title: Relevance of deep decortication and vascularization in a case of post-traumatic femoral non-union treated with grafts, platelet gel and bone marrow stromal cells.
abstract: OBJECTIVE
  A male patient suffering from non-union of the femoral diaphysis after a traumatic fracture was treated with deep decortication and grafted with lyophilized bone, platelet gel (PG) and autologous bone marrow stromal cells (BMSCs). After 40 days from surgery, he was re-operated, due to fracture secondary displacement, caused by inappropriate load during sports activity. In addition to radiographs, two bone biopsies were retrieved: this allowed for a histological evaluation of the early response of host bone to the graft. To our knowledge, there is no report describing such early tissue response.
  
  
  METHODS
  A clinical-radiographic evaluation of the patient and a histomorphometric analysis of the bone biopsies were performed.
  
  
  RESULTS
  An early reparative bone formation was observed adjacent to the osteointegrated graft. Non-resorbed bone chips and large islands of non-vital bone particles, surrounded by fibrous tissue, were observed in a zone of sclerotic diaphyseal bone, that is the process was delayed despite decortication.
  
  
  CONCLUSIONS
  These findings support the concept, until now evidenced only by imaging, that bone chips added with PG and BMSCs are effective in shortening the healing time in fracture non-union. The clinical relevance of deep decortication and vascularization is emphasized.
  
  
  METHODS
  Therapeutic studies-investigating the results of treatment, Level V.
authors: Orthopaedic and Traumathological Department I, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
authors: Dante
authors: D
authors: Dallari
authors: Lucia
authors: L
authors: Savarino
authors: Michelina
authors: M
authors: Greco
authors: Nicola
authors: N
authors: Rani
authors: Nicolandrea
authors: N
authors: Del Piccolo
authors: Nicola
authors: N
authors: Baldini
mesh_terms: D000328:Adult; D001792:Blood Platelets; D016025:Bone Transplantation; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D005782:Gels; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells
chemical_list: D005782:Gels