Maisenbacher Tanja C, Rollmann Mika F, Menger Maximilian M, Braun Niklas R, Braun Benedikt J, Herath Steven C, Stuby Fabian, Nuessler Andreas K, Histing Tina, Reumann Marie K
Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Klinik Tuebingen, Tuebingen, Germany.
Siegfried Weller Institut für Unfallmedizinische Forschung, Eberhard Karls University Tuebingen, BG Klinik Tuebingen, Tuebingen, Germany.
Bone Joint Res. 2025 Apr 9;14(4):341-350. doi: 10.1302/2046-3758.144.BJR-2024-0150.R2.
Fracture nonunion represents a major complication in orthopaedic surgery, occurring in 5% to 10% of fracture patients. Fracture nonunions are associated with pain and loss of function, and lead to a substantial socioeconomic burden. The present retrospective cohort study analyzed direct and indirect costs and length of hospital stay, number of surgical procedures, and hospital (re-)admissions of nonunion patients.
Data from 18- to 65-year-old patients surgically treated for lower limb fractures and nonunions in a German level I trauma centre between 2012 and 2018 were analyzed. A total of 193 patients with nonunion were included, and 2,511 patients with fractures served as the control group. Direct costs were calculated using reimbursement according to the diagnosis-related group (DRG). Indirect costs were calculated including daily sickness allowance and productivity loss.
The median healing time of nonunion patients was 45 weeks. Treatment expenses showed a 2.6-fold increase in direct costs, a 3.3-fold increase in indirect costs, and a 3.3-fold increase in total costs for nonunion patients compared to the control group. As every patient with a nonunion suffered from a fracture prior to nonunion treatment, costs were calculated by adding the median direct costs of €10,487 (IQR 9,173 to 15,262), median daily sickness allowance of €23,046 (IQR 14,892 to 36,264), median productivity loss of €85,714 (IQR 60,949 to 126,650), and median total socioeconomic burden of €123,334 (IQR 88,630 to 176,329).
Nonunions not only pose a significant burden on the injured individual and on healthcare systems, but also have a substantial socioeconomic impact. High direct and indirect costs illustrate that healing complications need to be detected and addressed as early as possible.
骨折不愈合是骨科手术中的一种主要并发症，发生率为骨折患者的5%至10%。骨折不愈合与疼痛和功能丧失相关，并导致巨大的社会经济负担。本回顾性队列研究分析了骨折不愈合患者的直接和间接成本、住院时间、手术次数以及医院（再）入院情况。
分析了2012年至2018年期间在德国一级创伤中心接受手术治疗的18至65岁下肢骨折和骨折不愈合患者的数据。共纳入193例骨折不愈合患者，2511例骨折患者作为对照组。直接成本根据诊断相关组（DRG）报销计算。间接成本计算包括每日病假津贴和生产力损失。
骨折不愈合患者的中位愈合时间为45周。与对照组相比，骨折不愈合患者的治疗费用显示直接成本增加2.6倍，间接成本增加3.3倍，总成本增加3.3倍。由于每个骨折不愈合患者在骨折不愈合治疗之前都曾发生过骨折，因此成本计算为将中位数直接成本10487欧元（四分位间距9173至15262欧元）、中位数每日病假津贴23046欧元（四分位间距14892至36264欧元）、中位数生产力损失85714欧元（四分位间距60949至126650欧元）以及中位数社会经济总负担123334欧元（四分位间距88630至176329欧元）相加。
骨折不愈合不仅给受伤个体和医疗系统带来重大负担，而且具有巨大的社会经济影响。高昂的直接和间接成本表明，愈合并发症需要尽早发现并加以解决。
