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1.
Mymensingh Med J ; 29(1): 32-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915332

RESUMO

Bone marrow is a source of osteoprogenitor cells which are the most important factor of bone formation and healing of fracture. The aim of the study is to evaluate the outcome of bone marrow injection in the management of delayed union and non-union. This prospective study was performed in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2017 to June 2019. In this study 21 patients with delayed union and non-union were treated by bone marrow injection. Bone marrow were aspirated from the anterior or posterior iliac crests then injected percutaneously into the fracture site. Full union was achieved in 15 cases, while failed in the others. No major complications were seen during or after the procedure. It is a safe, easy and a minimally invasive procedure compared to usual open bone graft especially for cases with high risk of anesthesia or risk of infection.


Assuntos
Transplante de Medula Óssea/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/terapia , Fraturas da Tíbia/terapia , Bangladesh , Fraturas Ósseas , Fraturas não Consolidadas/fisiopatologia , Humanos , Injeções , Masculino , Estudos Prospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
2.
Biomed Res Int ; 2019: 1983131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467871

RESUMO

Nonunion with bone defects, a common complication after long bone fracture, is a major challenge for orthopaedic surgeons worldwide because of the high incidence rate and difficulties in achieving successful treatment. Bone defects are the main complications of nonunion. The conventional biological treatments for nonunion with bone defects involve the use of autologous bone grafts or bone graft substitutes and cell-based therapy. Traditional nonunion treatments have always been associated with safety issues and various other complications. Bone grafts have limited autologous cancellous bone and there is a risk of infection. Additionally, problems with bone graft substitutes, including rejection and stimulation of bone formation, have been noted, and the health of the stem cell niche is a major consideration in cell-based therapy. In recent years, researchers have found that exosomes can be used to deliver functional RNA and mediate cell-to-cell communication, suggesting that exosomes may repair bone defects by regulating cells and cytokines involved in bone metabolism. In this review, we highlight the possible relationships between risk factors for nonunion and exosomes. Additionally, we discuss the roles of exosomes in bone metabolism and bone regeneration.


Assuntos
Regeneração Óssea/genética , Exossomos/genética , Fraturas Ósseas/terapia , Fraturas não Consolidadas/terapia , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Terapia Baseada em Transplante de Células e Tecidos/tendências , Exossomos/transplante , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Fraturas não Consolidadas/fisiopatologia , Humanos , Osteogênese
3.
Handchir Mikrochir Plast Chir ; 51(3): 164-170, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31167276

RESUMO

BACKGROUND: Operative procedures are considered gold standard in the treatment of scaphoid nonunion, albeit their considerable complexity and the risk of intraoperative complications. High energy extracorporeal shockwave therapy (ESWT) offers a non-invasive treatment option for scaphoid nonunion. The aim of this study was to explore the rate of bony consolidation and further outcome variables in patients with delayed union of scaphoid fractures and scaphoid nonunion treated with ESWT. PATIENTS AND METHODS: Due to delayed union (21) or nonunion (21) of a scaphoid fracture 42 patients (37 men, and 5 women) with an average age of 48,3 (15-66) years underwent ESWT followed by immobilization in a forearm cast including the proximal phalanx of the thumb for 6 to 8 weeks. In 13 patients the fracture was initially treated, 8 with immobilization, 5 with screw fixation. In 5 of the 29 patients without an initially treatment, the fracture resp. nonunion was secondarily treated with screw fixation (2) or a medial femur condyle (3) but failed to heal. 10 to 12 weeks after the ESWT bony healing was controlled with computed scanning in the long axis of the scaphoid. If 50 % of diameter of the scaphoid showed trabecula bony healing was considered. Factors with potential influence on bony healing (site of the fracture/nonunion, scapholunate angle, patient´s age, Body Mass Index, smoking and alcohol consume) were analyzed. In addition, 34 patients underwent a clinical follow-up examination including DASH and Mayo Wrist Score, pain analyzes (VAS). RESULTS: Seventy-one per cent of patients showed scaphoid fracture consolidation using ESWT. In 7 out of 8 patients with conservative treatment and in 4 out of 5 patients with screw fixation of the initial fracture bony healing was achieved. From the 5 patients with secondary surgical treatment of the scaphoid only 1 patient, treated with a medial femur condyle, failed to heal the scaphoid. 15 out of the 24 initially non-treated scaphoid fractures healed. The time between ESWT and the documented bony healing averaged 8.4 months (256 days). Neither fracture site, nor the scapholunate angle, alcohol and tobacco use, as well as biometric factors, such as age and BMI had influence on the success rate of the ESWT. Side effects of the ESWT were limited to local skin irritations and petechial bleedings. CONCLUSION: ESWT has a positive effect regarding bony healing of scaphoid fracture with delayed fracture healing and nonunion with a success rate of 71 %. The complication rate is low, and the clinical results regarding wrist motion and pain are satisfying. Further investigations are necessary to evaluate the input of fracture/nonunion characteristics like the morphological appearance on bony healing.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Fraturas não Consolidadas , Osso Escafoide , Adolescente , Adulto , Idoso , Parafusos Ósseos , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Fraturas não Consolidadas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Orthop Res ; 37(2): 299-307, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30480339

RESUMO

Delayed union and nonunion are a significant concern in long bone fractures and spinal fusions. Treatment of nonunion often entails multiple revision surgeries that further increase the financial, physical, and emotional burden on patients. The optimal treatment strategy for nonunions remains unclear in many cases, and the risk of complications after revision procedures remains high. This is in part due to our limited understanding of the biological mechanisms that inhibit proper bone healing and lead to nonunion. And yet, few preclinical models directly investigate how healing is impacted after establishment of nonunion, with most instead primarily focusing on treatment immediately after a fresh bone injury. Here, we utilized a critical size femoral defect model in rats where treatment was delayed 8 weeks post-injury, at which time nonunion was established. In this study, acute and delayed treatments with bone morphogenetic protein-2 (BMP-2) were assessed. We found that delayed treatment resulted in decreased bone formation and reduced mechanical strength compared to acute treatment, even when BMP-2 dose was increased by 2.5 times the acute treatment dose. Interestingly, serum cytokine analysis at 12 weeks post-treatment revealed signs of chronic immune dysregulation after delayed treatment. In particular, non-responders (rats that did not exhibit defect bridging) demonstrated higher overall expression of inflammatory cytokines, including TNFα and IL-1ß, compared to responders. These findings suggest that re-establishing long-term immune homeostasis may be critical for successful bone healing, particularly after nonunion. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:299-307, 2019.


Assuntos
Regeneração Óssea , Citocinas/sangue , Modelos Animais de Doenças , Consolidação da Fratura , Fraturas não Consolidadas/sangue , Animais , Feminino , Fraturas do Fêmur/sangue , Fraturas do Fêmur/terapia , Fraturas não Consolidadas/terapia , Ratos Sprague-Dawley
5.
Clin Sports Med ; 38(1): 17-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30466721

RESUMO

Platelet-rich plasma (PRP) is a promising treatment for musculoskeletal maladies and clinical data to date have shown that PRP is safe. However, evidence of its efficacy has been mixed and highly variable depending on the specific indication. Additional future high-quality large clinical trials will be critical in shaping our perspective of this treatment option. The heterogeneity of PRP preparations, both presently and historically, leads sweeping recommendations about its utility impossible to make. This heterogeneity has also made interpreting existing literature more complicated.


Assuntos
Fraturas Ósseas/terapia , Músculo Esquelético/lesões , Osteoartrite/terapia , Plasma Rico em Plaquetas , Entorses e Distensões/terapia , Traumatismos dos Tendões/terapia , Fraturas não Consolidadas/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Pediatr Med Chir ; 40(2)2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30514075

RESUMO

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/terapia , Ossos do Metatarso/lesões , Pseudoartrose/diagnóstico , Placas Ósseas , Parafusos Ósseos , Criança , Fraturas Ósseas/patologia , Fraturas não Consolidadas/terapia , Humanos , Masculino , Ossos do Metatarso/patologia , Pseudoartrose/etiologia , Resultado do Tratamento
7.
JBJS Case Connect ; 8(4): e93-4, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30489377

RESUMO

CASE: Osteopetrosis is a heritable disease that causes brittle bones that are prone to fracture. Furthermore, these brittle bones have a poor healing response and a high risk of subsequent refracture. Many treatment strategies have been described for initial fracture stabilization; however, there is a paucity of literature describing treatment of refractures and subsequent deformity. We present the long-term results of a unique case in which we used a circular external fixator, the TAYLOR SPATIAL FRAME (Smith & Nephew), to correct a deformity in a patient with osteopetrosis who suffered multiple refractures of the tibia. CONCLUSION: We propose the potential use of distraction osteogenesis as an option for fracture and deformity treatment in patients with osteopetrosis.


Assuntos
Fixadores Externos , Fraturas não Consolidadas/terapia , Osteogênese por Distração , Osteopetrose/complicações , Fraturas da Tíbia/terapia , Pré-Escolar , Feminino , Humanos
8.
Orthop Traumatol Surg Res ; 104(8): 1241-1248, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30293748

RESUMO

BACKGROUND: Substantial evidence exists demonstrating the individual effectiveness of both rhBMP-2 and -7 in the treatment of nonunions, data comparing the clinical effectiveness of adjunct rhBMP-2 and -7 remains scarce. Therefore, we examined our large single-center case series to compare the clinical effectiveness of both rhBMP-2 and -7 in non-union therapy aiming to answer: - Does a certain type of BMP have an advantageous effect on radiological outcome of applied lower limb non-union therapy? - Does application of a certain type of BMP have an advantageous effect on radiological outcome of infected lower limb nonunions? - Are there any additional risk factors associated with inferior outcome in context with an adjunct BMP treatment? HYPOTHESIS: Both BMPs have the same effect on the radiological outcome of surgically treated lower limb nonunions. PATIENTS AND METHODS: Single-center retrospective database analysis of a case series of patients with lower limb long bone nonunions receiving either a one- or two-stage (Masquelet-) procedure based on the "diamond concept" with application of rhBMP-2 or -7. The "diamond concept" summarizes core factors that need to be present to achieve bone healing. In particular, these factors relate to the optimization of the mechanical (stability) and biological environment (sufficient osteogenic and angiogenic cells, osteoconductive scaffolds and growth factors). All medical data from patients that received surgical treatment between 01/01/2010 and 31/12/2016 were assessed. In total, 356 patients were treated with BMPs and 156 patients 18 years or older with non-union of their tibia or femur having a follow-up of at least 1 year were included. Consolidation in context with type of rhBMP was compared and the influence of relevant risk factors assessed. RESULTS: Consolidation rate was significantly higher in patients treated with rhBMP-2 (rhBMP-2: 42/46 (91%) vs. rhBMP-7: 64/110 (58%); p<0.001). In particular, application of rhBMP-2 increased the likelihood of consolidation for tibial nonunions (OR 32.744; 95%CI: 2.909-368.544; p=0.005) and when used in two-stage therapy (OR 12.095; 95% CI: 2.744-53.314; p=0.001). Furthermore, regression modeling revealed a higher correlation between application of rhBMP-2 and osseous consolidation in infected nonunions (OR 61.062; 95% CI: 2.208-1688.475; p=0.015) than in aseptic nonunions (OR 4.787; 95% CI: 1.321-17.351; p=0.017). Risk factors negatively influencing the outcome of non-union treatment in context with rhBMPs were identified as active smoking (OR 0.357; 95% CI: 0.138-0.927; p=0.024), atrophic nonunion (OR 0.23; 95% CI: 0.061-0.869; p=0.030), higher BMI (OR 0.919; 95% CI: 0.846-0.998; p=0.046) and a larger defect size (OR 0.877; 95% CI: 0.784-0.98; p=0.021). DISCUSSION: Patients who received rhBMP-2 for the treatment of tibial nonunions and as part of the two-stage treatment had a significantly higher rate of healing compared to patients treated with rhBMP-7 regardless of infection. LEVEL OF EVIDENCE: III, retrospective case-control study.


Assuntos
Proteína Morfogenética Óssea 2/uso terapêutico , Proteína Morfogenética Óssea 7/uso terapêutico , Fraturas do Fêmur/terapia , Fêmur/patologia , Fraturas não Consolidadas/terapia , Tíbia/patologia , Fraturas da Tíbia/terapia , Fator de Crescimento Transformador beta/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atrofia/complicações , Índice de Massa Corporal , Transplante Ósseo , Quimioterapia Adjuvante , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fumar , Fraturas da Tíbia/diagnóstico por imagem , Falha de Tratamento , Adulto Jovem
9.
PLoS One ; 13(8): e0201077, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30067783

RESUMO

BACKGROUND: Non-union affects up to 10% of fractures and is associated with substantial morbidity. There is currently no single effective therapy for the treatment or prevention of non-union. Potential treatments are currently selected for clinical trials based on results from limited animal studies, with no attempt to compare results between therapies to determine which have the greatest potential to treat non-union. AIM: The aim of this systematic review was to define the range of therapies under investigation at the preclinical stage for the prevention or treatment of fracture non-union. Additionally, through meta-analysis, it aimed to identify the most promising therapies for progression to clinical investigation. METHODS: MEDLINE and Embase were searched from 1St January 2004 to 10th April 2017 for controlled trials evaluating an intervention to prevent or treat fracture non-union. Data regarding the model used, study intervention and outcome measures were extracted, and risk of bias assessed. RESULTS: Of 5,171 records identified, 197 papers describing 204 therapies were included. Of these, the majority were only evaluated once (179/204, 88%), with chitosan tested most commonly (6/204, 3%). Substantial variation existed in model design, length of survival and duration of treatment, with results poorly reported. These factors, as well as a lack of consistently used objective outcome measures, precluded meta-analysis. CONCLUSION: This review highlights the variability and poor methodological reporting of current non-union research. The authors call for a consensus on the standardisation of animal models investigating non-union, and suggest journals apply stringent criteria when considering animal work for publication.


Assuntos
Fraturas não Consolidadas/prevenção & controle , Fraturas não Consolidadas/terapia , Animais , Humanos
10.
J Tissue Eng Regen Med ; 12(9): 1972-1985, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30044550

RESUMO

Nonunion treatment has a high rate of success, although recalcitrant nonunion may determine the need for amputation. Therefore, new treatment options are continuously investigated in order to further reduce the risk of nonunion recurrence. This study aimed to (a) develop a new large animal model for bone atrophic nonunion and (b) compare the efficacy of demineralized bone matrix (DBM) and DBM in combination with mesenchymal stem cells (MSC) in the new nonunion model. The new model consists of a noncritical, full-thickness segmental defect created in the sheep tibia, stabilized by an intramedullary nail, and involves the creation of a locally impaired blood supply achieved through periosteum excision and electrocauterization of the stump ends. Six weeks after defect creation, lack of hard tissue callus and established nonunion was observed in all operated tibiae both by radiographic and clinical evaluation. Nonunion was treated with allogeneic DBM or autologous MSC cultivated on DBM particles (DBM + MSC) for 1 day before implantation. Twelve weeks after treatment, radiographic, microtomographic, histologic, and histomorphometric analysis showed the formation of bone callus in DBM group, whereas the fracture healing appeared at an early stage in DBM + MSC group. Torsional strength and stiffness of the DBM group appeared higher than those of DBM + MSC group, although the differences were not statistically significant. In conclusion, a new sheep bone nonunion model resembling the complexity of the clinical condition was developed. DBM is an effective option for nonunion treatment, whereas MSC do not improve the healing process when cultivated on DBM particles before implantation.


Assuntos
Técnica de Desmineralização Óssea , Matriz Óssea/química , Consolidação da Fratura , Fraturas não Consolidadas/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Animais , Fenômenos Biomecânicos , Modelos Animais de Doenças , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/patologia , Reprodutibilidade dos Testes , Ovinos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Torção Mecânica , Resultado do Tratamento , Microtomografia por Raio-X
11.
Curr Osteoporos Rep ; 16(4): 504-511, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29909597

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss the recent advances in gene therapy as a treatment for bone regeneration. While most fractures heal spontaneously, patients who present with fracture nonunion suffer from prolonged pain, disability, and often require additional operations to regain musculoskeletal function. RECENT FINDINGS: In the last few years, BMP gene delivery by means of electroporation and sonoporation resulted in repair of nonunion bone defects in mice, rats, and minipigs. Ex vivo transfection of porcine mesenchymal stem cells (MSCs) resulted in bone regeneration following implantation in vertebral defects of minipigs. Sustained release of VEGF gene from a collagen-hydroxyapatite scaffold to the mandible of a human patient was shown to be safe and osteoinductive. In conclusion, gene therapy methods for bone regeneration are systematically becoming more efficient and show proof-of-concept in clinically relevant animal models. Yet, on the pathway to clinical use, more investigation is needed to determine the safety aspects of the various techniques in terms of biodistribution, toxicity, and tumorigenicity.


Assuntos
Proteínas Morfogenéticas Ósseas/genética , Regeneração Óssea/genética , Consolidação da Fratura/genética , Fraturas não Consolidadas/terapia , Terapia Genética/métodos , Fator A de Crescimento do Endotélio Vascular/genética , Animais , Colágeno , Durapatita , Eletroporação , Humanos , Transplante de Células-Tronco Mesenquimais , Tecidos Suporte , Transfecção
12.
Curr Osteoporos Rep ; 16(3): 289-298, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29725836

RESUMO

PURPOSE OF REVIEW: The development of therapeutics that target anabolic pathways involved in skeletogenesis is of great importance with regard to disease resulting in bone loss, or in cases of impaired bone repair. This review aims to summarize recent developments in this area. RECENT FINDINGS: A greater understanding of how drugs that modulate signaling pathways involved in skeletogenesis exert their efficacy, and the molecular mechanisms resulting in bone formation has led to novel pharmacological bone repair strategies. Furthermore, crosstalk between pathways and molecules has suggested signaling synergies that may be exploited for enhanced tissue formation. The sequential pharmacological stimulation of the molecular cascades resulting in tissue repair is a promising strategy for the treatment of bone fractures. It is proposed that a therapeutic strategy which mimics the natural cascade of events observed during fracture repair may be achieved through temporal targeting of tissue repair pathways.


Assuntos
Remodelação Óssea , Consolidação da Fratura , Fraturas Ósseas/terapia , Osteogênese , Anabolizantes , Anticorpos Neutralizantes/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Proteínas Morfogenéticas Ósseas/antagonistas & inibidores , Proteínas Morfogenéticas Ósseas/imunologia , Proteínas Morfogenéticas Ósseas/uso terapêutico , Calo Ósseo , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Fraturas não Consolidadas/terapia , Marcadores Genéticos/imunologia , Humanos , Fator de Crescimento Derivado de Plaquetas/uso terapêutico , Transdução de Sinais , Teriparatida/uso terapêutico , Fator de Crescimento Transformador beta , Via de Sinalização Wnt
13.
Foot (Edinb) ; 35: 52-55, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29793139

RESUMO

BACKGROUND: There are no studies looking at the success rate of low-intensity pulsed ultrasound (LIPUS) in fifth metatarsal fracture delayed unions to our knowledge. The aim of this study is to investigate the use of LIPUS treatment for delayed union of fifth metatarsal fractures. METHODS: A retrospective review of patients who were treated with LIPUS following a delayed union of fifth metatarsal fracture was conducted over a three-year period. RESULTS: There were thirty patients (9 males, 21 females) in this cohort. The average age was 39.3 years. Type 2 fractures made up 43% of our cohort. Twenty-seven (90%) patients went on to progress to union clinically and radiologically following LIPUS treatment. Smoking (p=0.014) was predictive of non-union. Assuming that there were 10 delayed unions a year and 6 went on to non-union as previously suggested by a systematic review, the cost savings of using LIPUS (90% success rate; 10 LIPUS machine and surgery for 1 non-union) vs operative intervention (surgery for 6 non-union) equates to a cost saving of £7765 a year. CONCLUSION: There is a role for the use of LIPUS in delayed union of fifth metatarsal fractures and can serve as an adjunct prior to consideration of surgery. The findings of this study also suggest the use of LIPUS to be a cost effective treatment modality compared to surgical management. LEVEL OF EVIDENCE: Level 4.


Assuntos
Fraturas não Consolidadas/terapia , Ossos do Metatarso/lesões , Terapia por Ultrassom/métodos , Ondas Ultrassônicas , Adulto , Estudos de Coortes , Feminino , Seguimentos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/terapia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Adulto Jovem
14.
PLoS One ; 13(5): e0197768, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29787613

RESUMO

INTRODUCTION: Scaphoid non-union is a challenging and complex problem. Various methods have been proposed for the management of patients with scaphoid non-union and to reduce the risk of complications. In this study, our aim was to evaluate the clinical and functional outcomes of using a vascularized bone graft in the treatment of scaphoid non-union. METHODS: Patients with scaphoid non-union who underwent 1,2 intercompartmental supraretinacular artery pedicled vascularized bone graft between January 2005 and January 2011 were enrolled. The parameters assessed included clinical and functional outcomes, radiological measures, and potential risk factors. RESULTS: Forty-one patients were finally included. Thirty patients achieved union (73%) and 11 did not. Smoking was a significant risk factor for non-union after the surgery. In patients who achieved union, grip strength and radioulnar abduction were greater in comparison to that in patients who did not achieve union. Functional measures, including the Disabilities of Arm and Shoulder score and the Modified Mayo Wrist Score, improved in patients with scaphoid union. The scaphoid length also improved significantly postoperatively in these patients. CONCLUSION: Surgical treatment of scaphoid non-union using vascularized bone graft led to a high union rate with good clinical and functional outcomes. Smoking is a risk factor for non-union, even with the use of a vascularized bone graft. Avascular necrosis was not associated with an increased risk for non-union.


Assuntos
Transplante Ósseo/métodos , Fraturas não Consolidadas/terapia , Osso Escafoide/lesões , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Feminino , Consolidação da Fratura , Humanos , Masculino , Neovascularização Fisiológica , Estudos Retrospectivos , Fatores de Risco , Osso Escafoide/cirurgia , Fumar/efeitos adversos , Resultado do Tratamento , Adulto Jovem
15.
PLoS One ; 13(4): e0196051, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29698513

RESUMO

BACKGROUND: Autologous bone grafting (ABG) remains the gold standard for augmentation of bone defects. The RIA system has become more prevalent, but evidence regarding risk management and complications remain scarce. This study presents the risk management and complications associated with RIA in the largest single-center case series to date. METHODS: All records, operative notes, lab data and radiographs of patients receiving a RIA procedure at Heidelberg´s University Hospital between 01/01/2010 and 31/12/2016 were reviewed. Multivariate logistic regression models adjusting for clinically relevant covariates were used to examine the respective relevance regarding the presence and absence of prolonged postoperative pain (PPP). RESULTS: A total of 341 RIA procedures on 306 patients were performed at our level-1 trauma center. The femur was the main donor site (98.53%; N = 336) whereas only in 1.47% (N = 5) the tibia was utilized. A total of 11 patients showed a relevant loss of hemoglobin requiring blood transfusion. A total of 22 patients suffered from PPP directly associated with the RIA procedure resulting in prevalence of 6.45%. The 6 major complications in our study were of diverse origin and all intraoperative complications took place in the early phase of the RIA procedure in our center (2010-2013). Our data revealed influence of sex (p = 0.0459) and age (p = 0.0596) on the criterion PPP. The favored model including sex and age resulted in an AUC of 66.2% (CI: 55.5%-76.9%). CONCLUSION: Perioperative blood loss remains a prevalent complication during RIA reaming. In addition, PPP occurs with a prevalence of 6.45%. This study showed a complication rate of 1.76%, emphasizing RIA´s overall safety and furthermore highlighting the need for vigilance in its application and prior extensive hands-on training of surgeons. Level of Evidence: II.


Assuntos
Transplante Ósseo , Fraturas não Consolidadas/terapia , Complicações Pós-Operatórias , Gestão de Riscos , Coleta de Tecidos e Órgãos/métodos , Adulto , Idoso , Área Sob a Curva , Transfusão de Sangue , Feminino , Fêmur/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Curva ROC , Coleta de Tecidos e Órgãos/efeitos adversos , Transplante Autólogo
16.
J Biomed Mater Res A ; 106(9): 2552-2562, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29689623

RESUMO

Depending on the duration of healing process, 5-10% of bone fractures may result in either nonunion or delayed union. Because nonunions remain a clinically important problem, there is interest in the utilization of tissue engineering strategies to augment bone fracture repair. Three basic biologic elements that are required for bone regeneration include cells, extracellular matrix scaffolds and biological adjuvants for growth, differentiation and angiogenesis. Mesenchymal stem cells (MSCs) are capable to differentiate into various types of the cells including chondrocytes, myoblasts, osteoblasts, and adipocytes. Due to their potential for multilineage differentiation, MSCs are considered important contributors in bone tissue engineering research. In this review we highlight the progress in the application of biomaterials, stem cells and tissue engineering in promoting nonunion bone fracture healing. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2551-2561, 2018.


Assuntos
Osso e Ossos/fisiologia , Fraturas não Consolidadas/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Engenharia Tecidual , Animais , Consolidação da Fratura , Humanos
17.
Curr Osteoporos Rep ; 16(2): 155-168, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29536393

RESUMO

PURPOSE OF REVIEW: Impaired healing outcomes or even non-unions after bone injury are still a highly relevant problem in the daily clinical life. Especially within an aging population, the occurrence of bone fractures increases and thus novel treatment approaches to overcome compromised bone regeneration are needed. RECENT FINDINGS: The gold standard to treat delayed or non-healing bone injuries is still the use of autologous bone grafts to foster regeneration. Besides its successful treatment outcome, it also has disadvantages: a second surgery is needed in order to harvest the bone material and the material is highly limited. Looking into the recent literature, a multitude of different research approaches were already conducted to identify new possible strategies to treat impaired bone regeneration: application of mesenchymal stromal cells, platelet lysates, growth factors, interference in the immune system, or bone formation stimulation by ultrasound. This review gives an overview of the treatment approaches actually performed in the clinic as well as at the bench in the context of compromised bone healing. It clearly highlights the complexity of the nature of non-healing bone fractures as well as patient-dependent factors influencing the healing process.


Assuntos
Proteínas Morfogenéticas Ósseas/uso terapêutico , Transplante Ósseo/métodos , Fraturas não Consolidadas/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Plasma Rico em Plaquetas , Terapia por Ultrassom/métodos , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Humanos , Imunoterapia/métodos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Transplante Autólogo
18.
Clin Sports Med ; 37(2): 351-362, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29525032

RESUMO

The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes. Risks of OCD fixation are specific to the material of screw used.


Assuntos
Traumatismos em Atletas/cirurgia , Complicações Pós-Operatórias/terapia , Esportes Juvenis/lesões , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Parafusos Ósseos/efeitos adversos , Criança , Cotovelo/lesões , Cotovelo/cirurgia , Fibrose/etiologia , Fibrose/prevenção & controle , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas não Consolidadas/cirurgia , Fraturas não Consolidadas/terapia , Humanos , Redução Aberta/efeitos adversos , Osteocondrite Dissecante/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fraturas da Tíbia/cirurgia
19.
J Orthop Trauma ; 32 Suppl 1: S52-S57, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29461405

RESUMO

A substantial proportion of fractures can present with nonunion, and the management of nonunion continues to present a challenge for orthopaedic surgeons. A variety of biological, mechanical, patient, and injury factors can contribute to the occurrence of nonunion, and often the cause of nonunion may be multifactorial. Successful management often requires assessment and treatment of more than one of these factors. This article reviews common factors that may contribute to nonunion including infection, impaired biology, and metabolic disorders. In addition, new and evolving strategies for diagnosing the cause and effectively treating nonunion including the diagnosis of infection, metabolic workup, bone grafting, cell-based therapies, and biological adjuvants are reviewed and discussed.


Assuntos
Fraturas não Consolidadas/terapia , Produtos Biológicos , Substitutos Ósseos , Transplante Ósseo , Fraturas não Consolidadas/diagnóstico , Fraturas não Consolidadas/etiologia , Humanos
20.
Med Hypotheses ; 111: 4-7, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29406993

RESUMO

We propose a novel approach for the treatment of atrophic bone non-unions via parallel applications of extracorporeal shock wave therapy (ESWT) and an autologous mesenchymal stem cell transplant. The hypothesis resides on the potentiality of shock waves (SWs) to act as a tool for manipulating the patient's mesenchymal stem cells (MSCs). In addition to the conventional physical stimulus achieved by delivering SWs at the site of non-union to stimulate the well-known trophic effects on bone tissue, a series of concomitant ESWT would be administered in tandem at a bone marrow donor site, such as the iliac crest, to precondition resident bone marrow stromal cells (BMSCs) in vivo, priming resident MSCs by enlarging and conditioning their population prior to bone marrow aspiration. The resulting sample could then be treated to further augment cell concentration and injected, under fluoroscopic control, into the non-union site through a percutaneous approach.


Assuntos
Doenças Ósseas/terapia , Fraturas não Consolidadas/terapia , Ondas de Choque de Alta Energia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Atrofia , Regeneração Óssea , Transplante Ósseo , Osso e Ossos , Humanos , Ílio/patologia , Articulações , Modelos Teóricos , Transplante Autólogo
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