Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice

被引:52
|
作者
Wittauer, Matthias [1 ,2 ,3 ]
Burch, Marc-Antoine [1 ,2 ,3 ]
McNally, Martin [4 ]
Vandendriessche, Thomas [5 ]
Clauss, Martin [1 ,2 ,3 ]
Della Rocca, Gregory J. [6 ]
Giannoudis, Peter V. [7 ,8 ]
Metsemakers, Willem-Jan [9 ]
Morgenstern, Mario [1 ,2 ,3 ]
机构
[1] Univ Hosp Basel, Ctr Musculoskeletal Infect, Spitalstr 21, CH-4031 Basel, Switzerland
[2] Univ Hosp Basel, Dept Orthopaed & Trauma Surg, Spitalstr 21, CH-4031 Basel, Switzerland
[3] Univ Basel, Peterspl 1, CH-4001 Basel, Switzerland
[4] Oxford Univ Hosp, Bone Infect Unit, Nuffield Orthopaed Ctr, Windmill Rd, Oxford OX3 7LD, England
[5] KU Leuven Libs, 2Bergen, Learning Ctr Desire Collen, Herestr 49, B-3000 Leuven, Belgium
[6] Univ Missouri, Dept Orthopaed Surg, 1 Hosp Dr, Columbia, MO 65201 USA
[7] Univ Leeds, Acad Dept Trauma & Orthopaed, Sch Med, Leeds LS2 9JT, W Yorkshire, England
[8] Chapel Allerton Hosp, NIHR Leeds Biomed Res Ctr, Chapeltown Rd, Leeds LS7 4SA, W Yorkshire, England
[9] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Dev & Regenerat, Dept Trauma Surg, Herestr 49, B-3000 Leuven, Belgium
关键词
Nonunion; Fracture nonunion; Systematic review; Definition; Long-bone fracture; RADIOGRAPHIC UNION SCORE; FRACTURE; CONSENSUS; ETIOLOGY;
D O I
10.1016/j.injury.2021.09.008
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: Although nonunions are among the most common complications after long-bone fracture fixation, the definition of fracture nonunion remains controversial and varies widely. The aim of this study was to identify the definitions and diagnostic criteria used in the scientific literature to describe nonunions after long-bone fractures. Methods: A comprehensive literature search was performed in PubMed, Cochrane Library, Web of Science, and Embase. Prospective clinical studies, in which adult long-bone fracture nonunions were investigated as main subject, were included in this analysis. Data on nonunion definitions described in each study were extracted and collected in a database. Results: Although 148 studies met the inclusion criteria, only 50% (74/148) provided a definition for their main study subject. Nonunion was defined in these studies based on time-related criteria in 85% (63/74), on radiographic criteria in 62% (46/74), and on clinical criteria in 45% (33/74). A combination of clinical, radiographic and time-related criteria for definition was found in 38% (28/74). The time interval between fracture and the time point when authors defined an unhealed fracture as a nonunion showed considerable heterogeneity, ranging from three to twelve months. Conclusion: In the current orthopaedic literature, we found a lack of consensus with regard to the definition of long-bone nonunions. Without valid and reliable definition criteria for nonunion, standardization of diagnostic and treatment algorithms as well as the comparison of clinical studies remains problematic. The lack of a clear definition emphasizes the need for a consensus-based approach to the diagnosis of fracture nonunion centred on clinical, radiographical and time-related criteria. (C) 2021 The Authors. Published by Elsevier Ltd.
引用
收藏
页码:3200 / 3205
页数:6
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