Nonunion Of Long Bone Fractures Research Articles

Collective Review: Bioactive Implants Coated with Poly(D,L-lactide) and Growth Factors IGF-I, TGF-β1, or BMP-2 for Stimulation of Fracture Healing

Demographic data reveal that due to the increasing aging of the population, complications with the musculoskeletal system will increase in the next years. One major problem in orthopedic and trauma surgery are the delayed healing or non-unions of long bone fractures. The exogenous application of growth factors can stimulate the bone healing to reduce these complications. Beside the choice of the optimal growth factor the application system is important. Therefore, we developed a new bioactive coating method for implants, which is based on a biodegradable poly(D,L-lactide) (coating thickness: 10 mum). This coating allows the incorporation of growth factors and the controlled release of these factors during the healing process without the need for further devices. The effect of different growth factors (IGF-I, TGF-beta1, and BMP-2) locally released from coated intramedullary implants on fracture healing was investigated with biomechanical and histological analysis in rats. All investigated growth factors stimulated the fracture healing as assessed with biomechanical tests and histological analysis. The local application of combined IGF-I and TGF-beta1 had the most stimulating effect on fracture healing, followed by the effect of BMP-2, IGF-I, and TGF-beta1 alone. Bioactive coating of biomechanical well-established implants can on the one hand stabilize the fracture and on the other hand stimulate healing processes to increase healing and to reduce the rate of complications.

Critical analysis and efficacy of BMPs in long bones non-union

Non-union of long bone fractures is considered as multifactorial. The management of this entity continues to be difficult often requiring multiple procedures with unpredictable results. Bone morphogenetic proteins (BMPs) are power agents being used in the clinical setting for a variety of pathological conditions where tissue regeneration is required. This article analyses the currently existing evidence of the efficacy of BMPs for the management of non-union of long bone fractures.

Traitement chirurgical des pseudarthroses diaphysaires aseptiques

Many factors may interfere with a repair of normal fracture resulting in non-union. In more than 90% of concerned patients, non-unions of long bone fractures can be treated successfully by a surgical procedure. Treatment must be individually adapted to the patient, addressing all components of the problem. Basic therapies applicable for the treatment of long bone fracture non-unions are reviewed, and specific treatments for non-unions in different locations (leg, femur, humerus, and clavicle) are analysed.

Interlocking nail in treatment of delayed union and non-union of long bone fracture of the leg

目的 分析导致下肢长管状骨骨折不愈合和延迟愈合的原因及治疗方法. 方法对 13例下肢长管状骨骨折不愈合及延迟愈合患者均采用交锁髓内钉治疗.闭合穿钉 2例,切开复位内固定 11例,术中同时植骨 9例.所有病例术中均行静力型交锁,其中 4例后期动力化. 结果 13例患者均达到骨性愈合,愈合时间 12～ 23个月,平均 14.5个月.结论扩髓型交锁髓内钉治疗下肢长管状骨骨折的不愈合及延迟愈合效果满意,治疗的关键在于扩髓、选择合适的髓内钉、必要时动力化锁定.

Nonunion

Nonunions of long bone fractures can be treated successfully with one operative procedure in more than 90% of patients. In fact, 80% of patients can have good to excellent final restoration of mechanical axis alignment and proper length. Patients with infected nonunions may require more than one procedure to eliminate infection and heal the nonunion. Treatment must be tailored to the individual patient to address all components of the problem. We reviewed the main experimental data regarding the knowledge of nonunions and the basic methods that may be applied to the treatment of nonunions.

Treatment of nonunions of long bone fractures with shock waves

A prospective clinical study investigated the effectiveness of shock waves in the treatment of 72 patients with 72 nonunions of long bone fractures (41 femurs, 19 tibias, 7 humeri, 1 radius, 3 ulnas and 1 metatarsal). The doses of shock waves were 6000 impulses at 28 kV for the femur and tibia, 3000 impulses at 28 kV for the humerus, 2000 impulses at 24 kV for the radius and ulna, and 1000 impulses at 20 kV for the metatarsal. The results of treatment were assessed clinically, and fracture healing was assessed with plain x-rays and tomography. The rate of bony union was 40% at 3 months, 60.9% at 6 months and 80% at 12 months followup. Shock wave treatment was most successful in hypertrophic nonunions and nonunions with a defect and was least effective in atrophic nonunions. There were no systemic complications or device-related problems. Local complications included petechiae and hematoma formation that resolved spontaneously. In the author’s experience, the results of the shock wave treatment were similar to the results of surgical treatment for chronic nonunions with no surgical risks. Shock wave treatment is a safe and effective alternative method in the treatment of chronic nonunions of long bones.

Occurrence and treatment of nonunion in long bone fractures in children

Occurrence and treatment of nonunion in long bone fractures in children

Treatment of Established and Anticipated Nonunion of the Tibia in Childhood

Nonunion in long bone fractures is rare in the skeletally immature patient. The authors report the outcome of a series of patients treated for tibial bone loss and nonunion at average follow-up of 66 months. Nine children aged 18 months to 17 years were treated. Three patients had established nonunion ranging from 7 months to 6 years, three had bone loss (1-6 cm), and three had fractures in which nonunion was anticipated (one Gustilo IIIb and two Tscherne III). Treatment involved wound excision for open fractures, debridement of devascularized bone, and stabilization with monolateral fixators (two patients) and circular fixators (seven patients). Five patients had unifocal treatment and four had multifocal treatment (three bone transports). Treatment time ranged from 3 to 12 months and was not related to the complexity of treatment. Functional outcome was measured using the Short Musculoskeletal Functional Assessment, a validated outcome assessment tool. At the latest follow-up (average 66 months), the mean knee flexion was 134 degrees and mean ankle range was 12 degrees dorsiflexion, 31 degrees plantar flexion. Physeal arrest was present in three children (limb length discrepancy 2-4 cm), but with no deformity. Functional outcome revealed a "Dysfunction Index" of 0% to 19% (average 7%) and a "Bother Index" of 0% to 16% (average 6%). Good function can be obtained following treatment of these severe injuries.

Occurrence and treatment of nonunion in long bone fractures in children.

Because of favorable local biological factors, nonunion is rarely seen in long bone fractures in children, and there are few studies on pediatric nonunion in the literature. Twenty-six children under 15 years of age diagnosed with long bone nonunion were examined, and 19 received treatment. Patients with pseudarthrosis due to tumors or congenital causes were excluded from the study. The following factors were assessed for each patient: age and sex; cause, location, and type of fracture; form of initial treatment; incidence of infection and type of bacteria produced; time between fracture and diagnosis; and type of nonunion. Twenty-two of the patients had fractures in the lower extremities, and 4 in the upper extremities. The femur was the most commonly affected bone (12 patients), followed by the tibia (10 patients). The average age of the patients was 9.6 years (range 1-15 years). The frequency of occurrence increased after the age of 6, and all patients but two were above this cutoff age. In each case, there was at least one factor contributing to nonunion, such as open reduction and insufficient fixation, open fracture, and infection. Of the 19 patients treated, 3 required reoperation. In our opinion, claims that pediatric nonunion is an extremely rare condition are exaggerated, and we do not agree that it is always due to an error in treatment. Nonunion does occur in children despite appropriate treatment, especially after the age of 6, and it may be resistant to therapy.

Percutaneous autogenous bone-marrow injection in delayed union and nonunion of long bone fractures: a preliminary report

Objectives: To evaluate the clinical effectiveness of percutaneous autogenous bone-marrow injection in delayed union and nonunion of long bone fractures. Methods: In this prospective study, eight patients (2 women, 6 men; mean age 34.3 years; range 20-47 years) who developed delayed union or nonunion of long bone fractures were treated with percutaneous autogenous bone-marrow grafting. The fractures were localized in the tibia (n=3), humerus (n=2), ulna (n=2) and, radius (n=1). Results: One patient dropped out of follow-up. Five of the remaining patients achieved sufficient union and healing in a mean duration of 4.2 months (range 3-6 months). Conclusion: The results suggest that percutaneous autogenous bone-marrow injection is a safe, simple, and effective alternative in the treatment of union problems of long bone fractures in selected patients.

Protein release kinetics of a biodegradable implant for fracture non-unions

Non-union of long bone fractures is often a serious complication of fracture healing. It is estimated that 100000 non-unions occur in the United States annually and result in the loss of function of the involved limb. The present study was performed to develop a microporous polylactic acid-polyglycolic acid (PLA-PGA) implant for the delivery of bone morphogenetic protein (BMP) to sites of fracture non-unions, and to characterize the protein release kinetics of such an implant in vitro. A 50:50 copolymer of PLA-PGA was used to fabricate the implants using a gel formation technique. The implants were subjected to hydrolytic degradation in phosphate-buffered saline at 37 °C for up to 72 d. The protein release and the polymer degradation were monitored during this time period. The release kinetics of these implants were studied using a model protein, soybean trypsin inhibitor (TI), as well as BMP. The results indicate that there is a burst release of the proteins in the initial 48 h followed by a lower elution rate. The release of both the proteins followed similar trends. The molecular weight of the polymer decreased at a faster rate compared to its mass.

Quality of Life Assessment of Patients With Posttraumatic Fracture Nonunion, Chronic Refractory Osteomyelitis, and Lower-Extremity Amputation

One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, and posttraumatic amputation were evaluated to assess the impact of chronic disability on the quality of life. The quality of life parameters were defined by a functional assessment instrument, the Arthritis Impact Measurement Scale (AIMS), and a Psychosocial Adjustment to Illness Scale (PAIS). A spouse PAIS self-report instrument was administered to assess the psychosocial adjustment of spouses or significant others. A final questionnaire was developed to determine the reasons, in order of their importance, for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and nonunion or amputation patients. The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients. Subscale analysis of AIMS scores showed significant differences among the three groups with respect to health perception and scale of orthopaedic problem. The osteomyelitis patients were more severely affected than the nonunion or amputation patients. The PAIS was unable to detect any statistically significant differences in psychosocial adjustment of the spouses of patients in each of the three population groups. The most frequent reason for continuing medical and surgical management of nonunion and osteomyelitis was hopeful expectation for cure. The group who chose amputation did so in an attempt to put an end to the need for medical and surgical treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation. This study provides further insight into the quality of life experience for patients with long-term orthopaedic problems.

Pulsed electromagnetic fields

The Journal of Bone and Joint Surgery. British volumeVol. 73-B, No. 2 ArticlesFree AccessPulsed electromagnetic fieldsAT Barker, RA DixonAT BarkerSearch for more papers by this author, RA DixonSearch for more papers by this authorPublished Online:1 Mar 1991https://doi.org/10.1302/0301-620X.73B2.2005179AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByElectromagnetic fields do not affect bone micro-architecture in osteoporotic ratsO. P. van der Jagt, J. C. van der Linden, J. H. Waarsing, J. A. N. Verhaar, H. Weinans11 July 2014 | Bone & Joint Research, Vol. 3, No. 7Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults13 April 2011 | Cochrane Database of Systematic Reviews, Vol. 1The Effect of Pulsed Electromagnetic Field on Patients with Endocrine Ophthalmopathy13 March 2018 | European Journal of Ophthalmology, Vol. 8, No. 4Mechanical and electrical interactions in bone remodelingBioelectromagnetics, Vol. 18, No. 3 Vol. 73-B, No. 2 Metrics Downloaded 120 times History Published online 1 March 1991 Published in print 1 March 1991 InformationCopyright © 1991, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation.

One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, or posttraumatic amputation were evaluated for the impact of chronic disability on quality of life, as measured by the Arthritis Impact Measurement Scale (AIMS) and the Psychosocial Adjustment to Illness Scale (PAIS). A self-administered PAIS for spouses assessed psychosocial adjustment of spouses or significant others. A final questionnaire ranked the reasons for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and both nonunion and amputation patients (p less than .05). The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients (p less than .05). Subscale analysis of AIMS scores revealed significant differences among the three groups in health perception and scale of orthopedic problem: osteomyelitis patients were more severely affected than nonunion or amputation patients. The PAIS detected no statistically significant difference in psychosocial adjustment of spouses of patients in the three population groups. The most common reason for continuing medical and surgical management of nonunion and osteomyelitis was expectation for cure. The amputee group chose ablation to avoid further treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation.

L-Dopa in the Treatment of Nonunited Fractures

Twenty-five patients with delayed or nonunion of fractures of a long bone had adjunctive treatment with levodopa (L-dopa). Presumably, L-dopa stimulates growth hormone, which has been suggested as helpful in bone growth and repair. All patients had previously been immobilized, and 22 had one or more surgical procedures. L-dopa was administered 500 mg initially and over three weeks was gradually increased to 500 mg orally three times a day. Treatment was continued for six months or until the fracture healed. After six months, 21 patients (84%) had no pain with full activity and solid bony union by roentgenograms and were considered healed. This study suggests that L-dopa improves the capacity of nonunited fractures to heal. Proof would require a randomized, double-blind series of patients. L-dopa could prove to be a useful adjunct in the management of delayed or nonunion of long-bone fractures.

Nonunion of Long Bone Fractures in Children

Nonunions after diaphyseal fractures of long bones in children are rare. Thirty diaphyseal nonunions in 30 children are reported. The sites of nonunion were tibia (15), femur (5), ulna (4), humerus (3), radius (2), and fibula (1). Nonunions in children tend to occur after high-energy trauma, particularly when the fracture is compound, there is soft tissue loss, and infection develops. Open reduction and internal fixation may contribute to nonunion, particularly when the fixation is inadequate or holds the fracture apart. Repeated manipulation of the fracture after open reduction may also contribute to nonunion. Treatment of the nonunion must be individualized, but usually requires excision of the nonunion fibrous tissue, bone grafting, and internal fixation. Electrical stimulation was not used. The average time from fracture to union was 14.7 months, and multiple surgical procedures were required.

Nonunion of Long Bone Fractures in Children

Nonunion of Long Bone Fractures in Children

Treatment of delayed union and nonunion of long bone fractures by internal plate fixation with or without autologeous bone graft (author's transl)

Treatment of delayed union and nonunion of long bone fractures by internal plate fixation with or without autologeous bone graft (author's transl)

Roentgenologic findings in non-union of long bone fractures. An experimental study.

Roentgenologic findings in non-union of long bone fractures. An experimental study.

Predisposing Factors and Outcome of Treatment of Non-Union of Long-Bone Fractures in Ibadan, Nigeria

This study was done to find out factors that contribute to development of Non-union of long bone fractures in this environment and the outcome of operative intervention. This is a prospective hospital based study. All patients with Non-union of long bone fracture that presented in the hospital since January 1997 were recruited into the study. The data included causative factors, treatment given before presenting in the hospital, type of surgical procedure and result of treatment. The study was completed in December, 2005. 78 patients presented with 87 Non-union of long bones. A male, female ratio of 1.6:1 was encountered while 69.2 per cent of the patients were below the age 55years. Road Traffic Accident accounted for 68 fractures (78.2 per cent) while duration of injury before presentation varies from 6 months to 22 months. Atrophic non-union occurred in 60 cases (69.0 per cent) and hypertrophic non-union in 21 cases. Non-union of the femur occurred in 33 cases (37.9 per cent) humerus in 24 cases (27.6 per cent), tibia in 16 cases (18.4 per cent), radius and ulna in 14 cases (16.1 per cent). The initial treatments of the fresh fracture in the 78 patients with nonunion were by the traditional bonesetters in 51 patients (65.4 per cent) while the remaining fractures were treated by plaster of paris in hospital. Open reduction and internal fixation using plate and screws with bone grafting was the most common procedure for treating the non-union in most cases. Union was achieved in the entire patients following surgical intervention. Important factor that appears to contribute to non-union of long bone in this environment is soft tissue interposition between the fracture ends of the bone, which is found in all fractures with more than one diameter displacement. Another factor is interference with periosteal blood supply from disruption of soft tissue envelope as a result of high energy injuries which is also responsible for the displacements that were observed in these fractures. The treatment by traditional bone setters which entails daily massage of the fracture creating a macro movement at the fracture site is also an important contributing factor.