Abstract
Background: Non-union after fracture depicts a devastating complication in trauma surgery and studies assessing patient-reported outcome measures after stable bone consolidation are rare. Therefore, we aimed to evaluate the long-term impact of aseptic long bone non-union on the patients' physical health state and psychological wellbeing. For this purpose, quality of life after successful surgical ...
Abstract
Background: Non-union after fracture depicts a devastating complication in trauma surgery and studies assessing patient-reported outcome measures after stable bone consolidation are rare. Therefore, we aimed to evaluate the long-term impact of aseptic long bone non-union on the patients' physical health state and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of long bone non-union was assessed. Methods: Sixty-one patients with aseptic long bone non-union surgically treated in our department between November 2009 and March 2019 with achieved bone consolidation were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Results: With a minimum follow-up time of one year after the last surgery (mean 4.7 +/- 2.7 years) the mean physical health component score of the SF-36 was 38.9 +/- 13.7 and the mean mental health component score of the SF-36 was 49.0 +/- 5.9, indicating lower quality of life compared to German normative values of 48.4 +/- 9.4 (p <.001) and 50.9 +/- 8.8 (p = 1.61), respectively. The mean EQ-5D index value reached 0.827 +/- 0.18 with an EQ-5D VAS rating of 64.4 +/- 21.5 compared to scores of 0.922 (p <.001) and 72.9 +/- 1.1 (p <.001) obtained from an age-matched reference population. Mean scores of the ISR did not reveal significant psychological symptom burden in any scale, while an individual analysis showed moderate to severe impairments in 11.5% of the patients in total. Conclusion: Even 4.7 years on average after surgically successful treatment of aseptic long bone nonunion, patients still report significant lower quality of life in comparison to normative data. Future clinical studies on non-unions should focus on patient-related outcome measures. Newly emerging treatment strategies and interdisciplinary approaches should be implemented to improve the overall quality of life of non-union patients. (C) 2021 Elsevier Ltd. All rights reserved.
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