Risk factors for non-union after distal phalangeal fractures of the hand: a nationwide study in the US

Introduction

This study aims to identify risk factors associated with non-union following distal phalangeal fractures of the hand.

Materials and methods

This retrospective cohort study utilized the PearlDiver database (2010–2022) to identify adult patients with distal phalangeal fractures and at least one year of follow-up. Patients were categorized into union and nonunion groups using ICD and CPT codes. Risk factors for nonunion were assessed by analyzing demographics, comorbidities, fracture characteristics (open vs. closed, displaced vs. nondisplaced, number of fractured fingers), and treatment type (surgical: open/percutaneous vs. non-surgical: closed) using chi-square tests, t-tests, and multivariable logistic regression (P < 0.05 was considered significant).

Results

Nonunion was reported among 3,378 (3.0%) of the 114,667 patients with distal phalanx fractures. Nonunion patients were older and had greater rates of tobacco use, alcohol abuse, obesity, soft tissue injury, and surgical site infection. Fracture of the thumb was less likely to be associated with nonunion compared with other fingers. Open fracture, compared to closed fracture, and surgical treatment, compared to non-surgical treatment, were among the independent predictors of nonunion.

Conclusions

This study identifies key risk factors for nonunion in distal phalangeal fractures of the hand, including older age, obesity, tobacco use, alcohol abuse, displaced fractures, and surgical treatment. Addressing modifiable risk factors, such as smoking cessation and weight management, may help reduce the risk of nonunion. Further prospective studies are warranted to better understand additional contributors to bone healing.