Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Author:

Massari Leo1ORCID,Benazzo Francesco2,Falez Francesco3,Cadossi Ruggero4,Perugia Dario5,Pietrogrande Luca6ORCID,Aloj Domenico Costantino7,Capone Antonio8,D’Arienzo Michele9,Cadossi Matteo10,Lorusso Vincenzo1,Caruso Gaetano1,Ghiara Matteo2,Ciolli Luigi3,La Cava Filippo3,Guidi Marco5ORCID,Castoldi Filippo7,Marongiu Giuseppe8,La Gattuta Alessandra9,Dell’Omo Dario11,Scaglione Michelangelo11,Giannini Sandro10,Fortina Mattia12ORCID,Riva Alberto12,De Palma Pier Luigi13,Gigante Antonio Pompilio13,Moretti Biagio14,Solarino Giuseppe14,Lijoi Francesco15,Giordano Giovanni15,Londini Pier Giorgio16,Castellano Danilo16,Sessa Giuseppe17,Costarella Luciano17,Barile Antonio18,Borrelli Mariano18,Rota Attilio19,Fontana Raffaele19,Momoli Alberto20,Micaglio Andrea20,Bassi Guido21,Cornacchia Rossano Stefano22,Castelli Claudio23,Giudici Michele23,Monesi Mauro24,Branca Vergano Luigi24,Maniscalco Pietro25ORCID,Bulabula M’Putu25,Zottola Vincenzo26,Caraffa Auro27,Antinolfi Pierluigi27,Catani Fabio28,Severino Claudio28,Castaman Enrico29,Scialabba Carmelo29,Tovaglia Venceslao30,Corsi Pietro30,Friemel Paolo31,Ranellucci Marco31,Caiaffa Vincenzo32,Maraglino Giovanni33,Rossi Roberto34ORCID,Pastrone Antonio34,Caldora Patrizio35,Cusumano Claudio35,Squarzina Pier Bruno36,Baschieri Ugo36,Demattè Ettore37,Gherardi Stefano37,De Roberto Carlo38,Belluati Alberto39,Giannini Antonio39,Villani Ciro40,Persiani Pietro40ORCID,Demitri Silvio41,Di Maggio Bruno42,Abate Guglielmo42,De Terlizzi Francesca4,Setti Stefania4ORCID

Affiliation:

1. Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy

2. Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy

3. Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy

4. Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy

5. Orthopaedic and Traumatology Department, “Sant’Andrea” Hospital, Rome, Italy

6. Health Sciences Department, Operative Unit of Orthopaedics and Traumatology, “San Paolo” Hospital, University of Milan, Milan, Italy

7. Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy

8. Orthopaedic Department, University of Cagliari, Cagliari, Italy

9. Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy

10. Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy

11. Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy

12. Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy

13. Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy

14. Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy

15. Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy

16. Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy

17. Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy

18. Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy

19. Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy

20. Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy

21. Orthopaedic and Traumatology Department, A.O. Pavia Voghera Hospital, Pavia, Italy

22. Orthopaedic and Traumatology Unit, Ariano Irpino Hospital, Avellino, Italy

23. Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy

24. Orthopaedic and Traumatology Department, “M. Bufalini” Hospital, Cesena, Italy

25. Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy

26. Traumatology and Reconstructive Surgery Functional Department, “S. Anna” Hospital, Como, Italy

27. Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy

28. Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy

29. Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy

30. Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy

31. Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy

32. Orthopaedics and Traumatology Department, “Di Venere” Hospital, Bari, Italy

33. Orthopaedics and Traumatology Department, “SS. Annunziata” Hospital, Taranto, Italy

34. Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy

35. Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy

36. Orthopaedics Department, NOCSAE Hospital, Modena, Italy

37. Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy

38. Orthopaedics Unit, “Santa Maria di Loreto Mare” Hospital, Loreto Mare, Napoli, Italy

39. Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy

40. Orthopaedic Department, Sapienza University of Rome, Rome, Italy

41. Orthopaedic and Trauma Department, “Santa Maria della Misericordia” Hospital, AOUD Udine, Udine, Italy

42. Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy

Abstract

Background. Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r=0.63 (p<0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions. This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

Funder

IGEA

Publisher

Hindawi Limited

Subject

General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Medicine

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