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J Orthop Trauma. 2019 Mar 13. doi: 10.1097/BOT.0000000000001476. [Epub ahead of print]

Non-United Lower Extremity Fractures Initially Repaired Outside the Developed Western World Develop a High Rate of Post-Operative Complications Following Nonunion Repair.

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Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA.



To evaluate clinical and functional outcomes following operative repair of non-united lower extremity fractures initially repaired outside the developed Western world.


Retrospective analysis of prospectively collected data.


Academic medical center.


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 prior fracture surgery and had at least 12 months of post-operative follow-up.


Lower extremity fracture nonunion repair.


Post-operative complications, re-operation rate, time to union, and functional outcomes assessed using the Short Musculoskeletal Function Assessment (SMFA) and Visual Analog Scale (VAS) pain scores. Univariate and multivariate analyses were performed to evaluate for differences between patients who underwent initial fracture repair outside the developed Western world as opposed to within the United States of America (USA).


Twenty-one (9.3%) patients underwent initial fracture repair outside of 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 USA. This cohort also experienced a greater rate of post-operative complications following nonunion repair (23.8% vs. 6.3%, p=0.016). Geographic location of initial fracture repair was not associated with post-operative SMFA scores or VAS pain scores after controlling for possible confounding variables.


Patients who present with a non-united lower extremity fracture initially repaired outside the developed Western world experience a high rate of post-operative complications following fracture nonunion repair, but can expect good short- and long-term functional outcomes.


Prognostic level III.

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