Cargando…

The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection

OBJECTIVES: A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patien...

Descripción completa

Detalles Bibliográficos
Autores principales: Mills, L., Tsang, J., Hopper, G., Keenan, G., Simpson, A. H. R. W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108351/
https://www.ncbi.nlm.nih.gov/pubmed/27784669
http://dx.doi.org/10.1302/2046-3758.510.BJR-2016-0138
_version_ 1782467342651883520
author Mills, L.
Tsang, J.
Hopper, G.
Keenan, G.
Simpson, A. H. R. W.
author_facet Mills, L.
Tsang, J.
Hopper, G.
Keenan, G.
Simpson, A. H. R. W.
author_sort Mills, L.
collection PubMed
description OBJECTIVES: A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. METHODS: Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed. RESULTS: A total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients. In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results. CONCLUSION: Two thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion. Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016;5:512–519. DOI: 10.1302/2046-3758.510.BJR-2016-0138.
format Online
Article
Text
id pubmed-5108351
institution National Center for Biotechnology Information
language English
publishDate 2016
record_format MEDLINE/PubMed
spelling pubmed-51083512016-11-18 The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection Mills, L. Tsang, J. Hopper, G. Keenan, G. Simpson, A. H. R. W. Bone Joint Res Trauma OBJECTIVES: A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. METHODS: Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed. RESULTS: A total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients. In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results. CONCLUSION: Two thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion. Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016;5:512–519. DOI: 10.1302/2046-3758.510.BJR-2016-0138. 2016-11-09 /pmc/articles/PMC5108351/ /pubmed/27784669 http://dx.doi.org/10.1302/2046-3758.510.BJR-2016-0138 Text en © 2016 Mills et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.
spellingShingle Trauma
Mills, L.
Tsang, J.
Hopper, G.
Keenan, G.
Simpson, A. H. R. W.
The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title_full The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title_fullStr The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title_full_unstemmed The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title_short The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
title_sort multifactorial aetiology of fracture nonunion and the importance of searching for latent infection
topic Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108351/
https://www.ncbi.nlm.nih.gov/pubmed/27784669
http://dx.doi.org/10.1302/2046-3758.510.BJR-2016-0138
work_keys_str_mv AT millsl themultifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT tsangj themultifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT hopperg themultifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT keenang themultifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT simpsonahrw themultifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT millsl multifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT tsangj multifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT hopperg multifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT keenang multifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection
AT simpsonahrw multifactorialaetiologyoffracturenonunionandtheimportanceofsearchingforlatentinfection