{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:07:04Z","timestamp":1787580424176,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Research has suggested that bone fractures can hinder the health status of patients\u2019 life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes. Methods: Electronic databases \u2018PubMed\u2019, \u2018Cochrane\u2019, \u2018PsycInfo\u2019, \u2018Medline\u2019, \u2018Embase\u2019, \u2018Web of Science\u2019, and \u2018CINAHL\u2019 were used. Search terms used were nonunion OR non-union OR \u201cnon union\u201d OR \u201clong bone\u201d OR \u201cdelayed union\u201d AND \u201cquality of life\u201d OR qol OR depression OR anxiety OR psycholog* OR PTSD OR \u201cpost-traumatic stress disorder\u201d. Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture\/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The \u201cnon-union\u201d group to a normative, matched population and (2) the \u201cnon-union group\u201d to the same group after union was achieved. However, studies that did not use comparison groups were also included. Results: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery. Conclusions: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.<\/jats:p>","DOI":"10.3390\/jcm8111998","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T11:24:32Z","timestamp":1573817072000},"page":"1998","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Physical Health and Psychological Outcomes in Adult Patients with Long-Bone Fracture Non-Unions: Evidence Today"],"prefix":"10.3390","volume":"8","author":[{"given":"Louise","family":"Johnson","sequence":"first","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds Major Trauma Centre, Leeds General Infirmary, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5553-8068","authenticated-orcid":false,"given":"Emily","family":"Igoe","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds Major Trauma Centre, Leeds General Infirmary, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Kleftouris","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds Major Trauma Centre, Leeds General Infirmary, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5426-8158","authenticated-orcid":false,"given":"Ioannis V.","family":"Papachristos","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds Major Trauma Centre, Leeds General Infirmary, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costas","family":"Papakostidis","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Limassol General Hospital, PO BOX 56060 Limassol, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Academic Department of Trauma &amp; Orthopaedics, School of Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"key":"ref_1","first-page":"659","article-title":"Long bone nonunion","volume":"153","author":"Schmidmaier","year":"2015","journal-title":"Z. 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