Nonunion Fractures: Trends in Epidemiology and Treatment of Femur Fractures, 2017-2022

Kassem Ghayyad; Pascal Escobar; Tyler F Beaudoin; Luke Wandersleben; Michael Hawks; Atif Ahmed; Amir R Kachooei

doi:10.7759/cureus.70566

Nonunion Fractures: Trends in Epidemiology and Treatment of Femur Fractures, 2017-2022

Cureus. 2024 Sep 30;16(9):e70566. doi: 10.7759/cureus.70566. eCollection 2024 Sep.

Authors

Kassem Ghayyad¹, Pascal Escobar¹, Tyler F Beaudoin^{2

1}, Luke Wandersleben^{1

3}, Michael Hawks¹, Atif Ahmed¹, Amir R Kachooei^{4

1

5}

Affiliations

¹ Orthopaedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA.
² Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, USA.
³ Orthopaedic Surgery, Loma Linda University School of Medicine, Orlando, USA.
⁴ Orthopaedics, University of Central Florida, Orlando, USA.
⁵ Orthopedics, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN.

Abstract

Background: The incidence of femur fractures has increased in recent years, along with the rate of surgery and subsequent nonunion following these fractures. Nonunion is a significant concern due to the burden it places on both patients and the healthcare system. This study aims to investigate the demographic factors associated with femoral shaft fracture nonunion by comparing two surgical management approaches: open reduction internal fixation (ORIF) with plating versus closed reduction and fixation using intramedullary nailing (IMN).

Methods: The TriNetX database was queried using current procedural terminology (CPT) codes for surgical repair of femoral shaft fractures (FSFs), including IMN surgery (CPT: 27506) and femur ORIF (CPT: 27507). The subsequent chronological nonunion cases were identified using the 10th revision of the International Classification of Diseases (ICD-10) codes for femoral nonunion (S72.301K, S72.302K). Results were analyzed both descriptively and comparatively to assess differences among patients. Factors considered included age, sex, ethnicity, race, smoking status, and the type of surgical management (ORIF versus nailing) across the six-year study period.

Results: From 2017 to 2022, the prevalence of femoral shaft fracture surgeries increased for both IMN and ORIF. The rate of nonunion was 2.1% following IMN and 1.7% following ORIF. The mean age for nonunion was 54 years (SD: 20) following IMN and 63 years (SD: 18) following ORIF. Patients with a positive smoking history had higher rates of nonunion compared to those without.

Conclusion: Our study revealed a relatively consistent rate of FSFs and nonunion over the six-year period. However, with a growing population, the absolute number of cases is steadily increasing, underscoring the burden on the healthcare system. This study contributes to the growing body of literature focused on improving patient outcomes and promoting health equity in fracture management practices.

Keywords: intramedullary nailing (imn); non-union shaft femur; open reduction and internal fixation (orif); socio-demographic factors; trauma epidemiology.