Management and outcome of diaphyseal aseptic non-unions of the lower limb: A systematic review

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• 作者：Spiros G. Pneumaticos^a ; Michalis Panteli^b ; Georgios K. Triantafyllopoulos^a ; Costas Papakostidis^c ; Peter V. Giannoudis^b ; ^d ; ^{pgiannoudi@aol.com" class="auth_mail}
• 关键词：Aseptic ; Non-unions ; Diaphysis ; Shaft ; Lower limb ; Femur ; Tibia ; Long bones
• 刊名：The Surgeon
• 出版年：June 2014
• 年：2014
• 卷：12
• 期：3
• 页码：166-175
• 全文大小：529 K

文摘

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.