Treatment of Femoral Non-Union with the Gene-Activated Osteoplastic Material: А Case Report

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Abstract

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.

Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.

Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

About the authors

V. V. Khominets

Kirov Military Medical Academy

Email: Khominets_62@mail.ru
ORCID iD: 0000-0002-7000-6614

Vladimir V. Khominets — Dr. Sci. (Med.), Professor, Head of the Department of Military Traumatology and Orthopedics

St. Petersburg

Russian Federation

R. V. Deev

Mechnikov North-Western State Medical University

Email: romdey@gmail.com
ORCID iD: 0000-0001-8389-3841

Roman V. Deev — Cand. Sci. (Med.), Associate Professor, Head of the Department of Pathological Anatomy

St. Petersburg

A. L. Kudyashev

Kirov Military Medical Academy

Email: a.kudyashev@gmail.com

Alexey L. Kudyashev — Dr. Sci. (Med.), Associate Professor, Deputy Head of the Department of Military Traumatology and Orthopedics

St. Petersburg

S. V. Mikhailov

Kirov Military Medical Academy

Email: msv06@mail.ru
ORCID iD: 0000-0002-3738-0639

Sergey V. Mikhailov — Cand. Sci. (Med.), Assistant Lecturer of the Department of Military Traumatology and Orthopedics

St. Petersburg

D. A. Shakun

Kirov Military Medical Academy

Email: shakun72@gmail.ru
ORCID iD: 0000-0002-2723-3707

Dmitry A. Shakun — Cand. Sci. (Med.), Teacher of the Department of Military Traumatology and Orthopedics

St. Petersburg

A. V. Komarov

Kirov Military Medical Academy

Author for correspondence.
Email: komart23@gmail.com
ORCID iD: 0000-0002-8260-0311

Artem V. Komarov — Senior Resident of the Clinic of Military Traumatology and Orthopedics

St. Petersburg

I. Yu. Bozo

State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency; LLC “Histograft”

Email: bozo.ilya@gmail.com
ORCID iD: 0000-0002-0138-5614

Ilya Y. Bozo — Cand. Sci. (Med.); General Director

Moscow

A. V. Schukin

Kirov Military Medical Academy

Email: ossa.76@mail.ru

Alexey V. Schukin — Cand. Sci. (Med.), Head of the Department of the Clinic of Military Traumatology and Orthopedics

St. Petersburg

I. V. Foos

Kirov Military Medical Academy

Email: foosiv@mail.ru
ORCID iD: 0000-0002-7845-2133

Ivan V. Foos — Head of the Department of the Clinic of Military Traumatology and Orthopedics

St. Petersburg

References

  1. Khan AM, Tang QO, Spicer D. The epidemiology of adult distal femoral shaft fractures in a central London major trauma centre over five years. Open Orthop J 2017; 11:1277–91;
  2. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011;25 (Suppl 1):S8–14;
  3. Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop 2010; 34:271-81;
  4. Gangavalli AK, Nwachuku CO. Management of distal femur fractures in adults: an overview of options. Orthop Clin North Am. 2016; 47:85-96;
  5. Lou S, Lv H, Wang G, Zhang L, Li M, Li Z, Zhang L, Tang P. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int 2016; 2016: 6040379 [PMID: 27429980 doi: 10.1155/2016/6040379];
  6. Im GI, Lee SH. Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review. J Bone Metab 2015; 22: 183-189 [PMID: 26713309 doi: 10.11005/jbm.2015.22.4.183];
  7. Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: the diamond concept. Injury 2007;38(Suppl.4):S3–6; Calori GM, Giannoudis PV. Enhancement of fracture healing with the diamond concept: the role of the biological chamber. Injury 2011;42:1191-3;
  8. Weber BG, Cech O. Pseudoarthrosis: Pathology, Biomechanics, Therapy, Results. Berne, Switzerland:. Hans Huber Medical Publisher. 1976;
  9. Brinker M, Bruce D. Nonunions: evaluation and treatment. Browner, Jesse B. Jupiter, Alan M. Levine, Trafton PG editors. Skeletal trauma: basic science, management, and reconstruction. 3 ed. Bruce D. Philadelphia, USA: Saunders; 2003;
  10. Moghaddam A, Zietzschmann S, Bruckner T, Schmidmaier G. Treatment of atrophic tibia non-unions according to 'diamond concept': Results of one- and two-step treatment. Injury 2015; 46 Suppl 4: S39-S50 [PMID: 26542865 doi: 10.1016/S0020-1383(15)30017-6];
  11. Babu S, Sandiford NA, Vrahas M. Use of Teriparatide to improve fracture healing: What is the evidence? World J Orthop 2015; 6: 457-61 [PMID: 26191492 doi: 10.5312/wjo.v6.i6.457];
  12. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Dabino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;329:300–9;
  13. Le Baron M, Vivona JP, Maman P, Volpi R, Flecher X. Can the reamer/irrigator/aspirator system replace anterior iliac crest grafting when treating long bone nonunion? Orthop Traumatol Surg Res. 2019;105(3):529–33.
  14. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury. 2011;42(Suppl 2):S3–15;
  15. Nodarian T, Sariali E, Khiami F, Pascal-Mousselard H, Catonne Y. Iliac crest bone graft harvesting complications: a case of liver herniation. Orthop Traumatol Surg Res. 2010;96(5):593–6;
  16. Dimitriou R, Kanakaris N, Soucacos PN, Giannoudis PV. Genetic predisposition to non-union: evidence today. Injury. 2013;44(Suppl 1):S50–3.
  17. Singh R, Bleibleh S, Kanakaris NK, Giannoudis PV. Upper limb nonunions treated with BMP-7: efficacy and clinical results. Injury. 2016; 47(Suppl 6):S33–9.;
  18. Sasaki G, Watanabe Y, Miyamoto W, Yasui Y, Morimoto S, Kawano H. Induced membrane technique using beta-tricalcium phosphate for reconstruction of femoral and tibial segmental bone loss due to infection: technical tips and preliminary clinical results. Int Orthop. 2018 Jan;42(1):17-24. doi: 10.1007/s00264-017-3503-5. Epub 2017 May 24. PMID: 28536801;
  19. Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, Corradi A. Validation of the Non-Union Scoring System in 300 long bone nonunions. Injury 2014; 45 (Suppl 6): S93-7;
  20. Regenerating bone defects using new biomedical engineering approaches (REBORNE), 2010. https://cordis.europa.eu/project/rcn/ 92715/ factsheet/ en. (Accessed 7 April 2019);
  21. Gómez-Barrena E, Padilla-Eguiluz NG, García-Rey E, Hernández-Esteban P, Cordero-Ampuero J, Rubio-Suárez JC; REBORNE and ORTHOUNION Research Consortia. Validation of a long bone fracture non-union healing score after treatment with mesenchymal stromal cells combined to biomaterials. Injury. 2020 Apr;51 Suppl 1:S55-S62. doi: 10.1016/j.injury.2020.02.030. Epub 2020 Feb 11. PMID: 32081389;
  22. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018 Apr;36(4):707-714. doi: 10.1016/j.ajem.2018.01.008. Epub 2018 Jan 6. PMID: 29321111;
  23. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res. 2012 Jan;470(1):3-19. doi: 10.1007/s11999-011-2135-0. PMID: 22045067; PMCID: PMC3237971;
  24. Moghaddam-Alvandi A, Zimmermann G, Buchler A, Elleser C, Biglari B, Grutzner PA, et al. [Results of nonunion treatment with bone morphogenetic protein 7 (BMP-7)]. Der Unfallchirurg 2012;115:518–26;
  25. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011;25 (Suppl 1):S8–14;
  26. Brinker MR, Trivedi A, O'Connor DP (2017) Debilitating effects of femoral nonunion on health-related quality of life. J Orthop Trauma 31(2):e37–e42. https://doi.org/10.1097/BOT.0000000000000736;
  27. Y Jiang, et al., A report of a novel technique: The comprehensive fibular autograft with double metal locking plate fixation (cFALP) for refractory post-operative diaphyseal femur fracture non-union treatment, Injury (2016), http://dx.doi.org/10.1016/j. injury.2016.07.026;
  28. Deev, RV, Ordinary and Activated Bone Grafts: Applied Classification and the Main Features / RV Deev, AY Drobyshev, IY Bozo et al. Biomed Res Int. – 2015. – № 2015. – P. 365050;
  29. Deev R, Drobyshev A, Bozo I., (2015). Ordinary and Activated Osteoplastic Materials. Vestnik travmatologii i ortopedii imeni N.N. Priorova. 51-69. 10.32414/0869-8678-2015-1-51-69;
  30. Гололобов В.Г. Рассредоточенный камбий, "Остеогенная недостаточность" при остеорепарации Гололобов В.Г. Морфология. 2018. т. 153. № 3. с. 78;
  31. Gololobov V.G. Rassredotochennyj kambij, "Osteogennaja nedostatochnost'" pri osteoreparacii Gololobov V.G. Morfologija. 2018. t. 153. № 3. s. 78 (In Russ.)
  32. Zimmermann G, Muller U, Loffler C, Wentzensen A, Moghaddam A. [Therapeutic outcome in tibial pseudarthrosis: bone morphogenetic protein 7 (BMP-7) versus autologous bone grafting for tibial fractures]. Der Unfallchirurg 2007;110:931–8;
  33. Moghaddam A, Elleser C, Biglari B, Wentzensen A, Zimmermann G. Clinical application of BMP 7 in long bone non-unions. Arch Orthop Trauma Surg. 2010;130:71–6;
  34. Moghaddam A, Ermisch C, Schmidmaier G. Non-union current treatment concept. Int J Med Educa 2016; 3 [doi: 10.17795/soj-4546];
  35. Tressler MA, Richards JE, Sofianos D, Comrie FK, Kregor PJ, Obremskey WT. Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion. Orthopedics. 2011;34(12): e877–84;
  36. Hackl S, Hierholzer C, Friederichs J, Woltmann A, Buhren V, von Ruden C. Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion. BMC Musculoskelet Disord. 2017;18(1):342;
  37. Pape HC, Evans A, Kobbe P. Autologous bone graft: properties and techniques. J Orthop Trauma. 2010;24(Suppl 1):S36–40;
  38. Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S. Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 83-A Suppl. 2001;1(Pt 2):S151–8.

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