A comparative study of bone union and nonunion during distraction osteogenesis

• Published in: BMC musculoskeletal disorders Vol. 23; no. 1; pp. 1 - 7
• Main Authors: Liu, Qi, Liu, Ze, Guo, Hongbin, Wang, Min, Liang, Jieyu, Zhang, Yi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 03.12.2022; BioMed Central Ltd; BMC
• Subjects: Bone growth; Bone union and nonunion; Bones; Callus; Cell number; Comparative studies; Distraction osteogenesis; Epidemiology; External fixator; Fractures; Growth; Healing index; Infections; Internal Medicine; Lengthening index; Lymphocytes; Magnesium; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methods; Musculoskeletal diseases; Nonunion; Orthopedic surgery; Orthopedics; Patient outcomes; Pixel value ratio; Rehabilitation; Rheumatology; Smoking; Sports Medicine; Transplantation; China; External fixator index; Healing index; External fixator; Pixel value ratio; Lengthening index; Bone union and nonunion; Biochemical index; Distraction osteogenesis
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-06034-w

Background The clinical characteristics of bone nonunion during distraction osteogenesis (DO) were rarely discussed. This study was employed to specify the difference between bone union and nonunion during DO. Methods The patients with bone lengthening were recruited in our study. The bone union cases indicated the ones that remove the external fixator successfully, whereas the bone nonunion represented the bridging callus did not appear even after 9 months (an absence of bridging callus for at least three out of four cortices on plain radiographs) that needs autogenous bone transplantation. The differences in the pixel value ratio (PVR) growth of regenerated callus, lengthening index (LI), healing index (HI), external fixation index (EFI) and blood biochemical indexes between bone union and nonunion were analyzed. Results A total of 8 bone nonunion and 27 bone union subjects were included in this study. The PVR growth in bone nonunion was significantly lower than that in bone union (0.19 ± 0.06 vs. 0.32 ± 0.16, P  = 0.048). Interestingly, the HI and EFI in bone nonunion was significantly higher than that in bone union (62.0 ± 31.4 vs. 37.0 ± 27.4, P  = 0.036; 75.0 ± 30.9 vs. 49.9 ± 16.1, P  = 0.006). However, no significant difference with regard to LI was identified (0.76 ± 0.52 vs. 0.77 ± 0.32, P  = 0.976). Moreover, the circulating level of urea and lymphocyte count in bone union was significantly lower than that in bone nonunion (4.31 ± 1.05 vs. 5.17 ± 1.06, P  = 0.049; 2.08 ± 0.67 vs. 2.73 ± 0.54, P  = 0.018). On the contrary, the circulating level of magnesium in bone union was significantly higher than that in bone nonunion (0.87 ± 0.07 vs. 0.80 ± 0.07, P  = 0.014). Conclusion Compared to the bone union, the PVR growth was significantly lower, whereas the HI and EFI was significantly higher in the bone nonunion. Moreover, the circulating level of urea, magnesium and lymphocyte count was also different between these two. Therefore, the PVR, HI and EFI seems to be reliable and sensitive indicators to reflect the bone nonunion during DO, which might be considered in bone lengthening. Further prospective studies are still needed to elaborate the concerned issues.