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Combined use of the Ilizarov method, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma (PRP) to expedite healing of bimalleolar fractures.

Rodriguez-Collazo ER, Urso ML - Strategies Trauma Limb Reconstr (2015)

Bottom Line: Ten patients (mean age 52.9 years) were in the cBMA Group, and 10 patients (mean age 54 years) were in the Control Group.Comorbidities included diabetes, obesity, smoking, and renal disease.Radiographs showed a significant difference in the rate of complete healing in the cBMA Group at 16 ± 1.6 weeks post-surgery as compared to 24 ± 1.3 weeks in the Control Group (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Presence Saint Joseph Hospital, 2900 N Lake Shore Dr., Chicago, IL, 60657, USA. erodriguez@cfaas.com.

ABSTRACT
Distal tibial and fibular fractures, particularly in patients with comorbidities, heal slowly and have a high incidence of postoperative nonunion and infection. Autologous concentrated bone marrow aspirate (cBMA) and platelet-rich plasma (PRP) increase osteogenic potential of demineralized bone matrix (DBM). The purpose of this case series was to evaluate the efficacy of cBMA, PRP, DBM in conjunction with the Ilizarov fixator as compared to DBM and the Ilizarov fixator alone in expediting fracture healing. Ten patients (mean age 52.9 years) were in the cBMA Group, and 10 patients (mean age 54 years) were in the Control Group. Comorbidities included diabetes, obesity, smoking, and renal disease. Radiographs showed a significant difference in the rate of complete healing in the cBMA Group at 16 ± 1.6 weeks post-surgery as compared to 24 ± 1.3 weeks in the Control Group (P < 0.001). No differences were observed between groups in infection rate or nonunions. We conclude that the Ilizarov fixator combined with DBM, cBMA, and PRP expedites fracture healing of the distal tibia and fibula in patients with significant comorbidities.

No MeSH data available.


Related in: MedlinePlus

Tissue harvesting and application. a Bone marrow aspiration method. b Magellan platelet separator. c Syringe containing initial mixture of cBMA and DBM. d Final implantable mixture of cBMA and DBM. e Application of cBMA and graft material to fracture site. f Application of PRP using a spray tip cannula
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Fig1: Tissue harvesting and application. a Bone marrow aspiration method. b Magellan platelet separator. c Syringe containing initial mixture of cBMA and DBM. d Final implantable mixture of cBMA and DBM. e Application of cBMA and graft material to fracture site. f Application of PRP using a spray tip cannula

Mentions: For the 10 patients in the cBMA Group, 26 ml of bone marrow was harvested from the medial aspect of the proximal tibia (Fig. 1a). First, the 30-ml syringe was primed with 4 ml of anticoagulant citrate dextrose solution (ACD-A) (Arteriocyte Medical Systems, Hopkinton, MA). A mallet was then used to advance the 15-gauge Jamshidi needle (Arteriocyte Medical Systems, Hopkinton, MA) until a decrease in resistance was met. The decreased resistance was used to indicate that the needle had entered the marrow cavity. Bone marrow was then drawn back gently (to prevent lysing of the cells) into the 30-ml syringe that was primed with 4 ml of ACD-A. During the marrow draw, if significant resistance was met, the needle was repositioned until the marrow flowed easily. This prevented clotting and unnecessary physical disruption of the aspirate and avoid cell lysis and a reduction in growth factor content of the platelets. The needle was repositioned until a total volume of 30 ml, including the ACD-A, was harvested.Fig. 1


Combined use of the Ilizarov method, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma (PRP) to expedite healing of bimalleolar fractures.

Rodriguez-Collazo ER, Urso ML - Strategies Trauma Limb Reconstr (2015)

Tissue harvesting and application. a Bone marrow aspiration method. b Magellan platelet separator. c Syringe containing initial mixture of cBMA and DBM. d Final implantable mixture of cBMA and DBM. e Application of cBMA and graft material to fracture site. f Application of PRP using a spray tip cannula
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666232&req=5

Fig1: Tissue harvesting and application. a Bone marrow aspiration method. b Magellan platelet separator. c Syringe containing initial mixture of cBMA and DBM. d Final implantable mixture of cBMA and DBM. e Application of cBMA and graft material to fracture site. f Application of PRP using a spray tip cannula
Mentions: For the 10 patients in the cBMA Group, 26 ml of bone marrow was harvested from the medial aspect of the proximal tibia (Fig. 1a). First, the 30-ml syringe was primed with 4 ml of anticoagulant citrate dextrose solution (ACD-A) (Arteriocyte Medical Systems, Hopkinton, MA). A mallet was then used to advance the 15-gauge Jamshidi needle (Arteriocyte Medical Systems, Hopkinton, MA) until a decrease in resistance was met. The decreased resistance was used to indicate that the needle had entered the marrow cavity. Bone marrow was then drawn back gently (to prevent lysing of the cells) into the 30-ml syringe that was primed with 4 ml of ACD-A. During the marrow draw, if significant resistance was met, the needle was repositioned until the marrow flowed easily. This prevented clotting and unnecessary physical disruption of the aspirate and avoid cell lysis and a reduction in growth factor content of the platelets. The needle was repositioned until a total volume of 30 ml, including the ACD-A, was harvested.Fig. 1

Bottom Line: Ten patients (mean age 52.9 years) were in the cBMA Group, and 10 patients (mean age 54 years) were in the Control Group.Comorbidities included diabetes, obesity, smoking, and renal disease.Radiographs showed a significant difference in the rate of complete healing in the cBMA Group at 16 ± 1.6 weeks post-surgery as compared to 24 ± 1.3 weeks in the Control Group (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Presence Saint Joseph Hospital, 2900 N Lake Shore Dr., Chicago, IL, 60657, USA. erodriguez@cfaas.com.

ABSTRACT
Distal tibial and fibular fractures, particularly in patients with comorbidities, heal slowly and have a high incidence of postoperative nonunion and infection. Autologous concentrated bone marrow aspirate (cBMA) and platelet-rich plasma (PRP) increase osteogenic potential of demineralized bone matrix (DBM). The purpose of this case series was to evaluate the efficacy of cBMA, PRP, DBM in conjunction with the Ilizarov fixator as compared to DBM and the Ilizarov fixator alone in expediting fracture healing. Ten patients (mean age 52.9 years) were in the cBMA Group, and 10 patients (mean age 54 years) were in the Control Group. Comorbidities included diabetes, obesity, smoking, and renal disease. Radiographs showed a significant difference in the rate of complete healing in the cBMA Group at 16 ± 1.6 weeks post-surgery as compared to 24 ± 1.3 weeks in the Control Group (P < 0.001). No differences were observed between groups in infection rate or nonunions. We conclude that the Ilizarov fixator combined with DBM, cBMA, and PRP expedites fracture healing of the distal tibia and fibula in patients with significant comorbidities.

No MeSH data available.


Related in: MedlinePlus