ASSESSMENT OF RISK PREDICTORS FOR HUMERAL SHAFT NON-UNION: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE CENTRE IN NORTH INDIA
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Keywords
humeral shaft fracture, non-union, risk factors, smoking, diabetes mellitus, open fracture, infection
Abstract
Background: Non-union following humeral shaft fracture remains a clinically significant complication despite advances in fixation techniques. Reported rates range from 10–15%, often resulting in prolonged morbidity, repeated surgeries, and increased healthcare costs. Understanding the modifiable and non-modifiable predictors of non-union is crucial for targeted prevention and improved patient outcomes.
Objectives: To determine the prevalence and identify independent risk predictors for non-union among patients with humeral shaft fractures managed at a tertiary care centre in North India.
Methods: A hospital-based cross-sectional study was conducted in the Department of Orthopaedics from January to September 2025. A total of 162 adult patients (≥18 years) with radiologically confirmed humeral shaft fractures (AO/OTA 12) managed either operatively or non-operatively were included. Patients were followed up for at least nine months. Non-union was defined as the absence of bridging callus in ≥3 cortices, lack of progressive healing for three months, and persistent pain or mobility at the fracture site. Data on demographic, lifestyle, comorbidity, injury, and treatment characteristics were collected. Statistical analysis included Chi-square and t-tests for bivariate comparisons, followed by multivariable logistic regression to identify independent predictors. Model discrimination was assessed using the ROC curve.
Results: The overall incidence of non-union was 14.8% (n=24). Bivariate analysis revealed significant associations between non-union and smoking (p=0.001), diabetes mellitus (p=0.002), open fractures (p<0.001), surgical delay >5 days (p=0.001), and postoperative infection (p<0.001). Multivariable logistic regression identified five independent predictors: smoking (AOR=3.12, 95% CI 1.08–8.96), diabetes mellitus (AOR=2.97, 95% CI 1.01–8.70), open fracture (AOR=4.68, 95% CI 1.41–15.51), delay to surgery >5 days (AOR=2.83, 95% CI 1.00–8.00), and postoperative deep infection (AOR=9.87, 95% CI 2.78–35.02). The model showed excellent predictive performance (AUC=0.88). Postoperative infection emerged as the strongest predictor, increasing non-union odds nearly tenfold.
Conclusion: Non-union occurred in 14.8% of humeral shaft fracture cases. Smoking, diabetes, open fracture, delayed surgical fixation, and postoperative infection independently predicted non-union, with infection exerting the greatest impact. Early risk identification, meticulous surgical technique, and optimization of modifiable factors such as infection control, glycemic regulation, and smoking cessation are essential to improve union rates and functional recovery.
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Dr Aditya Chaubey
Post Graduate Resident, Department of Orthopaedics, Government Medical College, Jammu, India
Dr Jatin Rathore
Post Graduate Resident, Department of General Surgery, Government Medical College, Jammu, India
Dr Suraj Sahu
Post Graduate Resident, Department of General Surgery, Government Medical College, Jammu, India
Dr Jatin Prajapati
Post Graduate Resident, Department of Community Medicine, RNT Medical College, Udaipur, Rajasthan, India