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. 2017 Aug;88(4):434-439.
doi: 10.1080/17453674.2017.1321351. Epub 2017 May 16.

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

Leanora A Mills  1   2 , Stuart A Aitken  1   3 , A Hamish R W Simpson  1
Affiliations

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

Leanora A Mills et al. Acta Orthop. 2017 Aug.

Abstract

Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.

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Figures

Figure 1.
Figure 1.
Total number of non-unions treated over a 5-year period in Scotland.
Figure 2.
Figure 2.
Incidence of fractures per 100,000 population, according to sex.
Figure 3.
Figure 3.
Incidence of fractures per 100, 000 population, according to ISD-10 anatomical distribution.
Figure 4.
Figure 4.
Incidence of non-union per 1,000 fractures per annum, according to sex.
Figure 5.
Figure 5.
Incidence of non-union per 1,000 fractures, according to ISD-10 anatomical distribution.
Figure 6.
Figure 6.
Upper and lower estimates of clavicle non-union per fracture.
Figure 7.
Figure 7.
Incidence of non-union per 1,000 fractures, by age distribution, showing 95% confidence intervals.
Figure 8.
Figure 8.
Incidence of non-union per 1,000 fractures, according to anatomical distribution, showing 95% confidence intervals.
Figure 9.
Figure 9.
Comparison of the patterns of incidence of fractures, non-union, and non-union per fracture, according to age and sex.
See this image and copyright information in PMC

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