Early injection of autologous bone marrow concentrates decreases infection risk and improves healing of acute severe open tibial fractures

Therapeutic Efficacy and Safety of Osteoinductive Factors and Cellular Therapies for Long Bone Fractures and Non-Unions: A Meta-Analysis and Systematic Review

“…Based on the inclusion criteria, 528 studies were excluded after reading the full article, while 861 and 126 studies were excluded because they were review articles or were written in languages other than English, respectively (Figure 1). Finally, 18 studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] published between 1996 and 2020 met our inclusion criteria. The data from each study are summarised in Tables 1 and 2.…”

“…Overall, eighteen studies (Table 1) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] analysed the potential healing enhancement after intraoperative application of osteoinductive factors, such as BMPs, and PRP and osteogenetic factors (MSCs) in long bone fractures. Four studies [26,29,30,36] reported results from different anatomic locations [26,29] or osteoinductive factors [30] or doses of the applied factor [36].…”

“…All studies combined a broad spectrum of therapeutic techniques for fracture stabilisation such as intramedullary nailing (IMN), Ilizarov external fixation and open reduction and internal fixation (ORIF) and further osteoinductive and osteoconductive interventions such as autologous bone grafting. Furthermore, the efficacy of the applied factors in the enhancement of fracture healing was examined in close [10,24,34,37] and open fractures [21,22,27,32,34,36,37] as well as in non-union treatment [22][23][24][25][26][27][28][29][30][31]33,35,37,38].…”

“…Three studies analysed the efficacy of MSCs for sufficient osseous healing either in open tibial injuries associated with increased size of bone defects [21], in severe recalcitrant non-unions and pseudoarthrosis [24] as well as in previous infected tibial non-union fractures [25].…”

“…Despite the fact that the efficacy of osteoinductive and cellular treatment in open fractures was described in seven studies [21,22,27,32,34,36,37], only five [21,27,32,35,36] met the predefined criteria, and were included for meta-analysis. Similarly, their effectiveness in closed fractures was reported by four researchers [22,23,34,37], but only two provided sufficient data and were included for meta-analysis (Table 1).…”