• Injury · Jul 2019

    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, and Alfredo Schiavone Panni.
    • Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy. Electronic address: peppetoro@msn.com.
    • Injury. 2019 Jul 1; 50 Suppl 2: S75-S79.

    IntroductionHumeral 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.PurposeEvaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells.Material And MethodsA 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).Results6 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).DiscussionBone 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.ConclusionThe use cortical allograft with stem cells is a viable strategy to treat humeral shaft non-union in the elderly.Copyright © 2019 Elsevier Ltd. All rights reserved.

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