Bone Union in Allografts: Chemotherapy Considerations
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Delayed union
Abstract Background Pulsed electromagnetic fields (PEMF) stimulation for the treatment of bone nonunion or delayed union have been in use for several years, but on a limited basis. The aim of this study was to assess the overall efficacy of the method in tibial delayed unions and nonunions and identify factors that could affect the final outcome. Methods We prospectively reviewed 44 patients (27 men) with a mean age of 49.6 ± 18.4 years that received PEMF therapy due to tibial shaft delayed union or nonunion. In all cases, fracture gap was less than 1 cm and infection or soft tissue defects were absent. Results Fracture union was confirmed in 34 cases (77.3%). No relationship was found between union rate and age (p = 0.819), fracture side (left or right) (p = 0.734), fracture type (simple or comminuted, open or closed) (p = 0.111), smoking (p = 0.245), diabetes (p = 0.68) and initial treatment method applied (plates, nail, plaster of paris) (p = 0.395). The time of treatment onset didn’t affect the incidence of fracture healing (p = 0.841). Although statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (p = 0.081). Conclusion PEMF stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. Its success is not associated with specific fracture or patient related variables and it couldn’t be clearly considered a time-dependent phenomenon.
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Treatment of delayed union and nonunion of long bone fractures by using DBM(decalcified bone matrix)
Objective:To discuss the clinical effects of OSTEOSET decalcified bone matrix(DBM) in treatment of delayed union and nonunion of long bone fractures.Methods:Fifty-seven cases of delayed union and nonunion of long bone fractures were treated with Osteoset DBM.There were 45 male and 12 female with average age of 42 years(21 to 65 years).Among them,there were 17 cases of open fracture and 40 of closed fracture.Thirty-two cases of delayed union included 4 cases of humeral fracture,10 of femoral fracture and 10 of tibial fracture;twenty-five cases of nonunion included 5 of humeral fracture,4 of femoral fracture and 16 of tibial fracture.All patients were treated by DBM transplantation on the fracture ends and bone defect zone.Results:All 57 cases were followed-up from 4 to 37 months(7.8 months on average).In 32 cases of delayed union,31 cases got bone union,but 1 case of tibial fracture did nonunion;In 25 cases of nonunion,23 got bone union,but 2 cases did nonunion(1 tibial nonunion and 1 humeral nonunion).The union time was from 3 to 6.6 months(average 4.7 months).Conclusion:The treatment of delayed union and nonunion of long bone fractures by using Osteoset DBM has satisfactory effect and lower complications.
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Nonunion or delayed union remains one of the major complicatio ns of fractures. Repair of fractures involves a sequence of dynamic events which ultimately restore the integrity of bone and its biomechanical properties, incl uding such methods as surgery, internal fixation, bone grafting, external fixati on, electrical stimulation, ultrasound, and high-energy extracorporeal shock wa ve. The preferred management of nonunion and delayed union is autologous bone gr afting. However, the supply of suitable bone is limited and it often results in additional morbidity to the donor site. Recently some advances have been made in the therapeutic principle for nonunion or delayed union. It is aimed at providi ng non-invasion, less complication, and safe treatment. This article introduces the development of some effective and safe therapies for nonunion or delayed un ion.
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Delayed union of the tibia represents a diverse group of clinical problems that can at times be challenging for even the most experienced surgeon to treat. Early recognition and treatment can help patients avoid prolonged periods of pain and disability. Many factors have been associated with delayed union or nonunion; most of these factors are dictated by the injury and patient factors but others are within the surgeon's control. Although high rates of union are obtained in many series of tibial fractures using simple treatment methods, nonunion is seen by all practitioners treating tibial fractures. Early intervention to prevent nonunion seems to be in the best interest of patients and surgeons. Treatment must take into account the biologic and mechanical factors contributing to delay in fracture union.
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In summary, slow union can be caused from impaired blood supply, delayed union by inadequate immobilization, whether external or internal, and infection. Nonunion as well as delayed union may be caused by prolonged movement and interposition of soft tissue. Slow union and delayed union with too early cessation of immobilization cause nonunion. It may be said that if a fracture has not united within 4 months, delayed union is occurring. After 8 months, nonunion or pseudoarthrosis occurs (4).
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Objective: To investigate the effect of transcutaneous autologous bone marrow transplantation in treating delayed union and nonunion of limbs fractures. Method: Fifteen patients with delayed union or nonunion limb fractures were treated in our department between Jan.2006 and Jan.2009.All patients received transcutaneous autologous bone marrow transplantation,and were followed up to observe the effects. Result: The follow-up last from 6 to 20 months,average 12 months.14 of 15 patients were cured after 4-11 months,average 6 months.One patient suffered from nonunion,and then cured after bone grafting. Conclusion: Transcutaneous autologous bone marrow transplantation is a simple and effective method that can induce the osteogenesis in the delayed or nonunion fractures.
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