First mid-term results after cancellous allograft vitalized with autologous bone marrow for infected femoral non-union

IntroductionStandardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients.MethodsA comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated.ResultsThe search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies.ConclusionsThis extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.

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Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

106

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Bone marrow aspirate and bone marrow aspirate concentrate: Does the literature support use in long-bone nonunion and provide new insights into mechanism of action?

Moyal,

Li,

Adelstein

et al. 2024

Eur J Orthop Surg Traumatol

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Purpose To assess the use of bone marrow aspirate (BM) and bone marrow aspirate concentrate (BMAC) in the treatment of long-bone nonunion and to understand mechanism of action. Methods A systematic review of PubMed and EBSCOHost was completed to identify studies that investigated the use of BM or BMAC for the diagnosis of delayed union and/or nonunion of long-bone fractures. Studies of isolated bone marrow-mesenchymal stem cells (BM-MSCs) and use in non-long-bone fractures were excluded. Statistical analysis was confounded by heterogeneous fracture fixation methods, treatment history, and scaffold use. Results Our initial search yielded 430 publications, which was screened down to 25 studies. Successful treatment in aseptic nonunion was reported at 79–100% (BM) and 50–100% (BMAC). Septic nonunion rates were slightly better at 73–100% (BM) and 83.3–100% (BMAC). 18/24 studies report union rates > 80%. One study reports successful treatment of septic nonunion with BMAC and no antibiotics. A separate study reported a significant reduction in autograft reinfection rate when combined with BMAC (P = 0.009). Major adverse events include two deep infections at injection site and one case of heterotopic ossification. Most studies note transient mild donor site discomfort and potential injection site discomfort attributed to needle size. Conclusion The current literature pertaining to use of BM/BMAC for nonunion is extremely heterogeneous in terms of patient population and concomitant treatment modalities. While results are promising for use of BM/BMAC with other gold standard treatment methodologies, the literature requires additional Level I data to clarify the impact of role BM/BMAC in treating nonunion when used alone and in combination with other modalities. Level of evidence Level III.

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Pseudarthrosen am Femur inklusive Korrekturosteotomien

Reumann¹,

Meder²,

Klopfer³

et al. 2019

OP-JOURNAL

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Pseudarthrosen am Femur stellen komplexe Folgezustände nach Fraktur dar. Dies bedingt eine sozioökonomische Herausforderung sowohl für den Patienten selbst, seinen behandelnden Chirurgen als auch das Gesundheitssystem. Risiken für eine Pseudarthrose am Femur stellen u. a. Faktoren dar, die bereits im Rahmen der primären Verletzung begründet sein können, wie ein durch das Trauma assoziierter Weichteilschaden bei offener Fraktur, eine Verletzung im Rahmen eines Polytraumas (z. B. mit Schädel-Hirn-Trauma) sowie Nebenerkrankungen des Patienten wie Diabetes mellitus oder ausgeprägter Nikotinabusus. Auch systemische Erkrankungen oder Medikamenteneinnahme (z. B. Statine) nehmen Einfluss auf die Knochenheilung. Um die richtige Behandlungsstrategie zu wählen, bedarf es hoher chirurgischer Expertise und Erfahrung: Die Behandlung erfordert eine ausführliche klinisch-radiologische sowie laborchemische Diagnostik sowie biomechanisches und biologisches Verständnis der knöchernen Situation. Nur so kann eine zügige knöcherne Ausheilung der Pseudarthrose am Femur mit möglichst geringer Zahl an Revisionseingriffen erreicht werden.

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First mid-term results after cancellous allograft vitalized with autologous bone marrow for infected femoral non-union

Cited by 5 publications

References 32 publications

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bone marrow aspirate and bone marrow aspirate concentrate: Does the literature support use in long-bone nonunion and provide new insights into mechanism of action?

Pseudarthrosen am Femur inklusive Korrekturosteotomien

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