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      Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones

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          Abstract

          Background

          Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG) or demineralized-bone-matrix (DBM).

          Methods and results

          From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10) or DBM-augmentation (n = 10). At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014). Mean duration of follow-up was 56.6 months (ICABG-group) and 41.2 months (DBM-group). All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20%) whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146). No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20%) (p = 0.146). Pain intensity were comparable in both groups (p = 0.326). However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031).

          Conclusion

          With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160 €/case). Nevertheless, this study demonstrated that the application of DBM compared to ICABG led to an advanced outcome in the treatment of non-unions and simultaneously to a decreased quantity of adverse effects. Therefore we conclude that DBM should be offered as an alternative to ICABG, in particular to patients with elevated comorbidity and those with limited availability or reduced quality of autologous-bone graft material.

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          Most cited references 26

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          Bone-grafting and bone-graft substitutes.

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            Morbidity at bone graft donor sites.

            A review of the medical records of 239 patients with 243 autogenous bone grafts was undertaken to document the morbidity at the donor sites. The overall major complication rate was 8.6%. Major complications included infection (2.5%), prolonged wound drainage (0.8%), large hematomas (3.3%), reoperation (3.8%), pain greater than 6 months (2.5%), sensory loss (1.2%), and unsightly scars. Minor complications (20.6%) included superficial infection, minor wound problems, temporary sensory loss, and mild or resolving pain. There was a much higher complication rate (17.9% major) if the incision used for the surgery was also the same incision used to harvest the bone graft.
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              Enhancement of fracture-healing.

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                Author and article information

                Journal
                J Trauma Manag Outcomes
                Journal of Trauma Management & Outcomes
                BioMed Central
                1752-2897
                2009
                15 December 2009
                : 3
                : 11
                Affiliations
                [1 ]Department of Trauma Surgery, Campus Grosshadern, University Hospital of Munich, Germany
                Article
                1752-2897-3-11
                10.1186/1752-2897-3-11
                2801473
                20003511
                Copyright ©2009 Pieske et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Short Report

                Emergency medicine & Trauma

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