Use of bone marrow aspirate concentrate (BMAC) in the treatment of delayed unions and nonunions: a single-center case series.

BACKGROUND AND AIM: Surgical treatment of delayed unions and nonunions requires adherence to the principles of mechanical stability, as well as consideration of biological environment. Bone marrow aspirate concentrate (BMAC) provides cellular and growth factor supply acting as an osteoinductive and osteogenic stimulus in bone healing. The aim of the study is to analyze the outcome of delayed unions and nonunions treatment with autologous bone marrow concentrate supplementation at our institution. METHODS: Study included all patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2015 and January 2022 for delayed union or nonunion who received bone marrow aspirate concentrate (BMAC) supplementation. Initial treatment, definitive surgical treatment, radiographic healing and complications were retrospectively evaluated. Data collection was conducted by clinical database searching. RESULTS: The study population included 11 patients, F:M 7:4, mean age 61 years. Initial treatment was surgical in 82% of patients. Radiographic healing of the fracture occurred in 100% of cases. None of the patients presented complications. CONCLUSIONS: Bone marrow aspirate concentrate (BMAC) has shown encouraging results and a high safety profile. Thus, it could be an effective and safe method in the treatment of delayed unions and nonunion. However, further studies will be needed to clarify its role.

Distal femur periprosthetic knee fractures in elderly patients: clinical and radiographic outcome after internal fixation.

BACKGROUND AND AIM OF THE WORK: The incidence of periprosthetic knee fractures is steadily increasing, especially in the geriatric population. Surgical treatment in these patients must consider the poor bone quality and the risks of general complications related to age and comorbidities. The aim of the present study is to analyze the clinical and radiographic outcome of internal fixation for periprosthetic knee fractures of the distal femur in elderly patients (>75aa). METHODS: All patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2014 and September 2019 for distal femur periprosthetic fracture after total knee replacement were included in the study. Mortality, complications, radiographic healing and functional outcomes were retrospectively evaluated. Data collection was conducted by clinical database searching and telephone interview. Results were compared with the literature. RESULTS: The study population included 19 patients, F:M 16:3, mean age 84 years. Plate fixation was used in the majority of cases (90%). One-year mortality was 21.05%. Radiographic healing of the fracture occurred in 92% of cases. Nonetheless, 61% of patients saw a worsening in their functional outcome. CONCLUSION: Internal fixation is a valuable and safe option for distal femur periprosthetic fracture treatment in the elderly. The significant impact of periprosthetic knee fractures on the medium- to long-term survival and quality of life of the elderly patient is confirmed.

Fibula fractures management.

Isolated distal fibula fractures represent the majority of ankle fractures. These fractures are often the result of a low-energy trauma with external rotation and supination mechanism. Diagnosis is based on clinical signs and radiographic exam. Stress X-rays have a role in detecting associated mortise instability. Management depends on fracture type, displacement and associated ankle instability. For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results. Conservative treatment must also be considered in overaged unhealthy patients, even in unstable fractures. Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described. Outcome is excellent in most cases. Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon.