{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:59:41Z","timestamp":1769173181654,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T00:00:00Z","timestamp":1566432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Fractures in elderly patients are common and have severe implications on a socioeconomic level, as musculoskeletal integrity and competence is crucial for independence. Changes in both composition and biology of bones during aging potentially affect fracture healing adversely. The current study sought to determine the influence of age on the outcome of non-union therapy of atrophic and hypertrophic non-unions based on the \u201cdiamond concept\u201d, as well as to evaluate the well-known risk factors impairing bone healing. Patients and Methods: All medical records, operative notes, lab data, and radiological imaging of patients that received surgical treatment of both atrophic and hypertrophic non-unions of the femur or tibia between 1 January 2010 and 31 December 2016 were thoroughly reviewed and analyzed. Patients who participated in our standardized follow-up for at least 12 months were included into a database. Patients older than 60 years were matched with patients younger than 60 based on five established criteria. The study was approved by the local ethics committee (S-262\/2017). According to our inclusion criteria, a total of 76 patients older than 60 years were eligible for analysis. Via matching, two groups were formed: study group (SG; &gt;60 years; n = 45) and control group (CG; &lt;60 years; n = 45). Results: Twelve months subsequent to treatment, the consolidation rate was equivalent in both groups (SG: 71% vs. CG: 67%). The consolidation for all patients before matching was 73%. The clinical results for the complete collective were no pain or pain with high or medium strain for 62.5%, whereas 29.6% had pain with low strain or constant pain. 7.87% had no pain levels given. Logistic regression modeling showed no influence of age &gt;60 years on radiological or clinical outcome, whereas a significant negative correlation was revealed between patients aged 40\u201349 years and radiological non-union consolidation (b = \u22121.145 and p = 0.048). In addition, diabetes had a negative influence on non-union therapy (b = \u22121.145 and p = 0.048). As expected, the clinical outcome correlated significantly with the radiological outcome (p &lt; 0.001). Conclusion: Surgeons should optimize both modifiable risk factors such as diabetes mellitus, as well as surgical treatment in order to achieve the best possible outcome in elderly patients. Elderly patients benefit from osseous consolidation by enabling and maintaining musculoskeletal competence due to the close correlation between clinical and radiological outcome. Advanced age alone does not negatively influence the outcome of non-union therapy and should, therefore, not be considered a risk factor. In contrast, patients in their fifth decade suffering from lower limb non-unions should be considered as high-risk patients and treatment should be modified accordingly.<\/jats:p>","DOI":"10.3390\/jcm8091276","type":"journal-article","created":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T10:15:07Z","timestamp":1566555307000},"page":"1276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0243-8113","authenticated-orcid":false,"given":"Michael","family":"Tanner","sequence":"first","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wasilios","family":"Vlachopoulos","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Findeisen","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Miska","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Ober","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saskia","family":"Hagelskamp","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhard","family":"Schmidmaier","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-0387","authenticated-orcid":false,"given":"Patrick","family":"Haubruck","sequence":"additional","affiliation":[{"name":"HTRG\u2014Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, D-69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1359\/jbmr.070315","article-title":"Residual lifetime risk of fractures in women and men","volume":"22","author":"Nguyen","year":"2007","journal-title":"J. Bone Miner. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/1759720X17732562","article-title":"Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs","volume":"9","author":"Lems","year":"2017","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.berh.2017.11.002","article-title":"Musculoskeletal health and frailty","volume":"31","author":"McGuigan","year":"2017","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1007\/s40520-013-0096-8","article-title":"Fracture healing in elderly patients: New challenges for antiosteoporotic drugs","volume":"25","author":"Tarantino","year":"2013","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/17453674.2017.1321351","article-title":"The risk of non-union per fracture: Current myths and revised figures from a population of over 4 million adults","volume":"88","author":"Mills","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3356","DOI":"10.1002\/art.24884","article-title":"Circulating mesenchymal stem cells with abnormal osteogenic differentiation in patients with osteoporosis","volume":"60","author":"Valenti","year":"2009","journal-title":"Arthritis Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/j.injury.2011.05.011","article-title":"Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures","volume":"42","author":"Moghaddam","year":"2011","journal-title":"Injury"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1016\/j.orthres.2005.04.003.1100230610","article-title":"Cellular basis for age-related changes in fracture repair","volume":"23","author":"Lu","year":"2005","journal-title":"J. Orthop. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1097\/00005131-199711000-00009","article-title":"Functional recovery following hip fracture in the elderly","volume":"11","author":"Egol","year":"1997","journal-title":"J. Orthop. Trauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.otsr.2011.11.001","article-title":"Treatment of posttraumatic bone defects by the induced membrane technique","volume":"98","author":"Karger","year":"2012","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.maturitas.2016.07.014","article-title":"Fracture healing in the elderly: A review","volume":"92","author":"Foulke","year":"2016","journal-title":"Maturitas"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1016\/S0020-1383(15)30017-6","article-title":"Treatment of atrophic tibia non-unions according to \u2018diamond concept\u2019: Results of one- and two-step treatment","volume":"46","author":"Moghaddam","year":"2015","journal-title":"Injury"},{"key":"ref_13","first-page":"659","article-title":"Long Bone Nonunion","volume":"153","author":"Schmidmaier","year":"2015","journal-title":"Z Orthop. Unf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1302\/0301-620X.98B1.35682","article-title":"Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept","volume":"98-B","author":"Miska","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jor.2016.10.003","article-title":"Treatment of atrophic femoral non-unions according to the diamond concept: Results of one- and two-step surgical procedure","volume":"14","author":"Moghaddam","year":"2017","journal-title":"J. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s10195-019-0528-0","article-title":"The \u2018diamond concept\u2019 for long bone non-union management","volume":"20","author":"Andrzejowski","year":"2019","journal-title":"J. Orthop. Traumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S221","DOI":"10.1016\/j.main.2010.10.007","article-title":"Induced membrane technique for bone defects in the hand and wrist","volume":"29","author":"Masquelet","year":"2010","journal-title":"Chir. Main"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2147\/JIR.S110621","article-title":"The treatment of nonunions with application of BMP-7 increases the expression pattern for angiogenic and inflammable cytokines: A matched pair analysis","volume":"9","author":"Haubruck","year":"2016","journal-title":"J. Inflamm. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ocl.2009.07.011","article-title":"The concept of induced membrane for reconstruction of long bone defects","volume":"41","author":"Masquelet","year":"2010","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_20","first-page":"518","article-title":"Results of nonunion treatment with bone morphogenetic protein 7 (BMP-7)","volume":"115","author":"Zimmermann","year":"2012","journal-title":"Unfallchirurg"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0736-0266(03)00165-7","article-title":"Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration","volume":"22","author":"Pelissier","year":"2004","journal-title":"J. Orthop. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2147\/TCRM.S152008","article-title":"Initial peri- and postoperative antibiotic treatment of infected nonunions: Results from 212 consecutive patients after mean follow-up of 34 months","volume":"14","author":"Helbig","year":"2018","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.2147\/TCRM.S91532","article-title":"Are atrophic long-bone nonunions associated with low-grade infections?","volume":"11","author":"Dapunt","year":"2015","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.exger.2006.09.008","article-title":"Fracture healing in the elderly patient","volume":"41","author":"Gruber","year":"2006","journal-title":"Exp. Gerontol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.bone.2016.11.006","article-title":"Bone fracture nonunion rate decreases with increasing age: A prospective inception cohort study","volume":"95","author":"Zura","year":"2017","journal-title":"Bone"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"653","DOI":"10.3109\/17453674.2012.747054","article-title":"Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database","volume":"83","author":"Hernandez","year":"2012","journal-title":"Acta Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1177\/2151458514532811","article-title":"Older age does not affect healing time and functional outcomes after fracture nonunion surgery","volume":"5","author":"Taormina","year":"2014","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.injury.2017.11.006","article-title":"Diabetes and Healing Outcomes in Lower Extremity Fractures: A Systematic Review","volume":"49","author":"Gortler","year":"2018","journal-title":"Injury"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1053\/j.jfas.2012.11.012","article-title":"Factors associated with nonunion, delayed union, and malunion in foot and ankle surgery in diabetic patients","volume":"52","author":"Shibuya","year":"2013","journal-title":"J. Foot Ankle Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/BOT.0b013e318156c2a2","article-title":"Outcomes of tibial nonunion in older adults following treatment using the Ilizarov method","volume":"21","author":"Brinker","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.3928\/01477447-20140124-26","article-title":"Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7, and mesenchymal stem cells","volume":"37","author":"Murena","year":"2014","journal-title":"Orthopedics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"273","DOI":"10.5435\/JAAOS-20-05-273","article-title":"Assessment of compromised fracture healing","volume":"20","author":"Bishop","year":"2012","journal-title":"J. Am. Acad. Orthop. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/9\/1276\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:13:08Z","timestamp":1760188388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/9\/1276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,22]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["jcm8091276"],"URL":"https:\/\/doi.org\/10.3390\/jcm8091276","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,22]]}}}