Volume : 8, Issue : 3, March - 2019

Study to identify modifiable risk factors associated with adverse outcomes in patients with fracture healing.

Dr. Sumit Baheti, Dr. Sanjay Deshpande

Abstract :

Adverse outcome continues to be one of the most important post fracture problem .It may need multiple hospitalisations and surgical interventions, with an impact on the health of the patient and his/her surrounding family members. More over there is an additional burden to the health care system and the society as a whole due to the increased socioeconomic/financial implications. Patients with prolonged treatment for non-union have been reported to not only suffer from the physical sequelae of the disease process but also from psychological disturbances.Understanding the causative factors of fracture adverse outcome leads to both prevention and improvements in treatment. The purpose of this study was to understand the clinical characteristics and causative factors of adverse outcome. Methods Two hundred and ninety-one patients with fracture of the long bone who were surgically and conservatively treated in our hospital over the last 2 years wereanalysed. Data were collected by reviewing medical charts. Radiographs were reviewed to classify the adverse outcome by radiographic appearance. Causative factors of adverse outcome were identified for each patient. Factors relating to inadequate mechanical stability or reduction and those relating to a decline in biological activity were investigated. Mechanical factors included inappropriate reduction, inappropriate surgical management, insufficient fixation, and conservative treatment. Surgical technical errors were identified through careful review by three experienced trauma surgeons. Biological activity factors included comminution and bone loss, open fracture, excessive surgical exposure, alcohol abuse, diabetes mellitus, smoking, and metabolic disease or Osteoporosis . We also classified the causative factors as patient-dependent or patient-independent factors. Results Of the 291 patient, at 1 year follow up 199 patient had normal union and 18 patient were with delayed union .74 patient were had non-union at 1 year follow up.However, patients having multiple risk factors like male gender with lower socioeconomic status with smoking and alcohol addiction with comorbidities like Hypertension and Anaemia were found to be more prone for nonunion of fractures.