Biological enhancement of tibial diaphyseal aseptic non-unions: the efficacy of autologous bone grafting, BMPs and reaming by-products

Kanakaris, Nikolaos K.; Paliobeis, Christos; Manidakis, Nikolaos; Giannoudis, Peter V.

doi:10.1016/s0020-1383(07)80011-8

Cited by 74 publications

(32 citation statements)

References 73 publications

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“…Nevertheless, it is also associated with limited availability, longer operative time, and donor site morbidity [2]. For these reasons, other methods of biologic enhancement are currently the center of attention and the subject of a substantial amount of biomedical research [21,30,44,46].…”

Section: Introductionmentioning

confidence: 99%

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

Giannoudis

Kanakaris

Dimitriou

et al. 2009

Clin Orthop Relat Res

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117

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Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this ''graft expansion rationale.'' There were 45 patients (32 male) with a median age of 43 years (range, 19-76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12-65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1-7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3-14 months) and 6 months (range, 4-16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3-6 months). The median visual analog scale pain score was 0.9 (range, 0-2.8; maximum 10), and the median functional score was 86 (range, 67-95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients.

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Section: Introductionmentioning

confidence: 99%

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

Giannoudis

Kanakaris

Dimitriou

et al. 2009

Clin Orthop Relat Res

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117

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“…The accepted current treatment approaches for tibial fracture nonunions include excision of the fibrous tissue at the nonunion site, revision of the fixation using various forms of internal or external skeletal fixation devices (to achieve mechanical stability) and, not infrequently, the application of autologous bone graft [19,20].…”

Section: Introductionmentioning

confidence: 99%

“…These strategies include the use of exogenous growth and differentiation factors, mesenchymal stem cells, and gene therapy. Current evidence suggests that among the different factors that have been investigated to date, BMPs appear to have the most osteoinductive potential [13,16,17,19,22,27].…”

Section: Introductionmentioning

confidence: 99%

A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7

Dahabreh

Calori

Kanakaris

et al. 2008

International Orthopaedics (SICOT)

122

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The parameter of health economics in the use of any contemporary medical module plays a dominant role in decision making. A prospective nonrandomised comparative study of the direct medical costs on the first attempt of treating aseptic nonunions of tibial fractures, with either autologous-iliac-crest-bone-graft (ICBG) or bone morphogenetic protein-7 (BMP-7), is presented. Twenty-seven consecutive patients, who were successfully treated for fracture nonunions, were divided into two groups. Group 1 (n = 12) received ICBG and group 2 (n = 15) received BMP-7. All patients healed their nonunions, and the financial analysis presented represents a best-case scenario. Three out of 12 of the ICBG group required revision surgery while just one out of 15 required it in the BMP-7 group. Average hospital stay was 10.66 vs. 8.66 days, timeto-union 6.9 vs. 5.5 months, hospitals costs £2,133.6 vs. £1,733.33, and theatre costs were £2,413.3 vs. £906.67 for the ICBG and BMP-7 groups, respectively. The BMP-7 cost was £3002.2. Fixation-implant was £696.4 vs. £592.3, radiology £570 vs. £270, outpatient £495.8 vs. £223.33, and other costs were £451.6 vs. £566.27 for the ICBG and BMP-7 groups, respectively. The average cost of treatment with BMP-7 was 6.78% higher (P=0.1) than with ICBG, and most of this (41.1%) was related to the actual price of the BMP-7. In addition to the satisfactory efficacy and safety of BMP-7 in comparison to the gold standard of ICBG, as documented in multiple studies, its cost effectiveness is advocated favourably in this analysis.Résumé La paramètre des finances joue un rôle dominant en ce qui concerne l' usage de tout matériel médical contemporain. On présente une étude perspective, comparative et pas randomisée, du coût médical immédiat, pendant le premier effort du traitement des pseudarthroses aseptiques de tibia, avec l' usage d' autogreffe par la crête iliaque (ACI) où`a l' usage de protéines inductrices osseuses (BMP-7). Vingt-sept patients successifs qui ont été guéris avec succès par des fractures de pseudarthroses ont été divisés a deux groupes. Pour le premier groupe (12 patients) a été utilisé d'autogreffe par la crête iliaque. Pour le deuxième groupe (15 patients) a été utilisé BMP-7. Toutes ces pseudarthroses ont été guéries avec succès et l' analyse des finances présentée, prouve le meilleur scénario possible. Trois sur douze des patients du groupe ACI et seulement un sur quinze du groupe BMP-7 ont eu besoin de répéter l' opération chirurgicale. La comparaison entre le premier (ACI) et le deuxième (BMP-7) groupe a montré. La durée moyenne d' hospitalisation était 10,66 contre 8,66

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“…Thus, for the hypertrophic forms, associated with excessive motion, the first step is to obtain a stable fixation often by the revision of the method of fixation. Conversely, in the atrophic forms, the goal must be the restoration of a good biological environment [20]. Various surgical techniques have been proposed for treatment of forearm nonunions [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?

Faldini

Traina

Perna

et al. 2015

International Orthopaedics (SICOT)

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The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft.

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Biological enhancement of tibial diaphyseal aseptic non-unions: the efficacy of autologous bone grafting, BMPs and reaming by-products

Cited by 74 publications

References 73 publications

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7

Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?

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