Orthobiologics in delayed union and non-union of adult long bones fractures: A systematic review

IF 2.1 Q3 ENDOCRINOLOGY & METABOLISM Bone Reports Pub Date : 2024-04-06 DOI:10.1016/j.bonr.2024.101760

Lorenzo Impieri , Andrea Pezzi , Henrique Hadad , Giuseppe M. Peretti , Laura Mangiavini , Nicolò Rossi

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Abstract

Background

Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults.

Methods

A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded.

Results

The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors.

Conclusion

This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.

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矫形生物制剂在成人长骨骨折延迟愈合和不愈合中的应用：系统综述

背景骨折愈合是骨科领域的一项重大挑战。成功的骨再生需要机械稳定性和良好的生物微环境。本系统性综述旨在探讨矫形生物制剂在治疗成人长骨无菌性延迟愈合和非愈合中的临床应用。方法按照《系统性综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analyses，PRISMA）指南进行了系统性综述。在没有日期限制的情况下，使用与骨生物制品、延迟接合和非接合相关的关键词对三个数据库进行了检索。符合条件的研究包括以英文撰写的人类临床研究，并提供全文，这些研究探讨了富血小板血浆（PRP）、间充质干细胞（MSCs）和骨形态发生蛋白（BMPs）等骨生物制剂用于治疗成人无菌性延迟接合和非接合。动物研究、体外研究以及有关先天性缺陷、肿瘤或感染导致的非榫接的研究均被排除在外。这些研究涉及 493 名非骨结合患者和 256 名延迟骨结合患者，他们的平均年龄分别为 40.62 岁和 41.7 岁。非骨结合患者的平均随访时间为 15.55 个月，延迟骨结合患者的平均随访时间为 8.07 个月。PRP是使用最多的矫形生物制剂，其结果通过骨结合时间、功能评分和临床检查进行评估。结果表明，与不使用生物因子的外科手术相比，骨科生物制剂，尤其是 PRP，往往能产生更好的疗效。结论：这篇系统性综述表明，PRP、BMPs 和间充质干细胞等骨科生物制剂在治疗延迟愈合和非愈合骨折方面既有效又安全。这些生物治疗方法有可能提高骨折不愈合患者的愈合率、缩短愈合时间并改善功能预后。进一步的研究对于完善治疗方案、确定最适合特定患者群体和骨折类型的矫形生物疗法至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone Reports Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

4.00%

发文量

444

审稿时长

57 days

期刊介绍： Bone Reports is an interdisciplinary forum for the rapid publication of Original Research Articles and Case Reports across basic, translational and clinical aspects of bone and mineral metabolism. The journal publishes papers that are scientifically sound, with the peer review process focused principally on verifying sound methodologies, and correct data analysis and interpretation. We welcome studies either replicating or failing to replicate a previous study, and null findings. We fulfil a critical and current need to enhance research by publishing reproducibility studies and null findings.