Ghayyad Kassem, Escobar Pascal, Beaudoin Tyler F, Wandersleben Luke, Hawks Michael, Ahmed Atif, Kachooei Amir R
Orthopaedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA.
Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, USA.
Cureus. 2024 Sep 30;16(9):e70566. doi: 10.7759/cureus.70566. eCollection 2024 Sep.
The incidence of femur fractures has increased in recent years, along with the rate of surgery and subsequent nonunion following these fractures. Nonunion is a significant concern due to the burden it places on both patients and the healthcare system. This study aims to investigate the demographic factors associated with femoral shaft fracture nonunion by comparing two surgical management approaches: open reduction internal fixation (ORIF) with plating versus closed reduction and fixation using intramedullary nailing (IMN).
The TriNetX database was queried using current procedural terminology (CPT) codes for surgical repair of femoral shaft fractures (FSFs), including IMN surgery (CPT: 27506) and femur ORIF (CPT: 27507). The subsequent chronological nonunion cases were identified using the 10th revision of the International Classification of Diseases (ICD-10) codes for femoral nonunion (S72.301K, S72.302K). Results were analyzed both descriptively and comparatively to assess differences among patients. Factors considered included age, sex, ethnicity, race, smoking status, and the type of surgical management (ORIF versus nailing) across the six-year study period.
From 2017 to 2022, the prevalence of femoral shaft fracture surgeries increased for both IMN and ORIF. The rate of nonunion was 2.1% following IMN and 1.7% following ORIF. The mean age for nonunion was 54 years (SD: 20) following IMN and 63 years (SD: 18) following ORIF. Patients with a positive smoking history had higher rates of nonunion compared to those without.
Our study revealed a relatively consistent rate of FSFs and nonunion over the six-year period. However, with a growing population, the absolute number of cases is steadily increasing, underscoring the burden on the healthcare system. This study contributes to the growing body of literature focused on improving patient outcomes and promoting health equity in fracture management practices.
近年来，股骨骨折的发生率有所上升，同时此类骨折后的手术率及随后的骨不连发生率也在增加。骨不连是一个重大问题，因为它给患者和医疗系统都带来了负担。本研究旨在通过比较两种手术治疗方法：钢板切开复位内固定术（ORIF）与髓内钉闭合复位固定术（IMN），来调查与股骨干骨折骨不连相关的人口统计学因素。
使用当前手术操作术语（CPT）代码查询TriNetX数据库，以获取股骨干骨折（FSF）手术修复的相关信息，包括髓内钉手术（CPT：27506）和股骨ORIF（CPT：27507）。随后使用国际疾病分类第10版（ICD-10）代码（S72.301K、S72.302K）识别按时间顺序排列的骨不连病例。对结果进行描述性和比较性分析，以评估患者之间的差异。考虑的因素包括年龄、性别、种族、民族、吸烟状况以及在六年研究期间的手术治疗类型（ORIF与髓内钉固定）。
2017年至2022年期间，髓内钉固定术和ORIF的股骨干骨折手术患病率均有所上升。髓内钉固定术后骨不连发生率为2.1%，ORIF术后为1.7%。髓内钉固定术后骨不连的平均年龄为54岁（标准差：20），ORIF术后为63岁（标准差：18）。有吸烟史的患者骨不连发生率高于无吸烟史的患者。
我们的研究显示，在六年期间FSF和骨不连的发生率相对稳定。然而，随着人口增长，病例的绝对数量在稳步增加，凸显了医疗系统的负担。本研究为越来越多关注改善骨折治疗患者预后和促进骨折管理实践中健康公平性的文献做出了贡献。
