Background The management of long bone fractures is complex and the risk of healing complications persists. Previous studies have reported widely varying incidence and cost estimates for fracture healing complications, with the majority focusing on small cohorts with specific fracture types and treatment methods. Also, there is a lack of research on patient outcomes. The aim of this study was to describe the incidence, inpatient costs and 12-month outcomes of readmissions for healing complications following long bone fracture.
Methods All humeral, tibial and femoral fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over a 5-year period were linked with hospital data to identify 2-year readmissions for non-union, delayed union or mal-union. Study outcomes for patients with complication readmissions included hospital length of stay, inpatient costs, function (Extended Glasgow Outcome Scale), work status and quality of life (EQ-5D) measured 12 months post-injury. Cases with and without complications were compared using univariable and multivariable methods.
Results Of the 3908 patients included, 9% were readmitted for healing complications within 2 years of their index fracture. The most common complication type was non-union (77% of complications). Admissions for fracture healing complications incurred an extra 3 days in hospital and costs of up to AUD $25,000 per patient (AUD $5.4 M in total). Patients with healing complications reported worse function, quality of life and return to work rates 12 months post-injury. After adjusting for key confounders, patients had higher odds of developing complications if they were older, receiving compensation or had multiple fractures.
Conclusions Patients who develop complications have poorer outcomes and place additional burden on healthcare and compensation systems. As such, there is a need to prioritise future research aimed at preventing fracture healing complications and improving patient outcomes.