Skip to main content
SpringerLink
Log in

Trauma: Non-Union: New Trends

  • Chapter
  • First Online:
European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 10))

Abstract

Fracture healing is a complex physiological process caused by the interaction of cellular elements that are activated and controlled by an array of cytokines and signalling proteins [11]. This process is both temporal and spatial in nature and usually results in the formation of new bone, which is structurally and mechanically similar to the pre-fracture state [10]. For al lot of reasons this process can fail and result in non-union of bone in 10% of all fractures and in up in 50% of open fractures of the tibia. These patients develop a non-union, which leads to long-lasting inability to work, loss of employment and high social costs. These cost are estimated in a paper of Sprague 2002 to be at approximately $80,000 in case of 18 weeks delay of fracture healing [28]. The overall costs of delayed fracture healing are estimated to be at $14.6 million in United States alone [6].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aaron RK, Ciombor DM, Simon BJ (2004) Treatment of nonunions with electric and electromagnetic fields. Clin Orthop Relat Res (419):21–29

    Google Scholar 

  2. Agata H et al (2009) Feasibility and efficacy of bone tissue engineering using human bone marrow stromal cells cultivated in serum-free conditions. Biochem Biophys Res Commun 382(2):353–358

    Article  CAS  PubMed  Google Scholar 

  3. Claes L, Willie B (2007) The enhancement of bone regeneration by ultrasound. Prog Biophys Mol Biol 93(1–3):384–398

    Article  PubMed  Google Scholar 

  4. Connolly JF (1995) Injectable bone marrow preparations to stimulate osteogenic repair. Clin Orthop Relat Res (313):8–18

    PubMed  Google Scholar 

  5. Dimitriou R, Giannoudis PV (200) Application of rhOP-1 in non union. Report of 26 cases. Injury 375:524–528

    Google Scholar 

  6. Einhorn TA, Trippel SB (1997) Growth factor treatment of fractures. A.A.O.S.I.C. Lecture. American Academy of Orthopedic Surgeons Publications, Rosemont, IL, pp 483–494

    Google Scholar 

  7. Engelhardt P, Velasco R (1994) Prognosis of spongiosa-plasty of the fractured tibial shaft. Unfallchirurg 97(10):525–529

    CAS  PubMed  Google Scholar 

  8. Frankel VH, Mizuho K (2002) Management of non-union with pulsed low-intensity ultrasound therapy–international results. Surg Technol Int 10:195–200

    PubMed  Google Scholar 

  9. Friedlaender GE et al (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 83-A suppl 1(Pt 2):S151–S158

    Google Scholar 

  10. Gerstenfeld LC et al (2003) Fracture healing as a post-natal developmental process: molecular, spatial, and temporal aspects of its regulation. J Cell Biochem 88(5):873–884

    Article  CAS  PubMed  Google Scholar 

  11. Giannoudis PV, Kanakaris NK, Einhorn TA (2007) Interaction of bone morphogenetic proteins with cells of the osteoclast lineage: review of the existing evidence. Osteopo­ros Int 18(12):1565–1581

    Article  CAS  PubMed  Google Scholar 

  12. Giannoudis PV, Tzioupis C (2005) Clinical applications of BMP-7. The UK perspective. Injury 36S:47–50

    Article  Google Scholar 

  13. Griffin XL, Warner F, Costa M (2008) The role of electromagnetic stimulation in the management of established non-union of long bone fractures: what is the evidence? Injury 39(4):419–429

    Article  CAS  PubMed  Google Scholar 

  14. Hernigou P et al (2005) The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Joint Surg Br 87(7):896–902

    Article  CAS  PubMed  Google Scholar 

  15. Hernigou P et al (2005) Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am 87(7):1430–1437

    Article  PubMed  Google Scholar 

  16. Hernigou P et al (2006) Percutaneous autologous bone-marrow grafting for nonunions. Surgical technique. J Bone Joint Surg Am 88 Suppl 1 (Pt 2):322–327

    Article  PubMed  Google Scholar 

  17. Jingushi S (2009) [Bone fracture and the healing mechanisms. Fracture treatment by low-intensity pulsed ultrasound]. Clin Calcium 19(5):704–708

    PubMed  Google Scholar 

  18. Jingushi S et al (2007) Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures. J Orthop Sci 12(1):35–41

    Article  PubMed  Google Scholar 

  19. Malizos KN et al (2006) Low-intensity pulsed ultrasound for bone healing: an overview. Injury 37 suppl 1:S56–S62

    Article  Google Scholar 

  20. Matsuda Y et al (1998) Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nippon Geka Hokan 67(1):10–17

    CAS  PubMed  Google Scholar 

  21. Meister K, Segal D, Whitelaw GP (1990) The role of bone grafting in the treatment of delayed unions and nonunions of the tibia. Orthop Rev 19(3):260–271

    CAS  PubMed  Google Scholar 

  22. Muschler GF, Boehm C, Easley K (1997) Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am 79(11):1699–1709

    CAS  PubMed  Google Scholar 

  23. Ristiniemi J (2007) External fixation of tibial pilon fractures and fracture healing. Acta Orthop Suppl 78(326):3, 5–34

    Google Scholar 

  24. Romano CL, Romano D, Logoluso N (2009) Low-intensity pulsed ultrasound for the treatment of bone delayed union or nonunion: a review. Ultrasound Med Biol 35(4):529–536

    Article  PubMed  Google Scholar 

  25. Ronga M et al (2006) Recombinant human bone morphogenetic protein 7 for treatment of long bone non-union. Injury 375:551–556

    Google Scholar 

  26. Sakou T (1998) Bone morphogenetic proteins: from basic studies to clinical approaches. Bone 22(6):591–603

    Article  CAS  PubMed  Google Scholar 

  27. Sen MK, Miclau T (2007) Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions? Injury 38 suppl 1:S75–S80

    Article  Google Scholar 

  28. Sprague S, Bhandari M (2002) An economic evaluation of early versus delayed operative treatment in patients with closed tibial shaft fractures. Arch Orthop Trauma Surg 122(6):315–323

    PubMed  Google Scholar 

  29. Weise K, Winter E (1996) Role of intramedullary nailing in pseudarthrosis and malalignment. Orthopade 25(3):247–258

    CAS  PubMed  Google Scholar 

  30. Wozney JM (1989) Bone morphogenetic proteins. Prog Growth Factor Res 1(4):267–280

    Article  CAS  PubMed  Google Scholar 

  31. Wozney JM et al (1988) Novel regulators of bone formation: molecular clones and activities. Science 242(4885):1528–1534

    Article  CAS  PubMed  Google Scholar 

  32. Zimmermann G et al (2006) Clinical experience with bone morphogenetic protein 7 (BMP 7) in nonunions of long bones. Unfallchirurg 109(7):528–537

    Article  CAS  PubMed  Google Scholar 

  33. Zimmermann G et al (2007) Therapeutic outcome in tibial pseudarthrosis: bone morphogenetic protein 7 (BMP-7) versus autologous bone grafting for tibial fractures. Unfallchirurg 110(11):931–938

    Article  CAS  PubMed  Google Scholar 

  34. Zimmermann G et al (2007) Ergebnisse der Anwendung von Bone Morphogenetic Protein 7 bei Pseudarthrosen langer Röhrenknochen in Deutschland. In Congress of the German Society of Trauma Surgery, Berlin

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Theresienkrankenhaus Mannheim, Bassermannstrasse 1, 68165, Mannheim, Germany

    Gerald Zimmermann

Authors
  1. Gerald Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arash Moghaddam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerald Zimmermann .

Editor information

Editors and Affiliations

  1. Inst. Orthopaedics, RNOHT, Brockley Hill, Stanmore, Middx., HA7 4LP, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2010 EFORT

About this chapter

Cite this chapter

Zimmermann, G., Moghaddam, A. (2010). Trauma: Non-Union: New Trends. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 10. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11832-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-11832-6_2

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11831-9

  • Online ISBN: 978-3-642-11832-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation