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Marshall et al: Delayed union, non-union and mal-union in 442 dogs
Veterinary Surgery 7, 2022

🔍 Key Findings

  • Delayed union occurred in 13.9% of fractures; non-union in 4.6%; mal-union in 0.7%
  • Major implant failure increased odds of delayed or non-union by 12.9×
  • Surgical site infection increased risk 3.2×; bone grafting (any type) was also associated (OR 3.3)
  • Comminuted fractures had 4.2× greater odds of delayed or non-union
  • Older age increased risk, with odds increasing by 21% per year
  • Radius and ulna fractures in toy breeds were not high risk, contrary to historical belief
  • Most non-unions required revision surgery with rhBMP-2 or autograft to achieve union
  • Ilium fractures showed 0% delayed/non-union — possibly due to robust muscle envelope

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← Articles

Marshall et al: Delayed union, non-union and mal-union in 442 dogs
Veterinary Surgery 7, 2022

🔍 Key Findings

  • Delayed union occurred in 13.9% of fractures; non-union in 4.6%; mal-union in 0.7%
  • Major implant failure increased odds of delayed or non-union by 12.9×
  • Surgical site infection increased risk 3.2×; bone grafting (any type) was also associated (OR 3.3)
  • Comminuted fractures had 4.2× greater odds of delayed or non-union
  • Older age increased risk, with odds increasing by 21% per year
  • Radius and ulna fractures in toy breeds were not high risk, contrary to historical belief
  • Most non-unions required revision surgery with rhBMP-2 or autograft to achieve union
  • Ilium fractures showed 0% delayed/non-union — possibly due to robust muscle envelope

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Multiple Choice Questions on this study

In Marshall 2022 et al., what **effect did bone grafting** have on delayed or non-union outcomes?

A. Decreased odds of delayed union
B. No effect on outcome
C. Increased odds (OR 3.32) of delayed or non-union
D. Only increased risk if autograft was used
E. Only significant in open fractures

Answer: Increased odds (OR 3.32) of delayed or non-union

Explanation: Bone graft use was associated with a 3.32× increase in risk, likely reflecting selection bias.
In Marshall 2022 et al., on delayed and non-union risk, what was the **strongest predictor** of delayed or non-union in canine fractures?

A. Comminuted fracture
B. Surgical site infection
C. Bone graft use
D. Implant failure
E. Open fracture

Answer: Implant failure

Explanation: Implant failure had an OR of 12.94 — the strongest risk factor identified.
In Marshall 2022 et al., on fracture healing in dogs, how did **radius and ulna fractures in toy breeds** perform regarding delayed or non-union?

A. Were significantly more likely to result in non-union
B. Were significantly more likely to require bone grafting
C. Were no more likely to result in delayed or non-union
D. Were always treated with external coaptation
E. Were excluded from the study

Answer: Were no more likely to result in delayed or non-union

Explanation: The study found no increased odds of poor healing in toy breed radius/ulna fractures.
In Marshall 2022 et al., which **dog-related factor** significantly increased the odds of delayed or non-union?

A. Body weight
B. Breed
C. Sex
D. Age
E. BCS (body condition score)

Answer: Age

Explanation: Odds increased 21% per year of age (OR 1.21 per year).
In Marshall 2022 et al., on fracture healing outcomes, what was the **prevalence of non-union** among the 461 fractures reviewed?

A. 13.9%
B. 4.6%
C. 0.7%
D. 21.1%
E. 8.8%

Answer: 4.6%

Explanation: The authors reported non-union in 21 of 461 fractures (4.6%).

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