OBJECTIVE To observe the osteogenesis of percutaneous autogenous bone marrow grafting in cicatricial bone defect, to seek a good method for treating fracture nonunion. METHODS Eighteen rabbits were adopted in this study. 1 cm bone defect model was made in each side of radius, 6 weeks later, 2 ml autogenous bone marrow was injected in the right radial bone defect as experimental group, 2 ml autogenous peripheral blood in the left side as control group. X-ray features, histologic changes, Ca and P content in the site of bone defect were studied in various times. Also 15 patients were treated clinically for the nonunion fracture, the average time from nonunion to bone marrow grafting was 13 months. RESULTS In experimental group, the increasing new bone tissue were observed in X-ray and histologic examination. While in control group, no osteogenesis was observed. Ca and P content of experimental group was higher than that of control group. For the 15 patients, 13 cases healed in 5-9 months, 2 cases failed. CONCLUSION Percutaneous autogenous bone marrow grafting is capable of osteogenesis in the cicatricial bone defects. It can be used in nonunion cases which are not fit for operation of bone grafting because of poor condition of the skin.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Objective To study the effect of platelet-rich plasma (PRP) on repairing chronic wounds of lower l imbs. Methods From May 2007 to November 2007, 47 patients suffering from chronic wounds of lower l imbs were treated. There were 41 males and 6 females, aged from 15 to 68 years (43.2 years on average). The disease was caused by tibiofibulafracture in 20 cases, calcaneus fracture in 4 cases, metatarsal fracture in 1 case, multiple open fracture of lower l imbs in 3 cases, tibia osteomyel itis in 10 cases, femur osteomyel itis in 1 case, soft tissue injury of ankle in 4 cases, infection after amputation in 2 cases, infection after foot orthomorphia in 1 case, and infection after calcaneus tendon neoplasty in 1 case. Their chronic wounds did not healed after 2 to 4 months of therapy. Among them, chronic wounds compl icated with fracture nonunion in 23 cases and positive bacterial culture result in 38 cases. Debridement and autogenous PRP gel injection were appl ied every 2 months and for twice. Results The patients were followed up for 4 months after the first PRP injection. Two months after the first PRP injection, chronic wounds contracted significantly in 34 patients with purulence and necrosis tissue cleaned up, circulation of soft tissue improved and exposed bone or muscle tissue covered by neogenetic granulation. No patient was completely cured. Two months after the second PRP injection, the average coverage rate was 79.3% ± 18.0%, the total cure rate was 29.8%. The volume of the chronic wounds decreased by (9.3 ± 4.9) mL after PRP therapy (2.5 ± 2.7) mL when compared with (11.8 ± 5.6) mL of before therapy, showing significant difference (P lt; 0.05). X-ray photograph showed that among the 23 cases of fracture nonunion, fracture healed completely in 9 cases; bony callus formation increased obviously in 12 cases; no significant change was observed in 2 cases. No aggravated sign of osteomyel itis was notified. Positive results of bacterial culture reduced to 15 cases. Conclusion PRP efficiently enhances the recovery of soft tissue defect and speeds up the chronic wounds heal ing oflower l imbs.
OBJECTIVE To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.
To evaluate the initial cl inical effect of the autologous bone marrow integrating artificial bone and il ium periosteum transplantation in treatment of problematic nonunion. Methods From January 2004 to July 2006, 12 patients (13 l imbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and il iumperiosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 l imbs, the femur in 3 l imbs, the humerus in 2 l imbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 ∶ 1 X-rays before operation. Eleven l imbs were treated by internal fixation (10 l imbs by the bone nail and 1 l imb by the l imited contact-dynamic compression plate), 2 l imbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. Results All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 l imbs, but functional impairment occurred in 6 l imbs after union of fracture. Conclusion Autologous bone marrow integrating artificial bone and il ium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.
Objective To review the research progress of P75 neurotrophin receptor (P75NTR) so as to clarify its mechanism, and to explore its relationship with nonunion so as to provide a new idea for the treatment of nonunion. Methods The related domestic and foreign literature of P75NTR in recent years was extensively reviewed, summarized, and analyzed to find out the mechanism of action of P75NTR and the pathological factors of nonunion formation. Results P75NTR can express in nonunion tissues and lead to defect of fibrin degradation and inhibition of angiogenesis, which play an important role in the pathogenesis of nonunion. Conclusion It needs to be confirmed by further study whether the purpose of treating nonunion can be achieved by blocking the effects described above of P75NTR.
Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.
Objective To investigate the effectiveness of tunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft. MethodsThe clinical data of 23 cases of aseptic non-hypertrophic nonunion of femoral shaft treated with tunnel osteogenesis technique combined with locking plate between January 2017 and December 2020 were retrospectively analysed. There were 17 males and 6 females with an average age of 41.4 years (range, 22-72 years). There were 22 cases of closed fracture and 1 case of open fracture. The types of internal fixation at admission included intramedullary nail in 14 cases and steel plate in 9 cases. The number of nonunion operations received in the past was 0 to 1; the duration of nonunion was 6-60 months, with an average of 20.1 months. Among them, there were 17 cases of aseptic atrophic nonunion of the femoral shaft and 6 cases of dystrophic nonunion. Twenty-two cases were fixed with 90° double plates and 1 case with lateral single plate. The operation time, theoretical blood loss, hospitalization stay, nonunion healing, and postoperative complications were recorded. Harris hip function score, Lysholm knee function score, lower extremity function scale (LEFS), and short-form 36 health survey scale (SF-36) were used at last follow-up to evaluate hip and knee functions. Visual analogue scale (VAS) score was used to evaluate the relief of pain at 1 day after operation and at last follow-up. ResultsThe average operation time was 190.4 minutes, the average theoretical blood loss was 1 458.4 mL, and the average hospitalization stay was 8.2 days. All the 23 patients were followed up 9-26 months, with an average of 18.2 months. The healing time of nonunion in 22 patients was 3-12 months, with an average of 5.6 months. There were 8 cases of limb pain, 8 cases of claudication, 6 cases of limitation of knee joint movement, and 2 cases of limitation of hip joint movement. At last follow-up, the imaging of 1 patient showed that the nonunion did not heal, accompanied by pain of the affected limb, lameness, and limitation of knee joint movement. At 1 day after operation, the VAS score of 23 patients was 6.5±1.8, the pain degree was good in 7 cases, moderate in 12 cases, and poor in 4 cases; at last follow-up, the VAS score was 0.9±1.3, the pain degree was excellent in 21 cases and good in 2 cases, which were significantly better than those at 1 day after operation (t=12.234, P<0.001; Z=–5.802, P<0.001). At last follow-up, the average Harris hip function score of 22 patients with nonunion healing was 94.8, and the good rate was 100%; Lysholm knee function score averaged 94.0, and the excellent and good rate was 90.9%; LEFS score averaged 74.6; SF-36 physical functioning score averaged 85.0 and the mental health score averaged 83.6. ConclusionTunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft has a high healing rate and fewer complications, which can effectively relieve pain and improve lower limb function and quality of patients’ life.
ObjectiveTo evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. MethodsBetween January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. ResultsAfter operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. ConclusionAseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.
OBJECTIVE: To introduce the operation method of treatment of nonunion of scaphoid bone by transfer of pedicled radial periosteal bone flap. METHODS: From Match 1986, 26 cases with old nonunion of scaphoid bone were treated by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery, the size of bone flap was 1.0 cm x 0.4 cm x 0.5 cm. RESULTS: All patients with old nonunion of scaphoid bone were healed by first intention, bone union was occurred after 2 to 3 months of operation, and wrist joint almost recovered normal function. CONCLUSION: It is an effective operation method to treat nonunion of scaphoid bone.