Operative Treatment of Nonunions in the Elderly: Clinical and Radiographic Outcomes in Patients at Minimum 75 Years of Age

Authors

Clinton H. van Trikt, Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Johanna C. Donders, Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Craig E. Klinger, Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA. klingerc@hss.edu.
David S. Wellman, Orthopaedic Trauma Service, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
David L. Helfet, Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Peter Kloen, Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Author Type(s)

Faculty

DOI

10.1186/s12877-022-03670-8

Journal Title

BMC Geriatrics

First Page

985

Document Type

Article

Publication Date

12-20-2022

Department

Orthopedic Surgery

Abstract

BACKGROUND: Limited information exists on nonunion treatment in the elderly. This retrospective study evaluates whether results of operative treatment of nonunion of the humerus or femur in patients aged ≥ 75 years are comparable to those in younger patients. METHODS: We identified patients age ≥ 75 years with a nonunion of humerus or femur treated with open reduction and internal fixation. The Non-Union Scoring System was calculated. Complications, clinical outcome, and radiographic findings were assessed. Primary endpoint was nonunion healing. A literature review compared time to healing of humeral and femoral nonunion in younger populations. RESULTS: We identified 45 patients treated for a nonunion of humerus or femur with > 12 months follow-up. Median age was 79 years (range 75-96). Median time to presentation was 12 months (range 4-127) after injury, median number of prior surgeries was 1 (range 0-4). Union rate was 100%, with median time to union 6 months (range 2-42). Six patients underwent revision for persistent nonunion and healed without further complications. CONCLUSIONS: Using a protocol of debridement, alignment, compression, stable fixation, bone grafting and early motion, patients aged 75 years or older can reliably achieve healing when faced with a nonunion of the humerus or femur. LEVEL OF EVIDENCE: IV.

Recommended Citation

van Trikt, C. H., Donders, J. C., Klinger, C. E., Wellman, D. S., Helfet, D. L., & Kloen, P. (2022). Operative Treatment of Nonunions in the Elderly: Clinical and Radiographic Outcomes in Patients at Minimum 75 Years of Age. BMC Geriatrics, 22 (1), 985. https://doi.org/10.1186/s12877-022-03670-8