{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T01:53:21Z","timestamp":1793843601112,"version":"4.6.1"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The purpose of this study was to report the extent of the effects of femoral nonunion on health-related quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Tertiary referral center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants:<\/jats:title>\n                    <jats:p>One hundred eighty-seven consecutive patients (85 women, age 55.9 \u00b1 16.9 years; 102 men, age 42.8 \u00b1 16.1 years) with 188 nonunions of the femur, excluding those involving the hip or knee articular surfaces.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention:<\/jats:title>\n                    <jats:p>Average nonunion duration was 28.5 months. 5.7% of the nonunions were infected, and the distal third was the most frequently involved segment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measurements:<\/jats:title>\n                    <jats:p>SF-12 Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, Brief Pain Inventory (BPI), American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), and Time Trade-Off (TTO) reported at the time of initial clinical evaluation at our center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The MCS scores averaged 43 \u00b1 6.5, and the PCS scores averaged 26.3 \u00b1 6.5, indicating the large adverse impact of femoral nonunion on mental and physical health, respectively. The BPI average intensity score averaged 5.1 \u00b1 2.5, indicating moderate to severe pain. The LLCS averaged 53.9 \u00b1 20.0, indicating substantial lower extremity-specific disability. The TTO questionnaire responses indicated that these patients were willing to trade an average of 38.3% of their remaining years of life to regain health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The impact of femoral shaft nonunion on physical health was comparable to end-stage hip arthrosis and tibial nonunion and worse than many other medical conditions. Femoral shaft nonunion is a debilitating chronic medical condition with substantial negative effects on health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000000736","type":"journal-article","created":{"date-parts":[[2016,10,15]],"date-time":"2016-10-15T04:51:23Z","timestamp":1476507083000},"page":"e37-e42","source":"Crossref","is-referenced-by-count":96,"title":["Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life"],"prefix":"10.1097","volume":"31","author":[{"given":"Mark R.","family":"Brinker","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX;"},{"name":"Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Department of Health and Human Performance, University of Houston, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/00003086-199310000-00006","article-title":"Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation","volume":"295","author":"Lerner","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.2106\/JBJS.L.00803","article-title":"The devastating effects of tibial nonunion on health-related quality of life","volume":"95","author":"Brinker","year":"2013","journal-title":"J Bone Joint Surg Am."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"208","DOI":"10.2106\/00004623-200202000-00007","article-title":"The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population","volume":"84-A","author":"Hunsaker","year":"2002","journal-title":"J Bone Joint Surg Am."},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"902","DOI":"10.2106\/00004623-200405000-00003","article-title":"American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. 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