assessment scores or Visual Analog Scale pain scores after controlling for possible confounding variables.
Patients who present with a nonunited lower extremity fracture initially repaired outside the developed Western world experience a high rate of postoperative complications after fracture nonunion repair but can expect good short- and long-term functional outcomes.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估在西方发达国家以外地区初次治疗的下肢骨折不愈合患者的临床和功能结局。
前瞻性收集数据的回顾性分析。
学术医疗中心。
患者/参与者：2004 年 9 月至 2017 年 2 月，前瞻性注册研究共纳入 227 例下肢骨折不愈合患者，所有患者均行初次骨折手术，且术后随访至少 12 个月。
修复下肢骨折不愈合。
术后并发症、再次手术率、愈合时间和功能结局采用 Short Musculoskeletal Function Assessment（短肢功能评估）和视觉模拟评分（VAS）疼痛评分进行评估。采用单变量和多变量分析评估初次骨折修复在西方发达国家以外地区与在美国的患者之间的差异。
21 例（9.3%）患者初次骨折修复在西方发达国家以外地区。这些患者感染性不愈合发生率更高（47.6%比 23.3%；P = 0.015），初次就诊时前次植入物失败的比例更高（52.4%比 22.8%；P = 0.003）。该组患者在骨折不愈合修复后发生术后并发症的比例也更高（23.8%比 6.3%；P = 0.016）。在控制可能的混杂因素后，初次骨折修复的地理位置与术后 Short Musculoskeletal Function Assessment 评分或 VAS 疼痛评分无关。
在西方发达国家以外地区初次治疗的下肢骨折不愈合患者在骨折不愈合修复后有很高的术后并发症发生率，但可以获得良好的短期和长期功能结局。
预后 III 级。有关证据等级的完整描述，请参见作者指南。
