ArticleMedicine2018
Risk factors for nonunion of bone fracture in pediatric patients: An inception cohort study of 237,033 fractures.
Article in Medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Paediatric type I open tibia fractures: are antibiotics alone sufficient?Bone & joint open · 2025Pooled it
- Low intensity pulsed ultrasound (LIPUS) use for the management of instrumented, infected, and fragility non-unions: a systematic review and meta-analysis of healing proportions.BMC musculoskeletal disorders · 2021Pooled it
- Incidence, Risk Factors, Management, and Nonunion Rates of Pediatric Scaphoid Fractures: A National Database Study.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Review
- Novel Technique for Fracture Non-Union in Children - A Case Report.Journal of orthopaedic case reports · 2026Article
- Proximal Tibial Epiphyseal Injury in a 14-Year-Old Asian Male With Vitamin D Deficiency as a Possible Cause: A Case Report.Case reports in orthopedics · 2026Article
- Management of Fracture Non-union in Children: A Literature Review With Two Case Studies.Cureus · 2025Article
- Time to consider fracture nonunion an orphan disease? An update into pathophysiology, epidemiology and therapeutic solutions.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Review
- Nutritional Indicators of Bone Nonunion: A Systematic Review.Journal of clinical medicine · 2024Review
- Fracture nonunion and delayed union.Journal of the Pediatric Orthopaedic Society of North America · 2024Article
- Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture.Scientific reports · 2024Article
- Pediatric femoral shaft fracture requiring revision surgery for nonunion associated with vitamin D and K deficiencies: a case report.Journal of medical case reports · 2024Article
- Article
- Paediatric tibial shaft fractures: an instructional review for the FRCS exam.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Presentation and Referral Patterns in Pediatric Closed Hand Fractures.Hand (New York, N.Y.) · 2023Article
- Bone Healing Gone Wrong: Pathological Fracture Healing and Non-Unions-Overview of Basic and Clinical Aspects and Systematic Review of Risk Factors.Bioengineering (Basel, Switzerland) · 2023Review
- Low-Intensity Pulsed Ultrasound Therapy in Patients With Post-traumatic Delayed Union and Non-union.Cureus · 2022Article
- Effect of non-steroidal anti-inflammatory drugs on fracture healing in children: A systematic review.World journal of orthopedics · 2022Article
- Single stage open reduction, intramedullary rod, bone grafting, and plate fixation for managing adolescent midshaft femoral fracture non-union, report of two cases.Trauma case reports · 2022Article
- Obesity Increases Time to Union in Surgically Treated Pediatric Fracture Patients.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Adult fracture nonunion risk is related to injury severity and surgical technique, yet nonunion is not fully explained by these risk factors alone; biological risk factors are also important. We test a hypothesis that risk factors associated with pediatric fracture nonunion are similar to adult nonunion risk factors.Inception cohort study in a large payer database of pediatric fracture patients (0-17 years) in the United States in calendar year 2011. Continuous enrollment in the database was required for 12 months, to allow time to capture a nonunion diagnosis. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology (CPT) codes, comorbidities as per International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes, and drug prescriptions as per National Drug Code Directory (Red Book) codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion.Among 237,033 pediatric fractures in 18 bones, the nonunion rate was 0.85%. Increased nonunion risk was associated with increasing age, male gender, high body-mass index, severe fracture (e.g., open fracture, multiple fractures), and tobacco smoking (all, P < .0001). Nonunion rate varied with fracture location; scaphoid, neck of femur, and tibia/fibula were most likely to go to nonunion. Nonunion ORs were significantly increased for risk factors including; surgical procedure, cardiovascular disease, Vitamin D deficiency, osteoarthritis, osteoporosis, and opioid prescription (all, multivariable P < .001).Nonunion is rare in pediatric patients, but nonunion risk increases with increasing age. We confirm a hypothesis that risk factors for pediatric nonunion are similar to adult nonunion risk factors. Scaphoid fractures in adolescents have nearly the same risk of nonunion as in adults. Opioids should be used cautiously in pediatric patients, as they are associated with a significant and substantial elevation of nonunion risk. LEVEL OF EVIDENCE: Prognostic study, Retrospective, Level II.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.