Long-term patient-related quality of life after successfully treated aseptic non-unions of the long bones

Nike Walter; Maximilian Kerschbaum; Christian Pfeifer; Daniel Popp; Viola Freigang; Thilo Hinterberger; Volker Alt; Markus Rupp

doi:10.1016/j.injury.2021.04.041

Long-term patient-related quality of life after successfully treated aseptic non-unions of the long bones

Injury. 2021 Jul;52(7):1880-1885. doi: 10.1016/j.injury.2021.04.041. Epub 2021 Apr 16.

Authors

Nike Walter¹, Maximilian Kerschbaum², Christian Pfeifer², Daniel Popp², Viola Freigang², Thilo Hinterberger³, Volker Alt², Markus Rupp⁴

Affiliations

¹ Department for Trauma Surgery, University Medical Center Regensburg, Germany; Department for Psychosomatic Medicine, University Medical Center Regensburg, Germany.
² Department for Trauma Surgery, University Medical Center Regensburg, Germany.
³ Department for Psychosomatic Medicine, University Medical Center Regensburg, Germany.
⁴ Department for Trauma Surgery, University Medical Center Regensburg, Germany. Electronic address: markus.rupp@ukr.de.

PMID: 33910685
DOI: 10.1016/j.injury.2021.04.041

Abstract

Background: Non-union after fracture depicts a devastating complication in trauma surgery and studies assessing patient-reported outcome measures after stable bone consolidation are rare. Therefore, we aimed to evaluate the long-term impact of aseptic long bone non-union on the patients' physical health state and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of long bone non-union was assessed.

Methods: Sixty-one patients with aseptic long bone non-union surgically treated in our department between November 2009 and March 2019 with achieved bone consolidation were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data.

Results: With a minimum follow-up time of one year after the last surgery (mean 4.7 ± 2.7 years) the mean physical health component score of the SF-36 was 38.9 ± 13.7 and the mean mental health component score of the SF-36 was 49.0 ± 5.9, indicating lower quality of life compared to German normative values of 48.4 ± 9.4 (p < .001) and 50.9 ± 8.8 (p = 1.61), respectively. The mean EQ-5D index value reached 0.827 ± 0.18 with an EQ-5D VAS rating of 64.4 ± 21.5 compared to scores of 0.922 (p < .001) and 72.9 ± 1.1 (p < .001) obtained from an age-matched reference population. Mean scores of the ISR did not reveal significant psychological symptom burden in any scale, while an individual analysis showed moderate to severe impairments in 11.5% of the patients in total.

Conclusion: Even 4.7 years on average after surgically successful treatment of aseptic long bone non-union, patients still report significant lower quality of life in comparison to normative data. Future clinical studies on non-unions should focus on patient-related outcome measures. Newly emerging treatment strategies and interdisciplinary approaches should be implemented to improve the overall quality of life of non-union patients.

Keywords: Bone consolidation; Long-term impact; Non-union; Quality of life.

MeSH terms

Fractures, Bone*
Humans
Patient Reported Outcome Measures
Quality of Life*
Surveys and Questionnaires