{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:22:22Z","timestamp":1785198142841,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Internal project of the Institute of Medical Sciences of the University of Opole","award":["P-2024-001"],"award-info":[{"award-number":["P-2024-001"]}]},{"name":"Internal project of the Institute of Medical Sciences of the University of Opole","award":["P-2025-003"],"award-info":[{"award-number":["P-2025-003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patients with nonunion experience pain, mobility problems, and physical activity limitations; require long-term, costly treatment; and cannot resume work. Some authors recommend the use of pharmaceutical agents as an adjunct therapy in fracture and nonunion treatment. The aim of this study was to assess the effects of ossein\u2013hydroxyapatite complex used as an adjunct therapy in nonunion treatment with the Ilizarov external fixator. Methods: In this retrospective study, we assessed 31 patients (nine women, 22 men) at a mean age of 47 years (29\u201368 years), who were receiving osteogenon, with aseptic tibial shaft nonunion treated with the Ilizarov external fixator in the period 2019\u20132023, designated as Group 1. The control group comprised 29 patients (five women, 24 men), at a mean age of 48 years, with aseptic tibial shaft nonunion treated with the Ilizarov external fixator, who did not receive osteogenon during treatment, designated as Group 2. We assessed the following parameters\u2014duration of Ilizarov fixation, achieved bone union, time to resuming normal physical activity, maintained bone union, time to complete pain relief, the number of patients reporting complete pain relief, the number of patients who were fitted with a cast or splint following Ilizarov fixator removal, and the rate of complications. Results: The median time to Ilizarov fixator removal was 275 days in Group 1 and 218 days in Group 2. In Group 1, bone union was observed in 100% of patients, in Group 2, 93% of patients achieved bone union. This difference was statistically significant, p = 0.041. Maintained bone union was observed in 85.7% of patients from the osteogenon group and in 79.3% of patients from the control group, and the difference was not statistically significant. There were no differences between groups in the median time to resuming normal physical activity, the median time to achieving pain relief, the rate of complications, and the rate of pain relief. Conclusions: The use of ossein\u2013hydroxyapatite complex has a beneficial effect on fracture nonunion treatment with the Ilizarov method. The use of osteogenon helps increase the proportion of patients with fracture nonunion who achieve bone union following treatment with the Ilizarov method. Osteogenon does not significantly affect complication rates, time to fixator removal, time to achieving pain relief, time to resuming normal physical activity, maintained bone union rates, or the proportion of patients who achieve pain relief.<\/jats:p>","DOI":"10.3390\/jcm14103353","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T09:13:38Z","timestamp":1747041218000},"page":"3353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Use of Ossein\u2013Hydroxyapatite Complex in Conjunction with the Ilizarov Method in the Treatment of Tibial Nonunion"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7587-666X","authenticated-orcid":false,"given":"Piotr","family":"Morasiewicz","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3264-011X","authenticated-orcid":false,"given":"Monika","family":"Zaborska","sequence":"additional","affiliation":[{"name":"Institute of Medical Sciences, Faculty of Medicine, University of Opole, Witosa 26, 45-401 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8758-3986","authenticated-orcid":false,"given":"Micha\u0142","family":"Sobczak","sequence":"additional","affiliation":[{"name":"Institute of Medical Sciences, Faculty of Medicine, University of Opole, Witosa 26, 45-401 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4644-0111","authenticated-orcid":false,"given":"\u0141ukasz","family":"Tomczyk","sequence":"additional","affiliation":[{"name":"Department of Food Quality and Safety Management, Faculty of Food Science and Nutrition, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Pili","sequence":"additional","affiliation":[{"name":"Orthopedic and Trauma Department, G B. Mangioni Hospital, Via L. Da Vinci 49, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystian","family":"Kazubski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Leyko","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e162775","DOI":"10.1001\/jamasurg.2016.2775","article-title":"Epidemiology of Fracture Nonunion in 18 Human Bones","volume":"151","author":"Zura","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.injury.2021.02.053","article-title":"Epidemiology of long bone non-unions in Spain","volume":"52","year":"2021","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00104-017-0547-4","article-title":"Pseudarthroses of the long bones","volume":"89","author":"Everding","year":"2018","journal-title":"Chirurgie"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.rbo.2016.11.009","article-title":"Experience in fixation of infected non-union tibia by Ilizarov technique\u2014A retrospective study of 42 cases","volume":"52","author":"Meleppuram","year":"2016","journal-title":"Rev. Bras. Ortop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00402-020-03571-8","article-title":"A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia","volume":"141","author":"Szelerski","year":"2021","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yin, P., Ji, Q., Li, T., Li, J., Li, Z., Liu, J., Wang, G., Wang, S., Zhang, L., and Mao, Z. (2015). A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0141973"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1097\/BOT.0000000000000987","article-title":"Ilizarov Treatment Protocols in the Management of Infected Nonunion of the Tibia","volume":"31","author":"McNally","year":"2017","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","first-page":"279","article-title":"Ilizarov treatment of tibial nonunions results in 16 cases","volume":"66","author":"Laursen","year":"2000","journal-title":"Acta Orthop. Belg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/1071100714558509","article-title":"Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction","volume":"36","author":"Schoenleber","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.sjbs.2016.11.001","article-title":"Ilizarov method in combination with autologous mesenchymal stem cells from iliac crest shows improved outcome in tibial non-union","volume":"25","author":"Zhang","year":"2018","journal-title":"Saudi J. Biol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e8569","DOI":"10.1097\/MD.0000000000008569","article-title":"Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Morasiewicz, P., Zaborska, M., Sobczak, M., Tomczyk, \u0141., Leyko, P., Bobi\u0144ski, A., Kocha\u0144ska-Bieri, J., Pili, D., and Kazubski, K. (2024). The use of osteogenon as an adjunctive treatment in the lower leg fractures. Pharmaceuticals, 17.","DOI":"10.3390\/ph17111531"},{"key":"ref_13","first-page":"41","article-title":"Experience with the use of osteogenon in traumatology and orthopedics","volume":"4","author":"Rodionova","year":"2001","journal-title":"Bull. Traumatol."},{"key":"ref_14","first-page":"52","article-title":"Osteogenon in therapy of distal radial bone fractures in patients with secondary osteoporosis","volume":"79","author":"Varga","year":"2007","journal-title":"Ter. Arkhiv"},{"key":"ref_15","first-page":"21","article-title":"Ossein-hydroxyapatite complex in the treatment of patients with pseudoarthrosis of the femur and shin bones, complicated by systemic osteoporosis","volume":"2","author":"Gulnazurova","year":"2006","journal-title":"Bull. Traum"},{"key":"ref_16","first-page":"36","article-title":"Efficacy of Ossein-Hydroxyapatite Complex as a Pharmacological Corrector of Bone Loss (Review)","volume":"334","author":"Yakovleva","year":"2023","journal-title":"Georgian Med. News"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/BF03256920","article-title":"Comparison of the effects of ossein-hydroxyapatite complex and calcium carbonate on bone metabolism in women with senile osteoporosis: A randomized, open-label, parallel-group, controlled, prospective study","volume":"31","author":"Manasanch","year":"2011","journal-title":"Clin. Drug Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/13697137.2019.1685488","article-title":"Efficacy and safety of ossein-hydroxyapatite complex versus calcium carbonate to prevent bone loss","volume":"23","author":"Palacios","year":"2020","journal-title":"Climacteric"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.maturitas.2015.02.265","article-title":"Comparison of the effects of calcium carbonate and ossein-hydroxyapatite complex on back and knee pain and quality of life in osteopenic perimenopausal women","volume":"81","author":"Alvarez","year":"2015","journal-title":"Maturitas"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/13697137.2014.929107","article-title":"Use of ossein-hydroxyapatite complex in the prevention of bone loss: A review","volume":"18","year":"2015","journal-title":"Climacteric"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"227","DOI":"10.2165\/00044011-200727040-00001","article-title":"Prevention of osteoporosis: Four-year follow-up of a cohort of postmenopausal women treated with an ossein-hydroxyapatite compound","volume":"27","author":"Palazuelos","year":"2007","journal-title":"Clin. Drug Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.5604\/01.3001.0014.4151","article-title":"Osteoporotic Fractures During and after Pandemic Time\u2014Always Required Treatment. Approach of the Physician, Comments of the Professor","volume":"22","author":"Malachowski","year":"2020","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102881","DOI":"10.1016\/j.otsr.2021.102881","article-title":"Infected Tibial Nonunion: Assessment of compression distraction Ilizarov technique without debridement","volume":"107","author":"Meselhy","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1007\/s00264-022-05494-y","article-title":"Masquelet-Ilizarov technique for the management of bone loss post debridement of infected tibial nonunion","volume":"46","author":"Khaled","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Park, J., Yan, G., Kwon, K.-C., Liu, M., Gonnella, P., Yang, S., and Daniell, H. (2019). Oral delivery of novel human IGF-1 bioencapsulated in lettuce cells promotes musculoskeletal cell proliferation, differentiation and diabetic fracture healing. Biomaterials, 233.","DOI":"10.1016\/j.biomaterials.2019.119591"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1038\/ki.1996.164","article-title":"Pharmacokinetics of insulin-like growth factor-1 in advanced chronic renal failure","volume":"49","author":"Rabkin","year":"1996","journal-title":"Kidney Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1210\/endo.131.4.1382964","article-title":"Determination of the pharmacokinetic profiles of insulin-like growth factor binding proteins-1 and -2 in rats","volume":"131","author":"Young","year":"1992","journal-title":"Endocrinology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4292\/wjgpt.v11.i5.79","article-title":"Oral encapsulated transforming growth factor \u03b21 reduces endogenous levels: Effect on inflammatory bowel disease","volume":"11","author":"Hammer","year":"2020","journal-title":"World J. Gastrointest. Pharmacol. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1023\/A:1018995005775","article-title":"Pharmacokinetics and tissue distribution of recombinant human transforming growth factor beta1 after topical and intravenous administration in male rats","volume":"11","author":"Zioncheck","year":"1994","journal-title":"Pharm. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Moldovan, F. (2024). Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients. Diagnostics, 14.","DOI":"10.3390\/diagnostics14111112"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:31:11Z","timestamp":1760031071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103353"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103353","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]}}}