Abstract
Treatment of infected non-unions of the tibia is a challenging problem. The cornerstones of optimal infected non-union treatment consist of extensive debridement, fracture fixation, antimicrobial therapy and creation of an optimal local biological bone healing environment. The combination of S53P4 bioactive glass (BAG), as osteostimulative antibacterial bone graft substitute, and bone marrow aspirate concentrate (BMAC) for the implantation of mesenchymal stem cells and growth factors might be a promising combination. In this paper, preliminary results of a new treatment algorithm for infected non-unions of the tibia is presented. In this retrospective case series patients with infected non-unions of the tibia are treated according to a new treatment algorithm. Patients are treated with extensive debridement surgery, replacement of the osteosynthesis and implantation of S53P4 BAG and BMAC in a one-stage or two-stage procedure based on non-union severity. Subsequently patients are treated with culture based antibiotic therapy and followed until union and infection eradication. Five patients with an infected non-union were treated, mean age was 55, average NUSS-score was 44 and the average segmental bone defect was 4.6cm. One patient was treated in a one-stage procedure and four patients in a two-stage induced membrane-, or "Masquelet"-procedure. On average, 23 ml S53P4 BAG and 6.2 ml BMAC was implanted. The mean follow-up period was 13.6 months and at the end of follow-up all patients had clinical consolidation with an average RUST-score of 7.8 and complete eradication of infection. These early data on the combined implantation of S53P4 BAG and BMAC in treatment of infected non-unions shows promising results. These fracture healing results and eradication rates resulted in promising functional recovery of the patients. To substantiate these results, larger and higher quality studies should be performed.
Highlights
Treatment of infected non-unions of the tibia is a challenging problem
In this paper we report the preliminary data of a treatment protocol for infected non-unions of the tibia where we optimized our treatment algorithm by using S53P4 bioactive glass (BAG) as a bone defect filler and bone marrow aspirate concentrate (BMAC) for the addition of mesenchymal stem cells and induction of growth factors for stimulation of new bone and soft tissue formation
Four patients were treated with a two-stage technique due to high Non-Union Scoring System (NUSS) score combined with a severe infection
Summary
In orthopedic trauma surgery, infected (or septic) non-unions are one of the most challenging complications after primary fixation of a fracture. Treatment of infected non-unions is based on the combination of creating an optimal situation for bone regeneration and eradication of the infection [11]. An example of a bone graft substitute suitable for bone defect filling in non-union treatment is S53P4 bioactive glass (BAG, BonAlive, Turku, Finland). In this paper we report the preliminary data of a treatment protocol for infected non-unions of the tibia where we optimized our treatment algorithm by using S53P4 bioactive glass (BAG) as a bone defect filler and bone marrow aspirate concentrate (BMAC) for the addition of mesenchymal stem cells and induction of growth factors for stimulation of new bone and soft tissue formation. Based on severity of the infection and non-union characteristics patients were allocated to a one-stage or two-stage treatment algorithm, where a NUSS score of more than 25 indicates a twostage approach.
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