OTA 2013 Posters

Scientific Poster #25 Geriatric OTA 2013

Does Age Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery?

David P. Taormina, MS; Brandon S. Shulman, BA; Raj Karia, MPH; Allison B. Spitzer, MD; Sanjit R. Konda, MD; Kenneth A. Egol, MD;
Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA

Background/Purpose: Due to the concomitant setting of medical comorbidities, poor vascularization, osteopenic bone, and diminished osteogenic potential, age is a documented risk factor for fracture nonunion. The multiplicity of risk factors predicting fracture nonunion compound the success of nonunion revision surgery in the elderly. Our objective was to investigate the effect of patient age on clinical and functional outcome following long bone nonunion surgical repair.

Methods: 288 patients with fracture nonunion were prospectively enrolled in a trauma research registry between 2004 and 2012. Patients were treated irrespective of age by surgeons experienced in the care of these injuries. Length of hospital stay (LOS) at the time of surgery and past medical comorbidities were documented. Patients were tracked for a year with follow-up at regular intervals. Elderly patients >65 years of age (n = 45) were compared with nonelderly for postoperative wound complications, Short Musculoskeletal Function Assessment scores, healing, and surgical revision. Regression modeling was performed to look for associations between continuous age, smoking status, and history of previous nonunion surgery with healing.

Results: Follow-up data were available on 278 patients ranging from 18 to 91 years (mean [± standard deviation] = 48.0 [±16.8]). There were demographic differences in the aged population including significantly more females (P <0.01), medical comorbidities (P <0.01), and particularly osteopenia (P <0.05). Significantly fewer elderly reported smoking (P <0.01). Number of previous nonunion surgeries and body mass index did not differ. Rates of postoperative wound complications were similar. Surgical revision, progression to union, and union time were also similar. Elderly reported similar levels of function up to 12 months after surgery. Regression model analyses failed to show any association between age and final union nor time to union. However, the regression model did show a strong association between smoking status and previous nonunion surgeries with healing time.

Conclusion: Patient modifiable risk factors, such as smoking, and failure of previous surgical intervention were more associated with nonunion revision success than age in this trauma cohort. Advancing age may not be as strongly associated with nonunion surgery outcome in comparison with the risk factor milieu predisposing to baseline fracture nonunion.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.