Santolini, E, West, RM orcid.org/0000-0001-7305-3654 and Giannoudis, PV orcid.org/0000-0002-5205-7696 (2020) Leeds-Genoa Non-Union Index: a clinical tool for asessing the need for early intervention after long bone fracture fixation. International Orthopaedics, 44 (1). pp. 161-172. ISSN 0341-2695
Abstract
Aim of the study
The aim of this case–control study was to develop a clinical decision rule to support assessment of the risk of long-bone non-union and plan for appropriate early intervention.
Methods
Two hundred patients (100 cases and 100 controls) were recruited. Risk factors identified to contribute to the development of non-union were recorded and analysed with a multivariable logistic regression model. Tabulation of the outcome (non-union/union) against each risk factor in turn (univariable analysis) was carried out. Odds ratios and confidence intervals were derived using Wald’s method. A receiver–operator curve was calculated and the area under the curve was computed. Having established the eight most important risk factors, a non-union risk index was developed as the count of the risk factors present in each patient.
Results
The five risk factors for non-union with greater effect size were post-surgical fracture gap > 4 mm (odds ratio (OR) = 11.97 95% CI (4.27, 33.53)), infection superficial/deep (OR 10.16 (2.44, 42.36)), not optimum mechanical stability (OR 10.06 (3.75, 26.97)), displacement > 75% of shaft width (OR 6.81 (2.21, 20.95)), and site of fracture—tibia (OR 4.33 (1.32, 14.14)). The ROC curve for the non-union index was 0.924, sensitivity 91%, specificity 77%.
Conclusions
The non-union index derived from counting risk factors predicts union for 0–4 risk factors and non-union for 5–8 risk factors. It can be readily applied and can guide clinicians about the risk of development of long-bone non-union. It can become a powerful aid for assessing fracture fixation outcome and to support early intervention.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0/) |
Keywords: | Non-union; Prediction index; Early intervention; Femur; Tibia |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Centre for Health Services Research (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 17 Feb 2020 16:31 |
Last Modified: | 17 Feb 2020 16:31 |
Status: | Published |
Publisher: | Springer Nature |
Identification Number: | 10.1007/s00264-019-04376-0 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:157217 |
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