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Autogenous Iliac Crest Bone Grafting for the Treatment of Fracture Nonunion Is Equally Effective in Elderly and Nonelderly Patients

Carlock, Kurtis D. BS; Hildebrandt, Kyle R. BS; Konda, Sanjit R. MD; Egol, Kenneth A. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 15, 2019 - Volume 27 - Issue 18 - p 696-703
doi: 10.5435/JAAOS-D-18-00322
Research Article

Introduction: Autogenous iliac crest bone graft (ICBG) is considered the benchmark graft for nonunion repair. However, ICBG harvest is invasive and may provide reduced benefit to elderly patients. The purpose of this study was to compare the clinical and functional outcomes of ICBG use in fixation of fracture nonunions between elderly and nonelderly patients.

Methods: Over a 13-year period, 242 patients who underwent operative repair of a long bone fracture nonunion and received autogenous ICBG were enrolled in a prospective research registry and followed. Data collected included patient demographics, injury information, and nonunion management. All patients had a minimum of 12 months of postoperative follow-up. Patients at least 65 years of age were classified as elderly, whereas younger patients were classified as nonelderly. Functional outcomes were evaluated at routine intervals postoperatively using the short musculoskeletal function assessment (SMFA) and visual analog scale pain scores. Bony union was determined radiographically. All postoperative complications were recorded.

Results: Of the 242 patients included, 44 were elderly and 198 were nonelderly. No differences were found between groups with respect to postoperative pain scores or SMFA scores. Furthermore, time to union, rate of union, and postoperative complication rate did not differ between groups. Multivariate linear regression demonstrated that older age was not associated with time to union, postoperative pain scores, or postoperative SMFA scores after controlling for possible confounding variables.

Discussion: The use of ICBG in nonunion repair among elderly patients is as effective as use in younger patients with a long bone nonunion. Concerns of increased postoperative complications and decreased rate of union in elderly patients receiving ICBG for treatment of fracture nonunion should be alleviated. ICBG remains the benchmark graft for nonunion repair among all age groups.

From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY (Mr. Carlock, Mr. Hildebrandt, Dr. Konda, and Dr. Egol), and the Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY (Dr. Konda and Dr. Egol).

Correspondence to Dr. Egol:

Dr. Egol or an immediate family member has received IP royalties from and serves as a paid consultant to Exactech; serves as an unpaid consultant to Polypid; has received research or institutional support from Synthes; and serves as a board member, owner, officer, or committee member of Orthopaedic Trauma Association. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Carlock, Mr. Hildebrandt, and Dr. Konda.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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