Aseptic Pseudoarthrosis of the Humeral Diaphysis. Epidemiological Features—Therapeutic Assessment

Objective: The aim of this work was to assess the epidemiological factors of the pseudoarthroses of diaphyseal humeral fractures in order to prevent them and also to assess the results of their treatment by screwed plate associated with an auto-graft. Material and method: This was a retrospective series of 36 aseptic pseudoarthroses of the humeral diaphysis treated by screwed plate, associated or not with a bone autograft between January 1997 and December 2016 at the Treichville University Hospital. The criteria of inclusion refer to the existence of an aseptic pseudoarthrosis of the humeral diaphysis treated by screwed plate. The approach was antero-external. Two thirds of pseudoarthroses were between the middle 1/3. 23 atrophic pseudoarthroses (65%) and 13 hypertrophic pseudoarthroses. Functional results were assessed using the Steward and Hundley criteria. Results: Mortality was zero, and postoperative complications were dominated by 4 hematomas and 2 transient iatrogenic paresthesias of the radial nerve. The sequelae were minor and the consolidation was acquired in 97.25% of patients. Conclusion: The treatment of aseptic pseudoarthroses of the humerus by screwed plate associated with an auto-graft is a reliable technique, inexpensive with a satisfactory functional outcome.

Use of MSC in the Treatment of the Congenital Pseudoarthrosis in Children

Congenital pseudoatrhrosis of the tibia is one of the most frustrating conditions encountered in paediatric orthopaedic surgery because of the difficulty in achieving healing;There are different methods of treatment the most commonly used are: External fixator according Ilizarov’s technique, vascularised fibular grafting, bone grafting with intramedullary fixation, Boyd’s double bone grafting and also after several operation go bad and a significant shortening of the leg even the amputation has to be considered [1] [2]. Numerous treatment options have been explored with several degree of success. In this paper we show a combinated surgical technique using autogenous mesenchymal stem cells (MSC) by precursor of osteogenic differensation at the same time as adjuvant to the surgical stabilization by an external fixator or an intramedullary nailing. We used these combined technique in tibia congenital pseudoarthrosis with and without neurofibromatosis in children. In fact Bone Marrow has been shown to contain a population of rare mesenchymal stem cells that are capable of forming bone, cartilage and other connective tissues enhancing bone repair and regeneration.

Aseptic Pseudoarthrosis of Olecranon: Epidemiological Features and Therapeutic Assessment

Introduction: Pseudoarthrosis is one of the most dreadful complications of olecranon fractures. It seriously compromises the function of the elbow. Objectives: To determine the epidemiological factors of this complication in order to prevent them and to assess the results of the therapeutic management. Material and method: This was a retrospective study that involved patients with olecranon pseudoarthrosis who were treated in the department between January 2006 and December 2016. The diagnosis of pseudoarthrosis was made at least 6 months after the management of the fracture. There were 16 men and 5 women. We analyzed the epidemiological factors, the treatment of pseudoarthrosis, and the postoperative outcome. Results: The incriminated factors were the complexity of the fracture line and the quality of treatment of the recent fracture. The osteosynthesis of pseudoarthrosis is similar to that of recent fractures. It requires in some cases a bone graft. The results of the treatment are satisfactory with 100% of consolidation, and a good functional result in 75% of the cases. Conclusion: The treatment of olecranon pseudoarthrosis is based above all on prevention by an optimal management of the recent fractures. The curative treatment gives satisfactory functional results.

Investigational growth factors utilized in animal models of spinal fusion: Systematic review

BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40%of these procedures result in pseudoarthrosis even with iliac crest autograft, the current "gold standard" treatment. Tissue engineering has the potential to solve this problem via the creation of bone grafts involving bone-promoting growth factors(e.g., bone morphogenetic protein 2). A broad assessment of experimental growth factors is important to inform future work and clinical potential in this area. To date, however, no study has systematically reviewed the investigational growth factors utilized in preclinical animal models of spinal fusion.AIM To review all published studies assessing investigational growth factors for spinal fusion in animal models and identify promising agents for translation.METHODS We conducted a systematic review of the literature using PubMed, Embase,Cochrane Library, and Web of Science databases with searches run on May 29 th,2018. The search query was designed to include all non-human, preclinical animal models of spinal fusion reported in the literature without a timespan limit. Extracted data for each model included surgical approach, level of fusion,animal species and breed, animal age and sex, and any other relevant characteristics. The dosages/sizes of all implant materials, spinal fusion rates,and follow-up time points were recorded. The data were analyzed and the results reported in tables and text. PRISMA guidelines were followed for this systematic review.RESULTS Twenty-six articles were included in this study, comprising 14 experimental growth factors: AB204(n = 1); angiopoietin 1(n = 1); calcitonin(n = 3);erythropoietin(n = 1); basic fibroblast growth factor(n = 1); growth differentiation factor 5(n = 4), combined insulin-like growth factor 1 +transforming growth factor beta(n = 4); insulin(n = 1); NELL-1(n = 5); noggin(n= 1); P-15(n = 1); peptide B2 A(n = 2); and secreted phosphoprotein 24(n = 1).The fusion rates of the current gold standard treatment(autologous iliac crest bone graft, ICBG) and the leading clinically used growth factor(BMP-2) ranged widely in the included studies, from 0-100% for ICBG and from 13%-100% for BMP-2. Among the identified growth factors, calcitonin, GDF-5, NELL-1, and P-15 resulted in fusion rates of 100% in some cases. In addition, six growth factors-AB204, angiopoietin 1, GDF-5, insulin, NELL-1, and peptide B2 A-resulted in significantly enhanced fusion rates compared to ICBG, BMP-2, or other internal control in some studies. Large heterogeneity in animal species, fusion method,and experimental groups and time points was observed across the included studies, limiting the direct comparison of the growth factors identified herein.CONCLUSION Several promising investigational growth factors for spinal fusion have been identified herein; directly comparing the fusion efficacy and safety of these agents may inform clinical translation.