Treatment of pseudoarthrosis of the upper limb using expanded mesenchymal stem cells: a pilot study

S. Giannotti, V. Bottai, M. Ghilardi, G. Dell’osso, R. Fazzi, L. Trombi, M. Petrini, G. Guido

Department of Orthopedic and Traumatology, University of Pisa, Italy. s.giannotti@med.unipi.it

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• Orthopedics

BACKGROUND: In orthopedic field is growing interest in the use of stem cells: this mesenchymal multipotent line (MSCs) can lead to differentiation into osteocytes and thus the formation of bone tissue. In literature applications of this line are described in injuries of tendons and ligaments, small bony avulsions, nonunion fractures and cartilage defects.

AIM: Utilize MSCs expanded in laboratory in case of atrophic pseudoarthrosis of the upper limb.

MATERIALS AND METHODS: We obtain the amount of cell necessary for the implant by the collaboration with the UO Haematological Department.
For the procedure we make a blood sample from the iliac crest bone marrow and a subsequent phase of selection and cultivation of mesenchymal line for 3 weeks, to get a sufficient amount of tissue to be used, which is presented at the time of surgery on a scaffold made by autologous plasma gel and CaCl2.
We reassessed our experience in 8 different types of upper limb fractures result in pseudarthrosis and delayed of consolidation: 4 women and 4 men, average 44 years old followed with a follow-up of 50.3 months.
In all cases the site of non-union has been revitalized (by microfractures and drilling) and a synthesis was performed with a rigid plate. So we fill the bone gap with autologous bone and mesenchymal stem cells expanded in the laboratory.

RESULTS: We have a radiographic healing in 8 cases and no adverse events were highlighted.

CONCLUSIONS: Using this cells line we obtained encouraging but certainly not conclusive impressions, according to the limited number of cases and lack of adequate comparative studies. In tissue engineering are also certainly needed further investigations and developments.

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