Τίτλος:
Management and outcome of diaphyseal aseptic non-unions of the lower limb: A systematic review
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: To review current treatments utilising biological enhancement modalities and their efficacy for the management of lower limb long bone aseptic non-unions. Materials & methods: A systematic review of English articles using PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, supplemented by a manual search of bibliographies. Results: Thirteen manuscripts met the inclusion criteria reporting on 428 patients. The overall healing had a pooled estimate of effect size at 94.3%. The calculated summarised estimate of effect size for deep infection rate (413 patients) was 2.3%. Three subgroups were then created on the basis of the exact type of graft used at the non-union site (ABG, BMP-7, BMP-7 + ABG). Comparison between the above subgroups revealed that ABG resulted in approximately 3-fold increase of the odds of healing compared with the use of BMP-7. Combined use of ABGs and BMP-7 improved the odds of healing by 3.5 times compared with BMP-7 alone. However, the previous median operations prior to the implantation of ABG or BMP-7 treatment was 1.09 versus 2.3 respectively (p = 0.02). Although the implantation of ABG was associated with a greater incidence of infection the documented differences did not reach significance. Conclusions: Although ABG was found to have a higher success rate compared to BMP-7 (95% Vs 87%), patients treated with BMP-7 had a higher number of previous failed interventions, statistically significantly so (BMP-7 is used for the treatment of more recalcitrant non-unions). It is the surgeon's judgement that should determine the most suitable treatment modality, depending on the nature and characteristics (personality) of the non-union and the patient. © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
Συγγραφείς:
Pneumaticos, S.G.
Panteli, M.
Triantafyllopoulos, G.K.
Papakostidis, C.
Giannoudis, P.V.
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
diaphysis; disease management; fracture healing; Fractures, Ununited; human; injuries; leg; orthopedic surgery; procedures; treatment outcome, Diaphyses; Disease Management; Fracture Healing; Fractures, Ununited; Humans; Lower Extremity; Orthopedic Procedures; Treatment Outcome
DOI:
10.1016/j.surge.2013.10.007
