Relevance of deep decortication and vascularization in a case of post-traumatic femoral non-union treated with grafts, platelet gel and bone marrow stromal cells

Dante Dallari, Lucia Savarino, Michelina Greco, Nicola Rani, Nicolandrea Del Piccolo, Nicola Baldini

Research output: Contribution to journalArticle

Abstract

Purpose: A male patient suffering from non-union of the femoral diaphysis after a traumatic fracture was treated with deep decortication and grafted with lyophilized bone, platelet gel (PG) and autologous bone marrow stromal cells (BMSCs). After 40 days from surgery, he was re-operated, due to fracture secondary displacement, caused by inappropriate load during sports activity. In addition to radiographs, two bone biopsies were retrieved: this allowed for a histological evaluation of the early response of host bone to the graft. To our knowledge, there is no report describing such early tissue response. Methods: A clinical-radiographic evaluation of the patient and a histomorphometric analysis of the bone biopsies were performed. Results: An early reparative bone formation was observed adjacent to the osteointegrated graft. Non-resorbed bone chips and large islands of non-vital bone particles, surrounded by fibrous tissue, were observed in a zone of sclerotic diaphyseal bone, that is the process was delayed despite decortication. Conclusions: These findings support the concept, until now evidenced only by imaging, that bone chips added with PG and BMSCs are effective in shortening the healing time in fracture non-union. The clinical relevance of deep decortication and vascularization is emphasized. Level of evidence: Therapeutic studies-investigating the results of treatment, Level V.

Original languageEnglish
Pages (from-to)1834-1838
Number of pages5
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume20
Issue number9
DOIs
Publication statusPublished - Aug 2012

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Keywords

  • Bone marrow stromal cells
  • Decortication
  • Lyophilized bone
  • Non-union
  • Platelet gel
  • Vascularization

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

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