Skip to main content
SpringerLink
Log in

Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

  • Review
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

The successful treatment of nonunions represents a major challenge for orthopaedic surgeons. Lately, ongoing advances made in the field of molecular medicine and molecular biology have increased our understanding of the pathways and involvement of mediators surrounding the bone healing process. As a result, the surgeon’s armamentarium has been increased in terms of options for intervention. This article aims to provide an overview of minimally invasive techniques applicable in the treatment of nonunions of fractures.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Al Mukaimi A, Mokhtar A, Abo El Nass M (2005) The use of locked nails in the treatment of humeral shaft: delayed union and nonunion. Med Princ Pract 14:245–249

    PubMed  Google Scholar 

  2. Axelrad TW, Kakar S, Einhorn TA (2007) New technologies for the enhancement of skeletal repair. Injury 38:S49–S62

    PubMed  Google Scholar 

  3. Babhulkar SS, Pande KC, Babhulkar S (1995) Ankle instability after fibular resection. J Bone Joint Surg Br 77:258–261

    CAS  PubMed  Google Scholar 

  4. Betz OB, Betz VM, Nazarian A, Pilapil CG, Vrahas MS, Bouxsein ML, Gerstenfeld LC, Einhorn TA, Evans CH (2006) Direct percutaneous gene delivery to enhance healing of segmental bone defects. J Bone Joint Surg Am 88:355–365

    PubMed  Google Scholar 

  5. Betz VM, Betz OB, Glatt V, Gerstenfeld LC, Einhorn TA, Bouxsein ML, Vrahas MS, Evans CH (2007) Healing of segmental bone defects by direct percutaneous gene delivery: effect of vector dose. Hum Gene Ther 18:907–915

    CAS  PubMed  Google Scholar 

  6. Bhan S, Mehara AK (1993) Percutaneous bone grafting for nonunion and delayed union of fractures of the tibial shaft. Int Orthop 17:310–312

    CAS  PubMed  Google Scholar 

  7. Bilic R, Simic P, Jelic M, Stern-Padovan R, Dodig D, van Meerdervoort HP, Martinovic S, Ivankovic D, Pecina M, Vukicevic S (2006) Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 30:128–134

    CAS  PubMed  Google Scholar 

  8. Bishop GB, Einhorn TA (2007) Current and future clinical applications of bone morphogenetic proteins in orthopaedic trauma surgery. Int Orthop 31:721–727

    PubMed  Google Scholar 

  9. Burwell RG (1964) Studies in the transplantation of bone. VII. The fresh composite homograft-autograft of cancellous bone; an analysis of factors leading to osteonecrosis in marrow transplants and in marrow-containing bone grafts. J Bone Joint Surg Br 46:110–140

    CAS  PubMed  Google Scholar 

  10. Calori GM, Albisetti W, Agus A, Iori S, Tagliabue S (2007) Risk factors contributing to fracture non-unions. Injury 38:S11–S18

    PubMed  Google Scholar 

  11. Calori GM, D'Avino M, Tagliabue L, Albisetti W, d'Imporzano M, Peretti G (2006) An ongoing research for evaluation of treatment with BMPs or AGFs in long bone non-union: protocol description and preliminary results. Injury 37:S43–S50

    PubMed  Google Scholar 

  12. Caylan R, Bektas D, Dikmen T, Bektas O, Omay SB, Ovali E (2006) Mesenchymal stem cells in iatrogenic facial nerve paralysis: a possible role in the future. Eur Arch Otorhinolaryngol 263:963–967

    PubMed  Google Scholar 

  13. Centeno CJ, Kisiday J, Freeman M, Schultz JR (2006) Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: a case study. Pain Physician 9:253–256

    PubMed  Google Scholar 

  14. Chang CH, Stanton RP, Glutting J (2002) Unicameral bone cysts treated by injection of bone marrow or methylprednisolone. J Bone Joint Surg Br 84:407–412

    CAS  PubMed  Google Scholar 

  15. Chapman MW, Bucholz R, Cornell C (1997) Treatment of acute fractures with a collagen-calcium phosphate graft material. A randomized clinical trial. J Bone Joint Surg Am 79:495–502

    CAS  PubMed  Google Scholar 

  16. Clokie CM, Moghadam H, Jackson MT, Sandor GK (2002) Closure of critical sized defects with allogenic and alloplastic bone substitutes. J Craniofac Surg 13:111–121

    PubMed  Google Scholar 

  17. Colterjohn NR, Bednar DA (1997) Procurement of bone graft from the iliac crest. An operative approach with decreased morbidity. J Bone Joint Surg Am 79:756–759

    CAS  PubMed  Google Scholar 

  18. Connolly JF, Guse R, Tiedeman J, Dehne R (1991) Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res 266:259–270

    PubMed  Google Scholar 

  19. Connolly JF, Shindell R (1986) Percutaneous marrow injection for an ununited tibia. Nebr Med J 71:105–107

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  21. Dallari D, Fini M, Stagni C, Torricelli P, Nicoli Aldini N, Giavaresi G, Cenni E, Baldini N, Cenacchi A, Bassi A, Giardino R, Fornasari PM, Giunti A (2006) In vivo study on the healing of bone defects treated with bone marrow stromal cells, platelet rich plasma and freeze-dried bone allografts, alone and in combination. J Orthop Res 24:877–888

    CAS  PubMed  Google Scholar 

  22. Devine MJ, Mierisch CM, Jang E, Anderson PC, Balian G (2002) Transplanted bone marrow cells localize to fracture callus in a mouse model. J Orthop Res 20:1232–1239

    PubMed  Google Scholar 

  23. Einhorn TA, Majeska RJ, Mohaideen A, Kagel EM, Bouxsein ML, Turek TJ, Wozney JM (2003) A single percutaneous injection of recombinant human bone morphogenetic protein-2 accelerates fracture repair. J Bone Joint Surg Am 85-A:1425–1435

    PubMed  Google Scholar 

  24. Faundez AA, Taylor S, Kaelin AJ (2006) Instrumented fusion of thoracolumbar fracture with type I mineralized collagen matrix combined with autogenous bone marrow as a bone graft substitute: a four-case report. Eur Spine J 15:630–635

    PubMed  Google Scholar 

  25. Feldman DS, Shin SS, Madan S, Koval KJ (2003) Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor Spatial Frame. J Orthop Trauma 17:549–554

    PubMed  Google Scholar 

  26. Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 84-A:454–464

    PubMed  Google Scholar 

  27. Frangakis EK (1966) Intracapsular fractures of the neck of the femur. Factors influencing non-union and ischaemic necrosis. J Bone Joint Surg Br 48:17–30

    CAS  PubMed  Google Scholar 

  28. Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 83-A:S151–S158

    PubMed  Google Scholar 

  29. Friedlaender GE (2004) Osteogenic protein-1 in treatment of tibial nonunions: current status. Surg Technol Int 13:249–252

    PubMed  Google Scholar 

  30. Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M (2004) Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study. J Bone Joint Surg Am 86-A(6):1153–1160

    PubMed  Google Scholar 

  31. Gangji V, Hauzeur JP (2005) Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. Surgical technique. J Bone Joint Surg Am 87:106–112

    PubMed  Google Scholar 

  32. Garg NK, Gaur S, Sharma S (1993) Percutaneous autogenous bone marrow grafting in 20 cases of ununited fracture. Acta Orthop Scand 64:671–672

    CAS  PubMed  Google Scholar 

  33. Garg NK, Gaur S (1995) Percutaneous autogenous bone-marrow grafting in congenital tibial pseudarthrosis. J Bone Joint Surg Br 77:830–831

    CAS  PubMed  Google Scholar 

  34. Giannoudis P, Psarakis S, Kontakis G (2007) Can we accelerate fracture healing? A critical analysis of the literature. Injury 38:S81–S89

    PubMed  Google Scholar 

  35. Giannoudis PV, Einhorn TA, Marsh D (2007) Fracture healing: the diamond concept. Injury 38:S3–S6

    Google Scholar 

  36. Giannoudis PV, Psarakis S, Kanakaris NK, Pape HC (2007) Biological enhancement of bone healing with bone morphogenetic protein-7 at the clinical setting of pelvic girdle non-unions. Injury 38:S43–S48

    PubMed  Google Scholar 

  37. Giannoudis PV, Tzioupis C (2005) Clinical applications of BMP-7: the UK perspective. Injury 36:S47–S50

    PubMed  Google Scholar 

  38. Goel A, Sangwan SS, Siwach RC, Ali AM (2005) Percutaneous bone marrow grafting for the treatment of tibial non-union. Injury 36:203–206

    PubMed  Google Scholar 

  39. Goulet JA, Senunas LE, DeSilva GL, Greenfield ML (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res 339:76–81

    PubMed  Google Scholar 

  40. Govender S, Csimma C, Genant HK, Valentin-Opran A, Amit Y, Arbel R, Aro H, Atar D, Bishay M, Borner MG, Chiron P, Choong P, Cinats J, Courtenay B, Feibel R, Geulette B, Gravel C, Haas N, Raschke M, Hammacher E, van der Velde D, Hardy P, Holt M, Josten C, Ketterl RL, Lindeque B, Lob G, Mathevon H, McCoy G, Marsh D, Miller R, Munting E, Oevre S, Nordsletten L, Patel A, Pohl A, Rennie W, Reynders P, Rommens PM, Rondia J, Rossouw WC, Daneel PJ, Ruff S, Ruter A, Santavirta S, Schildhauer TA, Gekle C, Schnettler R, Segal D, Seiler H, Snowdowne RB, Stapert J, Taglang G, Verdonk R, Vogels L, Weckbach A, Wentzensen A, Wisniewski T, BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) study group (2002) Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am 84-A:2123–2134

    PubMed  Google Scholar 

  41. Green E, Lubahn JD, Evans J (2005) Risk factors, treatment, and outcomes associated with nonunion of the midshaft humerus fracture. J Surg Orthop Adv 14:64–72

    PubMed  Google Scholar 

  42. Grundel RE, Chapman MW, Yee T, Moore DC (1991) Autogeneic bone marrow and porous biphasic calcium phosphate ceramic for segmental bone defects in the canine ulna. Clin Orthop Relat Res 266:244–258

    PubMed  Google Scholar 

  43. Hak DJ, Lee SS, Goulet JA (2000) Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma 14:178–182

    CAS  PubMed  Google Scholar 

  44. Hase T, Miki T (2000) Autogenous bone marrow graft to non-ossifying fibroma with a pathologic fracture. Arch Orthop Trauma Surg 120:458–459

    CAS  PubMed  Google Scholar 

  45. Healey JH, Zimmerman PA, McDonnell JM, Lane JM (1990) Percutaneous bone marrow grafting of delayed union and nonunion in cancer patients. Clin Orthop Relat Res 256:280–285

    PubMed  Google Scholar 

  46. Hernigou P, Beaujean F (2002) Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 405:14–23

    PubMed  Google Scholar 

  47. Hernigou P, Poignard A, Beaujean F, Rouard H (2005) Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am 87:1430–1437

    PubMed  Google Scholar 

  48. Hierholzer C, Sama D, Toro JB, Peterson M, Helfet DL (2006) Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg Am 88:1442–1447

    PubMed  Google Scholar 

  49. Hill NM, Horne JG, Devane PA (1999) Donor site morbidity in the iliac crest bone graft. Aust NZ J Surg 69:726–728

    CAS  Google Scholar 

  50. Hollinger JO, Hart CE, Hirsch SN, Lynch S, Friedlaender GE (2008) Recombinant human platelet-derived growth factor: biology and clinical applications. J Bone Joint Surg Am 90:48–54

    PubMed  Google Scholar 

  51. Johnson LL, Morrison KM, Wood DL (2000) The application of arthroscopic principles to bone grafting of delayed union of long bone fractures. Arthroscopy 16:279–289

    Article  CAS  PubMed  Google Scholar 

  52. Jones CB, Mayo KA (2005) Nonunion treatment: iliac crest bone graft techniques. J Orthop Trauma 19:S11–S13

    PubMed  Google Scholar 

  53. Kanakaris NK, Giannoudis PV (2007) The health economics of the treatment of long-bone non-unions. Injury 38:S77–S84

    PubMed  Google Scholar 

  54. Kanakaris NK, Paliobeis C, Nlanidakis N, Giannoudis PV (2007) Biological enhancement of tibial diaphyseal aseptic non-unions: the efficacy of autologous bone grafting, BMPs and reaming by-products. Injury 38:S65–S75

    PubMed  Google Scholar 

  55. Kawcak CE, Trotter GW, Powers BE, Park RD, Turner AS (2000) Comparison of bone healing by demineralized bone matrix and autogenous cancellous bone in horses. Vet Surg 29:218–226

    CAS  PubMed  Google Scholar 

  56. Kettunen J, Makela EA, Turunen V, Suomalainen O, Partanen K (2002) Percutaneous bone grafting in the treatment of the delayed union and non-union of tibial fractures. Injury 33:239–245

    CAS  PubMed  Google Scholar 

  57. Khanal GP, Garg M, Singh GK (2004) A prospective randomized trial of percutaneous marrow injection in a series of closed fresh tibial fractures. Int Orthop 28(3):167–170

    CAS  PubMed  Google Scholar 

  58. Kitoh H, Kitakoji T, Tsuchiya H, Mitsuyama H, Nakamura H, Katoh M, Ishiguro N (2004) Transplantation of marrow-derived mesenchymal stem cells and platelet-rich plasma during distraction osteogenesis—a preliminary result of three cases. Bone 35:892–898

    PubMed  Google Scholar 

  59. Kocialkowski A, Wallace WA, Prince HG (1990) Clinical experience with a new artificial bone graft: preliminary results of a prospective study. Injury 21:142–144

    CAS  PubMed  Google Scholar 

  60. Koller M, Lorenz W (2007) Study types and study issues in clinical medicine. Forensic Sci Int 165:98–107

    PubMed  Google Scholar 

  61. Liang YT, Zhang BX, Lu SB (1999) Experimental study and clinical application on osteogenesis of percutaneous autogenous bone marrow grafting in bone defects. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 13:148–151

    CAS  PubMed  Google Scholar 

  62. Lim JK, Hui J, Li L, Thambyah A, Goh J, Lee EH (2004) Enhancement of tendon graft osteointegration using mesenchymal stem cells in a rabbit model of anterior cruciate ligament reconstruction. Arthroscopy 20:899–910

    PubMed  Google Scholar 

  63. Ma HL, Chen TH, Hung SC (2004) Development of a new method in promoting fracture healing: multiple cryopreserved bone marrow injections using a rabbit model. Arch Orthop Trauma Surg 124:448–454

    PubMed  Google Scholar 

  64. Maghsudi M, Neumann C, Hente R, Nerlich M (1998) Percutaneous minimal invasive autologous spongiosa transplantation. Langenbecks Arch Chir Suppl Kongressbd 115:1218–1220

    CAS  PubMed  Google Scholar 

  65. Mahendra A, Maclean AD (2007) Available biological treatments for complex non-unions. Injury 38:S7–S12

    PubMed  Google Scholar 

  66. Majors AK, Boehm CA, Nitto H, Midura RJ, Muschler GF (1997) Characterization of human bone marrow stromal cells with respect to osteoblastic differentiation. J Orthop Res 15:546–557

    CAS  PubMed  Google Scholar 

  67. Makino T, Kokubu T, Kurosaka M (2006) Effect of recombinant human bone morphogenetic protein on preventing atrophic nonunion. Clin Calcium 16(5):823–827

    CAS  PubMed  Google Scholar 

  68. Maneerit J, Meknavin S, Hanpanitkitkan S (2004) Percutaneous versus open bone grafting in the treatment of tibial fractures: a randomized prospective trial. J Med Assoc Thai 87:1034–1040

    PubMed  Google Scholar 

  69. Matsuda Y, Sakayama K, Okumura H, Kawatani Y, Mashima N, Shibata T (1998) Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nippon Geka Hokan 67:10–17

    CAS  PubMed  Google Scholar 

  70. Metheny-Barlow LJ, Tian S, Hayes AJ, Li LY (2004) Direct chemotactic action of angiopoietin-1 on mesenchymal cells in the presence of VEGF. Microvasc Res 68:221–230

    CAS  PubMed  Google Scholar 

  71. Milovancev M, Muir P, Manley PA, Seeherman HJ, Schaefer S (2007) Clinical application of recombinant human bone morphogenetic protein-2 in 4 dogs. Vet Surg 36:132–140

    PubMed  Google Scholar 

  72. Mukaimi A, Mokhtar A, Abo El Nass M (2005) The use of locked nails in the treatment of humeral shaft: delayed union and nonunion. Med Princ Pract 14:245–249

    PubMed  Google Scholar 

  73. Muller ME (1965) Treatment of nonunion by compression. Clin Orthop Relat Res 43:83–92

    Google Scholar 

  74. 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 79:1699–1709

    CAS  PubMed  Google Scholar 

  75. Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19:117–125

    CAS  PubMed  Google Scholar 

  76. Muschler GF, Nitto H, Matsukura Y, Boehm C, Valdevit A, Kambic H, Davros W, Powell K, Easley K (2003) Spine fusion using cell matrix composites enriched in bone marrow-derived cells. Clin Orthop Relat Res 407:102–118

    PubMed  Google Scholar 

  77. Nakajima F, Nakajima A, Ogasawara A, Moriya H, Yamazaki M (2007) Effects of a single percutaneous injection of basic fibroblast growth factor on the healing of a closed femoral shaft fracture in the rat. Calcif Tissue Int 81:132–138

    CAS  PubMed  Google Scholar 

  78. Niikura T, Hak DJ, Reddi AH (2006) Global gene profiling reveals a downregulation of BMP gene expression in experimental atrophic nonunions compared to standard healing fractures. J Orthop Res 24:1463–1471

    CAS  PubMed  Google Scholar 

  79. Nishimori M, Tateoka A, Tojyo A, Nakao Y, Yamada Y, Hanaoka K (2001) Self-reported recovery time of daily activity after bone marrow harvesting from healthy donors. J Anesth 15:1–5

    CAS  PubMed  Google Scholar 

  80. Nizankowski R, Petriczek T, Skotnicki A, Szczeklik A (2005) The treatment of advanced chronic lower limb ischaemia with marrow stem cell autotransplantation. Kardiol Pol 63(4):351–360

    PubMed  Google Scholar 

  81. Orozco L, Rodriguez L, Torrico C, Douville J, Hock JM, Armstrong RD, Garcia J, Solano C. Clinical feasibility study: the use of cultured enriched autologous bone marrow cells to treat refractory atrophic and hypotrophic nonunion fractures. http://files.shareholder.com/downloads/ASTM/98210462x0xS950134-05-10343/887359/filing.pdf. Accessed 07 October 2009

  82. Otto WR, Rao J (2004) Tomorrow's skeleton staff: mesenchymal stem cells and the repair of bone and cartilage. Cell Prolif 37:97–110

    CAS  PubMed  Google Scholar 

  83. Paley D, Young MC, Wiley AM, Fornasier VL, Jackson RW (1986) Percutaneous bone marrow grafting of fractures and bony defects. An experimental study in rabbits. Clin Orthop Relat Res 208:300–312

    PubMed  Google Scholar 

  84. Parikh SN (2002) Bone graft substitutes: past, present, future. J Postgrad Med 48:142–148

    CAS  PubMed  Google Scholar 

  85. Patel AA, Ricci WM, McDonald DJ, Borrelli J, Clohisy JC (2006) Treatment of periprosthetic femoral shaft nonunion. J Arthroplast 21:435–442

    Google Scholar 

  86. Patil S, Montgomery R (2006) Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br 88:928–932

    CAS  PubMed  Google Scholar 

  87. Pecina M, Vukicevic S (2007) Biological aspects of bone, cartilage and tendon regeneration. Int Orthop 31:719–720

    PubMed  Google Scholar 

  88. Piriou P, Martin JN, Garreau de Loubresse C, Judet T (2005) Tibia nonunion after intramedullar nailing for fracture: decortication and osteosynthesis by medial plating. Rev Chir Orthop Reparatrice Appar Mot 91:222–231

    CAS  PubMed  Google Scholar 

  89. Pountos I, Corscadden D, Emery P, Giannoudis PV (2007) Mesenchymal stem cell tissue engineering: techniques for isolation, expansion and application. Injury 38:S23–S33

    PubMed  Google Scholar 

  90. Pountos I, Georgouli T, Blokhuis TJ, Pape HC, Giannoudis PV (2008) Pharmacological agents and impairment of fracture healing: what is the evidence? Injury 39:384–394

    PubMed  Google Scholar 

  91. Pountos I, Giannoudis PV (2005) Biology of mesenchymal stem cells. Injury 3:S8–S12

    Google Scholar 

  92. Pountos I, Jones E, Tzioupis C, McGonagle D, Giannoudis PV (2006) Growing bone and cartilage. The role of mesenchymal stem cells. J Bone Joint Surg Br 88:421–426

    CAS  PubMed  Google Scholar 

  93. Quarto R, Mastrogiacomo M, Cancedda R, Kutepov SM, Mukhachev V, Lavroukov A, Kon E, Marcacci M (2001) Repair of large bone defects with the use of autologous bone marrow stromal cells. N Engl J Med 344:385–386

    CAS  PubMed  Google Scholar 

  94. Richmond J, Colleran K, Borens O, Kloen P, Helfet DL (2004) Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma 18:603–610

    PubMed  Google Scholar 

  95. Rozen N, Lewinson D, Bick T, Jacob ZC, Stein H, Soudry M (2007) Fracture repair: modulation of fracture-callus and mechanical properties by sequential application of IL-6 following PTH 1–34 or PTH 28–48. Bone 41:437–445

    CAS  PubMed  Google Scholar 

  96. Russell JL, Block JE (2000) Surgical harvesting of bone graft from the ilium: point of view. Med Hypotheses 55:474–479

    CAS  PubMed  Google Scholar 

  97. Saito N, Okada T, Horiuchi H, Ota H, Takahashi J, Murakami N, Nawata M, Kojima S, Nozaki K, Takaoka K (2003) Local bone formation by injection of recombinant human bone morphogenetic protein-2 contained in polymer carriers. Bone 32:381–386

    CAS  PubMed  Google Scholar 

  98. Schmidmaier G, Schwabe P, Wildemann B, Haas NP (2007) Use of bone morphogenetic proteins for treatment of non-unions and future perspectives. Injury 38:S35–S41

    PubMed  Google Scholar 

  99. Sebecic B, Gabelica V, Patrlj L, Sosa T (1999) Percutaneous autologous bone marrow grafting on the site of tibial delayed union. Croat Med J 40:429–432

    CAS  PubMed  Google Scholar 

  100. Seeherman HJ, Azari K, Bidic S, Rogers L, Li XJ, Hollinger JO, Wozney JM (2006) rhBMP-2 delivered in a calcium phosphate cement accelerates bridging of critical-sized defects in rabbit radii. J Bone Joint Surg Am 88:1553–1565

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  102. Sim R, Liang TS, Tay BK (1993) Autologous marrow injection in the treatment of delayed and non-union in long bones. Singapore Med J 34:412–417

    CAS  PubMed  Google Scholar 

  103. Siwach RC, Sangwan SS, Singh R, Goel A (2001) Role of percutaneous bone marrow grafting in delayed unions, non-unions and poor regenerates. Indian J Med Sci 55:326–336

    CAS  PubMed  Google Scholar 

  104. Sugiyama O, An DS, Kung SP, Feeley BT, Gamradt S, Liu NQ, Chen IS, Lieberman JR (2005) Lentivirus-mediated gene transfer induces long-term transgene expression of BMP-2 in vitro and new bone formation in vivo. Mol Ther 11:390–398

    CAS  PubMed  Google Scholar 

  105. Summers BN, Eisenstein SM (1989) Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 71:677–680

    CAS  PubMed  Google Scholar 

  106. Taguchi K, Ogawa R, Migita M, Hanawa H, Ito H, Orimo H (2005) The role of bone marrow-derived cells in bone fracture repair in a green fluorescent protein chimeric mouse model. Biochem Biophys Res Commun 331:31–36

    CAS  PubMed  Google Scholar 

  107. Tetreault P, Ouellette HA (2007) Healing of a clavicle fracture nonunion with bone marrow injection. J Shoulder Elbow Surg 16:e23–e24

    PubMed  Google Scholar 

  108. Tiedeman JJ, Connolly JF, Strates BS, Lippiello L (1991) Treatment of nonunion by percutaneous injection of bone marrow and demineralized bone matrix. An experimental study in dogs. Clin Orthop Relat Res 268:294–302

    PubMed  Google Scholar 

  109. Turner TM, Urban RM, Hall DJ, Cheema N, Lim TH (2003) Restoration of large bone defects using a hard-setting, injectable putty containing demineralized bone particles compared to cancellous autograft bone. Orthopedics 26:s561–s565

    PubMed  Google Scholar 

  110. Urban RM, Turner TM, Hall DJ, Infanger SI, Cheema N, Lim TH, Richelsoph K (2004) An injectable calcium sulfate-based bone graft putty using hydroxypropylmethylcellulose as the plasticizer. Orthopedics 27:s155–s159

    PubMed  Google Scholar 

  111. Vaibhav B, Nilesh P, Vikram S, Anshul C (2007) Bone morphogenic protein and its application in trauma cases: a current concept update. Injury 38:1227–1235

    PubMed  Google Scholar 

  112. Vail TP, Urbaniak JR (1996) Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am 78:204–211

    CAS  PubMed  Google Scholar 

  113. Wang L, Li WS, Zhang QS (2001) Autogenous bone marrow graft for the management of nonunion of tibia. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 15:24–25

    CAS  PubMed  Google Scholar 

  114. White AP, Vaccaro AR, Hall JA, Whang PG, Friel BC, McKee MD (2007) Clinical applications of BMP-7/OP-1 in fractures, nonunions and spinal fusion. Int Orthop 31:735–741

    PubMed  Google Scholar 

  115. Wilkins RM, Chimenti BT, Rifkin RM (2003) Percutaneous treatment of long bone nonunions: the use of autologous bone marrow and allograft bone matrix. Orthopedics 26:s549–s554

    PubMed  Google Scholar 

  116. Wilkins RM, Kelly CM (2003) The effect of allomatrix injectable putty on the outcome of long bone applications. Orthopedics 26:s567–s570

    PubMed  Google Scholar 

  117. Yu CW, Wu CC, Chen WJ (2002) Aseptic nonunion of a femoral shaft treated using exchange nailing. Chang Gung Med J 25:591–598

    PubMed  Google Scholar 

  118. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-based orthopaedic trauma working group (2006) Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma 20:76–79

    PubMed  Google Scholar 

  119. Zelle BA, Gruen GS, Klatt B, Haemmerle MJ, Rosenblum WJ, Prayson MJ (2004) Exchange reamed nailing for aseptic nonunion of the tibia. J Trauma 57:1053–1059

    PubMed  Google Scholar 

  120. Zhang P, He X, Liu K, Zhao F, Fu Z, Zhang D, Zhang Q, Jiang B (2004) Bone marrow stromal cells differentiated into functional Schwann cells in injured rats sciatic nerve. Artif Cells Blood Substit Immobil Biotechnol 32:509–518

    Article  CAS  PubMed  Google Scholar 

  121. Zimmermann G, Moghaddam A, Wagner C, Vock B, Wentzensen A (2006) Clinical experience with bone morphogenetic protein 7 (BMP 7) in nonunions of long bones. Unfallchirurg 109:528–537

    CAS  PubMed  Google Scholar 

  122. Zipfel GJ, Guiot BH, Fessler RG (2003) Bone grafting. Neurosurg Focus 14:e8

    PubMed  Google Scholar 

  123. Ziran BH, Smith WR, Morgan SJ (2007) Use of calcium-based demineralized bone matrix/allograft for nonunions and posttraumatic reconstruction of the appendicular skeleton: preliminary results and complications. J Trauma 63:1324–1328

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK

    Ippokratis Pountos & Theodora Georgouli

  2. Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Crete, Crete, Greece

    George Kontakis

  3. Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor A LGI, Great George Street, Leeds, LS1 3EX, UK

    Peter V. Giannoudis

Authors
  1. Ippokratis Pountos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theodora Georgouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George Kontakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter V. Giannoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter V. Giannoudis.

Additional information

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pountos, I., Georgouli, T., Kontakis, G. et al. Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today. International Orthopaedics (SICOT) 34, 3–12 (2010). https://doi.org/10.1007/s00264-009-0892-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-009-0892-0

Keywords

Search

Navigation