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

Fingerprint

Thigh
Mesenchymal Stromal Cells
Blood Platelets
Gels
Transplants
Bone and Bones
Biopsy
Diaphyses
Ambulatory Surgical Procedures
Osteogenesis
Sports
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

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

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 20, No. 9, 08.2012, p. 1834-1838.

Research output: Contribution to journalArticle

@article{23755638f3834b7fb16337dd423e9b2b,
title = "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",
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.",
keywords = "Bone marrow stromal cells, Decortication, Lyophilized bone, Non-union, Platelet gel, Vascularization",
author = "Dante Dallari and Lucia Savarino and Michelina Greco and Nicola Rani and Piccolo, {Nicolandrea Del} and Nicola Baldini",
year = "2012",
month = "8",
doi = "10.1007/s00167-011-1790-8",
language = "English",
volume = "20",
pages = "1834--1838",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",
number = "9",

}

TY - JOUR

T1 - 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

AU - Dallari, Dante

AU - Savarino, Lucia

AU - Greco, Michelina

AU - Rani, Nicola

AU - Piccolo, Nicolandrea Del

AU - Baldini, Nicola

PY - 2012/8

Y1 - 2012/8

N2 - 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.

AB - 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.

KW - Bone marrow stromal cells

KW - Decortication

KW - Lyophilized bone

KW - Non-union

KW - Platelet gel

KW - Vascularization

UR - http://www.scopus.com/inward/record.url?scp=84865470779&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865470779&partnerID=8YFLogxK

U2 - 10.1007/s00167-011-1790-8

DO - 10.1007/s00167-011-1790-8

M3 - Article

C2 - 22113222

AN - SCOPUS:84865470779

VL - 20

SP - 1834

EP - 1838

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 9

ER -