Outcomes of tibial nonunion in older adults following treatment using the Ilizarov method.
OBJECTIVE
To describe the functional outcomes of treatment using the Ilizarov method for tibial nonunions in older patients (>60 years of age).


METHODS
Prospective case series.


METHODS
Tertiary referral center.


METHODS
Twenty-three consecutive patients with an average age of 72 years (61 to 92) who had tibial nonunions for an average duration of 13 months (3 to 46). Fourteen patients had an associated deformity and eight patients had infection.


METHODS
Ilizarov deformity correction, compression, or bone transport.


METHODS
Brief Pain Inventory, American Academy of Orthopaedic Surgeons (AAOS) Lower Limb Core Scale, Short Form (SF)-12, quality-adjusted life years.


RESULTS
Three patients did not complete treatment: two patients died of cardiovascular disease during the treatment period and one patient demanded early removal of the Ilizarov device against medical advice. All 20 patients who completed treatment achieved bony union. Two of the 20 patients died before final follow-up, one patient was unable to participate in follow-up, and one patient was lost. At an average follow-up of 38 months (18 to 61), all of the remaining 16 patients were bearing full weight. AAOS Lower Limb Core Scale scores improved from 39 to 78 points (P < 0.001), pain intensity decreased from 3.6 to 0.9 (P = 0.001), SF-12 Physical Component Summary scores improved from 26.5 points to 35.3 points (P = 0.030), and SF-12 Mental Component Summary scores improved from 41.6 points to 48.7 points (P = 0.011). The improvement in quality of life is equivalent to 5.3 quality-adjusted life years per patient, which was larger than the average improvement in quality of life following total hip arthroplasty reported in published series.


CONCLUSIONS
Treatment using the Ilizarov method restored function and had a profoundly positive effect on quality of life in these elderly patients with tibial nonunions.
Brinker
Mark R
MR
Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston 77030-4509, TX. mbrinker@houston.rr.com
O'Connor
Daniel P
DP
D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013977:Tibia / Q000473:pathology* / Q000502:physiology / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology