Predictors of Non-Union in Long Bone Fractures Following High-Energy Trauma: A Prospective Cohort Study.

Rishabh  Agarwal; Dr Ruchika  Thakur; Atul  Saroj; Dr Aman  Srivastava; Rajeev  Kumar

doi:10.51168/sjhrafrica.v7i3.2594

Authors

Rishabh Agarwal Assistant Professor Department- Orthopedics Medical College- Uttar Pradesh Institute of medical sciences, India
Dr Ruchika Thakur Senior Resident Department- Physiology Medical College- Uttar Pradesh Institute of medical sciences, India
Atul Saroj Assistant professor Department of orthopaedic Dr Sonelal Patel Autonomous State Medical, Pratapgarh, Uttarpradesh, India
Dr Aman Srivastava Senior Resident Orthopedics Uttar Pradesh Institute of Medical Sciences, India
Rajeev Kumar Assistant Professor Orthopaedics Uttar Pradesh Institute of Medical Sciences, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2594

Keywords:

Long bone fractures, Non-union, High-energy trauma, Fracture healing, Postoperative infection, Delayed surgery

Abstract

Background:

Non-union of long bone fractures is a serious complication of high-energy trauma, resulting in prolonged disability, impaired functional outcomes, and increased healthcare costs. Early identification of predictors of non-union may facilitate timely interventions and improve fracture healing.

Methods:

This prospective cohort study was conducted in the Department of Orthopedics at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, over 18 months. A total of 72 patients with long bone fractures following high-energy trauma were enrolled. Clinical, radiological, and treatment-related variables were recorded. Patients were followed for 12 months to assess fracture healing. Non-union was defined as the absence of radiological union with persistent clinical symptoms. Univariate and multivariate logistic regression analyses were performed to identify predictors of non-union.

Results:

The mean age of participants was 41.8±13.6 years, and 75.0% (n=54) were males. The tibia was the most commonly affected bone (38.9%). Overall, 17 patients (23.6%) developed non-union. Non-union was significantly associated with open fractures (p=0.002), smoking (p=0.01), diabetes mellitus (p=0.03), postoperative infection (p<0.001), and delayed surgery >48 hours (p=0.01). Multivariate analysis identified postoperative infection (adjusted OR=5.8, 95% CI: 2.1-15.9; p<0.001) and delayed surgery >48 hours (adjusted OR=3.4, 95% CI: 1.2-9.6; p=0.02) as independent predictors of non-union.

Conclusion:

Non-union in long bone fractures is strongly associated with modifiable factors, particularly postoperative infection and delayed surgical intervention. Early surgery and effective infection control may significantly improve fracture healing outcomes.

Recommendation:

Early surgical stabilization and stringent infection prevention measures should be prioritized in patients with high-energy long bone fractures to reduce the risk of non-union.

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