Bone nonunion delays fracture end repair and is associated with inflammation. Although bone nonunion can be effectively repaired in clinical practice, many cases of failure. Studies have confirmed that BMP-2 and nHA/PA66 repaired bone defects successfully. There are few studies on the effects of the combined application of BMP-2 and NHA/PA66 on bone nonunion osteogenesis and inflammation. We aimed to investigate the expression level of inflammation-related genes in patients with bone nonunion and the effect of BMP-2-infected mesenchymal stem cells combined with nHA/PA66 on the level of inflammation in femur nonunion rats. We searched for a gene expression profile related to bone nonunion inflammation (GSE93138) in the GEO public database. Bone marrow mesenchymal stem cells (MSCs) of SD rats were cultured and passed through. We infected the third generation of MSCs with lentivirus carrying BMP-2 and induced the infected MSCs to bone orientation. We detected the expression level of BMP-2 by RT-PCR and the cell viability and alkaline phosphatase (ALP) activity by CCK8 and then analyzed the cell adhesion ability. Finally, the levels of related inflammatory factors, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and Erythrocyte Sedimentation Rate (ESR), were detected in nonunion rats. Our findings: The patients with nonunion had up-regulated expression of 26 differentially inflammatory genes. These genes are mainly enriched in innate immune response, extracellular region, calcium ion binding, Pantothenate and CoA biosynthesis pathways. The expression level of BMP-2 in the Lenti-BMP-2 group was higher (vs. empty lentivirus vector group: t=5.699; vs. uninfected group t=3.996). The cell activity of the MSCs + BMP-2 + nHA/PA66 group increased gradually. After being combined with nHA/PA66, MSCs transfected with BMP-2 spread all over the surface of nHA/PA66 and grew into the material pores. MSCs + BMP-2 + nHA/PA66 cells showed positive ALP staining, and the OD value of ALP was the highest. The levels of CRP, IL-6, TNF-alpha, and ESR in the MSCs + BMP-2 + nHA/PA66 group were lower than those in the MSCs and MSCs + nHA/PA66 group but higher than those in MSCs + BMP-2 group. The above comparisons were all P<0.05. The findings demonstrated that the expression level of inflammation-related genes increased in the patients with bone nonunion. The infection of MSCs by BMP-2 could promote the directed differentiation of MSCs into osteoblasts in the bone marrow of rats, enhance the cell adhesion ability and ALP activity, and reduce inflammation in rats with bone nonunion.
- MeSH
- dospělí MeSH
- femur metabolismus patologie MeSH
- fraktury femuru metabolismus genetika MeSH
- kostní morfogenetický protein 2 * metabolismus genetika MeSH
- krysa rodu Rattus MeSH
- kultivované buňky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezenchymální kmenové buňky * metabolismus MeSH
- nezhojené fraktury * genetika metabolismus MeSH
- osteogeneze MeSH
- potkani Sprague-Dawley * MeSH
- transplantace mezenchymálních kmenových buněk * MeSH
- zánět * metabolismus genetika MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- krysa rodu Rattus MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- BMP2 protein, human MeSH Prohlížeč
- kostní morfogenetický protein 2 * MeSH
PURPOSE OF THE STUDY: The basic aim of the treatment of cystic nonunion is to provide stable fi xation and mechanical compression to increase union, but there is no consensus on whether to perform bone grafting in the cystic area or not. The aim of this study was to compare the clinical and radiological results of patients with cystic scaphoid non-union who received open grafting, and internal fi xation and those treated with percutaneous fi xation without grafting. MATERIAL AND METHODS A retrospective evaluation was made of patients included those determined radiologically with Slade and Dodds grade IV scaphoid cystic non-union. Two different surgical procedures were performed. Percutaneous screw fi xation was carried out on the patients in group 1. Open curettage-grafting and screw fi xation were performed on the patients in group 2. Group 1 was comprised of 16 patients treated with percutaneous screw fi xation, and group 2 was comprised of 17 patients who had open curettage-grafting and screw fi xation. RESULTS In the radiological evaluation at the fi nal follow-up examination, union was determined in 12 of the 16 (75%) patients in group 1 and 15 of the 17 (88%) patients in group 2. There was no statistically signifi cant difference between the two groups in terms of union, functional outcomes and complication rates. DISCUSSION In the current study, the union rate was higher in the patients who had open curettage-grafting and fi xation with a headless screw (88%) than in those with percutaneous screw without grafting (75%), but the difference was not determined to be statistically signifi cant. The union rate of the group that received grafting was similar to the rates reported in the literature. CONCLUSIONS We think that both of these techniques may be successfully used for cystic scaphoid nonunions but percutaneous technique should be preferred as it is minimally invasive. Nevertheless, there is a need for further prospective, randomised studies with larger series to have better comparisons. KEY WORDS: scaphoid bone, nonunion, fracture fi xation, internal, bone grafting, bone screws.
- MeSH
- člunkovitá kost * chirurgie MeSH
- fraktury kostí * MeSH
- lidé MeSH
- pseudoartróza * chirurgie MeSH
- retrospektivní studie MeSH
- transplantace kostí MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Aseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODS Based on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODS Of the whole group (N=14), the nail was used in 5 cases (36%) - in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points - in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTS Shoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSION The results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONS When planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to have a thorough knowledge of etiopathogenesis with all predictive factors. The NUSS classification provides good guidance in treating this complication. Key words: aseptic nonunion, NUSS classification, predictive factors.
- MeSH
- fraktury humeru * diagnostické zobrazování chirurgie MeSH
- hojení fraktur MeSH
- humerus MeSH
- intramedulární fixace fraktury * metody MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- prostatický specifický antigen MeSH
- pseudoartróza * diagnóza chirurgie etiologie MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- prostatický specifický antigen MeSH
PURPOSE OF THE STUDY Most humeral nonunions can be successfully treated with a single procedure, but some are more difficult to heal. Humeral nonunions which have two or more surgical procedures were defined as refractory humeral nonunions, and this condition is a very challenging condition. The aim of the study is to show the results of atrophic refractory humeral nonunion treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty. MATERIAL AND METHODS Refractory humeral nonunions treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty from January 2010 to March 2019 were included this study retrospectively. Patient baseline information, number of previous surgeries, comorbidities, follow-up time, fracture union time, and complications were recorded. The functional outcome was evaluated with the Constant scores and Mayo scores at the end of the first year. The primary outcome variable was mentioned as bony union. RESULTS A total of 13 refractory humeral nonunions included this study. The average age of the patients was 50.92±15.55 years (range, 26-78 years), and 8 of them were female. Preoperative and postoperative mean Mayo scores were; 56.54±17.84, and 85.38±7.49 respectively (p<0.001). Preoperative and postoperative mean Constant scores were; 45±11.71, and 80.62±5.38 respectively (p<0.001). DISCUSSION The strict application of basic nonunion principles can result in successful salvage of refractory humeral nonunions. But this concept may not provide sufficient solution for each situation. On the other hand, we also applied the basic nonunion principles. Compression plating and autogenous bone grafting and spongioplasty have been considered as the gold standard in the management of humeral shaft nonunion. CONCLUSIONS Open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty should be considered as an alternative for the treatment of refractory atrophic humeral nonunions, whose treatment is a very challenging condition for surgeons. Key words: block graft, bone grafting, nonunion, refractory humeral nonunion, spongioplasty.
- MeSH
- dospělí MeSH
- fraktury humeru * diagnostické zobrazování chirurgie MeSH
- hojení fraktur MeSH
- humerus chirurgie MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nezhojené fraktury * chirurgie MeSH
- os ilium MeSH
- retrospektivní studie MeSH
- senioři MeSH
- transplantace kostí metody MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Treatment of nonunion of humerus continues to be a matter of debate. For this purpose, many treatment methods have been reported. The aim of this retrospective cohort study is to evaluate the results of patients who underwent revision surgery with compressive intramedullary nailing implemented a single type of surgical technique in aseptic humeral nonunions without bone defects. MATERIAL AND METHODS Data of 15 patients with humerus nonunion, all were treated with compressive intramedullary nailing between 2000 and 2019 were retrospectively evaluated. Three patients were hypertrophic and 12 were atrophic types. The mean ages of patients at the surgery was 47.3±18 years. In all cases, maximal bone contact was created between the proximal and distal bone fragments after reaming and debridement, and fixation was performed with compressive intramedullary nailing. Radiological assessment of union was performed based on the RUSHU criteria, and functional outcomes were assessed according to Constant-Murley scoring criteria. RESULTS The ten out of 15 patients were male. The radiological union was achieved at a mean duration of 16.6±2.3 weeks in 14 patients. The average time of follow-up after nonunion treatment was 25.2±8.8 months. Twelve out of 15 patients implemented bone grafting taken form iliac bone with spongiosa obtained via reaming. The functional results were made according to the Constant-Murley score and excellent functional results were obtained in nine patients, good in four patients and poor functional results in one patient. Implant failure was not observed. One patient has had post-operative transient ulnar nerve palsy and another patient developed transient radial nerve palsy. CONCLUSIONS Compressive intramedullary nailing is a useful method that provides excellent union in the surgical treatment of aseptic non-union of the humerus, without bone defects. Key words: intramedullary compressive humeral nail, nonunion, failed intramedullary nailing humerus fracture, fracture fixation, autologous bone grafting.
- MeSH
- dospělí MeSH
- fraktury humeru * diagnostické zobrazování chirurgie MeSH
- humerus chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nezhojené fraktury * chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Nonunion is one of the common fracture healing complications. Its diagnosis is based on clinical and X-ray/CT findings. Nonunions can be classified, according to Weber and Cech, as vital and nonvital. Low mechanical stability is the main underlying factor in the development of vital nonunions and therefore, the treatment should be focused on increasing their stability. Absence of biological activity is the causal factor in the development of nonvital nonunions; thus the therapy must be bolstered by bone grafting and decortication. Treatment of nonunions is time consuming and costly and the frequency of their incidence is not decreasing. However, significant progress has been made in the treatment of patients with this bone healing defect over the last decades owing to improved understanding of its genesis and the development of osteosynthetic materials. The presented case of nonunion after periprosthetic fracture includes a detailed description of the therapeutic considerations and techniques used in subsequent phases of treatment, accompanied by radiologic and pictorial documentation. Six months after application of a wave plate, the nonunion was successfully healed. The wave plate is a rarely used implant in our countries; however, its specific biomechanical and biological characteristics significantly support healing of indicated diaphyseal nonunions.
- Klíčová slova
- nonunion − stable fixation − wave plate − femur,
- MeSH
- biologie MeSH
- biomechanika MeSH
- fraktury femuru * MeSH
- hojení fraktur MeSH
- kostní destičky MeSH
- lidé MeSH
- nezhojené fraktury * diagnostické zobrazování etiologie chirurgie MeSH
- retrospektivní studie MeSH
- transplantace kostí MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Although the congenital short femur is morphologically well characterized, changes at the molecular level have not been described in the literature so far. The absence of such information, along with the unknown aetiology of the defect, was the motivation for analysing angiogenesis and osteogenesis in the pseudoarthrosis (false joint) tissue in PFFD patients compared to physiological bone. The authors expected differences in gene expression, particularly in the quantity of expressed genes. MATERIAL AND METHODS A piece of bone was removed during an elective surgery procedure, placed in an RNA stabilization reagent, which prevents RNA degradation, and deep frozen. Thereafter, RNA was isolated and the profile of transcription was analysed by biochip analysis (SuperArray Bioscience Corporation). In total, it is possible to detect 113 genes of osteogenesis and angiogenesis. From the end of 2005 until the end of 2008, samples of 7 patients with PFFD and 3 physiological bone samples were examined. Several analyses were repeated to confirm the results; in total 13 chips for osteogenesis and 11 chips for angiogenesis expression were used. RESULTS Differences in the quantity and representation of the genes were noted. Some genes were considered over-expressed in PFFD tissue compared with the control sample (e.g. the gene for calcitonin receptor, collagen XII, I alpha 2, collagen II, IX, FGFR2, fibronectin, integrin) and other genes under-expressed (e.g. the gene for annexin A5, collagen XVIII alpha1, collagen I alpha1, cathepsin K, FGFR1, FGFR3, IGF2, VEGFB). CONCLUSIONS The differences in gene expression confirmed the authors' hypothesis. So far, the results cannot be generalized; this is the first step for follow-up experiments to confirm the suggested information and to integrate it with clinical findings, such as the alternative blood supply of affected extremity in some patients. Key words: proximal femoral focal deficiency, gene expression, microarray analysis, angiogenesis, osteogenesis.
Fractures of the proximal tibia are high energy fractures. According to available literature, 3-4% of all fractures heal problematically with non-union or osteomyelitis. Usage of locking compression plating system as well as usage of hybrid fixator is associated with the risk of compartment syndrome, local infection and subsequent malunion, osteomyelitis or non-union. We present a case of 30-year-old male suffering from posttraumatic non-union. The medial femoral condyle flap was selected due to its favourable properties providing a highly vascularised osteogenic tissue in combination with anterolateral thigh flap and Corlett loop. Our case report describes a reconstruction of a long weight-bearing bone. Despite the amount of anastomoses and usage of vein graft, the selected method of reconstruction seems to be safe and with a long-lasting benefit for the patient.
- Klíčová slova
- Condyle, Osteomyelitis, free flap, lower extremity, osteogenesis, tibial fracture,
- MeSH
- anastomóza chirurgická MeSH
- dospělí MeSH
- femur chirurgie transplantace MeSH
- fraktury tibie chirurgie MeSH
- lidé MeSH
- nezhojené fraktury chirurgie MeSH
- stehno MeSH
- tibie chirurgie transplantace MeSH
- vény transplantace MeSH
- volné tkáňové laloky * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY The clinical prospective study presents the results of minimally invasive harvesting of cancellous bone tissue in trauma indications. We focused on evaluating the clinical outcomes of this technique, particularly on the amount of cancellous bone harvested, the effectiveness of its use and complications. The pain in the bone graft harvest site is evaluated and compared with the pain after a standard harvest from the iliac crest. MATERIAL AND METHODS All the patients aged 18-90 years, in whom cancellous bone was harvested by minimally invasive technique using a bone cutter were included prospectively in the study. It was used to fill the defect in treating a fracture or in surgical treatment of non-union. The patients, in whom the grafts harvested in this manner were combined with another substitute, were not included in the study. Thus, 57 adult patients (40 men, 17 women) were included in the group in the period from March 2012 to March 2016. 37 patients, i.e. 65% of the total number of 57 patients, arrived for the evaluation of the clinical outcome. The minimally invasive graft harvesting was performed using the Aesculap® cutters. The graft was harvested either from the skeleton directly in the area of surgical wound or by a mini incision above the harvest site in the area under surgical drapes. The diameter of the cutter was selected based on the planned necessary number of grafts and with account taken of the harvest site. There were 6 harvest sites selected - proximal humerus, proximal ulna, iliac crest, greater trochanter of femur, distal femur and proximal tibia. The age and gender of patients, harvest site, type of the used cutter and the total number of harvested grafts were recorded in the study. The patients underwent a clinical follow-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. The healing of the fracture or non-union was assessed on radiographs and in case of any doubt a CT scan was indicated. The pain at the graft harvest site was quantified with the use of the VAS score. A possible correlation between the age and the harvest site pain was explored by means of the Pearson s correlation coefficient. RESULTS In surgical management of fractures, 10.98 cm³ of bone marrow (σ 5.32) was harvested on average, in non-unions it was 10.85 cm³ (σ 5.52). With the above described technique, the mean healing time of lower extremity fractures was 26 weeks, in upper extremity it was 22 weeks. The non-unions of lower extremity and upper extremity healed after 28 weeks and 19 weeks, respectively. The average pain at the harvest site was 4.08 (σ 2.21, p ˂ 0.001). By calculating the Pearson's correlation coefficient it was confirmed that there is no correlation between the age and pain VAS score at the harvest site (r = -0.05). No early complications at the graft harvest site were observed in our group of patients. DISCUSSION On average, 10.98 cm³ of bone marrow was harvested in treated fractures, which in comparison to standard harvests from the iliac crest offers sufficient amount of tissue to treat complicated fractures and non-unions. Technically, the standard harvest site of cancellous bone tissue from the iliac crest is replaceable. The harvesting technique offers an interesting alternative also in terms of the duration of surgery and material. CONCLUSIONS Our study confirmed that by the minimally invasive technique of bone graft harvesting adequate amount of tissue to treat defect fractures and non-unions can be harvested. Spongioplasty using grafts harvested in this manner is effective, with a minimum percentage of non-unions. The advantage of this technique is the proximity of the harvest site and the operative field and low level of pain. The minimally invasive graft harvesting represents a technique with a low risk of postoperative and late complications. Key words: bone graft, autografts, minimally invasive surgery, ilium, pain.
- MeSH
- dospělí MeSH
- fraktury kostí chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nezhojené fraktury chirurgie MeSH
- odběr tkání a orgánů metody MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trabekulární kostní tkáň transplantace MeSH
- transplantace kostí metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinická studie MeSH
PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.
- MeSH
- diabetes mellitus 2. typu patologie patofyziologie MeSH
- fraktury vřetenní kosti patologie patofyziologie MeSH
- hojení fraktur fyziologie MeSH
- lidé MeSH
- nezhojené fraktury patologie patofyziologie chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH