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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

Postoperative outcome measures. There was a significant reduction in the time of external fixation in the cBMA Group. No differences were reported in incidence of infection or nonunion between groups. Data are mean ± SD. *P < 0.001
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Fig3: Postoperative outcome measures. There was a significant reduction in the time of external fixation in the cBMA Group. No differences were reported in incidence of infection or nonunion between groups. Data are mean ± SD. *P < 0.001

Mentions: Figure 3 illustrates outcome measures for the cBMA and Control Groups. The mean fixator time was 24 ± 1.3 weeks in the Control Group and 16 ± 1.6 weeks in the cBMA Group (P < 0.001). In the Control Group, postoperative radiographs for seven of 10 patients showed complete bone healing at the time of external fixator removal. In the cBMA Group, eight of 10 patients showed complete bone healing when the external fixator was removed at approximately 16 weeks post-surgery (Fig. 4). There were no significant differences between groups in the number of patients with complete bone healing (P = 0.6) at the time of fixator removal. Of the two patients in the cBMA Group who experienced delayed union, only one revision was required due to consistent pain. Four weeks post-revision, the patients’ pain had subsided. The second patient did not require a revision, but a percutaneous injection of cBMA was used to augment healing. Both patients healed within approximately 4 months without residual deformity or morbidity. In the Control Group, three patients developed a stiff nonunion without deformity. These patients were braced and were followed for 18 months until complete healing was observed. No surgical revisions were necessary.Fig. 3


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)

Postoperative outcome measures. There was a significant reduction in the time of external fixation in the cBMA Group. No differences were reported in incidence of infection or nonunion between groups. Data are mean ± SD. *P < 0.001
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Postoperative outcome measures. There was a significant reduction in the time of external fixation in the cBMA Group. No differences were reported in incidence of infection or nonunion between groups. Data are mean ± SD. *P < 0.001
Mentions: Figure 3 illustrates outcome measures for the cBMA and Control Groups. The mean fixator time was 24 ± 1.3 weeks in the Control Group and 16 ± 1.6 weeks in the cBMA Group (P < 0.001). In the Control Group, postoperative radiographs for seven of 10 patients showed complete bone healing at the time of external fixator removal. In the cBMA Group, eight of 10 patients showed complete bone healing when the external fixator was removed at approximately 16 weeks post-surgery (Fig. 4). There were no significant differences between groups in the number of patients with complete bone healing (P = 0.6) at the time of fixator removal. Of the two patients in the cBMA Group who experienced delayed union, only one revision was required due to consistent pain. Four weeks post-revision, the patients’ pain had subsided. The second patient did not require a revision, but a percutaneous injection of cBMA was used to augment healing. Both patients healed within approximately 4 months without residual deformity or morbidity. In the Control Group, three patients developed a stiff nonunion without deformity. These patients were braced and were followed for 18 months until complete healing was observed. No surgical revisions were necessary.Fig. 3

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