Eine Fraktur, welche nicht innerhalb von 4 Monaten ausheilt bezeichnet man als verzögerte Knochenheilung. Kommt es innerhalb von 6 bis maximal 8 Monaten nicht zur Knochenintegrität spricht man von einer Pseudarthrose. Trotz moderner Knochenosteosynthese und Osteoinduktiven Substanzen sind Knochenheilungsstörungen immer noch eine häufige und ernste Komplikation. Um die Qualität der Behandlung von Pseudarthrosen in der Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie der Universität Göttingen zu verbessern, wurde das Outcome von 175 Patienten mit Ergebnissen der aktuellen Literatur verglichen. Die fünf häufigsten Frakturlokalisationen Tibia, Femur, Humerus, Scaphoid und Clavicula wurden dabei detailliert untersucht.

The current gold standard of therapy for treatment of tibial fracture nonunion is iliac crest bone graft. However, this intervention is associated with significant morbidity to the donor site. Research into alternative interventions highlights the role of mesenchymal stem cells (MSCs). MSCs are capable of differentiating into mature, organized osseous tissue as well as recruiting local vascular cells. However, there are few prospective studies demonstrating the therapeutic potential of MSCs in fracture nonunion. The proposed study is a multicenter single-blinded controlled study of MSC application compared to iliac crest bone graft in the setting of fracture nonunion of the tibia. The study subjects will be evaluated at each return to care with mRUST radiographic scoring as well as Short-Form 12 evaluation of general health. These results will be correlated with MSC concentrations as assessed by FACS analysis. The data from this study will help to characterize MSCs as a possible therapeutic intervention in fracture nonunion.

In the first part of these studies, we have performed standard microsurgical procedures provide a solution for long standing bone and soft tissue defects, even in cases of longstanding osteomyelitis of long bones. When long bony segments are missing, the microvascular bone transfer provides a reliable method. In smaller soft tissue and bone defects, the application of a descending genicular osteomyocutaneous flap provides an option with low donor site morbidity. In the second part, we have focussed on reducing the donor site morbidity and expanded on the application of tissue engineering methods. MSCs derived from bone marrow can be injected percutaneous or be combined with an autologous bony scaffold for treatment of delayed union and nonunion. The outcome of our studies, however, limited in number of patients, clearly showed the possibilities and advantages of this new approach. A multimodality approach is essential, but it can provide promising solutions. Well-established microvascular and modern biotechnology methods will improve patient satisfaction and functional recovery in severe limb trauma, often the result of high-energy motorcycle accidents. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

With pressures on time and resources available to those undertaking research in paleopathology, poorly preserved archaeological human remains can often receive limited attention or be completely excluded from the analysis of archaeological sites. Although incomplete skeletons often yield minimal demographic information and can complicate the diagnosis of some pathological conditions, this is not universal. Significant information can be obtained even in partial remains on metabolic bone diseases (where, by definition, the whole skeleton is involved), and for conditions such as osteoarthritis and fractures which can be diagnosed in isolation. We present an example of an incomplete skeleton that provided valuable new information on pathological changes associated with osteomalacia, a condition that has been little studied to date in paleopathology. This skeleton also contributes to our understanding of the factors surrounding the classification of fractures, and provides new insight into the full range of circumstances in which eburnation can develop. This example demonstrates the value of including partial and poorly preserved skeletons in paleopathological analysis and the extent of information that can be obtained.