Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery
Open accessAbstract
Introduction: Elderly patients are at risk of fracture nonunion, given the potential setting of osteopenia, poorer fracture biology, and comorbid medical conditions. Risk factors predicting fracture nonunion may compromise the success of fracture nonunion surgery. The purpose of this study was to investigate the effect of patient age on clinical and functional outcome following long bone fracture nonunion surgery. Materials and Methods: A retrospective analysis of prospectively collected data identified 288 patients (aged 18-91) who were indicated for long bone nonunion surgery. Two-hundred and seventy-two patients satisfied study inclusion criteria and analyses were performed comparing elderly patients aged ≥65 years (n = 48) with patients <65 years (n = 224) for postoperative wound complications, Short Musculoskeletal Functional Assessment (SMFA) functional status, healing, and surgical revision. Regression analyses were performed to look for associations between age, smoking status, and history of previous nonunion surgery with healing and functional outcome. Twelve-month follow-up was obtained on 91.5% (249 of 272) of patients. Results: Despite demographic differences in the aged population, including a predominance of medical comorbidities ( P < .01) and osteopenia ( P = .02), there was no statistical differences in the healing rate of elderly patients (95.8% vs 95.1%, P = .6) or time to union (6.2 ± 4.1 months vs. 7.2 ± 6.6, P = .3). Rates of postoperative wound complications and surgical revision did not statistically differ. Elderly patients reported similar levels of function up to 12 months after surgery. Regression analyses failed to show any significant association between age and final union or time to union. There was a strong positive association between smoking and history of previous nonunion surgery with time to union. Age was associated (positively) with 12-month SMFA activity score. Conclusions: Smoking and failure of previous surgical intervention were associated with nonunion surgery outcomes. Patient’s age at the time of surgery was not associated with achieving union. Advanced age was generally not associated with poorer nonunion surgery outcomes.
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The failure rate in the treatment of nonunion patients is higher in smokers.
“Several studies have shown that the failure rate in the treatment of nonunion patients is higher in smokers [71,72].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [72]
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- Authors
- Taormina, D. P., Shulman, B. S., Karia, R., Spitzer, A. B., Konda, S. R., & Egol, K. A.
- Affiliations
- NYU Langone Health (US)
- George Washington University Hospital (US)
- Corresponding author
- Egol, Kenneth A.
- Venue
- Geriatric Orthopaedic Surgery & Rehabilitation
- Publisher
- SAGE Publications
- Published
- 2014-05-14
- Volume
- 5
- Issue
- 3
- Pages
- 116-121
- ISSN
- 2151-4585 (ISSN-L)
- 2151-4593
- PMC
- PMC4212425
- OpenAlex
- W1977854274
- Cited by
- 41
- References
- 24
- Citations by year
- 2024: 7 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 2 · 2019: 8 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 3
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Geriatric Orthopaedic Surgery & Rehabilitation (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Medicine › Surgery › Orthopedic Surgery and Rehabilitation
- Keywords
- nonunion, elderly patients, long bone fractures, functional outcome, smoking, postoperative wound complications, surgical revision, osteopenia, comorbidities, time to union
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