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Review
. 2019 Nov 15;8(11):1998.
doi: 10.3390/jcm8111998.

Physical Health and Psychological Outcomes in Adult Patients with Long-bone Fracture Non-unions: Evidence Today

Louise Johnson  1 , Emily Igoe  1 , George Kleftouris  1 , Ioannis V Papachristos  2 , Costas Papakostidis  3 , Peter V Giannoudis  4
Affiliations
Review

Physical Health and Psychological Outcomes in Adult Patients with Long-bone Fracture Non-unions: Evidence Today

Louise Johnson et al. J Clin Med. .

Abstract

Background: Research has suggested that bone fractures can hinder the health status of patients' life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes.

Methods: Electronic databases 'PubMed', 'Cochrane', 'PsycInfo', 'Medline', 'Embase', 'Web of Science', and 'CINAHL' were used. Search terms used were nonunion OR non-union OR "non union" OR "long bone" OR "delayed union" AND "quality of life" OR qol OR depression OR anxiety OR psycholog* OR PTSD OR "post-traumatic stress disorder". Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The "non-union" group to a normative, matched population and (2) the "non-union group" to the same group after union was achieved. However, studies that did not use comparison groups were also included.

Results: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery.

Conclusions: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.

Keywords: fracture non-union; physical health; psychological outcomes; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2009 Flow Diagram.
Figure 2
Figure 2
Funnel plot (publication bias).
Figure 3
Figure 3
SF-12 PCS pooled analysis of non-union versus normal population.
Figure 4
Figure 4
SF-12 MCS pooled analysis between non-union and respective normal population.
Figure 5
Figure 5
SF-12 PCS pooled analysis between nonunion and union.
Figure 6
Figure 6
SF-12 MCS pooled analysis between nonunion and union.
Figure 7
Figure 7
SF-12 PCS and MCS pooled analysis between tibial non-unions and norm.
Figure 8
Figure 8
SF-12 PCS and MCS pooled analysis between femoral non-unions and norm.
See this image and copyright information in PMC

References

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