Evaluating the Risk Factors of Nonunion in Long Bone Fractures of Patients Referred to Dr Shariati Hospital’s Orthopedic Clinic During 2007 - 2013

Abstract

Background: Despite improvements in the understanding of fracture repair and treatment techniques, delayed unions and nonunions still occur more frequently than expected. Although the prevalence of these complications is not very high and is reported to be approximately 2 to 7 percent, they are considered costly complications and impose great burden on patients and the health care system.
Objectives: We aimed to evaluate the risk factors associated with nonunion in long bone fractures in order to propose viable methods to control these factors and decrease the prevalence of nonunion.
Patients and Methods: In this retrospective case control study, all the patients with long bone nonunion fractures referring to Shariati Hospital’s orthopedic clinic during 2007 - 2013 were included as the case group. With a ratio of 1 to 3, patients matched according to the type of fractured bone were selected as the control group. Required data were gathered from the patients’ records in the archives. SPSS software version 20 was used to analyze the data.
Results: Multivariate regression analysis was performed to assess independent risk factors of nonunion. According to this analysis, aging (P value = 0.007), female sex (P value = 0.041), comminuted and segmental fractures (P value = 0.001), higher grades of soft tissue injury (P value < 0.001), smoking (P value < 0.001), and infection (P value < 0.001) were found to be independent risk factors for nonunion in long bone fractures.
Conclusions: Of the assessed risk factors, smoking, and infection can be controlled to decrease the prevalence of nonunion. Therefore, smoking cessation and prophylactic measures against infection might be viable actions for this objective.