Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries

M. Hofman*, H. Andruszkow, F.L. Heyer, P. Kobbe, F. Hildebrand, M. Poeze

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose Concomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union. Methods Patients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS). Results The total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development. Conclusion Our results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
Original languageEnglish
Pages (from-to)1903-1910
Number of pages8
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number6
Early online date5 Mar 2020
Publication statusPublished - Dec 2021


  • brain
  • callus formation
  • chest injury
  • damage control
  • dco
  • etc
  • external fixation
  • head-injury
  • non-union
  • orthopedic-surgery
  • shaft fractures
  • tbi
  • treatment strategy
  • Treatment strategy
  • Chest injury
  • TBI
  • DCO
  • ETC
  • Non-union

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