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Lam K, Bozynski CC, Cook CR, Kuroki K, Bezold W, Crist BD, Cook JL. Comparison of reamer irrigator aspirator (RIA) suspension versus bone marrow aspirate concentrate (BMC) for percutaneous treatment of long bone nonunions-A preclinical canine model. Injury 2024; 55:111590. [PMID: 38701674 DOI: 10.1016/j.injury.2024.111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To compare the bone healing effects of percutaneously delivered bone marrow aspirate concentrate (BMC) versus reamer irrigator aspirator (RIA) suspension in a validated preclinical canine ulnar nonunion model. We hypothesized that BMC would be superior to RIA in inducing bone formation across a nonunion site after percutaneous application. The null hypothesis was that BMC and RIA would be equivalent. METHODS A bilateral ulnar nonunion model (n= 6; 3 matched pairs) was created. Eight weeks after segmental ulnar ostectomy, RIA from the ipsilateral femur and BMC from the proximal humerus were harvested and percutaneously administered into either the left or right ulnar defect. The same volume (3 ml) of RIA suspension and BMC were applied on each side. Eight weeks after treatment, the dogs were euthanized, and the nonunions were evaluated using radiographic, biomechanical, and histologic assessments. RESULTS All dogs survived for the intended study duration, formed radiographic nonunions 8 weeks after segmental ulnar ostectomy, and underwent the assigned percutaneous treatment. Radiographic and macroscopic assessments of bone healing at the defect sites revealed superior bridging-callous formation in BMC-treated nonunions. Histologic analyses revealed greater amount of bony bridging and callous formation in the BMC group. Biomechanical testing of the treated nonunions did not reveal any significant differences. CONCLUSION Bone marrow aspirate concentrate (BMC) had important advantages over Reamer Irrigator Aspirator (RIA) suspension for percutaneous augmentation of bone healing in a validated preclinical canine ulnar nonunion model based on clinically relevant radiographic and histologic measures of bone formation.
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Affiliation(s)
- Kenrick Lam
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Cristi R Cook
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
| | - Will Bezold
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Brett D Crist
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
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Wittauer M, Burch MA, McNally M, Vandendriessche T, Clauss M, Della Rocca GJ, Giannoudis PV, Metsemakers WJ, Morgenstern M. Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice. Injury 2021; 52:3200-3205. [PMID: 34531088 DOI: 10.1016/j.injury.2021.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/06/2021] [Indexed: 02/02/2023]
Abstract
AIM Although nonunions are among the most common complications after long-bone fracture fixation, the definition of fracture nonunion remains controversial and varies widely. The aim of this study was to identify the definitions and diagnostic criteria used in the scientific literature to describe nonunions after long-bone fractures. METHODS A comprehensive literature search was performed in PubMed, Cochrane Library, Web of Science, and Embase. Prospective clinical studies, in which adult long-bone fracture nonunions were investigated as main subject, were included in this analysis. Data on nonunion definitions described in each study were extracted and collected in a database. RESULTS Although 148 studies met the inclusion criteria, only 50% (74/148) provided a definition for their main study subject. Nonunion was defined in these studies based on time-related criteria in 85% (63/74), on radiographic criteria in 62% (46/74), and on clinical criteria in 45% (33/74). A combination of clinical, radiographic and time-related criteria for definition was found in 38% (28/74). The time interval between fracture and the time point when authors defined an unhealed fracture as a nonunion showed considerable heterogeneity, ranging from three to twelve months. CONCLUSION In the current orthopaedic literature, we found a lack of consensus with regard to the definition of long-bone nonunions. Without valid and reliable definition criteria for nonunion, standardization of diagnostic and treatment algorithms as well as the comparison of clinical studies remains problematic. The lack of a clear definition emphasizes the need for a consensus-based approach to the diagnosis of fracture nonunion centred on clinical, radiographical and time-related criteria.
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Affiliation(s)
- Matthias Wittauer
- Center for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Marc-Antoine Burch
- Center for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Martin McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Windmill Rd, Oxford OX3 7LD, UK
| | - Thomas Vandendriessche
- KU Leuven Libraries - 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Martin Clauss
- Center for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Gregory J Della Rocca
- Department of Orthopaedic Surgery, University of Missouri, 1 Hospital Dr, Columbia, MO, 65201, USA
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Mario Morgenstern
- Center for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4001 Basel, Switzerland.
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