Outcomes of tibial nonunion in older adults following treatment using the Ilizarov method

Objectives: To describe the functional outcomes of treatment using the Ilizarov method for tibial nonunions in older patients (> 60 years of age). 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 transport. 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.