Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients

Flierl, Michael A.; Smith, Wade R.; Mauffrey, Cyril; Irgıt, Kaan; Williams, Allison; Ross, Erin; Peacher, Gabrielle; Hak, David J.; Stahel, Philip F.

doi:10.1186/1749-799x-8-33

Cited by 114 publications

(84 citation statements)

References 43 publications

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“…36 Our in vivo results show that the osteoconductive factor alone was not sufficient in healing critical-sized calvarial defects. We attribute this to the lack of osteoinductive factors stimulating neovascularization.…”

Section: Discussionmentioning

confidence: 94%

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

Fu¹,

Wang²,

Ch³

et al. 2015

IJN

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Most allogenic bone graft substitutes have only osteoconductive properties. Developing new strategies to improve the osteoinductive activity of bone graft substitutes is both critical and practical for clinical application. Previously, we developed novel simvastatin-encapsulating poly(lactic-co-glycolic acid) microspheres (SIM/PLGA) that slowly release simvastatin and enhance fracture healing. In this study, we combined SIM/PLGA with a rapidly absorbable calcium sulfate (CS) bone substitute and studied the effect on bone healing in critical-sized calvarial bone defects in a rat model. The cytotoxicity and cytocompatibility of this combination was tested in vitro using lactate dehydrogenase leakage and a cell attachment assay, respectively. Combination treatment with SIM/PLGA and the CS bone substitute had no cytotoxic effect on bone marrow stem cells. Compared with the control, cell adhesion was substantially enhanced following combination treatment with SIM/PLGA and the CS bone substitute. In vivo, implantation of the combination bone substitute promoted healing of critical-sized calvarial bone defects in rats; furthermore, production of bone morphogenetic protein-2 and neovascularization were enhanced in the area of the defect. In summary, the combination of SIM/PLGA and a CS bone substitute has osteoconductive and osteoinductive properties, indicating that it could be used for regeneration of bone in the clinical setting.

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Section: Discussionmentioning

confidence: 94%

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

Fu¹,

Wang²,

Ch³

et al. 2015

IJN

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“…Several terms have been used by surgeons to describe the radiographic characteristics of types of nonunion (atrophic, oligotrophic, hypertrophic, pseudarthrosis, fibrous, mobile and normotrophic), 34 often with different interpretations, in particular regarding atrophic nonunion and pseudarthrosis.…”

Section: Discussionmentioning

confidence: 99%

The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection

Mills

Tsang²,

Hopper

et al. 2016

Bone & Joint Research

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ObjectivesA successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion.MethodsCauses of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed.ResultsA total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients.In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results.ConclusionTwo thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion.Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016;5:512–519. DOI: 10.1302/2046-3758.510.BJR-2016-0138.

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“…The positively charged surface of the 3D rGO/PPY + scaffold allowed it to easily absorb the CPP molecules via the similar electrostatic interactions between the NH + groups in PDDA molecules and the negatively charged groups (amino acid sequence, hydroxyl and phosphate groups) in the CPP bio-molecules at physiological pH. 12 Finally, on xating the CPP molecules on scaffolds with cross-linking agents (including NHS, MES and EDC), 13,22 the CPP-modied 3D rGO/PYY composite was obtained, and marked as 3D rGO/PPY/CPP.…”

Section: Preparation and Characterization Of The Cpp-modied 3d Rgo/pmentioning

confidence: 99%

“…The increase in the water uptake rate of the 3D rGO/PPY/CPP scaffold is closely related to the hydrophilic functional groups in CPP molecules, such as an amino acid sequence, hydroxyl and phosphate groups, which tightly attract and hold the water molecules on the surface of the scaffold. 12 In literature, the higher water uptake rate of the bio-scaffolds was favourable for cell growth, and good water retention was thought to have a benecial effect in preventing the accumulation of inammatory exudates and dehydration. [30][31][32] …”

Section: -29mentioning

confidence: 99%

“…10,11 Therefore, plenty of experimental methods, such as plasma treatment, ozone or photo-induced graing, and surface oxidation strategies are generally needed to introduce some hydrophilic/bioactivity components onto the surfaces of the matrix. 12,13 Unfortunately, special/expensive equipment and complex-stepped fabrication processes are generally involved, thus limiting the applications in bone tissue engineering. It is therefore essential to develop a simple, but low-cost method for functionalizing the surface of the 3D rGO/PPY composite scaffold and endowing the scaffold surface with good biocompatibility, if possible, to mediate or boost the nucleation and growth of hydroxyapatite in vivo.…”

Section: Introductionmentioning

confidence: 99%

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Enhancing the proliferation of MC3T3-E1 cells on casein phosphopeptide-biofunctionalized 3D reduced-graphene oxide/polypyrrole scaffolds

Jie

Song

et al. 2017

RSC Adv.

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In bone tissue engineering, the 3D macro-scaffold plays an indispensable role as a matrix for cell proliferation, differentiation and tissue formation, for which a bioactive surface is required. Previously, we successfully prepared the 3D macro-reduced graphene oxide/polypyrrole (3D rGO/PPY) scaffold; in the present study, by using casein phosphopeptide (CPP) as a bioactive molecule, we have developed a 3D rGO/PPY/CPP composite scaffold through a simple, but low-cost electrostatic self-assembly method and have explored the application of the composite scaffold in bone tissue engineering. The results have indicated that the CPP successfully modified the backbone of the scaffold, and demonstrated that the developed 3D rGO/PPY/CPP scaffold has excellent hydrophilic behavior and water uptake performance, much better than that of 3D rGO/PPY. In the biomimetic mineralization experiment, the CPP-modified matrix, particularly 3D rGO/PPY/CPP20, could promote the rapid formation of hydroxyapatite in simulated body fluid solution on just the 1 st soaking day. On co-culturing with the MC3T3-E1 cells, the 3D rGO/PPY/CPP20 kept the cells at a higher proliferation state of 5.07 times that of the control group, superior to that of the 3D rGO/PPY/CPP10 (3.88 times) and the 3D rGO/PPY group (2.07 times). The excellent osteoblastic performance of the 3D rGO/PPY/CPP20 composite scaffold can be attributed to the good biological properties of CPP, and the unique 3D macro-structure with a high specific surface area. Our findings suggest that the 3D rGO/PPY/CPP20 can be considered as an attractive scaffold for bone healing and regeneration in the future.

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Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients

Cited by 114 publications

References 43 publications

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection

Enhancing the proliferation of MC3T3-E1 cells on casein phosphopeptide-biofunctionalized 3D reduced-graphene oxide/polypyrrole scaffolds

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