Autogenous Iliac Crest Bone Grafting for the Treatment of Fracture Nonunion Is Equally Effective in Elderly and Nonelderly Patients

Abstract

Introduction: Autogenous iliac crest bone graft (ICBG) is considered the benchmark graft for nonunion repair. However, ICBG harvest is invasive and may provide reduced benefit to elderly patients. The purpose of this study was to compare the clinical and functional outcomes of ICBG use in fixation of fracture nonunions between elderly and nonelderly patients. Methods: Over a 13-year period, 242 patients who underwent operative repair of a long bone fracture nonunion and received autogenous ICBG were enrolled in a prospective research registry and followed. Data collected included patient demographics, injury information, and nonunion management. All patients had a minimum of 12 months of postoperative follow-up. Patients at least 65 years of age were classified as elderly, whereas younger patients were classified as nonelderly. Functional outcomes were evaluated at routine intervals postoperatively using the short musculoskeletal function assessment (SMFA) and visual analog scale pain scores. Bony union was determined radiographically. All postoperative complications were recorded. Results: Of the 242 patients included, 44 were elderly and 198 were nonelderly. No differences were found between groups with respect to postoperative pain scores or SMFA scores. Furthermore, time to union, rate of union, and postoperative complication rate did not differ between groups. Multivariate linear regression demonstrated that older age was not associated with time to union, postoperative pain scores, or postoperative SMFA scores after controlling for possible confounding variables. Discussion: The use of ICBG in nonunion repair among elderly patients is as effective as use in younger patients with a long bone nonunion. Concerns of increased postoperative complications and decreased rate of union in elderly patients receiving ICBG for treatment of fracture nonunion should be alleviated. ICBG remains the benchmark graft for nonunion repair among all age groups.T raumatic fracture nonunion presents a perennial challenge for both patients and orthopedic surgeons. Patients experience symptoms such as prolonged pain, fracture site mobility, and reduced functional

Autologous bone graft: Is it still the gold standard?

“…Finally, the new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) [21] . Autograft appears to be equally efficacious in the elderly patient as in the young [22] .…”

Local H2 release remodels senescence microenvironment for improved repair of injured bone

“…Carlock et al found that the clinical outcomes of autogenous iliac crest bone graft (ICBG) for nonunion repair appeared to be as effective in elderly patients as in the young with a long bone nonunion, and ICBG is considered as the benchmark graft for nonunion repair among all age groups 52 , 53 . We speculate that high biocompatibility and osteoconduction of ICBG might bring a minimum burden for surrounding senescent cells/tissues compared with allotransplantation and artificial graft so that the accumulated senescent cell burden would not excess the threshold for self-regenation according to the above threshold theory.…”

Outcomes and complications of the reamer irrigator aspirator versus traditional iliac crest bone graft harvesting: a systematic review and meta-analysis

“…Dawson et al reported a higher union rate in the ICBG cohort compared to the RIA group [ 24 ]. Carlock et al reported a high union rate after ICBG, with 232 unions in 242 treated patients [ 35 ]. Furthermore, On Salawu et al reported a higher union rate following ICBG, with 81 unions in 86 patients [ 36 ].…”