Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients

Dailey, Hannah L.; Wu, Katherine A; Wu, Ping-Shi; McQueen, Margaret M.; Court-Brown, Charles M.

doi:10.1097/bot.0000000000001173

Cited by 59 publications

(59 citation statements)

References 36 publications

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“…Because they involve severe soft tissue damage, including stripping of the periosteum around the fracture site, infection and nonunion of open fractures are common [1, 2]. The rates of nonunion and delayed union have been reported as approximately 15% [3], but they can be as high as 45% if vascular injuries occur [4]. When initial treatment is not successful, patients experience prolonged physical, economic, and social disturbances.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of the effects of intermittent parathyroid hormone (1-34) by bone morphogenetic protein in a rat femoral open fracture model

et al. 2019

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BackgroundNonunion in cases of open fracture is common. Both bone morphogenetic protein 2 (BMP-2) and parathyroid hormone (PTH) have been used to enhance bone healing. We investigated the combination of BMP-2 and PTH and examined the effects on a rat model of open femoral fractures.MethodsGroup I (n = 11) was implanted with control carrier. Group II (n = 12) was implanted with carrier containing 1 μg of recombinant human BMP-2 (rhBMP-2). Group III (n = 12) was implanted with carrier alone, followed by injections of PTH 1-34. Group IV (n = 11) was implanted with carrier containing 1 μg of rhBMP-2, followed by injections of PTH 1-34. Group V (n = 11) was implanted with carrier containing 10 μg of rhBMP-2. Group VI (n = 11) was implanted with carrier containing 10 μg of rhBMP-2, followed by injections of PTH 1-34. Rats were euthanized after 8 weeks, and their fractured femurs were explanted and assessed by manual palpation, radiographs, micro-computerized tomography, and histological analysis.ResultsManual palpation tests showed that the fusion rates of groups III (66.7%), IV (63.6%), V (81.8%), and VI (81.8%) were considerably higher than those of group I. Groups V and VI had higher radiographic scores compared to group I. Micro-CT analysis revealed enhanced bone marrow density expressed as bone volume/tissue volume in groups V (61.88 ± 3.16%) and VI (71.14 ± 3.89%) versus group I (58.26 ± 1.86%). A histological analysis indicated that group VI had enhanced remodeling.ConclusionThe combination of abundant rhBMP-2 and PTH enhanced bone healing and remodeling of newly formed bone in a rat femoral open fracture model.

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Section: Introductionmentioning

confidence: 99%

Enhancement of the effects of intermittent parathyroid hormone (1-34) by bone morphogenetic protein in a rat femoral open fracture model

et al. 2019

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“…It is also possible that the scaffold was not sufficiently resorbed due to its design and geometry, which limited bone remodeling and reduced its strength. However, in humans it will take at least 4 months for most difficult fractures to heal, and therefore this slower scaffold resorption rate is likely required 44 . To this end, the data presented provides critical information in our transition to large‐animal models with the ultimate goal of translating this strategy into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Regional gene therapy for bone healing using a 3D printed scaffold in a rat femoral defect model

Kang

Ihn

Robertson

et al. 2021

J Biomedical Materials Res

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At the present time there are no consistently satisfactory treatment options for some challenging bone loss scenarios. We have previously reported on the properties of a novel 3D‐printed hydroxyapatite‐composite material in a pilot study, which demonstrated osteoconductive properties but was not tested in a rigorous, clinically relevant model. We therefore utilized a rat critical‐sized femoral defect model with a scaffold designed to match the dimensions of the bone defect. The scaffolds were implanted in the bone defect after being loaded with cultured rat bone marrow cells (rBMC) transduced with a lentiviral vector carrying the cDNA for BMP‐2. This experimental group was compared against 3 negative and positive control groups. The experimental group and positive control group loaded with rhBMP‐2 demonstrated statistically equivalent radiographic and histologic healing of the defect site (p > 0.9), and significantly superior to all three negative control groups (p < 0.01). However, the healed defects remained biomechanically inferior to the unoperated, contralateral femurs (p < 0.01). When combined with osteoinductive signals, the scaffolds facilitate new bone formation in the defect. However, the scaffold alone was not sufficient to promote adequate healing, suggesting that it is not substantially osteoinductive as currently structured. The combination of gene therapy with 3D‐printed scaffolds is quite promising, but additional work is required to optimize scaffold geometry, cell dosage and delivery.

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“…Tibia fractures generally have a low incidence of non-union ( < 2 %). However, the incidence of non-union can increase to as much as ~23 % when the fracture pattern is multi-fragmentary or wedgeshaped, versus simple [45]. Moreover, fractures that cause segmental bone loss and extensive injury to the surrounding soft tissue place an even greater risk of non-union compared to less severe open fractures with an observed incidence of 67 % [45].…”

Section: Fracture Healingmentioning

confidence: 99%

“…However, the incidence of non-union can increase to as much as ~23 % when the fracture pattern is multi-fragmentary or wedgeshaped, versus simple [45]. Moreover, fractures that cause segmental bone loss and extensive injury to the surrounding soft tissue place an even greater risk of non-union compared to less severe open fractures with an observed incidence of 67 % [45]. The causes for the impairment of fracture healing is mostly contributed to by the degree of damage of the surrounding soft tissue, disruption of vascular supply, and contamination of the wound.…”

Section: Fracture Healingmentioning

confidence: 99%

Musculoskeletal Regeneration, Rehabilitation, and Plasticity Following Traumatic Injury

2020

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AbstractThe musculoskeletal system has an integral role throughout life, including structural support to the body, protection, and allowing a range of fine to complex movements for daily living to elite sporting events. At various times, injuries to the musculoskeletal system occur resulting in varying levels of impact to the person both acutely and chronically. Specifically, there is a spectrum of complexity in orthopedic injuries, with some such as common muscle strains, that while burdensome will have no impact on life-long functional ability, and others that can result in long lasting disability. Focusing on extremity injuries, this review highlights: i)the current impact of orthopedic injuries in sport and daily life; ii) the foundation of bone and skeletal muscle repair and regeneration; and iii) the disruptions in regenerative healing due to traumatic orthopedic injuries. This review seeks to maximize the broad and collective research impact on sport and traumatic orthopedic injuries in search of promoting ongoing innovation for treatment and rehabilitation approaches aimed to improve musculoskeletal health throughout life.

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Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 59 publications

References 36 publications

Enhancement of the effects of intermittent parathyroid hormone (1-34) by bone morphogenetic protein in a rat femoral open fracture model

Enhancement of the effects of intermittent parathyroid hormone (1-34) by bone morphogenetic protein in a rat femoral open fracture model

Regional gene therapy for bone healing using a 3D printed scaffold in a rat femoral defect model

Musculoskeletal Regeneration, Rehabilitation, and Plasticity Following Traumatic Injury

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