The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures

Abstract

Purpose One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. Material and methods These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. Results Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrowderived mesenchymal stem cells to improve healing of fractures. Conclusion It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

[Retracted] Analysis of Expression of Inflammatory Factors and T Cell Lymphocyte in Patients with Orthopedic Trauma after Infection and Risk Factors

“…Wound infection of patients will not only have a certain impact on patients but also even threaten their lives [2]. e main reason for infection in open wounds is that the skin at the fracture site is damaged, which leads to the contact between the surrounding tissues at the fracture site and the outside world, and the continuous invasion of pathogenic microorganisms, leading to the occurrence of related infection after surgery [3]. Incidence of postoperative infection patients in a clinical study showed that wound healing time, hospitalization time, and the incidence of infection related complications are significantly higher than noninfectious patients; wound healing and longer duration of hospitalization not only bring physical discomfort to patients but also increase the hospitalization time and hospitalization cost, causing certain economic burden to patients [4,5].…”

Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization

“…In the other The last nonunion was due to the TTO-ND patient experiencing trauma. There were 2 nonunions that were treated by a TTO reoperation according to the Hernigou technique 15,16 and 2 TTO reoperations after an open reduction and internal fixation technique. All 4 patients did not have any further complications after their reoperation.…”

Available methods to enhance regenerative potential of plastic materials for bone defects replacement in orthopedics. Part 3. Use of autologous human red bone marrow

“…Использование аспирата ККМ в ортопедии находится на ранней стадии развития [38]. Хотя в увеличивающемся количестве публикаций на эту тему отмечаются хорошие клинические результаты, общепризнанных показаний для использования костного мозга не определено [39].…”