Humeral shaft non-union in the elderly: Results with cortical graft plus stem cells

Giuseppe Toro; Federica Lepore; Giampiero Calabrò; Gabriella Toro; Marco Rossini; Michele Vasso; Alfredo Schiavone Panni

doi:10.1016/j.injury.2019.01.050

Humeral shaft non-union in the elderly: Results with cortical graft plus stem cells

Injury. 2019 Jul:50 Suppl 2:S75-S79. doi: 10.1016/j.injury.2019.01.050. Epub 2019 Feb 27.

Authors

Giuseppe Toro¹, Federica Lepore², Giampiero Calabrò³, Gabriella Toro⁴, Marco Rossini², Michele Vasso², Alfredo Schiavone Panni²

Affiliations

¹ Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy. Electronic address: peppetoro@msn.com.
² Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.
³ Unit of Orthopaedics and Traumatology, Villa Malta Hospital, Sarno, Italy.
⁴ Unit of Radiology and Nuclear Medicine, Santa Maria della Speranza Hospital, Battipaglia, Italy.

PMID: 30846284
DOI: 10.1016/j.injury.2019.01.050

Abstract

Introduction: Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem cells are some of the augmentation techniques available to reach these goals.

Purpose: Evaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells.

Material and methods: A cohort of 21 patients with humeral shaft non-union was reviewed. Inclusion criteria were patients aged more than 65 years, with a diagnosis of humeral shaft non-union treated with cortical allograft and stem cells. Primary endpoints were 'bone healing' and 'time-to-union'. Secondary endpoints were shoulder and elbow function and patients' quality of life with Oxford Shoulder Score (OSS), Constant score and EuroQol-5D (EQ-5D).

Results: 6 patients met the inclusion criteria. In 5 of them, the cortical allograft was opposite to a plate, whereas in the other one a "Sandwich" technique was chosen because of large osteolysis. 'Bone healing' occurred in all patients after a mean of 3.3 months (range 2-5). In all but two patients, the elbow range of motion was in almost normal range (15-130). The mean OSS was 35.8 (+/- 6.4), whereas the mean Constant was 53.3 (+/- 2.2). The mean EQ-5D index was 0.451 (+/- 0.21).

Discussion: Bone healing occurred in all patients, with a time-to-union comparable or even better compared with other series. The use of cortical bone graft provide both stability and biological benefit, whereas stem cells improve the non-union environmental biology. Functional outcomes were lower than other series and patients' quality of life was similar to Italian elderly women.

Conclusion: The use cortical allograft with stem cells is a viable strategy to treat humeral shaft non-union in the elderly.

Keywords: Bone graft; Diamond concept; Elderly; Humeral shaft fractures; Humeral shaft non-union; Osteoporosis; Stem cells.

MeSH terms

Aged
Aged, 80 and over
Bone Transplantation*
Female
Fracture Fixation, Internal* / methods
Fracture Healing / physiology*
Fractures, Ununited / diagnostic imaging
Fractures, Ununited / physiopathology
Fractures, Ununited / surgery*
Humans
Humeral Fractures / diagnostic imaging
Humeral Fractures / physiopathology
Humeral Fractures / surgery*
Retrospective Studies
Stem Cell Transplantation*
Treatment Outcome