Molecular pathogenesis of fracture nonunion

Ding, Zichuan; Lin, Yi-Kai; Gan, Yaokai; Tang, Tingting

doi:10.1016/j.jot.2018.05.002

Cited by 42 publications

(37 citation statements)

References 115 publications

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“…Successful incorporation of allografts to host bone leads to augmentation of osseous restoration by a large margin. Osseous restoration was positively associated with ETO, which can be explained by the fracture healing process caused by ETO, including cytokine secretion and vascular invasion [32,33]. In the allografts group, we found a significant enhancement of femoral width, which reflected the reconstruction of the femoral bone stock through the application of cortical strut allografts.…”

Section: Discussionmentioning

confidence: 71%

“…Incorporation of cortical strut allografts to host bone was defined as complete union and bridging between them. Fracture nonunion was defined as a persistent fracture line or absence of bridging callus after six postoperative months [32]. Hip function evaluation was conducted by two observers not involved with the surgical and clinical care of the patients using Harris Hip Score (HHS).…”

Section: Methodsmentioning

confidence: 99%

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Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts

et al. 2020

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Background: Stress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear. Methods: We retrospectively reviewed 47 patients who underwent revision THA using extensively porous-coated stems combined with cortical strut allografts and 75 patients without allografts. The minimum follow-up was 2 years. Femoral bone remodeling signs, including stress shielding, bone restoration in bone defect area, distal cortical hypertrophy, and femoral width, were compared between patients with and without cortical strut allografts. Clinical outcomes were also compared between two groups. Results: Patients with cortical strut allografts showed less severe stress shielding (P = 0.01) than patients without allografts. Patients with allografts had more osseous restoration in bone defect area than patients without allografts (63.8% vs 30.7%, P < 0.001). Femoral width was significantly higher in femur with allografts than in femur without allografts at the immediate postoperative stage and latest follow-up (both P < 0.001). The hip function score, rerevision rate, and complications were comparable between two groups. Conclusion: The application of cortical strut allografts can decrease the severity of stress shielding, augment osseous restoration in bone defect area and improve femoral bone stock after revision THA using extensively porous-coated stems.

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Section: Discussionmentioning

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts

et al. 2020

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“…The fixation and stability of the cementless femoral component was evaluated according to the criteria of Engh et al [15] Subsidence of the stem was measured as previously described [16]. Radiolucent lines around the stems were divided into seven zones as described by Gruen et al [17] Nonunion of a PFF and ETO were defined as a persistent fracture line or the absence of a bridging callus, respectively, at 6 months postoperative [18]. The incorporation of cortical strut allografts into host bone was defined as complete union and bridging between them.…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

Ding

Ling

Yuan

et al. 2020

BMC Musculoskelet Disord

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Background: Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts. Methods: We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1-13.5) years. Results: The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7-99.5%) at 10 years. Conclusion: Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.

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“…The fracture line without dislocation is often not obvious in plain radiography at the early stage, which causes a high risk of delays in the diagnosis and treatment, and might lead to scaphoid nonunion. Scaphoid nonunion is frequently seen as a serious bone fracture complication, which remains a challenge in clinical practice [ 2 ]. Some case series of scaphoid fracture reported a nonunion rate of 11–12.3% [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

3D printing-assisted percutaneous fixation makes the surgery for scaphoid nonunion more accurate and less invasive

Yin

Feng

et al. 2020

Journal of Orthopaedic Translation

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Purpose The study was to explore whether the 3-dimensional printing guiding plate system could facilitate the modified procedure for arthroscopic treatment of nondisplaced scaphoid nonunion. Methods Patients, diagnosed with scaphoid nonunion without displacement, were randomly assigned into two groups. In Group A, the 3-dimensional printing guiding plate system was used for guiding fixation during the surgery. In Group B, fixation was performed with intra-operative fluoroscopy. The bone operation time was recorded during the surgery. The patients were evaluated before surgery and followed-up after six post-operative months, including motion ratio, strength ratio, Visual Analogue Scale, modified Mayo Scores, Patient Rated Wrist Evaluation scores, plain radiography and CT scan. Results Sixteen patients were recruited for the study. The average bone operation time in Group A was statistically shorter than that in Group B. Conclusions 3-dimensional printing technique-assisted arthroscopic bone graft and fixation of scaphoid nonunion constitute an effective and accurate clinical treatment option. The translational potential of this article The concept and technique of 3D printing assisted percutaneous fixation introduced in this paper have the potential to be applied in a variety of operations requiring accurate percutaneous fixation, especially for the joint injuries.

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Molecular pathogenesis of fracture nonunion

Cited by 42 publications

References 115 publications

Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts

Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

3D printing-assisted percutaneous fixation makes the surgery for scaphoid nonunion more accurate and less invasive

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