A case series utilizing bone marrow aspirate concentrate, cancellous bone autograft, platelet-rich plasma and autologous fibrin for the treatment of femur nonunions.

Aim: To assess the efficacy of a bioregenerative scaffold derived from bone marrow aspirate, cancellous bone autograft, platelet-rich plasma and autologous fibrin in treating supracondylar femur nonunions. Methods & materials: Three patients with nonunions following multiple surgical failures underwent bone stabilization and the application of a novel bioregenerative scaffold. x-rays and subjective scales were collected before surgery and at 6, 12 and 24 months post-surgery. Results: All nonunions exhibited healing with sufficient callus formation, as confirmed radiologically. After 6 months, all patients resumed full weight-bearing walking without pain. Statistical analysis showed improvements in all scales compared with pre-surgical values. Conclusion: This method presents itself as an option for treating supracondylar femur nonunions following multiple surgical failures.

What is this summary about? The objective of this case series study was to evaluate the effectiveness of a new biological autologous scaffold, comprised of stem and blood cells along with blood derivatives, in treating challenging cases of supracondylar femur nonunions.What were the results? Three participants underwent the application of this surgical method and were monitored for a period of 2 years. The therapy was well tolerated and deemed safe. Notably, all three patients experienced significant reductions in pain and improvements in functionality. Within a few months, they were able to walk with full weightbearing without pain, and clear indications of progressing toward bone union were evident by the 6 months.What do the results mean? This study demonstrates that the surgical application of autologous blood, cancellous bone and bone marrow, following the described concept and method, is an effective, safe and enduring treatment for femur nonunions. It markedly diminishes pain, enhances leg function and yields statistically significant improvements in quality of life.

Percutaneous injection of autologous platelet gel accelerate healing in diabetic tibial non union: On going longitudinal study.

INTRODUCTION: In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection. MATERIAL AND METHODS: This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views. RESULTS: Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003). CONCLUSION: This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.

Comparison of reamer irrigator aspirator (RIA) suspension versus bone marrow aspirate concentrate (BMC) for percutaneous treatment of long bone nonunions-A preclinical canine model.

OBJECTIVE: To compare the bone healing effects of percutaneously delivered bone marrow aspirate concentrate (BMC) versus reamer irrigator aspirator (RIA) suspension in a validated preclinical canine ulnar nonunion model. We hypothesized that BMC would be superior to RIA in inducing bone formation across a nonunion site after percutaneous application. The null hypothesis was that BMC and RIA would be equivalent. METHODS: A bilateral ulnar nonunion model (n= 6; 3 matched pairs) was created. Eight weeks after segmental ulnar ostectomy, RIA from the ipsilateral femur and BMC from the proximal humerus were harvested and percutaneously administered into either the left or right ulnar defect. The same volume (3 ml) of RIA suspension and BMC were applied on each side. Eight weeks after treatment, the dogs were euthanized, and the nonunions were evaluated using radiographic, biomechanical, and histologic assessments. RESULTS: All dogs survived for the intended study duration, formed radiographic nonunions 8 weeks after segmental ulnar ostectomy, and underwent the assigned percutaneous treatment. Radiographic and macroscopic assessments of bone healing at the defect sites revealed superior bridging-callous formation in BMC-treated nonunions. Histologic analyses revealed greater amount of bony bridging and callous formation in the BMC group. Biomechanical testing of the treated nonunions did not reveal any significant differences. CONCLUSION: Bone marrow aspirate concentrate (BMC) had important advantages over Reamer Irrigator Aspirator (RIA) suspension for percutaneous augmentation of bone healing in a validated preclinical canine ulnar nonunion model based on clinically relevant radiographic and histologic measures of bone formation.

Polytherapy versus monotherapy in the treatment of tibial non-unions: a retrospective study.

BACKGROUND: Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of polytherapy compared with monotherapy in treating tibial non-unions of varying severity. MATERIALS AND METHODS: Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18 months post-surgery, were recorded. Initially, a comparison was made between the polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis. RESULTS: A total of 34 patients were included and divided into a polytherapy group (n = 15) and a monotherapy group (n = 19). The polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = -2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = -2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively. CONCLUSIONS: Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions. LEVEL OF EVIDENCE: Level III.

SVF Therapy of Delayed Fracture Union in Patients with Multiple Combat Injury. Case Report.

Delayed union of fractures is one of the most frequent complications in orthopedic practice, especially in polytrauma patients. With the development of new methods of regenerative medicine, including the use of adipose derived stromal cells as a component of the stromal-vascular fraction (SVF), new possibilities for conservative treatment of this problem have emerged. This article presents a clinical case of conservative treatment of delayed union of a radial bone fracture using local SVF injections. In the fracture space, SVF with PRP creates a pool of cells that could differentiate towards surrounding tissue, releases various inducers of tissue growth and, via an indirect chemotactic effect on receptors, mobilizes the body's own resources and creates conditions for angiogenesis and trophism in the injured segment. In the patient with delayed consolidation after SFV-therapy, progress in clinical and radiological dynamics was noted with complete healing within 7 months. The positive clinical result provides a basis for further study and implementation in practice.

Approach to Tibial Shaft Nonunions: Diagnosis and Management.

The tibia is the most common long bone at risk for nonunion with an annual incidence ranging from 12% to 19%. This topic continues to be an area of research as management techniques constantly evolve. A foundational knowledge of the fundamental concepts, etiology, and risk factors for nonunions is crucial for success. Treatment of tibial shaft nonunions often requires a multidisciplinary effort. This article provides guidance based on the most recent literature that can be used to aid the treating provider in the diagnosis, workup, and management of tibial shaft nonunions.

Are displaced distal clavicle fractures associated with inferior clinical outcomes following nonoperative management? A systematic review.

BACKGROUND: Management of displaced distal clavicle fractures remains a topic of discussion because of notoriously high nonunion rates, but there is little documented in the literature as to what effect this may have on patient-reported function. The aim of this systematic review was to look at nonoperative management following displaced distal clavicle fractures to determine union rates, complications, and patient-reported outcome measures. METHODS: A review of the online databases MEDLINE and Embase was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies that included a cohort of nonoperatively managed displaced distal clavicle fractures and reported on union rate, complications, and patient-reported functional scores were included. RESULTS: Eleven studies were eligible for inclusion (2 randomized controlled trials, 1 prospective noncomparative cohort study, 5 retrospective comparative cohort studies, and 3 case series) with a total of 779 patients included in this review. Average union rate was 63.2% (22.2%-94.4%) in nonoperatively managed patients, compared with 96.3% (87.9%-100%) in operatively managed patients. The Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand questionnaire were the most frequently used outcome measure tools. No study demonstrated any significant difference in any outcome measure when comparing nonoperative with operative treatment. Complication rate (including nonunion) in nonoperatively managed patients was 45.1%, with 11.1% requiring delayed surgery. Average complication rate in the operatively managed groups was 41.2%, with 40.1% requiring a second operation. CONCLUSION: Nonoperative management of displaced distal clavicle fractures results in higher nonunion rates, but shoulder function remains excellent, and risk of complications and delayed surgery are low. Decision making must take into account patient factors and expectations to provide high-quality, individualized care.

Enriquecimiento de injerto autologo con concentrado de factores de crecimiento / Autologous graft combined with growth factors concentrate

Introducción: Debido a los cambios recientes en torno al tratamiento de las fracturas, en los últimos años se ha priorizado una combinación de métodos no sólo mecánicos sino también biológicos. En este estudio se evalúan los resultados de un tratamiento combinado mediante osteosíntesis y aplicación de injerto enriquecido con agregado plaquetario, con resultados alentadores. Materiales y métodos: Nuestra serie comprendió 29 pacientes tratados entre 1999 y 2006, laboralmente activos, con una edad promedio de 42 años (rango, 26 a 62 años). En todos los casos se efectuó osteosíntesis con el agregado plaquetario rico en factores de crecimiento plaquetario. Los resultados se analizaron en función de la formación de callo fracturario a los 6 meses. La obtención de injerto esponjoso fue dificultosa en los pacientes reintervenidos. Resultados: La obtención y preparación del agregado plaquetario no presentó inconvenientes. La consolidación clínica y radiológica se alcanzó en los 29 casos al término de 4 meses (2-6 meses); en 2 casos fue necesario repetir el procedimiento de aporte sin recambio del implante a los 2 meses de la primera intervención. Conclusiones: El injerto autólogo enriquecido con plasma rico en factores de crecimiento pudo haber contribuido de manera favorable a la consolidación de estos casos complejos, con gran ausencia biológica, en los que habían fracasado otros métodos

Efecto del injerto de médula ósea autóloga percutánea como tratamiento de fracturas con retardo de consolidación en pacientes atendidos en el Hospital Central de Maracay: enero de 2002 - junio de 2003 / Effect of autologous bone marrow graft and percutaneous treatment of fractures with delayed consolidation in patients treated at the Hospital Central de Maracay: january 2002 - june 2003

Se realizó un estudio prospectivo en 40 pacientes que presentaron retardo de consolidación en el Hospital Central de Maracay, en el lapso comprendido entre enero de 2002 a junio de 2003, para determinar la eficacia del tratamiento con injerto percutáneo de médua ósea autóloga. Se evaluaron pacientes desde el punto de vista clínico y radiológico reportándose excelentes y buenos resultados en el 85 por ciento de los casos. Se utilizó una técnica segura y fácil de realizar sin ninguna complicación posterior. El paciente no ameritó hospitalización para realizar dicho procedimiento.

Uso de la magnetoterapia en afecciones articulares y periarticulares / Use of magnetotherapy in articular and periarticular disorders

Se analizan los resultados obtenidos en 200 pacientes tratados en el Policlínico Integral Docente Centro, de Camagüey, con diversas artropatías y enfermedades ortopédicas y reumatológicas. Se utilizó el campo magnético producido por el equipo TERAMAG-MT-200. Se obtuvo buen resultado en 189 casos (94,5 por ciento). Las afecciones más beneficiadas fueron las de la rodilla (osteoartritis, sinovitis, fibrosis y rigideces posquirúrgicas, condromalacia y enfermedad de Hoffa), la epicondilitis y otras lesiones del codo, la periatritis escapulohumeral, tendinitis, insercionitis, trocanteritis, síndrome de Barré-Liéou y los dedos en resorte. Se describen los métodos utilizados en cada afección

Estimulaçäo eletromagnética de fraturas näo consolidadas no prazo normal: resultados obtidos nos primeiros 28 casos / Electromagnetic stimulation of ununited fractures within normal term: results obtained in the first 28 cases

O autor estuda 28 casos de fraturas näo consolidadas no tempo normal e que, por esse motivo, passaram a ser tratadas pela estimulaçäo eletromagnética pulsátil (EEMP). O estimulador utilizado foi desenvolvido na Universidade Estadual de Campinas (Unicampi). Todos os casos, exceto um, foram tratados no Ambulatório de Ortopedia do Hospital das Clínicas (HC) da Unicamp. Uma paciente abandonou o tratamento; dos 27 que permanecem no programa, 22 obtiveram a consolidaçäo da fratura. As cinco falhas säo discutidas pormenorizadamente. O autor relata a experiência adquirida com o emprego do método em nosso meio. A percentagem de cura obtida, 80%, é semelhante à da literatura médica. Conclui-se que a EEMP com emprego do equipamento desenvolvido na Unicamp e com observaçäo das normas preconizadas por Bassett é método eficaz no tratamento de casos selecionados de retarde de consolidaçäo e de pseudartrose

Estimulación eléctrica como tratamiento de elección en retardos de consolidación y fracturas no consolidadas / Electric stimulation as elective treatment in delayed union and nonunited fractures

Se emplea un estimulador eléctrico de corriente directa constante por medio de clavos percutáneos colocados durante doce semanas en el foco de fracturas en retardo de consolidación o no consolidadas. Se presentan solamente los casos con seguimiento mayor a seis meses; se obtuvo consolidación clínica y radiológica en el 88.2% para un total de 34 fracturas. Se confirma la bondad del método que se coloca de acuerdo a estos resultados entre los tratamientos para fracturas abiertas o cerradas, en retardo de consolidación o no consolidadas, en donde otros métodos han fracasado. En nuestro servicio, utilizamos este método para tratamiento de fracturas con las características anotadas, desde agosto de 1980

Seudoartrosis / Pseudoarthrosis

Se presentaron 40 casos de seudoartrosis correspondientes al Hogar Clínica San Juan de Dios y Hospital Hipólito Unánue, sobre los cuales se ha realizado un estudio con referencia a la etiología, tiempo de fractura, tratamiento previo a la seudoartrosis, localización, tratamientos empleados y sus resultados