Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1903-1910. doi: 10.1007/s00068-020-01335-y. Epub 2020 Mar 5.
Concomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union.
Patients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS).
The total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development.
Our results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
已知胸部合并伤会对骨骼代谢和骨折愈合产生负面影响，而创伤性脑损伤（TBI）似乎对骨骼代谢有积极影响。成骨作用也可能受到骨折固定时间的影响。我们旨在确定胸部损伤、TBI 和骨折固定策略如何影响骨不连的发生率。
回顾性分析了 2004 年至 2014 年间治疗的下肢长骨骨折患者。骨不连定义为骨折未在预期时间内愈合，且既没有愈合进展也没有成功愈合的预期，除非进行干预。使用社会科学统计软件包（SPSS）对各种临床和影像学参数进行了统计学分析。
在进行固定之前的总手术次数是长骨骨折患者发生骨不连的独立预测因素（优势比 [OR] = 6.416，p < 0.001）。更具体地说，根据损伤控制骨科（DCO）原则治疗的患者发生骨不连的风险明显高于根据早期全面护理（ETC）原则治疗的患者（OR = 7.878，p = 0.005）。胸部合并伤和 TBI 不能被确定为影响骨不连发展的因素。
我们的结果表明，应尽量减少长骨骨折患者的手术次数，并仔细注意 DCO 治疗的适应证和时机，以最大程度地降低骨不连发展的风险。
