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Open AccessArticle

Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

1
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia
2
Department of Orthopaedic Surgery, Alfred Hospital, Melbourne VIC 3004, Australia
3
Department of Surgery, Epworth Healthcare, Richmond VIC 3121, Australia
4
Department of Surgery, University of Melbourne, Parkville VIC 3052, Australia
5
Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(12), 2845; https://doi.org/10.3390/ijerph15122845
Received: 8 November 2018 / Revised: 10 December 2018 / Accepted: 11 December 2018 / Published: 13 December 2018
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications. View Full-Text
Keywords: bone; fracture; non-union; delayed union; mal-union; data linkage; costs bone; fracture; non-union; delayed union; mal-union; data linkage; costs
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Ekegren, C.L.; Edwards, E.R.; De Steiger, R.; Gabbe, B.J. Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture. Int. J. Environ. Res. Public Health 2018, 15, 2845.

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