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Greater rate of nonunions found among fracture patients with anemia
Increased odds of nonunion were found when anemia is combined with smoking, older age or NSAID use.
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Anemia can slow or prevent fracture healing, especially in the femur and tibia, according to findings presented by Thomas F. Varecka, MD, at Orthopedics Today Hawaii 2012.
When combined with anemia, Varecka noted that older age, smoking or NSAID use increased the odds of nonunion.
Little is known about why anemia may cause fracture nonunion, and there is a lack of published studies on the subject. Varecka said that the potential culprit of fracture nonunion in patients with anemia may be fat stored in the intramuscular layers of the extremity that give rise to multipotential cells, which participate in fracture healing. These cells may fail to convert to osteoblasts in anemic conditions. Hypervolemia may occur as a result of hemorrhagic anemia.
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To address the knowledge gap, Varecka and his co-investigator Lindsay L. Wiesner conducted a retrospective study of 734 patients with upper and lower extremity diaphyseal fractures. They defined acute anemia as depletion of intravascular red cell mass as measured by clinical peripheral hemoglobin levels of less than or equal to 8 gm%. They defined union in patients who had all of their symptoms resolved with radiographic evidence of bridging callus on two orthogonal views.
The investigators found an overall healing rate of 85%. Patients who were anemic had a 35% greater chance of nonunion than those without the condition. When hemoglobin levels fell below 8 gm% in patients with tibial fractures, there was a 72% relative risk of developing a nonunion. Patients with femur fractures had a 36% greater risk of nonunion, Varecka said.
Patients who smoked faced a 52% greater chance of nonunion. When smoking was combined with anemia, patients faced a 100% risk of nonunion. Of the 47 patients who were smokers and anemic, Varecka said all had nonunions.
With each 10-year increase in age, the risk of nonunion increased 19%. Patients older than 46 years had a 62% increase in nonunions.
“The tibia, and to a certain extent, the femur, are profoundly affected by red cell loss,” Varecka said. “The age and/or history of smoking when accompanied by anemia have a history of severe negative effects on fracture healing.” – by Renee Blisard
Reference:For more information:
- Varecka TF, Wiesner LL. The influence of acute hemorrhagic anemia on fracture healing. Presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
- Thomas F. Varecka, MD, can be reached at Department of Orthopaedic Surgery, Hennepin County Medical Center, 701 Park Ave. South, Minneapolis, MN 55415; 612-873-2812.
- Disclosure: Varecka received research support in part by the Minneapolis Medical Research Foundation.