Objective: The purpose of this study was to determine whether the finding of failed fracture implants in association with lower extremity long bone fracture nonunion portends worse clinical or functional outcome after surgical nonunion repair.
Design: Retrospective analysis of prospectively collected data.
Setting: Academic Medical Center.
Patients: One hundred eighty-one patients who presented to our institution over a 10-year period and underwent surgical repair of a lower extremity fracture nonunion.
Intervention: Surgical repair of lower extremity fracture nonunion.
Main outcome measurements: Time to union, postoperative complications, visual analog scale pain scores, and Short Musculoskeletal Function Assessment scores after lower extremity nonunion repair. Data were analyzed to assess for differences in postoperative outcomes based on the integrity of fracture implants at the time of nonunion diagnosis. Implant integrity was defined using 3 groups: broken implants (BI), implants intact (II), and no implants (NI).
Results: There was no significant difference in time to union after surgery between the BI, II, or NI groups (mean 8.1 months vs. 7.6 months vs. 6.2 months, respectively). Fourteen patients (7.7%) failed to heal, including 5 BI patients, 7 II patients, and 2 NI patients. One tibial nonunion patient in each of the 3 groups underwent amputation for persistent nonunion after multiple failed revision attempts at a mean of 4.8 years after initial injury. There was no difference in postoperative pain scores, the rate of postoperative complications, or functional outcome scores identified between the 3 groups.
Conclusions: The finding of failed fracture implants at the time of lower extremity long bone nonunion diagnosis does not portend worse clinical or functional outcome after surgical nonunion repair. Patients who present with failed fracture implants at the time of nonunion diagnosis can anticipate similar time to union, complication rates, and functional outcomes when compared with patients who present with intact implants or those with history of nonoperative management.
Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.