Why Bones Don’t Heal: Researchers Identify Risk Factors for Fracture Non-Union

    To better understand the risk factors that contribute to the failure of fractured bones to heal, a national team of orthopaedic surgeons examined health records from 90.1 million patients.

    Their goal was to describe the epidemiology of fracture non-union in adults using the information available to physicians at patient presentation. The study was published online on September 7 by JAMA Surgery.

    The researchers found 309,330 fractures in patients ages 18 to 63 years old. The non-union rate was 4.93% overall, with substantial variation from bone to bone:

    • The lowest non-union rates were in the metacarpals at 1.47% and the radius at 2.10%.
    • The highest non-union rates were in the scaphoid at 15.46%, the tibia and fibula at 13.95%, and the femur at 13.86%.

    The odds of non-union odds were significantly increased by many risk factors including:

    • Number of fractures
    • Use of prescription analgesics (NSAIDs and opioids)
    • Operative treatment
    • Open fracture
    • Anticoagulant use
    • Osteoarthritis with or without rheumatoid arthritis
    • Anticonvulsant use with or without benzodiazepine
    • Diabetes
    • High-energy injury
    • Osteoporosis
    • Male gender
    • Insulin use
    • Smoking
    • Obesity
    • Antibiotic use
    • Vitamin D deficiency
    • Diuretic use
    • Renal insufficiency

    This research contributes novel insights into the causes of fracture non-union, as the investigators were able to identify the most significant risk factors: severity and location of the fracture, the presence of other diseases, and medication use. This information could be used to develop a predictive algorithm.

    “Understanding key risk factors and their interplay will help us determine which fractures are at greatest risk of non-union,” concludes Robert Zura, MD, Professor and Head of Orthopaedics at LSU Health New Orleans.

    “We can alter our approach to those and modify those risk factors we can, such as prescription medicines, to improve healing.”