Injury
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The management of open fractures continues to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction. The use of bone morphogenetic proteins (BMPs) in the treatment of open fractures has been assessed by a number of different clinical trials, both in the acute management of open fractures and in the delayed reconstruction of bone defects secondary to open fracture. This review describes the scientific basis for the use of BMPs in open fractures, reviews the current evidence for their use in open fractures, provides grades of recommendation for the different uses of BMPs in open fractures, and identifies important areas for additional research.
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The study presents a surgical technique using two suture anchors combined with two non-absorbable suture tension bands and the clinical and radiological results obtained in patients with acute distal clavicle fractures associated with coracoclavicular ligaments disruption. ⋯ Coracoclavicular reconstruction using two suture anchors and supplementary interfragmentary fixation using two non-absorbable suture tension bands for acute distal clavicle fracture are reliable techniques for restoring stability in patients with acute distal clavicle fracture.
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A systematic review of the literature was conducted to investigate data regarding femoral head fractures, particularly focusing on their management, complications and clinical results. Twenty-nine eligible articles, meeting prespecified inclusion criteria, reported on 453 femoral head fractures in 450 patients (mean age of 38.9 years with a mean follow-up of 55.6 months). 84.3% of patients had been victims of an automobile accident. The most widespread classification scheme used was that of Pipkin (65.4% of cases) whereas clinical results were evaluated mainly according to Thompson-Epstein criteria (63.3% of cases). ⋯ Wound infection was encountered with a rate of 3.2% of surgical cases and sciatic nerve palsy complicated 3.95% of fracture-dislocations. Major late complications included avascular necrosis (11.9%), post-traumatic arthritis (20%) and heterotopic ossification (16.8%). Neither the trochanteric-flip nor the anterior approach seems to put in more danger the femoral head blood supply compared to the posterior one, with the former giving promising long-term functional results and lower incidence of major complication rates.
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Case Reports Multicenter Study
Application of bone morphogenetic proteins to femoral non-unions: a 4-year multicentre experience.
Fracture non-unions often complicate orthopaedic trauma. BMPs (bone morphogenetic proteins) are currently considered the most appealing osteoinductive agents. Applications of BMP-7 since January 2004 were prospectively recorded in a multicentre registry of aseptic femoral non-unions. ⋯ No adverse events were associated with BMP-7 application. Our case series supports the safety and efficacy of BMP-7 in femoral non-unions. Multicentre networks and systematic, long-term follow-up of patients may improve understanding of this promising osteoinductive bone substitute.
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The recent development of new orthopaedic devices and advanced techniques for soft-tissue reconstruction have clearly improved the outcome in trauma and orthopaedic surgery. Nevertheless, large bone defects are still difficult to treat and require a careful analysis of the situation. Individual planning of the reconstructive strategy is desirable. ⋯ BMPs are often used in combination with autogenic, allogenic, xenogenic or synthetic grafting materials and even with mesenchymal stem cells. In addition, gene therapy approaches present an attractive option. Experimental studies and first clinical results are promising in the use of BMPs for treatment of critical-size defects; however, there is obvious need for further controlled studies to define strategies.