OBJECTIVES : There are currently no studies evaluating resource utilisation and costs for fracture non-union compared with routine healing for a wide variety of fracture types. The purpose of this study is to present an analysis on the burden of ten different types of fracture non-union vs routine healing.

METHODS : In a large US claims database, all adult patients diagnosed with a long-bone fracture in 2012 were stratified into two cohorts: with and without subsequent claims of a non-union diagnosis based on ICD-9-CM diagnosis codes. Healthcare resource use and medical costs of fracture were compared in patients with and without non-union.

RESULTS : Out of 4,963 patients with long bone fractures, 3% (n=163) had a subsequent diagnosis of fracture non-union within 2 years of their fracture. The overall non-union rate varied significantly by fracture type. The highest non-union rates were for the humeral shaft (18%), followed by the tibial shaft (10%) and femoral shaft (9%). The lowest nonunion rates were for the lower end radius/ulna (2%) and elbow (2%). Overall, medical costs of non-union fracture patients were higher than that of the routine healing cohort. This was true for all types of fracture. The mean total care cost for non-union patients was more than double that of patients without a non-union ($35,317 vs $102,989, P = 0.0006).

CONCLUSIONS : Patients whose fractures fail to heal routinely often have significantly greater healthcare resource use and, in turn, incur higher medical costs. Future research should be focused on strategies to improve fracture healing rates with the goal to reduce costs for patients, third party payers, employers, and governments by decreasing usage of healthcare services.