title: Autologous bone grafting on steroids: preliminary clinical results. A novel treatment for nonunions and segmental bone defects.
abstract: Clinical management of delayed healing or nonunion of long bone fractures and segmental bone defects poses a substantial orthopaedic challenge. Surgical advances and bone tissue engineering are providing new avenues to stimulate bone growth in cases of bone loss and nonunion. The reamer-irrigator-aspirator (RIA) device allows surgeons to aspirate the medullary contents of long bones and use the progenitor-rich "flow-through" fraction in autologous bone grafting. Dexamethasone (DEX) is a synthetic steroid that has been shown to induce osteoblastic differentiation. A series of 13 patients treated with RIA bone grafting enhanced with DEX for nonunion or segmental defect was examined retrospectively to assess the quality of bony union and clinical outcomes. Despite the initial poor prognoses, promising results were achieved using this technique; and given the complexity of these cases the observed success is of great value and warrants controlled study into both standardisation of the procedure and concentration of the grafting material.
authors.affiliation: Department of Orthopaedic Trauma, Massachusetts General Hospital, Boston, MA, USA. mmiller17@partners.org
authors.forename: Micah A
authors.initials: MA
authors.lastname: Miller
authors.forename: Alan
authors.initials: A
authors.lastname: Ivkovic
authors.forename: Ryan
authors.initials: R
authors.lastname: Porter
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Estok
authors.forename: R Malcolm
authors.initials: RM
authors.lastname: Smith
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Evans
authors.forename: Mark S
authors.initials: MS
authors.lastname: Vrahas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone