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

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