Faktor Risiko Delayed Union Dan Nonunion Pada Fraktur Tulang Panjang: Literature Review

Naurah Navalia Izzatul Wafirah; Jennifer Jessica Ami Budinata; Fachrizal Arfani Prawiragara

doi:10.31004/koloni.v5i3.1208

Authors

Naurah Navalia Izzatul Wafirah Universitas Pembangunan Nasional “Veteran” Jawa Timur, Surabaya
Jennifer Jessica Ami Budinata Universitas Pembangunan Nasional “Veteran” Jawa Timur, Surabaya
Fachrizal Arfani Prawiragara Universitas Pembangunan Nasional “Veteran” Jawa Timur, Surabaya

DOI:

https://doi.org/10.31004/koloni.v5i3.1208

Keywords:

delayed union; nonunion; long bone fracture; risk factor; literature review

Abstract

Delayed union and nonunion are complications in the healing of long bone fractures that can cause delayed functional recovery, decreased quality of life for patients, and increased need for further interventions. This condition occurs due to disturbances in the bone healing process influenced by various biological and mechanical factors. This literature review aims to identify and analyze risk factors associated with the occurrence of delayed union and nonunion in long bone fractures. This study uses the literature review method thru the process of identification, selection, and analysis of various scientific articles based on inclusion and exclusion criteria. The review results show that risk factors include fracture characteristics such as high-energy trauma, open fractures, soft tissue damage, and bone loss; patient factors such as advanced age, diabetes mellitus, osteoporosis, malnutrition, obesity, and smoking; factors related to the operative procedure such as reduction quality, fixation stability, and timing of definitive fixation; and postoperative complications, especially infections. These factors can disrupt vascularization, osteoblast activity, mechanical stability, and callus formation. It can be concluded that delayed union and nonunion are multifactorial conditions that require early risk identification, optimization of patient conditions, and appropriate fracture management to improve bone healing success.

References

Aldhafian, M., Alotaibi, F., Alzahrani, A., Almajid, H., Alamri, A., Aljandal, A., Alamri, F., Alhawas, F., & Khalifa, A. F. M. (2020). Patient ‑ dependent factors for fractures union failure among Riyadh population 2016. Wolters Kluwer - Medknow, 9(12), 6224–6227. https://doi.org/10.4103/jfmpc.jfmpc

Badan Penelitian dan Pengembangan Kesehatan. (2018). Laporan nasional Riset Kesehatan Dasar (Riskesdas) 2018. Kementerian Kesehatan Republik Indonesia. https://repository.badan.kebijakan.kemkes.go.id/id/eprint/3514/

Bahney, C. S., Zondervan, R. L., Allison, P., Theologis, A., Ashley, J. W., Ahn, J., Miclau, T., Marcucio, R. S., & Hankenson, K. D. (2019). Cellular Biology of Fracture Healing. J Orthop Res, 37(1), 35–50. https://doi.org/10.1002/jor.24170.Cellular

Baht, G. S., Vi, L., & Alman, B. A. (2018). The Role of the Immune Cells in Fracture Healing. Current Osteoporosis Reports, 16(138), 138–145. https://doi.org/doi.org/10.1007/s11914-018-0423-2

Cone, R., Roszman, A., Conway, Y., Cichos, K., Mcgwin, G., & Spitler, C. A. (2023). Risk Factors for Nonunion of Distal Femur Fractures. Wolters Kluwer Health, Inc, 37(4), 175–180. https://doi.org/10.1097/BOT.0000000000002553

Duan, Z., & Lu, H. (2021). Effect of Mechanical Strain on Cells Involved in Fracture Healing. CHINESE ORTHOPAEDIC ASSOCIATION AND JOHN WILEY &SONS AUSTRALIA, 13, 369–375. https://doi.org/10.1111/os.12885

Freigang, V., Gschrei, F., Bhayana, H., Schmitz, P., Weber, J., Kerschbaum, M., Nerlich, M., & Baumann, F. (2019). Risk factor analysis for delayed union after subtrochanteric femur fracture : quality of reduction and valgization are the key to success. BMC MUsculoskeletal Disorders, 20(391), 1–8. https://doi.org//doi.org/10.1186/s12891-019-2775-x

Guan, G., Fu, Z., & Sun, Q. (2026). Risk factors for delayed healing after traumatic limb fractures and a comparative assessment of external versus internal fixation in delayed union. Am J Transl Res, 18(3), 2753–2767. https://doi.org/https://doi.org/10.62347/WYVZ4875

Hirda, T. A., Dhedie, A., Sam, P., & Amiruddin, A. (2025). TATALAKSANA NON-UNION TIBIA DENGAN ORIF ( OPEN REDUCTION AND INTERNAL FIXATION ) DAN MALUNION FIBULA DENGAN OSTEOTOMI : LAPORAN KASUS. PREPOTIF : Jurnal Kesehatan Masyarakat, 9(3), 7557–7562.

Hofman, M., Andruszkow, H., Heyer, F. L., Kobbe, P., Hildebrand, F., & Poeze, M. (2021). Risk factors of non ‑ union in intramedullary stabilized diaphyseal long bone fractures : identifying the role of fracture stabilization strategies and concomitant injuries. European Journal of Trauma and Emergency Surgery, 47(6), 1903–1910. https://doi.org/10.1007/s00068-020-01335-y

Kuo, Y. R., Ko, P. Y., Lee, C. Y., Tsai, T. C., Chuang, C. H., & Yao, S. H. (2025). Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures. Journal of Orthopaedics and Traumatology, 26(28). https://doi.org/10.1186/s10195-025-00843-0

Li, Z., Luo, C., Yu, X., Ye, L., Duan, C., Xu, S., Zeng, M., Xu, H., Peng, Z., Wang, P., Wang, Y., Ruan, W., Xue, M., Zhang, C., & He, D. (2025). World Journal of. World Journal of Diabetes, 16(10), 1–34. https://doi.org/10.4239/wjd.v16.i10.111813

Makaram, N. S., Leow, J. M., Clement, N. D., Oliver, W. M., Ng, Z. H., Simpson, C., & Keating, J. F. (2021). Risk factors associated with delayed and aseptic nonunion following tibial diaphyseal fractures managed with intramedullary nailing. Bone Jt Open, 2(4), 227–235. https://doi.org/10.1302/2633-1462.24.BJO-2021-0012.R1

Meliana, B. P., & Budi, A. W. S. R. (2024). Jurnal Penelitian Perawat Profesional. Jurnal Penelitian Perawat Profesional, 6(6), 2411–2420.

Mills, L., Tsang, J., Hopper, G., Keenan, G., & Simpson, A. H. R. W. (2016). The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res, 5(10), 512–519. https://doi.org/10.1302/2046-3758.510.BJR-2016-0138

Molitoris, K. H., Huang, M., & Baht, G. S. (2024). Osteoimmunology of Fracture Healing. Current Osteoporosis Reports, 22, 330–339. https://doi.org/10.1007/s11914-024-00869-z

Puccetti, V. L. Y. A., Miranda, F. L. de, Figueiredo, C. C. N. de, Medeiros, K. A. de A., Leonhardt, M. de C., Silva, J. dos S., & Kojima, K. E. (2024). RISK FACTORS AT NON-UNION OF TIBIAL FRACTURE TREATED WITH INTRAMEDULLARY NAIL FATORES DE RISCO PARA NÃO-UNIÃO DA FRATURA DE. Acta Ortop Bras, 32(2), 1–8. https://doi.org/doi.org/10.1590/1413-785220243202e278581

Saul, D., Menger, M. M., Ehnert, S., Nüssler, A. K., Histing, T., & Laschke, M. W. (2023). Bone Healing Gone Wrong : Pathological Fracture Healing and Non-Unions — Overview of Basic and Clinical Aspects and Systematic Review of Risk Factors. Bioengineering, 10(35). https://doi.org/doi.org/10.3390/ bioengineering10010085

Vanderkarr, M. F., Ruppenkamp, J. W., Vanderkarr, M., Holy, C. E., & Blauth, M. (2023). Risk factors and healthcare costs associated with long bone fracture non ‑ union : a retrospective US claims database analysis. Journal of Orthopaedic Surgery and Research, 3, 1–10. https://doi.org/10.1186/s13018-023-04232-3

World Health Organization. (2018). Global status report on road safety 2018. https://www.who.int/publications/i/item/9789241565684

Westgeest, J., Physiol, B., Weber, D., Frcs, C., Dulai, S. K., Frcs, C., Bergman, J. W., Frcs, C., Buckley, R., Frcs, C., & Beaupre, L. A. (2016). Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture : A Prospective Cohort Study of 736 Subjects. J Orthop Trauma, 30(3), 149–155.

Zura, R., Xiong, Z., Einhorn, T., Watson, J. T., Ostrum, R. F., Prayson, M. J., Rocca, G. J. Della, Mehta, S., Mckinley, T., Wang, Z., & Steen, R. G. (2016). Epidemiology of Fracture Nonunion in 18 Human Bones. JAMA Surgery, 27703(11), 1–12. https://doi.org/10.1001/jamasurg.2016.2775