ArticleJournal of orthopaedic surgery and research2023
Risk factors and healthcare costs associated with long bone fracture non-union: a retrospective US claims database analysis.
Article in Journal of orthopaedic surgery and research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Bone morphogenetic protein, platelet-rich plasma, and bone marrow aspiration concentrate in the treatment of bone delayed union or nonunion: a systematic review and network meta-analysis of randomized controlled trials.European journal of medical research · 2025Pooled it
- Anticipating femoral shaft nonunion at 1-3 months: a multimodal framework with automated X‑ray segmentation despite metal implants.International orthopaedics · 2026Article
- From metabolic node to smart building block: α-Ketoglutarate-empowered biomaterials for programmable cell fate.Materials today. Bio · 2026Review
- Granulate-to-Filament: An Extrusion-Mixed PLA-Human Bone Material System for 3D-Printed Bone Scaffolds.Journal of functional biomaterials · 2026Article
- Surgically Treated Non-Unions and Fractures of the Femur and Tibia in Adults: A Nationwide Analysis of 888,442 Cases from the German InEK Database.Journal of epidemiology and global health · 2026Article
- A Needlelike Nano-hydroxyapatite-Based Hydrogel Accelerates Critical Bone Defect Regeneration via Osteo-/Angiogenesis and Osteoimmune Regulation.Biomaterials research · 2026Article
- Commentary: Beyond PLR - rethinking biomarkers in fracture healing.International journal of surgery (London, England) · 2026Article
- Risk factors and a predictive nomogram for nonunion following intramedullary nailing of femoral shaft fractures.BMC musculoskeletal disorders · 2025Article
- Biomimetic Silk Fibroin Scaffolds Functionalized with Hydroxyapatite and Platelet Growth Factors for Bone Tissue Engineering.Biomimetics (Basel, Switzerland) · 2025Article
- Non-Union Treatment in the Shoulder, Arm, Wrist, and Fingers: A Multicentre Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark ScrewLife (Basel, Switzerland) · 2025Article
- Temporal Molecular Signatures of Early Human Clavicle Fracture Healing: Characterization of Hematological, Cytokine, and miRNA Profiles.International journal of molecular sciences · 2025Article
- Global Research Trends and Hotspots in Fracture Nonunion and Delayed Union: A 2-Decade Bibliometric Analysis.Indian journal of orthopaedics · 2025Article
- The Financial Toll of Social Determinants of Health on Orthopedic Trauma Care: A National Perspective.Cureus · 2025Article
- Efficacy of biomarkers in the endochondral phase of fracture repair and healing in long bones: A clinical observational studys.PLoS medicine · 2025Observational
- BioBone - A prospective, blinded, multicenter validation study of the CD8 + terminal differentiated effector memory cells (CD8 + TEMRA cells) as prognostic biomarker for disturbed fracture healing - study design.Journal of orthopaedic surgery and research · 2025Article
- The Genetic and Biological Basis of Pseudoarthrosis in Fractures: Current Understanding and Future Directions.Diseases (Basel, Switzerland) · 2025Review
- Surgical and microbiological characteristics that influence the probability of reoperation to promote bone healing after fracture-related infection diagnosis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Induced membrane technique for aseptic recalcitrant nonunion of the femur and tibia: Bone union and deformity correction outcomes.Journal of clinical orthopaedics and trauma · 2025Article
- Hyperbaric Oxygen Therapy for the Treatment of Bone-Related Diseases.International journal of molecular sciences · 2025Review
- Evaluating catastrophic health expenditures among patients with long bone fractures in Ghana's major teaching hospitals: a hospital-based analysis.BMC health services research · 2025Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFew contemporary US-based long bone non-union analyses have recently been published. Our study was designed to provide a current understanding of non-union risks and costs, from the payers' perspective.
methodsThe Merative™ MarketScan
resultsA total of 12,770, 13,504, and 4,805 patients with femoral, tibial, or humeral surgically treated fractures were identified, 74-89% were displaced, and 18-27% were comminuted. Two-year rates of non-union reached 8.5% (8.0%-9.1%), 9.1% (8.6%-9.7%), and 7.2% (6.4%-8.1%) in the femoral, tibial, and humeral fracture cohorts, respectively. Shaft fractures were at increased risk of non-union versus fractures in other sites (risk ratio (RR) in shaft fractures of the femur: 2.36 (1.81-3.04); tibia: 1.95 (1.47-2.57); humerus: 2.02 (1.42-2.87)). Fractures with severe soft tissue trauma (open vs. closed, Gustilo III vs. Gustilo I-II) were also at increased risk for non-union (RR for Gustilo III fracture (vs. closed) for femur: R = 1.96 (1.45-2.58), for tibia: 3.33 (2.85-3.87), RR for open (vs. closed) for humerus: 1.74 (1.30-2.32)). For all fractures, younger patients had a reduced risk of non-union compared to older patients. For tibial fractures, increasing comorbidity (Elixhauser Index 5 or greater) was associated with an increased risk of non-union. The two-year marginal cost of non-union ranged from $33K-$45K. Non-union reoperation added $16K-$34K in incremental costs. Concurrent infection further increased costs by $46K-$86K.
conclusionsNon-union affects 7-10% of surgically treated long bone fracture cases. Shaft and complex fractures were at increased risk for non-union.
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