Background Rheumatoid arthritis patients exhibit a high prevalence of osteoporosis and bone fractures. Furthermore, these patients are reported to be more often affected by delayed or impaired fracture healing. The inflammatory disease itself but also antirheumatic drugs are suspected to contribute to these complications. Recent animal studies suggest a negative correlation existing between comorbidities such as autoimmune diseases, diabetes, high blood pressure or smoking and impaired fracture healing. However, there are only a few studies focusing on the number of afflicted patients indicating the negative impact of comorbidities or even standard medications.
Objectives The aim of this study is to identify clinically relevant potential risk factors (including medications) for fracture healing disorders. According to the Federal Health Monitoring System-report 20111 14,746 non-unions, 1,421 delayed unions as well as 2,628 mal unions were documented in Germany emphasizing the importance of our study to identify potentially undervalued risk factors.
Methods A single-center retrospective study has been performed based on the database of the Center for Musculoskeletal Surgery at Charité University Hospital Berlin. To identify target patients, we filtered the patients data based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Patients in 2012 undergoing a surgical treatment due to fracture healing complications were included. We defined an age below 18 years at initial fracture, open fracture, and tumor or metastasis closed to fracture location as exclusion criteria. Our data were matched with respective information available on the general German population.
Results To date, 70 patients were included, 35 (50.0%) women and 35 (50.0%) men. The data suggest similar prevalence of rheumatoid arthritis (5 patients, 0.71%) with respect to the general population of Germany (0.65% to 0.8%1). Compared to the general population (30.0%1), the rate of smoking persons with age above 18 is numerically higher in our cohort (27 patients, 38,9%). The prevalence of high blood pressure is considerably higher (30 patients, 42,9%) than in the general population (23,1%1). Furthermore, we found a similar prevalence for diabetes type 2 (6 patients, 8,6% in study, 8.9% in general population1).
Conclusions To our knowledge, this is the first retrospective study focusing on risk factors for bone healing complications in Germany. The result we have obtained so far support the relations known from in vitro and in vivo studies in humans. High blood pressure as well as smoking appear to have a negative influence on fracture healing outcome. For rheumatoid arthritis and diabetes type 2 we could not show difference so far. Next we will survey a larger cohort of patients suffering from fracture-healing complications which will be compared to a randomized control group.
GBE-Bund (Federal Health Monitoring System).
Disclosure of Interest None declared