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

Authors Tanner MC, Hagelskamp S, Vlachopoulos W, Miska M, Findeisen S, Grimm A, Schmidmaier G, Haubruck P

Received 14 December 2019

Accepted for publication 7 May 2020

Published 21 July 2020 Volume 2020:15 Pages 1221—1230


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

Michael C Tanner, Saskia Hagelskamp, Wasilios Vlachopoulos, Matthias Miska, Sebastian Findeisen, Andreas Grimm, Gerhard Schmidmaier, Patrick Haubruck

Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany

Correspondence: Michael C Tanner
Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg D-69118, Germany
Tel +49-6221-5635987
Fax +49-6221-5626300
Email [email protected]

Background: Patients > 60 years suffering from non-unions are often unable to perform activities of daily living and often become dependent on nursing care. Evidence regarding treatment options and outcome is nonexistent. This study sought to determine the clinical effectiveness and safety of one- or two-step non-union therapy in elderly patients.
Methods: This study was a single-site retrospective database analysis of older adults with long bone non-unions treated via “diamond concept”. All medical records of patients receiving surgical treatment of non-unions between 01/01/2010 and 31/12/2016 were reviewed. Clinical and radiological outcome subsequent to non-union therapy were evaluated.
Results: A total of 76 patients (37 patients were treated with one-step and 39 patients with Masquelet therapy) suffering from a non-union older than 60 years treated between 01/01/2010 and 31/12/2016 in our institution were included into the current study. Bone consolidation was achieved in 91.9% after one-step and 76.9% after the Masquelet therapy. Analysis of age as a risk factor in the outcome of non-union therapy revealed no significant differences in patients treated with the one-step procedure according to the “diamond concept”. On the contrary, age had a significant negative influence on the outcome of the Masquelet therapy (p = 0.027).
Conclusion: Non-union therapy according to the “diamond concept” is an effective and reliable treatment option in elderly patients. According to findings of the current study, older adults suffering from an infected non-union benefit from a two-stage procedure, whereas in patients suffering from a non-infected non-union, a one-step surgical treatment is beneficial.

Keywords: fracture healing, Masquelet-procedure, non-union therapy, pseudarthrosis

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