OTA 2006 Posters

OTA 2006 Posters

Scientific Poster #107 Geriatrics

Ilizarov Treatment of Tibial Nonunion in Older Adults
Mark R. Brinker, MD^1,2(n); Daniel P. O'Connor, PhD²(n);
¹Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas, USA;
²Joe W. King Orthopedic Institute, Houston, Texas, USA

Purpose: Amputation is often offered as a treatment for tibial nonunion in older adults. In the elderly population, amputation often produces disability and decreases quality of life. This study describes the functional outcomes of Ilizarov treatment of tibial nonunions in older patients.

Methods: 22 consecutive elderly patients (15 women and 7 men; mean age 73 years, range 61 to 92 years) with tibial nonunion underwent Ilizarov treatment at our center between July 1996 and July 2003. The patients had undergone an average of 2 prior surgeries (range, 0 to 7). All patients had a viable, sensate foot; 19 patients had an associated deformity and 8 patients had infected nonunions. All patients had been offered amputation elsewhere. The average duration of nonunion was 13 months (range, 1 to 46 months). All patients completed the Brief Pain Inventory, American Academy of Orthopaedic Surgeons Lower Limb Core score, Medical Outcomes Survey Short Form 12 Physical Component Scale (SF-12 PCS), and Time Trade Off instruments at presentation and at follow-up.

Results: Two patients died of cardiovascular disease at home during the treatment period. Another patient demanded early removal of the external fixator and refused further treatment or follow-up. Average Ilizarov treatment time for the remaining 19 patients was 285 days (range, 180 to 587 days). The infected nonunions required a significantly longer treatment duration (365 days) than did aseptic nonunions (247 days) (P = 0.023). All 19 patients (100%) achieved solid bony union. One patient died of cardiovascular disease before the minimum follow-up period. At follow-up (41 months, range 15 to 108 months), none of the remaining 18 patients (0%) has required further treatment for their tibial nonunion. All patients (100%) were full weight bearing. Pain intensity decreased from 3.6/10 to 0.9/10 (P = 0.001); 6 patients (33%) reported having no pain (0/10) at the latest follow-up. The Lower Limb Core score improved from 39.0 to 78.1 points (P <0.001). The SF-12 PCS improved from 26.5 to 35.3 points (P = 0.027). The years of life patients were willing to trade in exchange for perfect health decreased from 5 years before Ilizarov treatment to 1.5 years at follow-up (P = 0.003). Before Ilizarov treatment, 73% of patients rated their overall quality of life as "Poor" or "Fair"; after treatment 64% rated their overall quality of life as""Excellent" or "Very Good."

Conclusion/Significance: Ilizarov treatment of tibial nonunion restored function and had a large effect on quality of life in these elderly patients. Amputation should be considered only for patients with severe vascular disease, a nonviable or insensate foot, or severe medical conditions that preclude other surgical options.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

· 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.