J Orthop Trauma, Vol. 2, No. 9, October 2007
Author: M.R. Brinker, MD and Daniel P.O O'Conner, PhD
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Objectives: To describe the functional outcomes of treatment using
the Ilizarov method for tibial nonunions in older patients (.60 years
Design: Prospective case series.
Setting: Tertiary referral center.
Patients: 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.
Intervention: Ilizarov deformity correction, compression, or bone
Main Outcome Measurements: 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.
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