Artikel
Evaluation of potential risk factors for fracture healing complications in long bones
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Veröffentlicht: | 12. September 2014 |
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Background: Rheumatoid arthritis (RA) patients are reported to be often affected by fracture-healing complications. The inflammatory diseases itself but also anti-rheumatic drugs (e.g. glucocorticoids, GC) are suspected to facilitate complications. However, current literature studies reporting the number of afflicted patients and/or indicating the negative impact of comorbidities or even standard medications are scarce. The aim of this study is to evaluate the clinical relevance of RA and GC treatment as potential risk factors for fracture healing disorders in long bones.
Methods: A single-center retrospective study has been performed based on the database of the Center for Musculoskeletal Surgery at Charité University Hospital Berlin. Patients who underwent surgery at our institution to treat fracture healing complications in 2012 were considered for inclusion. Exclusion criteria were age below 18 years at initial fracture, open fracture, and metastases close to fracture location. Our data were compared with a control group matched for age and type of fracture at the ratio of two.
Results: To date, 74 patients with fracture-healing complications in long bones and 131 controls have been included. Both sexes were almost equally represented in the two groups. Interestingly, our data suggest a higher prevalence of bone healing complications in RA patients (0.67 %) with respect to the control group (0.08 %). Furthermore, our study shows a higher percentage of regular oral glucocorticoid-intake in the case group (8.1 %) as compared to the control group (3.1 %). In parallel, we have performed in vitro studies using mesenchymal stem cells which confirmed an inhibitory effect of GC at high dosages on osteogenesis.
Conclusion: To our knowledge, this is the first retrospective study focusing on risk factors for bone healing complications of long bones. The results we have obtained so far support the hypothesis that both RA and GC usage appear to have a negative influence on fracture healing outcome.