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Factors associated with fracture nonunion and infection in polytrauma patients: A retrospective multi-center study
Tony Daniel Baldini1,2, Jane Burgan1,3, Ivo David Gutmann4
1Department of Orthopaedic Surgery, UC Davis Health, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA.
Insights
Polytrauma patients with higher Injury Severity Scores (ISS) face increased risks of fracture nonunion and infection. Male sex, open fractures, and delayed fixation are key contributing factors to these complications.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Clinical Research
Background:
- Polytrauma significantly impacts young adults, often leading to delayed fracture healing or nonunion.
- Identifying factors contributing to nonunion and infection is crucial for improving outcomes in polytrauma patients.
Purpose of the Study:
- To identify patient, injury, and treatment-related factors associated with fracture nonunion and infection in polytrauma patients.
- To investigate the correlation between higher Injury Severity Score (ISS) and increased rates of infection and nonunion.
Main Methods:
- Retrospective, multi-center international study of multiply injured patients (age ≥18) with operatively treated fractures.
- Data collected from 2015-2023 at two Level I Trauma Centers, excluding patients with <3 months follow-up.
- Analysis of demographics, fracture characteristics, injury types, procedures, hospital care, outcomes, and lab values concerning union and infection status.
Main Results:
- A cohort of 1352 outcomes (ISS >9) revealed male sex, lower Glasgow Coma Scale scores, open fractures, delayed fixation, and soft tissue coverage as significant contributors to nonunion.
- Factors associated with infection included articular fractures, open fractures, delayed fixation, soft tissue coverage, and nonunion.
- An ISS >20 correlated with nonunion, mortality, and reoperation, while an ISS cutoff of 15 did not significantly associate with nonunion.
Conclusions:
- Patient, injury, and treatment factors significantly influence fracture nonunion and infection rates in polytrauma.
- Higher injury severity, indicated by a greater ISS, is associated with increased nonunion and infection rates in polytrauma patients.
Background:
Polytrauma causes significant morbidity in young adults and often leads to delayed fracture healing or nonunion. This study aims to identify patient, injury, and treatment related factors associated with fracture nonunion and infection in polytrauma patients. Higher Injury Severity Score (ISS) is hypothesized to correlate with increased rates of infection and nonunion.
Methods:
This is a retrospective multi-center international study. Patients admitted between 2015 and 2023 at the University of California, Davis Level I Trauma Center and University Hospital of Giessen and Marburg (UKGM) Giessen campus met the following criteria: Multiply injured patients with operatively treated fractures and age 18 or older. Patients were excluded if follow-up length did not reach 3 months. Data for demographics, fracture characteristics, injury types, procedures, hospital care and outcomes, and lab values were analyzed concerning union and infection status postoperatively.
Results:
The cohort included 1352 nonunion and infection outcomes (ISS >9). Key findings indicate that male sex (79.4% p = 0.040), Glasgow Coma Scale score (12.28 p = 0.029), open fracture (62.7% p=<0.001), delayed fixation (67.05 p=<0.001), soft tissue coverage (23.9% p=<0.001), and deep infections (20.6% p=<0.001) significantly contribute to nonunion. Factors associated with infection include articular fractures (85% p = 0.030), open fractures (59% p=<0.001), delayed fixation (71.39 p=<0.001), soft tissue coverage (25% p=<0.001), and nonunion (38.9% p=<0.001). Demographics, hospital characteristics, fracture types, and laboratory values, were associated with nonunion and infection. An ISS >20 was associated with nonunion, mortality, and reoperation outcomes, whereas an ISS cutoff of 15 was not statistically associated with nonunion.
Conclusion:
This study identifies patient, injury, and treatment related factors associated with fracture nonunion and infection in polytrauma patients. The findings suggest that greater injury severity, as reflected by higher ISS, is associated with increased rates of nonunion and infection.
Level Of Evidence:
Level III.
