Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail / 中国骨伤

OBJECTIVE@#To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.@*METHODS@#A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.@*RESULTS@#All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).@*CONCLUSION@#On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.

Application of autologous platelet-rich plasma in the treatment of postoperative bone nonunion for long bone shaft fractures during and after operation / 中国输血杂志

【Objective】 To explore the clinical effects of autologous platelet-rich plasma (PRP) in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation. 【Methods】 A total of 34 patients with postoperative bone nonunion for long bone shaft fracture, who were admitted and cured in the Orthopedics Department of our hospital from January 2019 to June 2020, were selected. They were randomly divided into the experimental group(n=17) and control group(n=17). Individuals in the control were treated with autologous iliac bone alone., while the experimental group were treated with autologous iliac bone graft plus autologous PRP during and after operation. After surgery, the autogenous PRP was accurately injected with ultrasound guidance every 7 days (5 mL/person, 4 occasions in total). The clinical healing time of the fracture, the grading of callus formation and the functional rehabilitation level of limbs on the affected side at different time were observed in both groups. 【Results】 All 34 patients were followed up. In the experimental group and the control group, the clinical healing time (month) of the fracture was (5.03±1.24) vs (6.91±1.41), P<0.05. The healing rate of the fracture for 6 months and 9 months was 94%(16/17)vs 59%(10/17)and 94%(16/17)vs 82%(14/17), respectively (P<0.05). The grading of callus formation within 3, 6 and 9 months was (2.11±0.69) vs (1.53±0.80), (3.06±0.90) vs (2.59±0.87) and (3.82±0.73) vs (3.35±0.86), respectively (P<0.05). The acceptance rate of functional rehabilitation of limbs on the affected side was 82.35%(14/17)vs 76.47%(13/17), P<0.05. 【Conclusion】 The application of autologous PRP in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation can achieve good clinical treatment.

Application of Wall Thickness Analysis in Estimating the Degree of Tibial Fracture Bone Healing / 医用生物力学

Objective To quantitatively judge the degree of tibial bone healing using the finite element wall thickness analysis method, so as to provide an intuitive diagnostic basis for clinical judgment of tibial union and delayed bone healing. Methods After three-dimensional (3D) modeling for the affected and healthy limb side of 48 patients, the maximum wall thickness (MWT) was calculated, and the ratio (B value) was used as a quantitative index of bone healing. When both BMWT2 and BMWT1 were greater than 0.9, bone healing could be judged. When BMWT2 was between 0.9 and 0.7, bone union was judged to be poor, and there was no significant increase in this value after regular reexamination. When BMWT3 was above 0.9 while both BMWT1 and BMWT2 were smaller than 0.7, it could be judged as internal fixation failure, which should be replaced during the second operation. The clinical diagnosis was revised twice, and the final clinical healing results were observed. Results Clinical diagnosis analysis and finite element wall thickness analysis were carried out in 48 patients during each review period, and 21 cases of delayed bone healing and 27 cases of bone nonunion were judged clinically. Among them, 2 cases were judged to be ineffective, and bone grafting intervention was adopted to replace the internal fixation, 12 cases were judged to be still effective, and all cases were finally healed by surgical intervention of bone grafting alone. By Bowker test, P=0.094 was obtained, indicating that the wall thickness analysis method was consistent with the clinical diagnosis. Conclusions The wall thickness analysis method can be used to quantitatively analyze the degree of bone healing at fracture end and realize the rapid calculation of bone healing degree. The case results in this study show that the finite element wall thickness analysis method is superior to the simple clinical diagnosis method, and has better differential diagnostic significance for early diagnosis of poor bone healing.

Uso da associação entre hidroxiapatita e plasma rico em plaqueta no tratamento de uma não união óssea de rádio e ulna em um cão - relato de caso / Use of the association between hydroxyapatite and platelet-rich plasma in the treatment of radius and ulna nonunion in a dog - case report / Asociación de hidroxiapatita y plasma rico en plaqueta en el tratamiento de ausencia ósea de radio y cúbito en un perro - relato de caso

A não união óssea é uma complicação ortopédica que ocorre normalmente devido à instabilidade da fratura em decorrência de uma escolha de fixação inadequada ou inapropriada, suprimento sanguíneo deficiente, osteomielite e afastamento excessivo dos fragmentos; sendo mais comumente em cães de raças pequenas e miniatura; e de maior ocorrência em regiões distais de rádio, ulna, tíbia e fíbula. Este trabalho relata a utilização da associação entre Hidroxiapatita e Plasma Rico em Plaqueta no tratamento de uma não união óssea de rádio e ulna e esclarece os benefícios desses biomateriais no processo de regeneração do tecido ósseo. O presente trabalho tem por objetivo relatar o caso de um canino com não união óssea de rádio/ulna devido ao alinhamento inadequado dos fragmentos ósseos no tratamento conservador com bandagem, proporcionando instabilidade do foco da fratura. O tratamento cirúrgico consistiu na colocação de uma placa óssea e enxertia com Hidroxiapatita e Plasma Rico em Plaqueta para melhor regeneração óssea. A utilização de tais biomateriais no tratamento da não união foi benéfica para a formação do calo ósseo primário, não produzindo efeitos adversos para o paciente. A partir desse resultado pode-se concluir que, a utilização desses biomateriais e enxertia precisa ser mais bem estudada e aprimorada na reparação óssea de uma não união, visto que, a aplicabilidade dessa associação mostrou-se um método eficiente, não apresentando sinais de infecção e nem evidência de rejeição.(AU)

Bone nonunion is an orthopedic complication that usually occurs due to fracture instability as a result of an inadequate or inappropriate choice of fixation, deficient blood supply, osteomyelitis, and excessive removal of fragments; which is more commonly seen in small and miniature breeds; and more frequent in the distal regions of radius, ulna, tibia, and fibula. This paper reports on the use of the association between Hydroxyapatite and Platelet-Rich Plasma in the treatment of a radius and ulna nonunion and clarifies the benefits of these biomaterials in the bone tissue regeneration process. This study reports the case of a dog presenting nonunion of radius and ulna bone due to inadequate alignment of bone fragments in a conservative treatment with bandage, providing instability of the fracture focus. The surgical treatment consisted of placing a bone plate and grafting with Hydroxyapatite and Platelet-Rich Plasma for better bone regeneration. The use of such biomaterials in the treatment of nonunion injuries was beneficial for the formation of the primary bone callus, without producing adverse effects for the patient. From this result, it can be concluded that the use of these biomaterials and grafting needs to be further studied and improved for use in bone repair of nonunion cases, since the applicability of this association proved to be an efficient method, with no signs of infection or evidence of rejection.(AU)

Ausencia de unión ósea es uma complicación ortopédica que normalmente ocurre debido a la instabilidade de la fractura como resultado de uma elección de fijación inadecuada o inapropriada, aporte sanguíneo deficiente, osteomielitis y remoción excessiva de fragmentos; que se observa com mayor frecuencia en perros de razas pequeñas y miniaturas; y más frecuente em regiones distales de radio, cúbito, tíbia y peroné. Este artículo informa sobre el uso de la asociación de Hidroxiapatita y Plasma rico en plaqueta en el tratamiento de ausencia de unión del radio e el cúbito, y aclara los benefícios de esos biomateriales en el processo de regeneración del tejido ósseo. Esa investigación ha tenido como objetivo reportar el caso de un perro sin unión de radio / cúbito por alineación inadecuada de fragmentos óseos en tratamiento conservador con vendaje, proporcionando inestabilidad del foco de la fractura. El tratamiento quirúrgico consistió en la colocación de una placa ósea e injerto con Hidroxiapatita y Plasma rico en plaqueta para uma mejor regeneración ósea. El uso de tales biomateriales en el tratamiento de ausencia de unión ha sido beneficioso para la formación del callo óseo primario, sin producir efectos adversos para el paciente. A partir de ese resultado se puede concluir que, el uso de esos biomateriales e injertos necesitan ser mejor estudiado y mejorado en la reparación de ausencia ósea, ya que la aplicabilidad de esa asociación demostró ser um método eficaz, sin presentar signos de infección y evidencia de rechazo.(AU)

Psoralen induces proliferation of rabbit endosteal mesenchymal stem cells and constructs cell-scaffold bone complex innonunionrepair / 中国组织工程研究

BACKGROUND: Psoralen is a plant estrogen, and a large number of studies have confirmed its role in promoting cell proliferation and differentiation. OBJECTIVE: To construct a cell-scaffold composite bone using psoralen, rabbit endosteal mesenchymal stem cells and polycaprolactone and to explore its effect on the treatment of rabbit nonunion. METHODS: (1) Rabbit endosteal mesenchymal stem cells were cultured and cultured until the third generation for each experiment. Passage 3 cells were seeded onto culture plates containing 50 mg/L bone morphogenetic protein 2 (positive control), 10-8, 10-7 and 10-6 mol/L psoralen (low-, middle-, and high-concentration psoralen groups) or the same volume of purified water (control group). The cell proliferation of each group was detected on the 3rd, 5th and 7th days after intervention using MTT method. (2) The three-dimensional polycaprolactone scaffold was added to the bottom of the cell culture plate, and rabbit endosteal mesenchymal stem cells were seeded into the scaffold at a density of 1×103 per well. Then, 10-6 mol/L of psoralen was added. Cell-scaffold composite bone was taken after 21 days of culture. (3) Animal models of radial nonunion were established in 27 New Zealand white rabbits, and were then randomized into experimental, scaffold and control groups followed by implantation of cell-scaffold composite bone, simple scaffold, and nothing, respectively. Pathological hematoxylin-eosin staining for observation of bone healing was performed at the 2nd, 4th, and 8th weeks after surgery. Healing of nonunion was observed on the X-ray films that were taken at the 4th week after surgery. RESULTS AND CONCLUSION: (1) Three concentrations of psoralen could induce the proliferation of rabbit endosteal mesenchymal stem cells. Compared with the control group, 10-6 mol/L psoralen exerted the strongest stimulation effect on rabbit endosteal mesenchymal stem cells (P 0.05). (2) Pathological hematoxylin-eosin staining of radial nonunion showed that the number of osteoblasts in the experimental group was higher than that in the scaffold and control groups (P < 0.05). (3) The X-ray films revealed bone healing in the experimental group, partial healing in the scaffold group and non-healing in the control group. Overall findings indicate that psoralen can promote the proliferation of rabbit endostealmesenchymal stem cells, and the effect is certainly related to the concentration of psoralen. Psoralen can be combined with rabbit endosteal mesenchymal stem cells and polycaprolactone scaffold to form composite bone, achieving good outcomes in the treatment of nonunion in animals.

Mechanism and progress of exosomes in the treatment of nonunion / 中国组织工程研究

BACKGROUND: Bone nonunion is a common complication after fracture, which brings great distress to patients. With the continuous development of exosomal technology, exosomes gradually show their advantages in the treatment of nonunion, which has become a new research direction in medical work. OBJECTIVE: To summarize the researches in and outside China and explore the role of exosomes in the treatment of nonunion. METHODS: The authors retrieved related Chinese articles published from 2003 to 2019 in Wanfang database, CNKI and VIP database with the key words of “exosomes, nonunion, bone remodeling, bone regeneration, vascular injury, osteoblasts, osteoclasts” and related English articles published from 2003 to 2019 in PubMed with the key words of “exosomes, nonunion, bone remodeling”. Totally 50 articles were selected based on inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) In recent years, more and more attention has been paid to the study of exosomes on bone nonunion. MiRNAs and proteins in exosomes can affect bone nonunion by affecting the differentiation of osteocytes. (2) Studies have found that exosomes can treat bone nonunion by regulating bone remodeling, promoting vascular repair, and improving systemic diseases. (3) However, the current research on exosomes is still in the experimental stage. The specific method of how to better apply it to clinical treatment needs further exploration.

Molecular mechanism of icariin in the treatment of bone nonunion / 中国组织工程研究

BACKGROUND: Nonunion is a common clinical complication in orthopedics, which seriously impacts the physical and mental health and quality of life of patients. In recent years, a large number of studies have found that icariin plays a significant role in promoting fracture healing and treating bone defects. Bone nonunion and fracture healing coexist, and the research on the mechanism of fracture healing actually focuses on the treatment of bone nonunion. OBJECTIVE: To review the research progress in the molecular mechanism of icariin in the treatment of bone nonunion. METHODS: The first author used “icariin, bone nonunion, bone marrow mesenchymal stem cells, periosteal cell, osteoblasts, osteoclast” as key words in English and Chinese to search PubMed, CNKI, WanFang and VIP databases. A total of 542 articles were retrieved and screened manually according to the selection criteria and exclusion criteria. Finally, 44 articles were included for result analysis. RESULTS AND CONCLUSION: Icariin can effectively promote fracture healing and treat bone nonunion by promoting the proliferation and differentiation of bone marrow mesenchymal stem cells and periosteal cells, promoting the proliferation and maturation of osteoblasts and inhibiting the osteoclast effect of osteoclasts. However, most of the experiments are still in the basic experimental research, and there is still a need for a large number of clinical studies as well as studies on related proteins and genes, to provide a new idea for the clinical use of Chinese herbs in the treatment of bone nonunion.

Nitinol memory alloy two foot fixator with autologous cancellous bone grafting for old scaphoid fracture and nonunion / 中国修复重建外科杂志

Objective: To summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion. Methods: Between 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. Results: The 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). Conclusion: For 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.

Fracture Non-Union: A Review of Clinical Challenges and Future Research Needs

@#Non-union of bone following fracture is an orthopaedic condition with a high morbidity and clinical burden. Despite its estimated global prevalence of nine million annually, the limit of bone regeneration therapy still results in patients living with pain, a reduced quality of life and associated psychological, social and financial repercussions. This review provides an overview of the current epidemiological and aetiological data, and highlights where the clinical challenges in treating non-union lie. Current treatment strategies are discussed as well as promising future research foci. Development in biotechnologies to treat non-union provides exciting scope for more effective treatment for this debilitating condition.

Application of three-point rigid internal fixation technique in reduction malarplasty / 中华医学美学美容杂志

Objective To evaluate the effect of three-point rigid internal fixation technique in reduction malarplasty for prominent malar complex.Methods From January of 2014 to January of 2017,45 patients with prominent malar complex were treated with double L shape osteotomy combined bony Z plasty and three-point rigid internal fixation for prominent malar complex.The preoperative and postoperative photographs were taken to monitor the contour improvement,the adverse effects were recorded,and 3D CT was used to assess the bone union situation at 6 months after operation.Results All the wounds got primary intention healing and no severe complication occured in perioperative period.3D CT showed good bone recovery 6 months after operation.Postoperative appearance of all cases showed that the width of middle face was efficiently reduced.All patients expressed high levels of satisfaction.Conclusions Reduction malarplasty with three-point rigid internal fixation for prominent malar complex is an effective and safe method for the treatment of prominent malar complex.

Fibular osteotomy with autogenous iliac bone graft in treatment of postoperative nonunion of tibia / 第二军医大学学报

Objective To assess the clinical efficacy of fibular osteotomy with autogenous iliac bone graft for treatment of nonunion of the tibia. Methods A cohort of 45 patients with postoperative nonunion of tibia between Jul. 2008 and Jun. 2013 were treated by fibular osteotomy combined with autogenous iliac bone graft in Changhai Hospital of Second Military Medical University. According to anatomical classification, there were 29 cases of hypertrophic nonunion, 17 cases of atrophic nonunion and two cases of pseudoarthrosis. For primary fixation, 32 cases had plates internal fixation, 11 had intramedullary nail and two had external fixation. Eight patients with stable plate internal fixation were treated by fibular osteotomy with autogenous iliac bone graft, 35 patients with failed internal fixation and two patients with failed external fixation were treated by removing implant and exchanging compression plate with fibular osteotomy using autogenous iliac bone graft The status of fracture healing and relative complications were assessed by lateral and frontal X-ray. Functional recovery of the ankle was evaluated by Olerud-Molander Ankle Score (OMAS). Results The operation time was 1. 3-2. 5 (1. 7 ± 0. 5) h, the intra-operation blood loss volume was 200-500 (250. 0 ± 59. 6) mL, the fibular osteotomy length was 2-3 (2. 4 ± 0. 5) cm, and the volume of iliac grafting was 3-23 (7. 8 ± 1. 3) cm3. The follow-up time was 12-48 (16. 5 ± 3. 3) months and the fraction healing time was 3-11 (5. 6 ± 2. 4) months. The healing of 26(58%) patients took 3-5 months, 13(29%) patients took 6-8 months and 6(13%) patients took 9-11 months. Twenty-seven patients had no limb shortening, nine patients had limb shortening of 2 cm. The function of lower limb joints was excellent in 23 cases, good in 14 cases, common in 5 cases and bad m 3 cases at last follow-up. Conclusion The fibular osteotomy with autogenous iliac bone graft can create pressure on the broken bone end and increase the broken bone end contact area, promoting fracture healing and reducing complications.

Clinical effect and safety of cortical bone decortication combined locking plate fixation for treatment of patients with long bone nonunion of limbs / 中国综合临床

Objective To analyze the clinical effect and safety of cortical bone decortication combined locking plate fixation for treatment of long bone nonunion of limbs. Methods Eighty patients with long bone nonunion of limbs who were treated in the Zhongshan Hospital Affiliated to Dalian University from Jun. 2010 to Jun. 2013 were selected as our subjects and their clinical data were recorded. According to different treatment methods,the patients were divided into control group and observation group,and each group with 40 cases. Patients in observation group were treated with cortical bone decortication combined locking plate fixation, while in control group were treated with locking plate combined slotted bone graft. Clinical effects and safety of two groups were compared. Results Excellent and good rate in observation group was 100%(40/40),obviously higher than that of control group(90. 0%(36/40);χ2 =4. 21,P﹤0. 05). Bleeding amount during operation in observation group was(370. 5 ± 56. 5)ml,obviously less than that of control group((486. 5 ± 64. 5)ml;t=8. 56,P﹤0. 01). And the fracture healing time was(5. 6 ± 1. 2)months in observation group,shorter than control group((7. 2 ± 1. 5)months;t =5. 27,P ﹤0. 01). The postoperative complication occurrence rate was 5. 0%(2/40),significantly lower than control group(20. 0%(8/40);χ2 =4. 11,P ﹤0. 05). Conclusion Cortical bone decortication combined locking plate fixation for treatment of long bone nonunion of limbs is safe and effective,and it can reduce operation injury and accelerate postoperative healing of fracture.

Treatment on bone nonunion by extracorporeal shock wave combine hyperbaric oxygen / 重庆医学

Objective To explore the effect and action principle of extracorpoporeal shock wave(ESW) combine hyperbaric oxygen(HBO) in bone nonunion treatment .Methods Totally 50 standard New Zealand white rabbits were chosen ,and 48 rabbits were successfully made to models .Then ,they were divided into four groups by using the random number table ,12 in each group . The group A was in ESW combine HBO group ;The group B was in hyperbaric oxygen group ;The group C was in pure ESW group ;The group D was in control group .X‐ray inspected before treatment and after treatment in 4 、8 、12 weeks .The calcium con‐tent was checked ,the osteoblast in bone callus was observed by the optical microscope ,and the data was analyzed by statistics .Re‐sults There was a significant difference in 4 ,8 ,12 weeks between group A and group B ,C ,D in the nonunion gap(P< 0 .05) ,there was significant difference in 4 ,8 ,12 weeks between group A and group B ,C ,D in the generation bone callus(P< 0 .05) .Callus calci‐um content of group A was higher than group C ,the difference was statistical significance(P< 0 .05) ,there was significant differ‐ence in 4 ,8 weeks between group A and group C in callus osteoblast count(P < 0 .05) .Conclusion ESW combine HBO treatment for bone nonunion is better than pure ESW therapy ,simple hyperbaric therapy has no obvious help for the treatment of bone nonun‐ion ,HBO can be used as a good synergy method in the extracorporeal shock wave treatment of bone nonunion .

Extracorporeal shock wave therapy plus enhanced load fibrin glue bone growth factors for nonunion or delayed osseous union of rabbit / 中国免疫学杂志

Objective:To evaluate the effect of Extracorporeal Shock Wave combined percutaneous injection of enhanced fibrin glue loaded bone growth factor in accelerating the bone nonunion healing and promoting osteogenesis process .Methods: 48 radius model rabbits were randomly divided into four groups.Group A rabbits were treated with ESW;Group B rabbits were treated with ESW combined with FG;Group C rabbits were treated with ESW combined with FG/rhBMP-2/rhbFGF;Group D rabbits were treated with ESW combined with FG/rhBMP-2/rhbFGF/rhVEGF.After a combination therapy of 8 week,conventional X-ray radiography,optical in-spection organization form and biomechanical test were applied to evaluate the therapeutic effect .Results:Compared with the group B , the X-ray group C showed that the fracture line was fuzzy ,bony callus area began to increased ,fracture end range reduced.The histo-morphology showed that cartilage began to form , cartilage cell began to proliferate actively , and new blood vessels were forming surrounding fibrous connective tissue.Biomechanical determination found there was no statistical significance between the two groups ( P>0.05 ).FG/rhBMP-2/rhbFGF+ESW group showed the fracture line was still fuzzy , bony callus disappeared and apparent proliferative bone trabecula ,and biomechanical results showed that there was statistical significance between the two groups compared to the group B(P<0.01).FG/rhBMP-2/rhbFGF/rhVEGF+ESW group showed the fracture line was slightly fuzzy ,apparent proliferative bone trabecula in 4 week,and in 8 week,the fracture line was disappeared and moulding of healing was good.The histomorphology showed that the distribution was filled with fibrous connective tissue and many bone tissue .Biomechanical results showed that it could resistance to bending ,there was statistical significance between the two groups compared to the group C ( P<0.01 ).Conclusion: ESW therapy combined percutaneous injection of enhanced fibrin glue loaded bone growth factor can promote fracture healing and the method of combination is expected to be a good choice of non-surgical treatment of bone nonunion.

Open autologous minimal morselized bone grafting with vancomycin repairs infected tibial defects / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.25.004

Research progress of fracture healing and its early diagnosis / 中国矫形外科杂志

Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes ofclinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunionand the significance of the basic multicellular unit(BMU)and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc.have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.

Treatment of refractory bone nonunion with cancellous bone autograft plus external fixator / 中华创伤杂志

Objective To investigate the curative effect of granulated cancellous bone autograft in treatment of refractory bone nonunion after limited contouring of bone ends. Methods Between 2003 and 2006, 13 patients with refractory bone nonunion were treated with external fixation and granulated cancellous bone autograft after limited contouring of bone ends. Results The mean follow-up period was 22.6 months (19-30 months), which showed that all patients gained bone union and resumed com-plete weight loading or previous job at final follow-up. The mean fixation time of external fixators was 10.6 months (7-18 months). The intermittent or persistent pin-track infection occurred in eight patients and relieved by pin-track care and oral or parenteral antibiotics, with no infection after removing external fixator. Conclusion The granulated cancellous bone autograft after limited contouring of bone ends is an effective method for treatment of refractory bone nonunion.

Effect of Percutaneous Autogenous Bone Marrow Stem Cell Transplant on Bone Nonunion / 中国康复理论与实践

@#Objective To investigate the clinical effect of percutaneous autogenous bone marrow stem cell transplant on bone nonunion. Methods 140 patient with bones nonunion were divided into the autogenous bone transplants (A) group and the autogenous bone marrow stem cell transplant (B) group, with 70 cases in each group. They were assessed 2 and 5 months after operation. Results A few calluses could be observed at the end of fracture in 42 cases in group A 2 months after operation, and massive callus formation could be observed in 46 cases 5 months after operation. However, massive callus formation could be observed in 60 cases in group B 2 months after operation, and continual callus formation could be observed in 45 cases 5 months after operation. The mean healing time was (8.4±1.8) months in group A, and (6.5±2.0) months in group B (P<0.05). No side-effects have been observed during the treatment. Conclusion The percutaneous autogenous bone marrow stem cell transplant is more effective on bone nonunion compared with the traditional treatment.

Research progress of fracture healing and it's early diagnosis / 中国矫形外科杂志

Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes of clinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunion and the significance of the basic multicellular unit (BMU) and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc,have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.

Study of Marrow Stem Cell Transplant for Treatment of Bone Nonunion and Bone Defection / 中国康复理论与实践

@#ObjectiveTo observe the curative effect of marrow stem cell transplant on bone nonunion and bone defection.Methods140 patients were randomly divided into the group A (with auto-iliac bone transplant) and group B (with auto-marrow stem cell transplant). There were 70 cases in each group. All patients in two groups were treated by operation and inside and outside fixation.ResultsAfter treatment, the average cicatrization time of group A was (7.0±2.0) months, that of group B was (5.0±1.5) months, there was a significant difference between two groups( P<0.05). There were no obvious adverse reactions found during the treatment period.ConclusionCompared with the traditional bone grafting, treating bone nonunion and bone defection by auto-marrow stem cell transplant has obvious superiority with better curative effect, short course and no adverse reactions.