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

Clinical Interventions in Aging, 2020 · DOI: http://doi.org/10.2147/CIA.S241936 · Published: July 17, 2020

Simple Explanation

This study investigates the effectiveness and safety of treating long bone non-unions in elderly patients using the “diamond concept,” a surgical approach. The study found that the “diamond concept” is a reliable treatment, with a one-step surgical procedure being beneficial for non-infected non-unions and a two-step procedure (Masquelet therapy) being more suitable for infected cases. Age negatively influenced outcomes with Masquelet therapy, while location of non-union (femur vs. tibia) also influenced success rates with each surgical approach.

Study Duration

01/01/2010 and 31/12/2016

Participants

76 patients older than 60 years

Evidence Level

Retrospective database analysis

Key Findings

1
Bone consolidation was achieved in 91.9% of patients after one-step and 76.9% after the Masquelet therapy.
2
Age had a significant negative influence on the outcome of the Masquelet therapy (p = 0.027).
3
Patients suffering from a non-union of the metaphyseal tibia that was treated with the Masquelet therapy had a significantly better outcome compared to the one-step surgery (p = 0.047).

Research Summary

This study evaluated the clinical effectiveness and safety of one- or two-step non-union therapy based on the “diamond concept” in older adults. The results indicated that non-union therapy according to the “diamond concept” is an effective and reliable treatment option in elderly patients. The study suggests that older adults with infected non-unions benefit from a two-stage procedure, while those with non-infected non-unions benefit from a one-step surgical treatment.

Practical Implications

Treatment Choice

Caregivers should consider the patient’s age, the location of the non-union (femur vs. tibia), and the presence of infection when deciding between one-step and two-step surgical procedures.

Infection Management

For older adults with infected non-unions, a two-stage Masquelet procedure is recommended due to its effectiveness in eradicating infection and promoting bone regeneration.

Surgical Expertise

The method of osteosynthesis should be chosen based on the surgeon’s experience and the anatomical location of the non-union, as the study found no influence of the osteosynthesis method on the outcome.

Study Limitations

1
Small patient collective.
2
Elderly patients’ willingness to adhere to follow-up protocol might be hampered for numerous reasons.
3
Differences in radiological consolidation might have been influenced by the rater.

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