Fractures That Fail to Heal May be Predictable Based on Patient Risk Factors

Recent research has shed light on the predictability of fractures that fail to heal, known as nonunions. All nonunions are a function of severity, location and disease comorbidity and while risk factor interaction is complex, a new study reports that it may become possible to predict nonunion based on the patient-specific presentation of risk factors. The findings are published in the Sept. 7 issue JAMA Surgery.
 
The study found that in 2011, among 309,330 fractures in 18 bones, the overall nonunion rate was 4.93 percent. However, higher nonunion risk was associated with severe fractures, high body mass index, smoking and alcoholism. While females had more fractures, males were more prone to nonunion. In addition, the risk of nonunion increased for patients who used certain medications including antibiotics, anticoagulants, and opioids, as well as for patients who had diseases such as obesity, osteoarthritis, and osteoporosis.
 
“We hypothesized that the interplay between a patient’s physiological risk factors and fracture characteristics increased the risk of fracture nonunion,” said Dr. R. Grant Steen, manager of medical affairs for Bioventus. “We now believe clinicians can use this information to describe the epidemiology of fracture nonunion in adult patients.”
 
The study was funded by Bioventus and used fracture patients from a health plan database. Patients with fracture were identified and continuous enrollment in the database was required for 12 months after fracture, to allow sufficient time to capture a nonunion diagnosis.
 
Authors of this study include Steen; Robert Zura, M.D., LSU Health Science Center, New Orleans, La.; Ze Xiong, MS, Dept. of Statistics, North Carolina State University; Thomas Einhorn, M.D., NYU Langone Medical Center, New York N.Y.; J. Tracy Watson, M.D., Saint Louis University School of Medicine, St. Louis, Mo.; Robert F. Ostrum, M.D., University of North Carolina; Michael J. Prayson, M.D., Wright State University, Fairborn, Ohio; Gregory J. Della Rocca, M.D., Ph.D., University of Missouri; Samir Mehta, M.D., Hospital of the University of Pennsylvania; Todd McKinley, M.D., Indiana University; Zhe Wang, MS, Dept. of Statistics, North Carolina State University.
 
Bioventus is an orthobiologics company that develops products that help people heal quickly and safely. Durham, N.C.-based Bioventus has two product portfolios for orthobiologics, Bioventus Active Healing Therapies and Bioventus Surgical.