About the Author(s)


Sevani Singaram Email symbol
Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

Mergan Naidoo symbol
Discipline of Family Medicine, University of KwaZulu-Natal, Durban, South Africa

Citation


Singaram S, Naidoo M. The physical, psychological and social impact of long bone fractures on adults: A review. Afr J Prm Health Care Fam Med. 2019;11(1), a1908. https://doi.org/10.4102/phcfm.v11i1.1908

Review Article

The physical, psychological and social impact of long bone fractures on adults: A review

Sevani Singaram, Mergan Naidoo

Received: 12 Aug. 2018; Accepted: 07 Feb. 2019; Published: 30 May 2019

Copyright: © 2019. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Long bone fractures are common injuries caused by trauma and are a common cause for referral to hospitals. Little consideration has been given to the impact of long bone fractures in adults despite the World Health Organization’s statement that such injuries cause substantial morbidity in low- and middle-income countries.

Aim: This review targeted published studies conducted from 1990 to 2017 that examined the impact of long bone fractures on the psychological, social, financial, occupational and physical health of adults.

Method: This scoping review involved a systematic literature search using key terms in Science Direct, Cochrane Library, BMJ Online, PubMed, Jstor, SpringerLink, Emerald Insight and Ebscohost Research databases and Google Scholar.

Results: From a total of 297 publications, 19 met the inclusion criteria: four publications focused on the impact of fractures of the humerus, one publication looked at ulna fractures, six publications focused on distal radius fractures, five looked at femur fractures and three focused on tibial fractures.

Conclusion: Long bone fractures have a considerable impact on many facets of a patient’s life. In some cases, the fracture prevents patients from working and meeting financial obligations. The injury limited previously normal social interactions and pre-injury functioning. Future research should examine the impact of long bone fractures in Africa, as there were very limited studies, which were identified.

Keywords: long bone fractures; impact; physical; psychological; occupational; financial; social.

Introduction

Numerous studies and reports by the World Health Organisation indicate that injury is a substantial cause of morbidity and mortality in low- and middle-income countries (LMICs).1 The 2013 Global Burden of Disease and Injury study shows that road injuries are the seventh most common cause of disability adjusted life years.2 The Centres for Disease Control and Prevention indicates that fractures feature in the top-20 first-line diagnoses presenting to emergency departments.3 A fracture is ‘any loss in the continuity of bone’.4 Over the last several years, long bone fractures are becoming increasingly common, particularly because of road traffic injuries. More than 90% of injuries, particularly fractures of the extremity, occur in LMICs.2 Some studies have indicated that road traffic accidents cause 68.14% of fractures in some LMIC countries. Falls are also a serious public health problems worldwide because they can also cause re-injury. Some studies have demonstrated that falls have a prevalence of 21.8% and 35.1%.5 The burden of long bone fractures impacts society through the loss of productivity, the direct and indirect costs of treatment and the additional contribution to morbidity and mortality. The management and treatment of long bone fractures add significantly to the expenses of any health care system because of the cost of surgery, possible rehospitalisation and the physical rehabilitation of patients.6

Depressive symptoms such as catastrophic thinking, changes in appetite and sleep pattern are common after a fracture.7 As the standard of health and lifestyle improves in LMICs, one can expect that the older population, who are more prone to falls and fractures, will be greatly affected. Therefore, the burden is expected to rise substantially. We sought to answer the following question: what effect do long bone fractures have on the psychological, social, financial, occupational and physical health of patients?

Methods

Search strategy

Literature searches were conducted in Science Direct, Cochrane Library, BMJ Online, PubMed, Jstor, SpringerLink, Emerald Insight Ebscohost Research databases and Google Scholar to avoid missing other relevant articles not published in a journal. The reference lists of all chosen publications were also searched to source additional publications that may not have appeared in the search results. The search terms used were the following: impact of long bone fractures and/or psychological impact of long bone fractures and/or social impact of long bone fractures and/or financial impact of long bone fractures and/or occupational impact of long bone fractures and/or physical impact of long bone fractures and/or impact of humerus fractures and/or impact of radius fractures and/or impact of ulna fractures and/or impact of femur fractures, impact of tibia fractures and/or impact of fibula fractures.

Publications that were published in English only were included in the review. The inclusion criteria concentrated on studies that included participants aged 18 years and older who sustained one long bone fracture because of injury or pathology. For this review, only six long bones were included: the humerus, radius, ulna, femur, tibia or fibula. Both qualitative and quantitative studies published in English were included.

The study needed at least one outcome, that is, the psychological, social, financial, occupational or physical impact of the long bone fracture. Studies conducted before 1990, or those that did not reveal the age of participants or the name of the fractured bone, were excluded from the study.

To reduce bias, both authors (S.S. and M.N.) screened all titles and abstracts while being guided by the inclusion and exclusion criteria. Disagreement was resolved through discussion and final consensus. Publication bias was reduced by considering studies with limited sample sizes and studies with non-statistically significant results. Google Scholar was also searched to source grey literature.

Review results

The study selection involved three steps:

In the first step, keywords and screening of titles were searched that returned 286 publications. Eleven publications were identified through a search of the reference lists. A total of 297 publications were included after exclusion criteria and duplicates were excluded.

The second step was the screening of the titles and abstracts, which was performed by the second reviewer that resulted in 267 publications being excluded. Five additional publications were excluded by the second reviewer after screening of the titles and abstracts.

Full-text screening was performed on 30 records. After full-text screening, five publications were excluded. This resulted in 25 publications having been assessed using the mixed-methods appraisal tool (MMAT) version 2018, a reliable critical appraisal tool that allows researchers to assess the methodological quality of publications because critical appraisal is an important aspect of scoping reviews.8,9 The MMAT is presented in Appendix 1. Only studies with a score of 50% or more were included. Six publications were excluded after being assessed using MMAT. Approximately 25 minutes was spent on the appraisal of each article. Finally, 19 eligible publications were included in the analysis.

Data extraction and analysis

The PRISMA 2009 flow diagram tool was used to demonstrate the search process (see Figure 1). A standardised data extraction template was used to obtain data from the publications using the population, intervention, comparison, outcome and study design (PICOS) framework (see Tables 1 and 2). A meta-analysis was unsuitable because of the heterogeneity of the study variables and research designs. Content analysis was used to identify categories and report on findings. Content on the psychological, social, financial, occupational and physical impact was extracted from each publication.

FIGURE 1: PRISMA 2009 flow diagram tool.

TABLE 1: Upper extremity long bone fractures.
TABLE 2: Lower extremity long bone fractures.
Ethical considerations

This review is part of a PhD thesis, which has been reviewed by the Biomedical Research Ethics Committee, under the protocol reference number BE 583/16. The title of the thesis is ‘The perceived psychological, social, financial, occupational and physical impact of long bone fractures in adults in KwaZulu-Natal’. The study enrolled 821 research participants from nine hospitals. To our knowledge, there is no other study investigating this topic. The purpose of this review is to gather information on this topic.

Results

Study characteristics

The average age of participants in all studies was 63.7 years. The earliest study was conducted in 1997 and the latest study was in 2016. Three studies were set in Japan, three in Canada, one in Australia, one in France, one in Austria, one in Norway, four in the United Kingdom, and three in the United States of America, two of which were in New York City and one in Grand Rapids. Orthopaedic research regarding the psychological, social, financial and occupational impact of long bone fractures in LMICs has unfortunately been very limited because these countries have mainly focused on infectious and nutritional illnesses.29–31

Extent and trend of the studies

The sample size ranged from 9 to 609 respondents per study. In some studies, the respondents had a surgical orthopaedic intervention. Four studies focused on fractures of the humerus, one on ulna fractures, six on distal radius fractures, five on femur fractures and three on tibial fractures. Most of the studies focused on distal radius and femur fractures. Three studies focused on the physical impact of proximal humerus fractures, one on the physical and occupational impact of ulna fractures, two on the physical and occupational impact of long bone fractures, two on the physical impact of distal radius fractures and one on the physical and psychological impact of distal radius fractures. Four studies focused on the physical impact of femoral fractures; one on the physical and social impact of femur fractures; one on the financial, occupational and social impact of tibia fractures; one on the physical impact of tibia fractures; and one on the physical, financial, social, psychological and occupational impact of tibia fractures. There were very few studies on the impact of fibula fractures, but none of them met the criteria for this systematic review. Most of the studies focused on the physical impact of the long bone fractures.

The biopsychosocial approach to long bone fractures

The World Health Organization states that ‘health is a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’.32,33 The biopsychosocial model (BPSM) offers a broader and holistic approach for healthcare professionals to understand human behaviour, disease and infirmities.32,33 The biopsychosocial approach should be applied after a patient sustains a fracture and this may aid in addressing other factors that might influence an individual’s recovery. The BPSM comprises three dimensions that can be used to assess post-fracture outcomes: biological, psychological and social factors. The biological dimension deals with the physical impact of the fracture.33 The psychological dimension comprises the psychodynamic factors affecting patients after the fracture and the social dimension examines the external influences such as support from family and friends, financial influences and possible changes to job or loss of income after the fracture. Research from high-income countries suggests that timely and adequate treatment leads to quicker recovery. Various authors have suggested that health care resources and finances of the patient also influence a patient’s recovery.34 To accurately understand the impact of long bone fractures, the BPSM was adopted as the analytical framework. The literature supports this framework as fractures affect the biological, psychological and social aspects of a patient’s life (see Figure 2).

FIGURE 2: The biopsychosocial model.

The results will therefore be presented under three headings, namely, psychological and social, financial and occupational and physical impact of long bone fractures.

Psychological and social impact of long bone fractures

Psychological sequelae are common after long bone fractures and include post-traumatic stress disorder, depression and anxiety.35 Depression is common following injury and may adversely affect clinical outcomes. Further to this, a failure to return to the level of functioning before the fracture may cause symptoms of depression.35 Trickett and colleagues’27 qualitative study described how patients felt after an open tibial fracture. All patients were fearful of falling and were conscious of the aesthetic appearance of the fractured limb. Two patients described using alcohol as a means of coping with the circumstances surrounding the injury. In contrast, MacDermid and colleagues14 found that distal radius fractures had minimal effect on the patient’s psychological state. In a 2017 study by Grenier et al.36 it was found that the presence of a fear of falling causes dysfunction in the neural networks connected to motor imagery abilities, and therefore these patients are more susceptible to re-injury. Fearful patients may not comply with the physical rehabilitation which may reduce one’s ability to complete activities of daily living leading to an increase in patient dependency. Glover and colleagues37 advise that the most effective approach to managing fear of falls is psychological and physical intervention. Kammerlander et al.22 found that 23% of patients were physically unable to leave their home after sustaining a distal femoral fracture and as a result were not able to socialise. In 2012, Trickett and colleagues27 also confirmed that a tibial fracture prevented previously normal social interactions. This lack of social support may contribute to injury reoccurrence, rehospitalisation and higher personal and societal health care costs. The use of caregivers with a health care background is a useful way of lending emotional support to patients to reach their recovery goals.38

Financial and occupational impact of long bone fractures

Volgas and colleagues28 examined the financial implications of tibial fractures after 6–20 months and found that 29% of patients returned to work at the anticipated time of recovery, 36.8% reported selling possessions to pay their expenses and 42.1% used social welfare initiatives. It was noted that all patients in white-collar jobs returned to work sooner than others, whereas only 14.3% of blue-collar workers returned to work at the last follow-up visit. Forty-two percent of patients used friends and family as a source of financial aid. Only 29.2% of patients returned to work at a mean follow-up of 11.8 months.28 Trickett and colleagues27 described how the inability to work, following a tibial fracture, led to financial implications. Larsen and colleagues39 suggest that fractures of the lower extremity limit positive results, such as returning to work and performing activities of daily living independently. Returning to work is regarded as an important outcome in orthopaedic treatment. Mackenzie et al. state that patients who return to work sooner are usually younger and have higher social support.40 Coulibaly and colleagues20 found that in isolated ulna shaft fractures, 87% of patients returned to a pre-fracture level of activity or work. MacDermid and colleagues17 described the days lost from work following a distal radius fracture. Patients with a limited range of motion were less likely to return to work. The average number of weeks lost from work was 9.5. Trickett and colleagues27 indicated that many non-retired patients wanted to return to work soon after a tibial fracture because of the inability to financially provide for themselves and to return to normality. One patient described how he had to adapt his duties and hours of work after the injury to remain involved at work.

Sluys and colleagues41 confirm that patients with fractures of the lower extremity return to work later compared to those with fractures of the upper extremity.

Physical impact of long bone fractures

Pain is one of the main symptoms of a fracture that causes the patient to seek medical attention after the initial injury. Swelling, reduced mobility of the affected joint and deformity of the limb are common causes of pain. Some fractures are associated with less pain, resulting in some patients presenting late for treatment.4,42 The possible implications of not receiving appropriate and timely treatment after sustaining a fracture are malunion, avascular necrosis, fat embolism syndrome and prolonged immobility.4 Fractures with injury extension to the soft tissue, nerve or vasculature may cause complex regional pain syndrome.43 An important consideration in the initial management of fractures is a clinical pathway for pain management. Pain is often dependent on a host of factors that may or may not be because of the severity of the fracture. Good pain management facilitates patient comfort and reduces anxiety, allowing for a better orthopaedic assessment and compliance with the rehabilitation plan.4,42

Upper extremity long bone fractures often affect activities such as personal hygiene, eating and writing, especially if the dominant limb is fractured. Frail geriatrics may require additional support during the period of immobilisation. Swelling following fracture is a common contributor of pain that is exacerbated by a tight plaster cast, but this could be managed by elevation of the arm and monitoring the swelling. Lower limb long bone fractures often result in an inability to carry out activities of daily living and usually affect employment, especially if the patient requires mobility in their occupation. Many patients with lower limb fractures require hospitalisation.4,39,42

Osteoarthritis is a long-term complication of fractures, especially in the lower limbs, and can lead to chronic pain. Approximately 12% of all patients seeking treatment for symptomatic arthritis reported previous injury to the joint.44 There can be significant joint degeneration after severe joint injury such as an articular fracture.4

Discussion

This scoping review aimed to investigate the impact of long bone fractures on the psychological, social, financial, occupational and physical health of adults. The psychological impact of long bone fractures includes fear of falling and, therefore, limiting participation in physical activities, being conscious of the aesthetic appearance of the affected limb, post-traumatic stress disorder, acute stress disorder, depression and anxiety. Fractures can also impact the patient’s social life because of limited mobility that compromises social activity. Patients reported selling possessions and making use of social assistance programmes to pay for expenses incurred as a direct result of the fracture. Some used friends and family as a source of financial aid. Physical discomfort, pain, immobilisation, deformity and the nature of some fractures result in prolonged absence from work. Patients with limited range of motion were less likely to return to work without vigorous physical rehabilitation. Those who were gainfully employed expressed a need to return to work to honour their financial obligations and as a signal of the gradual return to normality.

The fracture prevented patients from returning to previous level of activity for many months, with pain being the common reason for this.

The public health impact of fractures includes increases in physical impairments and psychological symptoms of fear of re-injury and post-traumatic stress disorder.45 Further to this, equal access to orthopaedic care and surgery in many African countries remains a challenge because of the shortage of health care practitioners and limited resources.

As many countries in Africa are already struggling with poverty, human immunodeficiency virus and a shortage of health care workers, sustaining an injury can place an added burden on patients.46 Another important public health consideration is that in some instances, a proximal femur fracture places the individual at a high risk of sustaining another fracture. This may create additional costs to the individual because of possible rehospitalisation and loss of work.45

Study limitations

This review only included studies published in English as it would have been costly and time-consuming to enlist the services of many translators for various languages. This review shows the need for studies that include younger participants. We acknowledge that we may have missed important evidence because of our inclusion and exclusion criteria.

Implications and recommendations

According to the World Health Organization, 90% of injuries occur in LMICs, such as those in Africa. Therefore, there is a need for more studies to assess the financial, occupational, social and psychological impacts of long bone fractures because there are many studies that only have documented the physical impact of long bone fractures, particularly in Africa. The impact of fractures in LMICs could be magnified because of poorly developed trauma care and limited social infrastructure.

Conclusion

Long bone fractures have a considerable impact on the physical outcome of patients. In some cases, the fracture prevents patients from working and meeting financial obligations. In many cases, the injury limited previously normal social interactions and pre-injury functioning. The findings should be considered while training health workers and providing counselling to orthopaedic patients.

Acknowledgements

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors’ contributions

S.S. was responsible for conceptualisation of the review, searching of databases, accrediting publications, data extraction and planning of the final manuscript. M.N. assisted in designing the article, reviewing publications for inclusion and critically reviewing and revising the manuscript.

Funding information

A PhD scholarship from the University of KwaZulu-Natal facilitated the conduct of the study and writing of the article.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

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APPENDIX 1: Mixed methods appraisal tool, version 2018.

 

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Journal of Biomedical Materials Research Part B: Applied Biomaterials  vol: 110  issue: 4  first page: 743  year: 2022  
doi: 10.1002/jbm.b.34953

3. Adult patients' experiences after a distal radius fracture – A qualitative systematic review
Caroline Moos, Charlotte Abrahamsen, Bjarke Viberg, Charlotte Myhre Jensen
International Journal of Orthopaedic and Trauma Nursing  vol: 54  first page: 101101  year: 2024  
doi: 10.1016/j.ijotn.2024.101101

4. Anxiety and depression in school-age patients with spinal muscular atrophy: a cross-sectional study
Mei Yao, Yu Xia, Yijie Feng, Ying Ma, Yi Hong, Yanyi Zhang, Jie Chen, Changzheng Yuan, Shanshan Mao
Orphanet Journal of Rare Diseases  vol: 16  issue: 1  year: 2021  
doi: 10.1186/s13023-021-02008-8

5. Low-cost locally manufacturable unilateral imperial external fixator for low- and middle-income countries
Mehdi Saeidi, Spencer C. Barnes, Michael A. Berthaume, Sander R. Holthof, Giovanni S. Milandri, Anthony M. J. Bull, Jonathan Jeffers
Frontiers in Medical Technology  vol: 4  year: 2022  
doi: 10.3389/fmedt.2022.1004976

6. Prediction of psychological continuing health problems based on types of injury and manner of accident in Mozambique: A population-based analysis of burns, fractures, internal injuries, and wound injuries
Shrouq Shaher Al-Sabaileh, Laith Ashour, Khalaf Alnowaishiri, Ghada Alzoubi, Zaid Alhabashneh, Mutaz Ashour, Samar Hamdan, Nour Al Qurneh
Injury  vol: 56  issue: 6  first page: 112274  year: 2025  
doi: 10.1016/j.injury.2025.112274

7. Bone mineral density, nutrient intake, and physical activity among young women from Uganda
Renee Heffron, Timothy R. Muwonge, Jade Boyer, Flavia Matovu, Yasaman Zia, Monica Bagaya, Timothy Ssebuliba, Susan Morrison, Felix Bambia, Rogers Nsubuga, Josephine Badaru, Gabrielle Stein, Kenneth K. Mugwanya, Christina Wyatt, Jared M. Baeten, Michael T. Yin, Andrew Mujugira, Katherine Thomas, Elena A. Rechkina, Andrew Hoofnagle, Oliver Sapiri, Agnes Nakyanzi, Lydia Valarie Nambala, Florence Nambi, Olivia Nampewo, Robert Nyanzi, Miriam Nampala Ryder, Mary Nakayiza, Flavia Matovu Kiweewa, Andrew Kateregga, Stephen Bule, Mike Yin, Mark Marzinke, Peter Anderson
Archives of Osteoporosis  vol: 17  issue: 1  year: 2022  
doi: 10.1007/s11657-022-01155-0

8. Three-Dimensional Cell Cultures: The Bridge between In Vitro and In Vivo Models
Ornella Urzì, Roberta Gasparro, Elisa Costanzo, Angela De Luca, Gianluca Giavaresi, Simona Fontana, Riccardo Alessandro
International Journal of Molecular Sciences  vol: 24  issue: 15  first page: 12046  year: 2023  
doi: 10.3390/ijms241512046

9. Pharmacological interventions for bone health in people with epilepsy
Rajeswari Aghoram, Sreekumaran Nair, Pradeep Nair, Deepak Menon, Joseph S Peedicail
Cochrane Database of Systematic Reviews  vol: 2024  issue: 1  year: 2024  
doi: 10.1002/14651858.CD014880

10. RETRACTED: Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta‐analysis
Kamran Asadi, Pooya M. Tehrany, Amir Salari, Pooyan Ghorbani Vajargah, Amirabbas Mollaei, Milad Sarafi, Mohammad Taghi Ashoobi, Mohammad Sadegh Esmaeili Delshad, Poorya Takasi, Amin Fouladpour, Samad Karkhah, Ramyar Farzan, Arash Aris
International Wound Journal  vol: 20  issue: 10  first page: 4349  year: 2023  
doi: 10.1111/iwj.14300

11. The burden of long bone fracture and health system response in Malawi: A scoping review
Shazra Abbas, Linda Chokotho, Nohakhelha Nyamulani, Victoria L. Oliver
Injury  vol: 55  issue: 2  first page: 111243  year: 2024  
doi: 10.1016/j.injury.2023.111243

12. Solid locked intramedullary nailing for expeditious return of bone-setting-induced abnormal fracture union victims to work in South-western Nigeria
Stephen Adesope Adesina, Samuel Uwale Eyesan, Isaac Olusayo Amole, Akinsola Idowu Akinwumi, Olufemi Timothy Awotunde, Adewumi Ojeniyi Durodola, James Idowu Owolabi
Scientific Reports  vol: 12  issue: 1  year: 2022  
doi: 10.1038/s41598-022-25862-3

13. Elevation of depressed tibial plateau fractures using rafting one-third of the tubular plate
El-Sayed El-Harmel, Kamal M. Hafez, Muhammad A. Quolquela, Ahmed S. Helal, Mohammed R. El-Tabbakh
The Egyptian Orthopaedic Journal  vol: 59  issue: 4  first page: 470  year: 2024  
doi: 10.4103/eoj.eoj_54_24

14. In Vivo Assessment of High-Strength and Corrosion-Controlled Magnesium-Based Bone Implants
Hamdy Ibrahim, Caroline Billings, Moataz Abdalla, Ahmed Korra, David Edger Anderson
Bioengineering  vol: 10  issue: 7  first page: 877  year: 2023  
doi: 10.3390/bioengineering10070877

15. The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study
Qiaoyan Dai, Mingxia Peng, Chunyan Li, Sijia Deng, Peiyan Huang, Xuemei Guo, Yi Yang
Journal of Pediatric Nursing  vol: 79  first page: 126  year: 2024  
doi: 10.1016/j.pedn.2024.08.009

16. Pain State Classification of Stiff Knee Joint Using Electromyogram for Robot-Based Post-Fracture Rehabilitation Training
Yang Zheng, Dimao He, Yuan He, Xiangrui Kong, Xiaochen Fan, Min Li, Guanghua Xu, Jichao Yin
Sensors  vol: 25  issue: 16  first page: 5142  year: 2025  
doi: 10.3390/s25165142

17. Identification of miRNA Regulatory Networks and Candidate Markers for Fracture Healing in Mice
Xianglu Li, Zhaohua Zhong, Enguang Ma, Xiaowei Wu, Tao Huang
Computational and Mathematical Methods in Medicine  vol: 2021  first page: 1  year: 2021  
doi: 10.1155/2021/2866475

18. Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)
Saskia H. Van Bergen, Esther M. M. Van Lieshout, Kiran C. Mahabier, Alexandra J. L. M. Geraerds, Suzanne Polinder, Dennis Den Hartog, Michael H. J. Verhofstad, Ivo Beetz, Hugo W. Bolhuis, P. Koen Bos, Maarten W. G. A. Bronkhorst, Milko M. M. Bruijninckx, Jeroen De Haan, Axel R. Deenik, P. Ted Den Hoed, Martin G. Eversdijk, J. Carel Goslings, Robert Haverlag, Martin J. Heetveld, Albertus J. H. Kerver, Karel A. Kolkman, Peter A. Leenhouts, Sven A. G. Meylaerts, Ron Onstenk, Martijn Poeze, Rudolf W. Poolman, Bas J. Punt, Ewan D. Ritchie, W. Herbert Roerdink, Gert R. Roukema, Jan Bernard Sintenie, Nicolaj M. R. Soesman, Edgar J. T. Ten Holder, Wim E. Tuinebreijer, Maarten Van der Elst, Frank H. W. M. Van der Heijden, Frits M. Van der Linden, Peer Van der Zwaal, Jan P. Van Dijk, Hans-Peter W. Van Jonbergen, Egbert J. M. M. Verleisdonk, Jos P. A. M. Vroemen, Marco Waleboer, Philippe Wittich, Wietse P. Zuidema, Ahmed Al Khanim, Jelle E. Bousema, Kevin Cheng, Yordy Claes, J. Daniël Cnossen, Emmelie N. Dekker, Aron J. M. De Zwart, Priscilla A. Jawahier, Boudijn S. H. Joling, Cornelia A. W. Notenboom, Jaap B. Schulte, Nina Theyskens, Gijs J. J. Van Aert, Boyd C. P. Van der Schaaf, Tim Van der Torre, Joyce Van Veldhuizen, Lois M. M. Verhagen, Maarten Verwer, Joris Vollbrandt
European Journal of Trauma and Emergency Surgery  vol: 49  issue: 2  first page: 929  year: 2023  
doi: 10.1007/s00068-022-02160-1

19. Ulmus macrocarpa Hance trunk bark extracts inhibit RANKL-induced osteoclast differentiation and prevent ovariectomy-induced osteoporosis in mice
Chanhyeok Jeong, Chang Hyung Lee, Yongjin Lee, Jiwon Seo, Weihong Wang, Kyu-Hyung Park, Eunseok Oh, Youbin Cho, Chanyoon Park, Young-Jin Son, Jung Han Yoon Park, Heonjoong Kang, Ki Won Lee
Journal of Ethnopharmacology  vol: 319  first page: 117285  year: 2024  
doi: 10.1016/j.jep.2023.117285

20. REHABILITATION AFTER AN ATHLETE'S ANKLE INJURY
Ratko Zlatičanin, Amila Jaganjac, Amila Kapetanović, Bojan Kraljević, Adela Erović Vranešić, Amna Vefić
Homosporticus  year: 2023  
doi: 10.61886/1840-4324.2023.25.2.24

21. Physiotherapists’ Use of Outcome Measure Tools in the Assessment of Neuro-Musculoskeletal Injuries for Short-Term Functional Rehabilitation Domains to Minimize Impairments and Disability following Commercial Motorcycle Road-Related Accident, Eldoret, Kenya
Catherine Mwikali Muia, Collins Situma Sindani Masinde, Musimbi Chantell Imbwaga
African Journal of Empirical Research  vol: 5  issue: 2  first page: 581  year: 2024  
doi: 10.51867/ajernet.5.2.52

22. The physical impact of long bone fractures on adults in KwaZulu-Natal
Sevani Singaram, Mergan Naidoo
South African Journal of Physiotherapy  vol: 76  issue: 1  year: 2020  
doi: 10.4102/sajp.v76i1.1393

23. Poly-ε-Caprolactone 3D-Printed Porous Scaffold in a Femoral Condyle Defect Model Induces Early Osteo-Regeneration
Arianna De Mori, Aikaterina Karali, Evangelos Daskalakis, Richard Hing, Paulo Jorge Da Silva Bartolo, Glen Cooper, Gordon Blunn
Polymers  vol: 16  issue: 1  first page: 66  year: 2023  
doi: 10.3390/polym16010066

24. Impact of Surgical Timing on Fracture Healing in Tibial Shaft Injuries: A Comparative Review of Intramedullary Nailing Techniques
Samarth Kashyap, Ratnakar Ambade, Suhas Landge, Ankur Salwan
Cureus  year: 2024  
doi: 10.7759/cureus.70978

25. Corrosion behaviour of WE43 magnesium alloy printed using selective laser melting in simulation body fluid solution
Jan Suchý, Lenka Klakurková, Ondřej Man, Michaela Remešová, Miroslava Horynová, David Paloušek, Daniel Koutný, Patrícia Krištofová, Dalibor Vojtěch, Ladislav Čelko
Journal of Manufacturing Processes  vol: 69  first page: 556  year: 2021  
doi: 10.1016/j.jmapro.2021.08.006

26. Correlation between psychological status, revised Müller AO classification and patient-reported outcomes: a prospective cohort analysis
Eduardo Campos Martins, Thiago Martins Teixeira
Archives of Orthopaedic and Trauma Surgery  vol: 144  issue: 5  first page: 2149  year: 2024  
doi: 10.1007/s00402-024-05288-4

27. Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia
Nemanja Gvozdenović, Ivana Šarac, Andrijana Ćorić, Saša Karan, Stanislava Nikolić, Isidora Ždrale, Jelena Milešević
Nutrients  vol: 16  issue: 16  first page: 2702  year: 2024  
doi: 10.3390/nu16162702

28. miR-21-5p Enriched Exosomes from Human Embryonic Stem Cells Promote Osteogenesis via YAP1 Modulation
Xinqia Huang, Ziquan Zhao, Weiqiang Zhan, Mingzhu Deng, Xuyang Wu, Zhoutao Chen, Jiahao Xie, Wei Ye, Mingyan Zhao, Jiaqi Chu
International Journal of Nanomedicine  vol: Volume 19  first page: 13095  year: 2024  
doi: 10.2147/IJN.S484751

29. The CAPE TOWN modified squat and smile test: correlation with fracture union in long bone fractures of the lower limb
Delroy Arnolds, Sithombo Maqungo, Michael Held, Nando Ferreira, Roopam Dey, Robyn Waters, Maritz Laubscher, Simon Matthew Graham
European Journal of Orthopaedic Surgery & Traumatology  vol: 36  issue: 1  year: 2025  
doi: 10.1007/s00590-025-04532-w

30. Promoting a Cobalt Complex of Qingzhuan Dark Tea Polysaccharides on Fracture Healing in Rats
Min Zheng, Yong Chen, Ziyao Wang, Chen Xie, Chi Zhou, Le Wang, Fang Xiong, Ling Li, Jun Xing, Cai Wang, Hongfu Zhou
Tissue Engineering Part A  vol: 30  issue: 15-16  first page: 437  year: 2024  
doi: 10.1089/ten.tea.2023.0125

31. The Impact of Perceived Usefulness of Wearable Devices on Treatment Adherence in Fracture Patients: The Chain Mediating Roles of Self-Efficacy and Meaning in Life
Xiaoxue Tan, Shanshan Cai, Yanan Kan, Nan Xu, Ying Chen, Min Xu, Donghong Huang
Patient Preference and Adherence  vol: Volume 20  first page: 1  year: 2026  
doi: 10.2147/PPA.S555791

32. Bone fracture healing within a continuum bone remodelling framework
Ina Schmidt, Jacob Albert, Marina Ritthaler, Areti Papastavrou, Paul Steinmann
Computer Methods in Biomechanics and Biomedical Engineering  vol: 25  issue: 9  first page: 1040  year: 2022  
doi: 10.1080/10255842.2021.1998465

33. Patient Perspectives on Key Outcomes for Vocational Rehabilitation Interventions Following Traumatic Injury
Kay Bridger, Blerina Kellezi, Denise Kendrick, Kate Radford, Stephen Timmons, Mike Rennoldson, Trevor Jones, Jade Kettlewell
International Journal of Environmental Research and Public Health  vol: 18  issue: 4  first page: 2035  year: 2021  
doi: 10.3390/ijerph18042035

34. Loss of Independence after Index Hospitalization Following Proximal Femur Fracture
Hannan A Maqsood, Adam Pearl, Awni Shahait, Basmah Shahid, Santosh Parajuli, Harendra Kumar, Khaled J. Saleh
Surgeries  vol: 5  issue: 3  first page: 577  year: 2024  
doi: 10.3390/surgeries5030047

35. Gallic Acid Loaded Alginate‐Gelatin Beads for Potential Bone Tissue Engineering Applications
Mehmet Ali Karaca, Ali Reza Kamali, Bita Erin Kamali, Bilge Temiz, Furkan Özben, Duygu Ege, Hale Saybaşılı
Biopolymers  vol: 116  issue: 4  year: 2025  
doi: 10.1002/bip.70033

36. Sociopolitical, clinical, and ethical challenges of sustainable fracture care in Haiti
Antoinette J. Charles, Mikhail A. Bethell, Marc‐Alain Pean, Brielle Ochoa, Bernard Nau, Christian A. Pean
World Journal of Surgery  vol: 48  issue: 10  first page: 2327  year: 2024  
doi: 10.1002/wjs.12323

37. Development and Evaluation of Scaffolds Based on Perch Collagen–Hydroxyapatite for Advanced Synthetic Bone Substitutes
Alina Elena Coman, Ana Maria Rosca, Maria Minodora Marin, Madalina Georgiana Albu Kaya, Raluca Gabor, Catalina Usurelu, Mihaela Violeta Ghica, Laurentiu Dinca, Irina Titorencu
Pharmaceutics  vol: 18  issue: 1  first page: 33  year: 2025  
doi: 10.3390/pharmaceutics18010033

38. Exploratory Examination of Knee Self-Efficacy in Individuals With a History of ACL Reconstruction and Sport-Related Concussion
Francesca M. Genoese, Aaron J. Zynda, Kayla Ford, Matthew C. Hoch, Johanna M. Hoch, Tracey Covassin, Shelby E. Baez
Journal of Sport Rehabilitation  vol: 32  issue: 2  first page: 177  year: 2023  
doi: 10.1123/jsr.2022-0086

39. Comparing Ultrasonography With Plain Radiography in the Diagnosis of Long Bone Fractures
Amjad Ali Khan, Zareen Fatima, Raham Bacha, Bakht Rokhan, Sajid Akhtar, Majid Iqbal, Irum Raheem
Journal of Diagnostic Medical Sonography  vol: 39  issue: 6  first page: 575  year: 2023  
doi: 10.1177/87564793231193430

40. Comparison of the Analgesic Effects of Low-Dose Ketamine Versus Fentanyl in Patients With Long Bone Fractures in the Emergency Department: A Prospective Observational Study
Muhammet Yılmaz, Emre Kudu, Erkman Sanri, Sinan Karacabey, Haldun Akoglu, Arzu Denizbasi
Cureus  year: 2023  
doi: 10.7759/cureus.46344

41. Design of osteosynthesis plate for detecting bone union using wire natural frequency
Pisitpong Chancharoen, Pairat Tangpornprasert, Chavarin Amarase, Saran Tantavisut, Chanyaphan Virulsri
Scientific Reports  vol: 14  issue: 1  year: 2024  
doi: 10.1038/s41598-024-63530-w

42. The Epidemiology of US Upper Extremity Amputations: An Analysis of the Global Burden of Disease Database (1990-2019)
Ambrose Loc T Ngo, Cameron J Sabet, Gabrielle Dykhouse, Ayah Ibrahim, Taylor J Manes, Arsalaan Sayyed, Shaheryar Asad, Benjamin C Taylor
Cureus  year: 2025  
doi: 10.7759/cureus.97244

43. Transcriptomic analysis of bone transport reveals different functions between both ends
Maochun Wang, Jiao Zhang, Chongxu Qiao, Shunchao Yan, Weicheng Gao, Guoping Wu
Frontiers in Physiology  vol: 16  year: 2025  
doi: 10.3389/fphys.2025.1592288

44. Managing the Extra-Articular Distal Radius Malunion
Francisco Rodriguez-Fontan, Alexander Lauder
Hand Clinics  vol: 40  issue: 1  first page: 63  year: 2024  
doi: 10.1016/j.hcl.2023.06.002

45. Epidemiology of geriatric orthopaedic injuries in a tertiary hospital in southwestern Nigeria
Stephen Adesope Adesina, Isaac Olusayo Amole, Imri Goodness Adefokun, Adepeju Olatayo Adegoke, Ehimen Oluwadamilare Odekhiran, Olusola Tunde Ekunrin, Akinsola Idowu Akinwumi, Simeon Ayorinde Ojo, Adewumi Ojeniyi Durodola, Olufemi Timothy Awotunde, Innocent Chiedu Ikem, Samuel Uwale Eyesan
Scientific Reports  vol: 14  issue: 1  year: 2024  
doi: 10.1038/s41598-024-70108-z

46. Outcomes of Intramedullary Nailing Versus Plate Fixation in the Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis
Adeel Nadeem, Hannah Abbasi
Cureus  year: 2024  
doi: 10.7759/cureus.72473

47. Effect of Cannabis Use on Postoperative Opiate Requirements After Long Bone Fracture
Katherine Kozlowski, Jacob Mogerman, Siderah Pryce, Jamie Bousleiman, Ellen Lutnick
Journal of Orthopaedic Reports  first page: 100861  year: 2025  
doi: 10.1016/j.jorep.2025.100861

48. Exploring the collaborative care of patients with pelvic fractures in Tshwane, South Africa
Ntombenkosi A. Sobantu, Muziwakhe D. Tshabalala, Verusia Chetty
South African Family Practice  vol: 65  issue: 1  year: 2023  
doi: 10.4102/safp.v65i1.5705

49. Analysis of the nursing effects of traditional Chinese medicine featured care combined with individualized care on patients with upper limb fractures
Ying Ma, Shuman Qian
Medicine  vol: 104  issue: 38  first page: e42772  year: 2025  
doi: 10.1097/MD.0000000000042772

50. Pharmacological agents for bone fracture healing: talking points from recent clinical trials
Filippo Migliorini, Federico Cocconi, Gianluca Vecchio, Luise Schäefer, Julian Koettnitz, Nicola Maffulli
Expert Opinion on Investigational Drugs  vol: 32  issue: 9  first page: 855  year: 2023  
doi: 10.1080/13543784.2023.2263352

51. Building a predictive model for depression risk in fracture patients: insights from cross-sectional NHANES 2005–2020 data and an external hospital-based dataset
Xin Liu, Xin Jin, Wujia Cen, Yi Liu, Shaoting Luo, Jia You, Sha Tian
BMC Public Health  vol: 24  issue: 1  year: 2024  
doi: 10.1186/s12889-024-19696-z