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Frontiers in non-union research.

ABSTRACT: Multifactorial aetiology defines non-unions, with a biological and a mechanical distortion of the timeline of bone healing.Research on new advances to increase osteogenesis and promote non-union healing is strongly directed towards new forms of cell products.Basic science and research on non-union treatments is needed to compile preclinical data on new treatments.Bone marrow concentration and expanded mesenchymal stromal cells still require extensive clinical research to confirm efficacy in non-union treatment.Solid preclinical studies, precise cell product definition and preparation, and appropriate ethical and regulatory approvals are needed to assess new advanced therapy medicinal products. Cite this article: EFORT Open Rev 2020;5:574-583. DOI: 10.1302/2058-5241.5.190062.

SUBMITTER: Gomez-Barrena E

PROVIDER: S-EPMC7608578 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Frontiers in non-union research.

Gómez-Barrena Enrique E Padilla-Eguiluz Norma G NG Rosset Philippe P

EFORT open reviews 20201026 10

Multifactorial aetiology defines non-unions, with a biological and a mechanical distortion of the timeline of bone healing.Research on new advances to increase osteogenesis and promote non-union healing is strongly directed towards new forms of cell products.Basic science and research on non-union treatments is needed to compile preclinical data on new treatments.Bone marrow concentration and expanded mesenchymal stromal cells still require extensive clinical research to confirm efficacy in non- ...[more]

PMID: 33204499

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Project description:BackgroundAlthough relatively rare, non-unions and mal-unions of tibial plateau fractures present significant challenges for the orthopedic surgeon. With careful pre-operative planning, tibial plateau mal-union or non-union revision surgery with intra-articular and varus opening osteotomies can provides good functional results when performed early (within 1 year) after primary surgical procedure.Questions/purposesWe present our treatment algorithm for approaching and treating non-union or mal-union of tibial plateau fractures. Our aim is to give surgeons treating these difficult injuries an overview of the pertinent literature as well as describe the challenges and pitfalls we have experienced when treating non-union or mal-union of tibial plateau fractures.MethodsUsing two case examples from our institution, one for mal-union and one for mal-reduction, we describe our treatment algorithm and surgical technique for managing these difficult injuries. We also provide a brief literature review outlining relevant studies and summarizing outcomes for similar injuries. A systematic literature review was conducted with the aim of determining the methods and outcomes commonly reported in the literature regarding revision surgery following tibial plateau non-union or mal-union. Due to the nature of revision surgery, there are no long-term randomized trials dealing with outcomes, but rather several smaller case series exist from which larger conclusions have to be drawn.ResultsTo date, we have successfully treated approximately 35 patients with this technique, and clinical follow-up continues to show good functional outcomes with reduced pain and little radiographic evidence of arthritic changes. Restoring long leg alignment, anatomic reduction of the articular surface, and achieving stable internal fixation are paramount in achieving the best long-term outcome. Due to the shallow soft tissue envelope around the proximal tibia, and the tendency for these fractures to fall into progressive valgus collapse, these problems can seem intimidating and complex. However, with well-planned surgery and meticulous surgical technique, reliable healing can be achieved.ConclusionBy outlining our method, we hope to provide other surgeons with an algorithm to guide clinical and operative decision making. These difficult injuries can be daunting to treat, but if performed before the onset of severe degenerative arthritis, early revision surgery, as we describe, can be a viable alternative to total knee arthroplasty, particularly in younger, more active patients.

Project description:BackgroundAs one of the most common complications of stroke, post-stroke pneumonia significantly increases the incidence of adverse outcomes, mortality, and healthcare costs for patients with stroke. As the field of post-stroke pneumonia has gained interest in the recent years, there has been an increasing number of publications on post-stroke pneumonia research worldwide. Therefore, a more comprehensive understanding of the field is needed now. This paper is intended to analyze the research status and detect the research frontiers in this field.MethodsVOS viewer, CiteSpace, and the online scientometric platform (https://bibliometric.com/) were the main visualization tools used in this paper. They were used to perform citation analysis of countries/institutions, co-citation analysis of authors/journals/references, co-authorship analysis of authors, co-occurrence analysis of keywords, and citation bursts analysis of references.ResultsThe number of publications in this field has increased rapidly since 2010 and is expected to continue to increase in the next few years. The countries contributing most to post-stroke pneumonia research were the USA, China, and Germany. The most productive institution was Harvard University, followed by Humboldt University of Berlin, Charité Universitätsmedizin Berlin, and Free University of Berlin from Germany. Meanwhile, the German authors Meisel A, Meisel C, and Dirnagl U, who have contributed significantly to this field, were all associated with these three German institutions. The high-quality and high output journal was STROKE. In the coming years, the hot topic keywords "risk & risk-factors," "outcome & impact," "management & guidelines," and "predictors" will gain more attention in this field. Finally, hot keywords were grouped into four clusters in this paper: cluster 1 (risk-factors studies of post-stroke pneumonia), cluster 2 (clinically relevant studies of post-stroke pneumonia), cluster 3 (mechanism studies of post-stroke pneumonia), and cluster 4 (care studies of post-stroke pneumonia).ConclusionThis study shows the knowledge structure and evolution of the field of post-stroke pneumonia research and predicts research trends through visualization analysis. The future trend of post-stroke pneumonia research will gradually shift from clinical and mechanistic studies to treatment and prevention studies.

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Frontiers in non-union research.

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Frontiers in non-union research.

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