Operative Treatment of Nonunions in the Elderly: Clinical and Radiographic Outcomes in Patients at Minimum 75 Years of Age
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.
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. https://doi.org/10.1186/s12877-022-03670-8