<p>Non-Union Treatment Based on the “Diamond Concept” Is a Clinically Effective and Safe Treatment Option in Older Adults</p>

Abstract

Background: Patients >60 years suffering from non-unions are often unable to perform activities of daily living and often become dependent on nursing care. Evidence regarding treatment options and outcome is nonexistent. This study sought to determine the clinical effectiveness and safety of one-or two-step non-union therapy in elderly patients. Methods: This study was a single-site retrospective database analysis of older adults with long bone non-unions treated via "diamond concept". All medical records of patients receiving surgical treatment of non-unions between 01/01/2010 and 31/12/2016 were reviewed. Clinical and radiological outcome subsequent to non-union therapy were evaluated. Results: A total of 76 patients (37 patients were treated with one-step and 39 patients with Masquelet therapy) suffering from a non-union older than 60 years treated between 01/01/2010 and 31/12/2016 in our institution were included into the current study. Bone consolidation was achieved in 91.9% after one-step and 76.9% after the Masquelet therapy. Analysis of age as a risk factor in the outcome of non-union therapy revealed no significant differences in patients treated with the one-step procedure according to the "diamond concept". On the contrary, age had a significant negative influence on the outcome of the Masquelet therapy (p = 0.027). Conclusion: Non-union therapy according to the "diamond concept" is an effective and reliable treatment option in elderly patients. According to findings of the current study, older adults suffering from an infected non-union benefit from a two-stage procedure, whereas in patients suffering from a non-infected non-union, a one-step surgical treatment is beneficial.

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

“…Rather than reporting a mixed cohort of nonunion locations, we limited our study to the two most frequent occurring nonunion (humerus and femur) in the elderly. While others reported on nonunion in the elderly, their minimum inclusion age was much lower than ours [ 26 , 64 , 65 ]. We believe our group represents a different age bracket.…”

“…Many studies have reported on techniques and complications following nonunion treatment [ 20 , 23 , 37 – 63 ]. To date, few have reported on nonunion treatment specifically in older patients [ 26 , 64 , 65 ]. To the best of our knowledge, no studies have restricted their findings to nonunion patients aged over 74 years.…”

“…To date, few have reported on nonunion treatment specifically in older patients [26,64,65]. To the best of our knowledge, no studies have restricted their findings to nonunion patients aged over 74 years.…”

“…Although many studies have reported on patient outcomes following nonunion treatment, to date no studies have reported outcomes of nonunion treatment in patients aged 75 years or older [ 25 , 26 ]. Specifically, we were interested in whether treatment of nonunions of the humerus and femur resulted in similar osseus union rates and time to union in the elderly as compared to younger cohorts reported in the literature.…”

Osteogenic Induction with Silicon Hydroxyapatite Using Modified Autologous Adipose Tissue-Derived Stromal Vascular Fraction: In Vitro and Qualitative Histomorphometric Analysis

“…The presence of host cells, a signal mechanism to trigger differentiation of cells to bone forming cells, an artificial scaffold or matrix on which the new bone can form, and adequate blood supply are necessary for bone healing and/or bone graft incorporation [ 1 , 3 ]. In this context, “the diamond concept” is based on four biological essential components, namely, bone forming cells, an osteoinducive stimulus, osteoconductive material, and a hospitable environment [ 4 ].…”