Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow ‐derived mesenchymal stromal cells

AbstractThe study reports the prospective outcome of treating severe recalcitrant fracture nonunion in patients with autologous bone marrow ‐derived mesenchymal stromal cells (BMSC) from 2003‐2010 and analyse predictors of union. Autologous BMSC were culture expanded and inserted at nonunion site with or without carriers in addition to surgical stabilisation of the fracture. Radiological union was ascertained by musculoskeletal radi ologists on plain radiographs and/or CT scans. A logistic regression analysis was performed with cell‐expansion parameters (cell numbers, cell doubling time) and known clinical factors (e.g. smoking and diabetes) as independent variables and fracture union as the dependent variable to identify the factors that influence bony healing. An Eq5D index score assessed the effect of treatment on general quality of health. A total of 35 patients (mean age 51 +/ − 13 years) with established nonunion (median 2.9 years,1‐33) and, at least one failed nonunion surgery (median 4,1‐14) received t reatment. Fracture union was achieved in 21 patients (60%; 95% CI 44‐75) at 2.6 years. Multiple penalized logistic regression revealed faster cell doubling time (p = 0.07), absence of diabetes (p = 0.003), less previous surgeries (p = 0.008) and lower age at cell implantation (p =  0.02) were significant predictors for fracture union. A significant increase in Eq5D index (p = 0.01) was noted with a mean rise of the score by 0.34 uni...
Source: Journal of Orthopaedic Research - Category: Orthopaedics Authors: Tags: Special Issue Research Article Source Type: research