Nonunited Lower Extremity Fractures Initially Repaired Outside the Developed Western World Develop a High Rate of Postoperative Complications After Nonunion Repair

J Orthop Trauma. 2019 Aug;33(8):e296-e302. doi: 10.1097/BOT.0000000000001476.


Objectives: To evaluate the clinical and functional outcomes after operative repair of nonunited lower extremity fractures initially repaired outside the developed Western world.

Design: Retrospective analysis of prospectively collected data.

Setting: Academic medical center.

Patients/participants: From September 2004 through February 2017, 227 patients who underwent operative repair of a lower extremity fracture nonunion were prospectively enrolled in a research registry. All patients underwent previous fracture surgery and had at least 12 months of postoperative follow-up.

Intervention: Repair of lower extremity fracture nonunion.

Main outcome measurements: Postoperative complications, reoperation rate, time to union, and functional outcomes were assessed using the Short Musculoskeletal Function Assessment and Visual Analog Scale pain scores. Univariate and multivariate analyses were performed to evaluate the differences in patients who underwent initial fracture repair outside the developed Western world as opposed to within the United States.

Results: Twenty-one patients (9.3%) underwent initial fracture repair outside the developed Western world. These patients had a greater incidence of infected nonunions (47.6% vs. 23.3%; P = 0.015) and failure of a previous implant at the time of presentation (52.4% vs. 22.8%; P = 0.003) than those initially managed within the United States. This cohort also experienced a greater rate of postoperative complications after nonunion repair (23.8% vs. 6.3%; P = 0.016). The geographic location of initial fracture repair was not associated with postoperative Short Musculoskeletal Function Assessment scores or Visual Analog Scale pain scores after controlling for possible confounding variables.

Conclusions: Patients who present with a nonunited lower extremity fracture initially repaired outside the developed Western world experience a high rate of postoperative complications after fracture nonunion repair but can expect good short- and long-term functional outcomes.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adult
  • Aged
  • Developing Countries*
  • Female
  • Femoral Fractures / surgery*
  • Fibula / injuries*
  • Fractures, Ununited / diagnostic imaging
  • Fractures, Ununited / etiology
  • Fractures, Ununited / surgery*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Reoperation
  • Retrospective Studies
  • Tibial Fractures / surgery*
  • Treatment Outcome
  • United States