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Harris Hip Score (HHS) and VAS pain scale comparison between Groups A and B at 30, 60, and 90 days ( P * < 0.05 ).
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Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the...
Similar publications
Osteoporosis is the severe reduction in bone mineral density and load bearing capabilities. Individuals with osteoporosis, especially the elderly, are at a higher risk of bone fracture as a result of trauma, with hip fractures being the most prevalent and life threatening. There are currently a number of preventive treatments available; however the...
Citations
... The interTan and PFNA [35,83] and the pertrochanteric nails and PFNA [79] were not associated with weight bearing. Extramedullary implant facilitators included dynamic compression locking system (DCLS) (compared with multiple cannulated compression screw (MCCS)) [84], percutaneous compression plate (PCCP) (compared with dynamic hip screw (DHS)) [80], DHS with scaffold enriched with the autologous bone marrow stem cells concentrate (compared with DHS alone) [92], and Medoff sliding plate (MSP) (compared with dynamic condylar screw, DHS, and DHS with trochanteric stabilising plate) [73]. No association was reported between extramedullary DHS and derotation screw alone or with trochanteric wiring [81], minimally invasive DHS and conventional DHS [62], and weight bearing. ...
Purpose:
This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults.
Methods:
Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach.
Results:
In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year.
Conclusion:
Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.
... Bonelike® is a glass-reinforced hydroxyapatite (HA) composite [P2O5-CaO glass-based system within a HA matrix] with osteoconductive proprieties that can be applied as a synthetic bone graft. Its advantages have been demonstrated in several clinical applications, namely dental, maxillofacial and orthopedic surgery (Gutierres et al., 2007;Gutierres et al., 2006;Gutierres et al., 2005;Pavan Kumar et al., 2014;Torres et al., 2014). One of the main morphological properties of biomaterials, with the purpose of bone ingrowth, is the existence of open and interconnected pores. ...
... The use of Bonelike® as a calcium phosphate-based synthetic bone substitute had been previously demonstrated in non-critical-sized bone defects (Atayde et al., 2015;Cortez et al., 2011;Cortez et al., 2012;Lopes et al., 2001), in its granular formulation (Gutierres et al., 2006;Torres et al., 2014;Atayde et al., 2015;Campos et al., 2018a;Cortez et al., 2011;Cortez et al., 2012;Campos et al., 2018b) or in wedges or cylinders of macroporous architecture (Gutierres et al., 2007;Gutierres et al., 2008), in both human and veterinary application. This report is the first in which the macroporous formulation of Bonelike® was used to fill critical-sized bone defects, resulting in complete bone healing. ...
The effective treatment of non-unions and critical-sized defects remains a challenge in the orthopedic field. From a tissue engineering perspective, this issue can be addressed through the application bioactive matrixes to support bone regeneration, such as Bonelike®, as opposed to the widespread autologous grafting technique. An improved formulation of Bonelike® Poro, was assessed as a synthetic bone substitute in an ovine model for critical-sized bone defects. Bone regeneration was assessed after 5 months of recovery through macro and microscopic analysis of the healing features of the defect sites. Both the application of natural bone graft or Bonelike® Poro resulted in bridging of the defects margins. Untreated defect remained as fibrous non-unions at the end of the study period. The characteristics of the newly formed bone and its integration with the host tissue were assessed through histomorphometric and histological analysis, which demonstrated Bonelike® Poro to result in improved healing of the defects. The group treated with synthetic biomaterial presented bone bridges of increased thickness and bone features that more closely resembled the native spongeous and cortical bone. The application of Bonelike® Poro enabled the regeneration of critical-sized lesions and performed comparably to the autograph technique, validating its octeoconductive and osteointegrative potential for clinical application as a therapeutic strategy in human and veterinary orthopedics.
... While there are few human clinical trials using scaffolds for bone defects, some preliminary trials have shown promise. Accelerated recovery and improved bone healing was demonstrated in femoral intertrochanteric fractures treated with scaffolds made of Glass Reinforced HA Composite Pellets was injected with bone marrow aspirate [142] . The scaffolds were administered through the hip screw canal after drilling. ...
Abtract
Osteobiologics are defined as a group of natural and synthetic materials used to augment bone healing. The selection of the most appropriate osteobiologic from the growing list of available options can be a challenging task. In selecting a material, surgeons should weigh a variety of considerations, including the indication for their use (the when), the most suitable substance (the what), and the correct mode of application (the how). This summary reviews these considerations and seeks to provide the surgeon with a basis for informed clinical evidence-based decision-making in their choice of a successful option.
... Traumatic bone defect and non-unions are a challenging problem in clinical medicine, which are recently under translational investigation [24][25][26][27] . Autologous and allogenic cell sources are tested for their osteogenic potential [ 28 , 29 ] to cure these musculoskeletal diseases. ...
Bone tissue engineering is a fast-growing field in regenerative medicine. Consequently, there is a high demand for new, fast and reliable methods to track and quantify the osteogenic differentiation of cells. Recently, a novel method was published to non-destructively quantify the hydroxyapatite content of monolayer and 3-dimensional mesenchymal stem cell cultures using the ability of ⁹⁹mTechnetium-methylene diphosphonate (MDP), a well-established tracer in clinical nuclear medicine, to bind to newly synthesized hydroxyapatite. In the present study, two other commonly used ⁹⁹mTechnetium tracers, 2,3-dicarboxypropane-1,1-diphosphonate (DPD) and hydroxydiphosphonate (HDP), were evaluated to see if they could also be used for the same purpose. Furthermore, we investigated if labelling at various timepoints influenced the effectiveness of the labelling. The results were analyzed using one-factor ANOVA followed by Bonferroni post-hoc testing. This revealed a highly significant difference between the three osteogenic groups at each timepoint compared to their corresponding negative controls. However, there was no statistically significant difference between the three different tracers (MDP, DPD, HDP) in the osteogenic groups. Therefore all three tracers are of similar value when quantifying the extracellular hydroxylapatite content in osteogenic stem cells cultures.
... Previously, Torres et al. [51] hypothesized that adding mBMSC concentrate to the hydroxyapatite scaffolds and then placing them in the fracture site would be beneficial for the surgical fixation of hip fractures. Results of their study showed that mBMSCs added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. ...
Macro-channeled porous hydroxyapatite (HA) scaffolds were fabricated by a polymer foam replication method. Composites were prepared by coating the surface of HA scaffolds with polycaprolactone (PCL) in the presence of graphene nanopowders (in the form of flakes) and multi-walled carbon nanotubes (MWCNTs) at different concentrations. Compression strength of the scaffolds was investigated as a function of additive concentration. Results revealed that the use of PCL coating increased the mechanical strength of HA scaffolds. Besides, addition of graphene or MWCNTs further improved the compression strength of the constructs when they were used at 0.25 wt% and a decrease was observed at higher graphene and MWCNT concentrations. Highest mechanical performance was obtained in composite HA scaffolds involving MWCNTs. In vitro acellular bioactivity experiments revealed that both graphene and MWCNT-incorporated HA scaffolds showed higher bioactivity in simulated body fluid compared to bare scaffolds. However, HA formation ability was more pronounced with MWCNTs compared to graphene nanoflakes where they were possibly acted as an effective nucleation sites to induce the formation of a biomimetic apatite. Additionally, scaffolds prepared in the study were found to be nontoxic to the mouse bone marrow mesenchymal stem cells. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
... Tabatabaee et al. 53 Journal of Arthroplasty 2015 I Osteonecrosis of femoral head Torres et al. 54 Biomedical Research International 2014 II Intertrochanteric hip fracture fixation Vulcano et al. 55 European Review for Medical and Pharmacological Sciences 2013 IV Acetabular bone defect in revision hip surgery Yoshioka et al. 56 International Orthopaedics 2011 IV Osteonecrosis of femoral head that relevant studies not identified on the initial search were included. The criteria for inclusion were human clinical trials evaluating autologous preparations of bone marrow aspirate or BMAC in the treatment of orthopaedicrelated and sports medicineerelated conditions and published in English. ...
Purpose:
To perform a systematic review of clinical studies evaluating bone marrow aspirate concentrate (BMAC) in the treatment of musculoskeletal pathology to compare levels of reporting with recently published minimum standards.
Methods:
A systematic review of the clinical literature from August 2002 to August 2017 was performed. Human clinical studies published in English and involving the administration of BMAC for musculoskeletal applications were included. Studies evaluating non-concentrated preparations of bone marrow aspirate or preparations of laboratory cultured cells were excluded. Studies evaluating the treatment of dental or maxillofacial conditions were excluded. Similarly, in vitro studies, editorials, letters to the editor, and reviews were excluded. Levels of reporting were compared with previously published minimum standards agreed on through an international Delphi consensus process.
Results:
Of 1,580 studies identified on the initial search, 46 satisfied the criteria for inclusion. Considerable deficiencies in reporting of key variables including the details of BMAC preparation and composition were noted. Studies reported information on only 42% (range, 25%-60%) of the variables included within established minimum reporting standards. No study provided adequate information to enable the precise replication of preparation protocols and accurate characterization of the BMAC formulation delivered.
Conclusions:
We found that all existing clinical studies in the literature evaluating BMAC for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. Deficient reporting of the variables that may critically influence outcomes precludes interpretation, prevents other researchers from reproducing experimental conditions, and makes comparisons across studies difficult. We encourage the adoption of emerging minimum reporting standards for clinical studies evaluating the use of mesenchymal stem cells in orthopaedics.
Level of evidence:
Level IV, systematic review of Level I through IV studies.
... MSC injection improved degeneration of enthesis (connective tissue between tendon or ligament and bone) in rats within 45 days [21]. In racehorses suffered from digital flexor tendinopathy, MSCs intra-lesion injections reduced injury [22]. Autologous MSCs and bone marrow stem cells also treated 10 patients of degenerative disc defects and 15 patients of intertrochanteric hip fractures, respectively [23]. ...
Undifferentiated types of cells found in multicellular organisms are called stem cells, having characteristic to differentiate into a range of different types of adult cells. These basic cells have the ability to self-renew them without any limit and are also considered as multipotent. These two main features make them potent for tissue engineering and regenerative medicine. Differentiation of these potent cells depends upon various factors, including physical, chemical and biological cues.
... Marcucio et al. hypothesized that mesenchymal stem cells (MSCs) might influence bone repair through different mechanisms: 1) differentiation into osteoblasts; 2) triggering the division and differentiation of native connective tissue progenitors; 3) modulating cells of the immune system; 4) secretion of trophic molecules that inhibit apoptosis and fibrosis and/or promote angiogenesis; 5) homing to the fracture site through chemokine receptors, such as CCR1, CCR7, CCR9, and CXCR4-6 and other pathways (36). MSCs use is widely accepted for the treatment of AVN of the femoral head (37,38) and recently their use has been demonstrated to improve intertrochanteric fracture healing (39). In "a" the antero-lateral approach performed in order to refresh and reduce the fracture; in "b" the stem cells concentrate in liquid and gelled physical state; in "c" application of the stem cells. ...
Case. A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed.
Conclusion. To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging.
The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.
... Later studies further demonstrated the promising results of culture expanded autologous osteoprogenitors loaded onto porous HA ceramic scaffolds in the repair of critical size long bone defects [113,114]. More lately, Torres et al., [115] utilized centrifugation technique to concentrate bone marrow aspirates having 200−2000 mesenchymal stem cells/mL-mixed with hydroxyapatite matrix for implantation into the fracture site. Significant improvement in Harris Hip Scores [HHS] and Visual Analogue Pain Scale (VAS) was observed in the bone marrow concentrate group compared to controls. ...
Mesenchymal stem cells hold the promise to treat not only several congenital and acquired bone degenerative diseases but also to repair and regenerate morbid bone tissues. Utilizing MSCs, several lines of evidences advocate promising clinical outcomes in skeletal diseases and skeletal tissue repair/regeneration. In this context, both, autologous and allogeneic cell transfer options have been utilized. Studies suggest that MSCs are transplanted either alone by mixing with autogenous plasma/serum or by loading onto repair/induction supportive resorb-able scaffolds. Thus, this review is aimed at highlighting a wide range of pertinent clinical therapeutic options of MSCs in the treatment of skeletal diseases and skeletal tissue regeneration. Additionally, in skeletal disease and regenerative sections, only the early and more recent preclinical evidences are discussed followed by all the pertinent clinical studies. Moreover, germane post transplant therapeutic mechanisms afforded by MSCs have also been conversed. Nonetheless, assertive use of MSCs in the clinic for skeletal disorders and repair is far from a mature therapeutic option, therefore, posed challenges and future directions are also discussed. Importantly, for uniformity at all instances, term MSCs is used throughout the review.
... Hence, the treatment is almost always surgical [8,9]. The most common options are either the dynamic hip screw (DHS) or Asia proximal femoral nail anti-rotation (PFNA-II) [10]. Current evidence-based clinical research, however, has revealed that DHS may cause more intra-and postoperative complications [8,[11][12][13][14]. ...
Background
The purpose of this study was to evaluate whether PFNA-II (Asia proximal femoral nail anti-rotation) and DHS (dynamic hip screw) carry substantial post-operative hidden blood loss and to compare PFNA-II with DHS in terms of post-operative hidden blood loss in elderly high-risk patients with intertrochanteric femur fractures(IFFs).
Methods
The clinical data from Jan 2005 to Apr 2015 of 186 patients with PFNA-II and 177 patients with DHS were analyzed retrospectively. Indexes including pre- and post-operative blood routine, intra- and post-operative blood loss and blood transfusion situation were analyzed. The situation of perioperative blood loss (visible and hidden) was assessed.
Results
The intra-operative blood loss in the PFNA-II group was 34.7 ± 2.5 ml, the post-operative visible blood loss was 54.7 ± 2.5 ml, and the hidden blood loss was 277.2 ± 7.6 ml. In the DHS group, the intra-operative blood loss was 102.0 ± 7.0 ml, the post-operative visible blood loss was 78.8 ± 4.7 ml, and the hidden blood loss was 139.3 ± 9.6 ml. The intra-operative blood loss and the post-operative visible blood loss in the PFNA-II group were significantly less than in the DHS group (p < 0.01). However, the post-operative hidden blood loss and the total blood loss in the PFNA-II group were larger than in the DHS group (p < 0.01).
Conclusion
This study demonstrated that with PFNA-II and DHS, much post-operative hidden blood loss exists in the treatment of intertrochanteric fractures in elderly high-risk patients and DHS is more favourable than PFNA-II in terms of post-operative hidden blood loss.
