Incidence, costs and predictors of non-union, delayed union and mal-union following long bone fracture

Christina L. Ekegren, Elton R. Edwards, Richard de Steiger, Belinda J. Gabbe

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114 Citations (Scopus)


Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

Original languageEnglish
Article number2845
Number of pages11
JournalInternational Journal of Environmental Research and Public Health
Issue number12
Publication statusPublished - 13 Dec 2018


  • Bone
  • Costs
  • Data linkage
  • Delayed union
  • Fracture
  • Mal-union
  • Non-union

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