Operative treatment of nonunions in the elderly: Clinical and radiographic outcomes in patients at minimum 75 years of age

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.

Immunoengineering Biomaterials for Musculoskeletal Tissue Repair across Lifespan

“…[235] These observations are likely due to multiple cellular and molecular changes in the healing environment, including the reduced regenerative capacity of skeletal stem cells, decreased vascularization, and elevated local and systemic chronic inflammation. [235,236] Given that age-associated delays in healing can result in poor clinical outcomes, [237,238] devising strategies to accelerate bone regeneration will be necessary for treating older individuals.…”