RISK FACTORS OF DELAYED/ NON UNION OF FRACTURE LONG BONES
Asheeb.A*, Aswathy.U, Anish. G. Nair, P.B. Kumari Jayageetha#
Inadequate response to the fracture injury sometimes occurs, resulting in delayed union or non-union. According to previous studies, the risk factors for delayed union include smoking, compound fractures, site of fracture, infection at site of fracture, systemic illness like diabetes. Delayed union creates a low quality of life and much economic burden. So present study focuses on the factors responsible for delayed union/ non union of fractures.
To find out various risk factors associated with delayed union / non union of fracture of long bones and strength of association of each factor.
MATERIALS AND METHODS
Design of study was case control study and was done in Orthopaedics OPD, MCH Trivandrum from Oct 15- Dec 15 2007. Patients who attended orthopaedics OPD with delayed union/non union fracture long bones during the period Oct 15- Dec 15 2007 were cases and patients who attended the orthopaedics OPD with united fractures were taken as controls. Cases: 45, Controls: 90. Data collection was by Interview method using pre-tested semi structured questionnaire. Chi- square test, odds ratio and logistic regression were used as statistical methods.
Ageing is associated with increased chances of delayed union. (Chi square = 51.929; P value = 0.000).
Low per capita income, low socioeconomic (Chi square = 32.286; P value = 0.000) and educational status(Chi square = 12.795; P value = 0.000 ;Odds ratio = 3.864) leads to delay in healing of fractures.
Fractures in lower limb like femoral, tibial fractures are likely than upper limb fractures to proceed to delayed union. (Chi square = 22.227; P Value= 0.001)
Compound fractures (Chi square value =43.618; Odds ratio =24.39; P value= 0.000). and those fractures with history of infection (Chi square = 45.643; Odds ratio = 77.875,P value = 0.000) at the site are of risk for delayed union.
History of systemic illness like diabetes is definitely a risk factor . (Chi square = 47.651; P value = 0.000)
Habits of smoking (Odds ratio= 9.33. Chi square value 22.804. P value < 0.05). and alcoholism (Chi square =14.817 Odds ratio =12.571; P value = 0.000) disrupt healing process and lead to delayed union.
In multi variate analysis it was found that risk factors- low educational status, type of fracture and history of infection alone contribute for 47.9% cases of delayed healing/ non union of fractures.
Pathological fractures can be reduced to a great extent by treating debilitating conditions. Written policies should be established in peripheral units for automatic referral of patients with compound fracture to a specialist in the area Develop an anti-tobacco advertising campaign for print, radio, and television media, and request free placement and air time.