Gupta Rajul, Burkhart Andrew, Barnes Tyler, Beltran Michael, Laughlin Richard, Sagi Henry Claude
Department of Orthopedics and Sports Medicine, University of Cincinnati, Cincinnati, OH.
J Orthop Trauma. 2025 Feb 1;39(2):41-45. doi: 10.1097/BOT.0000000000002936.
The aim of the study was to determine if routine dual-stage nonunion repair (DSR) surgery leads to better outcomes than single-stage nonunion (SSR) repair surgery in fracture nonunions without evident clinical or laboratory signs of infection.
Retrospective comparison study.
Level 1 Trauma Center affiliated with an academic teaching hospital.
Skeletally mature patients diagnosed with fracture nonunion between June 2013 and January 2022 were included. Patients with previous nonoperative treatment, definitive external fixation, previous or current diagnosis of fracture-related infection, or <12 months of follow-up were excluded.
Patient characteristics and details of the primary and the revision surgery were recorded. Comparison of the primary outcome measures, fracture-related infection, recalcitrant nonunion, and implant failures was performed between SSR and DSR groups.
A total of 113 patients met the eligibility criteria. Eighty-six patients (mean age 44.8 years, range 17-80 years, 64% men) underwent SSR, while 27 patients (mean age 50.8 years, range 21-77 years, 52% men) underwent DSR. Seventy-six percent underwent SSR and 24% underwent DSR. Baseline characteristics were similar between groups (open fractures, P = 0.918; smoking, P = 0.86; lower limb fractures, P = 0.238; diabetes, P = 0.503; erythocyte sedimentation rate, P = 0.27; C-reactive protein, P = 0.11; age, P = 0.11; Charlson comorbidity index, P = 0.06) except for a higher rate of DSR in cases initially treated elsewhere ( P = 0.015) and in obese patients ( P = 0.044). Bone grafting was more frequent in DSR using plates ( P = 0.030). No significant differences were observed in subsequent infections (6.97% vs. 7.41%, P = 0.939), persistent nonunion (28.2% vs. 14.81%, P = 0.169), or implant failure (19.76% vs. 22.22%, P = 0.782) between SSR and DSR.
No difference was found in infection, recalcitrant nonunion, and implant failure between SSR and DSR for nonunions without overt signs of infection. The study challenges the routine use of DSR, questions the necessity of subjecting patients to 2 surgical procedures, and advocates for a more judicious approach in the absence of overt fracture-related infection in a fracture nonunion.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在确定在无明显临床或实验室感染迹象的骨折不愈合中，常规双阶段不愈合修复（DSR）手术是否比单阶段不愈合（SSR）修复手术能带来更好的治疗效果。
回顾性比较研究。
一所学术教学医院附属的一级创伤中心。
纳入2013年6月至2022年1月期间诊断为骨折不愈合的骨骼成熟患者。排除既往接受过非手术治疗、确定性外固定、既往或当前诊断为骨折相关感染或随访时间<12个月的患者。
记录患者特征以及初次手术和翻修手术的详细情况。对SSR组和DSR组的主要结局指标进行比较，包括骨折相关感染、顽固性不愈合和植入物失败情况。
共有113例患者符合纳入标准。86例患者（平均年龄44.8岁，范围17 - 80岁，男性占64%）接受了SSR手术，27例患者（平均年龄50.8岁，范围21 - 77岁，男性占52%）接受了DSR手术。76%的患者接受了SSR手术，24%的患者接受了DSR手术。两组间基线特征相似（开放性骨折，P = 0.918；吸烟，P = 0.86；下肢骨折，P = 0.238；糖尿病，P = 0.503；红细胞沉降率，P = 0.27；C反应蛋白，P = 0.11；年龄，P = 0.11；Charlson合并症指数，P = 0.06），但在最初在其他地方接受治疗的病例（P = 0.015）和肥胖患者（P = 0.044）中DSR手术率较高。在使用钢板的DSR手术中骨移植更频繁（P = 0.030）。SSR组和DSR组在后续感染（6.97%对7.41%，P = 0.939）、持续性不愈合（28.2%对14.81%，P = 0.169）或植入物失败（19.76%对22.22%，P = 0.782）方面未观察到显著差异。
对于无明显感染迹象的骨折不愈合，SSR和DSR在感染、顽固性不愈合和植入物失败方面没有差异。本研究对DSR的常规使用提出了质疑，对让患者接受两次手术的必要性提出了疑问，并主张在骨折不愈合且无明显骨折相关感染的情况下采取更审慎的方法。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
