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Background <p>Non-unions after fractures are known to be a devastating complication in trauma surgery and studies assessing long-term patient-reported, clinical, and radiological outcome measures are scarce. Most evidence-based research on non-unions and their long-term follow-up evaluate the first two post-operative years while excluding subsequent years and their impact on the overall outcome. This study aimed to evaluate the functional, clinical and radiological outcomes five years post-operative.</p> Methods <p>In this prospective study, all patients treated operatively between June 2018 and December 2020 for non-unions including every site were systematically reviewed for inclusion and summoned for a follow-up after 5&#xa0;years. The outcome was evaluated using the modified Lane-Sandhu-Score (LSS), the short-form 12 (SF-12), active range of motion (ROM) and visual analogue scale (VAS). Furthermore, data on complications was collected. For all analyses, a <i>p</i>-value &lt; 0.05 was evaluated as significant.</p> Results <p>A total of 45 patients were included in the study with a follow-up time of 63&#xa0;months (IQR: 55; 66). The LSS median after five years was 4 (IQR: 4; 4) and of the VAS 0 (IQR: 0; 4). 95.6% of patients were satisfied with the therapy after five years. Regarding the SF-12, the median score for the mental component was 55.2 (IQR: 48.7; 58.8) and the physical component averaged at 44 ± 10.84. From the second to the fifth post-operative year, patients showed significant improvements in the LSS (Z = −&#xa0;4.334, <i>p</i> &lt; 0.0001). Additionally, improvements in VAS (3 [IQR: 0.5; 4.5] at one year vs. 0 [IQR: 0; 4.5] at five years; <i>p</i> = 0.008) as well as quality of life (SF12m median at 1&#xa0;year 54.05 [IQR: 47.4; 57.05] vs. SF-12&#xa0;m median at 5&#xa0;years 56.2 [IQR: 50.7; 57.6, <i>p</i> = 0.08]; mean SF-12p at 1&#xa0;year 42.77 ± 9.15 vs. mean SF-12p at 5&#xa0;years 45.4 ± 9.91, <i>p</i> = 0.0468) were evident. 31% of the patients experienced an improvement in ROM compared to the last follow-up.</p> Conclusion <p>This study demonstrates that even beyond the second postoperative year, significant progress in both radiological and clinical findings continues. As a result, patients with non-unions should continue to be examined in special out-patient clinics even after completing the first two years of follow-up.</p>

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Long-term clinical and radiological outcomes following non-union surgery: ongoing remodeling and improvement in clinical findings after five years

  • 期刊论文

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  • 发表日期：

    2026年5月30日

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  • Jessica C. Böpple,
  • Anas Skeik,
  • Michael Tanner,
  • Thomas Ferbert,
  • Tim Niklas Bewersdorf,
  • Christian Schamberger,
  • Gerhard Schmidmaier,
  • Sebastian Findeisen

摘要

Background

Non-unions after fractures are known to be a devastating complication in trauma surgery and studies assessing long-term patient-reported, clinical, and radiological outcome measures are scarce. Most evidence-based research on non-unions and their long-term follow-up evaluate the first two post-operative years while excluding subsequent years and their impact on the overall outcome. This study aimed to evaluate the functional, clinical and radiological outcomes five years post-operative.

Methods

In this prospective study, all patients treated operatively between June 2018 and December 2020 for non-unions including every site were systematically reviewed for inclusion and summoned for a follow-up after 5 years. The outcome was evaluated using the modified Lane-Sandhu-Score (LSS), the short-form 12 (SF-12), active range of motion (ROM) and visual analogue scale (VAS). Furthermore, data on complications was collected. For all analyses, a p-value < 0.05 was evaluated as significant.

Results

A total of 45 patients were included in the study with a follow-up time of 63 months (IQR: 55; 66). The LSS median after five years was 4 (IQR: 4; 4) and of the VAS 0 (IQR: 0; 4). 95.6% of patients were satisfied with the therapy after five years. Regarding the SF-12, the median score for the mental component was 55.2 (IQR: 48.7; 58.8) and the physical component averaged at 44 ± 10.84. From the second to the fifth post-operative year, patients showed significant improvements in the LSS (Z = − 4.334, p < 0.0001). Additionally, improvements in VAS (3 [IQR: 0.5; 4.5] at one year vs. 0 [IQR: 0; 4.5] at five years; p = 0.008) as well as quality of life (SF12m median at 1 year 54.05 [IQR: 47.4; 57.05] vs. SF-12 m median at 5 years 56.2 [IQR: 50.7; 57.6, p = 0.08]; mean SF-12p at 1 year 42.77 ± 9.15 vs. mean SF-12p at 5 years 45.4 ± 9.91, p = 0.0468) were evident. 31% of the patients experienced an improvement in ROM compared to the last follow-up.

Conclusion

This study demonstrates that even beyond the second postoperative year, significant progress in both radiological and clinical findings continues. As a result, patients with non-unions should continue to be examined in special out-patient clinics even after completing the first two years of follow-up.