Fracture union rates across a century of war: a systematic review of the literature.
INTRODUCTION
Fractures have been a common denominator of the injury patterns observed over the past century of warfare. The fractures typified by the blast and ballistic injuries of war lead to high rates of bone loss, soft tissue injury and infection, greatly increasing the likelihood of non-union. Despite this, no reliable treatment strategy for non-union exists. This literature review aims to explore the rates of non-union across a century of conflict, in order to determine whether our ability to heal the fractures of war has improved.


METHODS
A systematic review of the literature was conducted, evaluating the rates of union in fractures sustained in a combat environment over a 100-year period. Only those fractures sustained through a ballistic or blast mechanism were included. The review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Quality and bias assessment was also undertaken.


RESULTS
Thirty studies met the inclusion criteria, with a total of 3232 fractures described across 15 different conflicts from the period 1919-2019. Male subjects made up 96% of cases, and tibial fractures predominated (39%). The lowest fracture union rate observed in a series was 50%. Linear regression analysis demonstrated that increasing years had no statistically significant impact on union rate.


CONCLUSIONS
Failure to improve fracture union rates is likely a result of numerous factors, including greater use of blast weaponry and better survivability of casualties. Finding novel strategies to promote fracture healing is a key defence research priority in order to improve the rates of fractures sustained in a combat environment.
['Stewart|Sarah K|SK|', 'Tenenbaum|O|O|', 'Higgins|C|C|', 'Masouros|S|S|', 'Ramasamy|A|A|']
D001753:Blast Injuries D017102:Fracture Healing D050723:Fractures, Bone D006801:Humans D014857:Warfare D014948:Wounds, Gunshot
adult orthopaedics limb reconstruction orthopaedic & trauma surgery trauma management