Injury - 2026-08-11 - Journal Article; Review
Complications after operatively treated fractures in patients with solid organ transplantation - A systematic review of the literature.
Hübner CT, Anranter A, Kalbas Y, Klingebiel FK, Shehu A, Halvachizadeh S, Pfeifer R, Rössler F, Pape HC, Teuben MP
Topics
Key Takeaway
Among 2,317 solid organ transplant recipients treated operatively for fractures, the pooled infection rate was 10% and 90-day readmission rate was 20%, which the authors argue are not substantially elevated compared to the general fracture population.
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Summary
This PRISMA-compliant systematic review asked whether solid organ transplant recipients face elevated complication rates after operative fracture fixation. Six studies (n=2,317) were identified from 3,743 screened; three focused on proximal femoral fractures, two on lower extremity fractures, and one on distal radius fractures. Pooled infection rate was 10%, 90-day readmission was 20%, and mortality ranged widely from 2% to 52% depending on fracture type and cohort.
Key Limitation
Only six studies with extreme heterogeneity in fracture type, transplanted organ, immunosuppression regimen, and follow-up duration were available, making any pooled complication estimate unreliable and limiting actionable conclusions.
Original Abstract
INTRODUCTION
Solid organ transplantation is associated with multiple risk factors, reduced bone quality and relevant comorbidities, which may negatively affect postoperative outcomes after fracture treatment. Furthermore, these patients usually require lifelong immunosuppressive therapy. A systematic review was performed to evaluate the incidence of postoperative complications and to assess whether specific considerations are required in this special patient group.
METHODS
A systematic review of the literature according to the PRISMA guidelines was performed. A total of 3743 studies were identified and subsequently assessed for eligibility. Studies investigating elective orthopedic procedures were excluded. After full-text screening, six studies were included in the final analysis.
RESULTS
Overall, the six studies investigated 2317 patients. Cohort sizes ranged from 12 to 2163 patients, with a median cohort size of 33.5 patients. Mean age of patients was 67.9 years. Follow-up durations varied between 18 weeks and 3 years. The most frequently investigated fracture type was proximal femoral fractures with three studies, followed by lower extremity fractures (two studies). One study examined distal radius fractures. Infectious complications were reported in four studies, with a pooled infection rate of 10%. The pooled 90-day readmission rate was 20%. Mortality was reported heterogeneously across studies, ranging from 2% to 52%.
CONCLUSION
Studies investigating outcomes after operatively treated fractures in solid organ transplant recipients are rare. Interestingly, infectious complication rates and 90-day readmission rates do not appear to be substantially increased compared to the general population. The wide range of reported mortality rates is likely attributable to differences in fracture types and patient populations, as certain fractures-such as femoral neck fractures-are associated with high mortality even in non-transplanted patients.