Treatment of Humeral Shaft Aseptic Nonunions in Elderly Patients With Opposite Structural Allograft, BMP-7, and Mesenchymal Stem Cells

Murena, Luigi; Canton, Gianluca; Vulcano, Ettore; Surace, Michele Francesco; Cherubino, Paolo

doi:10.3928/01477447-20140124-26

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…Our literature review revealed only one other study evaluating the clinical effectiveness of BMP-7 in long-bone non-union treatment of elderly adults. Murena et al analyzed the outcome of humeral shaft non-union therapy using BMP-7 in two older adults [31]. They reported BMP-7 to be a safe and effective treatment option.…”

Section: Discussionmentioning

confidence: 99%

Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis

Tanner¹,

Vlachopoulos²,

Findeisen³

et al. 2019

JCM

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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 “diamond concept”, 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; >60 years; n = 45) and control group (CG; <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 >60 years on radiological or clinical outcome, whereas a significant negative correlation was revealed between patients aged 40–49 years and radiological non-union consolidation (b = −1.145 and p = 0.048). In addition, diabetes had a negative influence on non-union therapy (b = −1.145 and p = 0.048). As expected, the clinical outcome correlated significantly with the radiological outcome (p < 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.

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Section: Discussionmentioning

confidence: 99%

Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis

Tanner¹,

Vlachopoulos²,

Findeisen³

et al. 2019

JCM

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“…Various kinds of treatment using intramedullary nailing, screw fixation, and plate fixation with or without bone grafts are available; however, the ideal treatment for nonunion of the proximal humerus remains unclear (Allende & Allende, ; King et al, ; Volgas et al, ). Although the recently developed anatomical locking plate has improved the stability of bone fixation for fractures of the proximal humerus (Rose et al, ), additional augmentation to allow acceleration of bone healing may be needed in more complicated cases (Murena, Canton, Vulcano, Surace, & Cherubino, ). Although a vascularized bone graft that has an abundant blood supply and appropriate biological characteristics is considered to be suitable for bone healing, there are few reports of an operative procedure using a locking plate combined with a vascularized bone graft for treating a nonunion of the proximal humerus.…”

Section: Discussionmentioning

confidence: 99%

“Half‐folded” pedicled scapular bone flap for nonunion after humeral neck fracture: A case report

et al. 2017

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Treatment of a nonunion of the proximal humerus remains a challenge because of the small proximal fragment and poor central cancellous bone stock of the humeral head. In this report, we describe our experience using a "half-folded" pedicled scapular bone flap with an anatomical locking plate to treat an atrophic nonunion of the proximal humerus in a 64-year-old right-handed woman. The patient had fallen and experienced a common humeral neck fracture 2.5 years previously. During the operation, we elevated the pedicled scapular bone flap, which measured 8.0 cm long and 1.5 cm wide, with a vascular pedicle about 10 cm long. We modified the bone flap to the half-folded type to fill the massive bone cavity in the humeral head. The proximal tip of the flap was divided into two segments while keeping the ventral soft tissue intact. The grafted bone bridging between the head and shaft of the humerus was rigidly fixed with a plate and screw. The operated shoulder was fixed with a sling and a chest belt for 3 weeks, after which the patient began active motion exercises of the shoulder joint. The flap survived without serious donor site morbidity, and good bone healing was obtained about 3.5 months after surgery. The patient was able to use the shoulder comfortably in daily activity without any serious donor site morbidity at 16 months after the surgery. This procedure may be effective in treating nonunion of the proximal humerus with a massive bone cavity in the humeral head.

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“…On the other hand, this literature research also revealed that most of the clinical findings are based on case reports or case series with small patient populations, characterized by different delivery approaches, anatomical locations, bone pathologies and dosages, which makes it difficult to draw any final conclusion about the real potential of BMPs therapy and the best protocol they can be applied to [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Therefore, further research in this direction is needed.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Krishnakumar

Roffi

Reale

et al. 2017

International Orthopaedics (SICOT)

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Purpose This paper documents the existing evidence on bone morphogenetic proteins (BMPs) use for the treatment of bone fractures, non-union, and osteonecrosis, through a review of the clinical literature, underlying potential and limitations in terms of cost effectiveness and risk of complications. Methods A systematic review was performed on the PubMed database using the following string: (bone morphogenetic proteins OR BMPs) and (bone repair OR bone regeneration) including papers from 2000 to 2016. The search focused on clinical trials dealing with BMPs application to favor bone regeneration in bone fractures, non-union, and osteonecrosis, in English language, with level of evidence I, II, III, and IV. Relevant data (type of study, number of patients, BMPs delivery material, dose, site, follow-up, outcome, and adverse events) were extracted and analyzed. Results Forty-four articles met the inclusion criteria: 10 randomized controlled trials (RCTs), 7 comparative studies, 18 case series, and 9 case reports. rhBMP-2 was documented mainly for the treatment of fractures, and rhBMP-7 mainly for non-unions and osteonecrosis. Mixed results were found among RCTs and comparative papers: 11 reported positive results for BMPs augmentation, 3 obtained no significant effects, and 2 showed negative results. The only study comparing the two BMPs showed a better outcome with rhBMP-2 for non-union treatment. Conclusion Clinical evidence on BMPs use for the treatment of fractures, non-union, and osteonecrosis is still controversial, with the few available reports being mainly of low quality. While positive findings have been described in many studies, mixed results are still present in the literature in terms of efficacy and adverse events. The difficulties in drawing clear conclusions are also due to the studies heterogeneity, mainly in terms of different BMPs applied, with different concomitant treatments for each bone pathology. Therefore, further research with well-designed studies is needed in order to understand the real potential of this biological approach to favour bone healing.

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Treatment of Humeral Shaft Aseptic Nonunions in Elderly Patients With Opposite Structural Allograft, BMP-7, and Mesenchymal Stem Cells

Cited by 14 publications

References 18 publications

Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis

Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis

“Half‐folded” pedicled scapular bone flap for nonunion after humeral neck fracture: A case report

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

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