The Aseptic Femoral and Tibial Shaft Non-Union in Healthy Patients – An Analysis of the Health-Related Quality of Life and the Socioeconomic Outcome

Christian Zeckey*, Philipp Mommsen, Hagen Andruszkow, Christian Macke, Michael Frink, Timo Stübig, Tobias Hüfner, Christian Krettek, Frank Hildebrand
Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany

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© Zeckey et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Trauma Department, Hannover Medical School, D-30625 Hannover, Germany; Tel: +49-(0)511/5322050; Fax: +49-(0)511/5325877; E-mail:


Long bone non-unions may lead to recurrent surgical procedures and in-hospital stays. Thus, restrictions of the health-related quality of life and of socioeconomic parameters might be expected. Knowledge of the impact on several parameters of professional life is sparse. Therefore, we analyzed the outcome in patients following non-unions of the tibial and femoral shaft after fracture compared to patients with uneventful healing.

Material and Methodology:

51 patients following non-unions of the the femoral (FNU) or tibial shaft (TNU) were compared to 51 patients (groups FH and TH) with uneventful fracture healing. Physical and mental health was assessed using the Short-Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). We also analyzed employment status and the usage of medical aids.


Scores of the SF-12 physical and psychological were lower in group TNU compared to group TH, the score of SF-12 physical but not psychological was significantly lower in group FNU compared to FH. Compared to uneventful healing, a significantly more frequent usage of medical aids was found in both non-union groups. A higher incidence of early retirement and unemployment was found in group FNU but not in group TNU.


There is a profound influence on the quality of life following femoral or tibial non-unions after trauma. Compared to patients with uneventful fracture healing, patients with tibial and even more so femoral non-union show worse scores of the SF-12. Medical aids are frequently used following both, femoral and tibial non-unions. Not tibial, but femoral non-unions frequently lead to severe restrictions in professional life such as early retirement and unemployment.

Keywords: Non-union, posttraumatic complications, long bone fracture.