Abstract
Nonunion fractures and aseptic bone necrosis are both characterized by some impairment of the cellular part of bone repair: a reduction of the mesenchymal stem cell (MSC) number and an impairment of the osteoblastic activation. Both seem to be good candidates for cell-based therapies using stem cells, especially MSC. Many animal studies, together with a few human trials, have been published. In this chapter, a review of the human trials is discussed.
The majority of the trials used autologous bone marrow aspirate to implant MSC. Only one tested culture to expand MSC before local implantation.
In nonunion fractures, a direct injection – 15 to 150 ml – was made in four case studies. In another, the bone marrow aspirate was concentrated before injection. The results were encouraging.
In bone necrosis, only two level II studies were published. The results at 24 months were positive in terms of reduction of the necrosis and appearance of collapse. These results were confirmed at 60 months. In three case studies, treatment with concentrated bone marrow aspirates was deemed useful with good results in 76–96 %.
These results are interesting but need confirmation by controlled studies.
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Hauzeur, JP. (2013). Cell Therapy Using Adult Stem Cells in Osteonecrosis and Nonunion Fractures. In: Danquah, M., Mahato, R. (eds) Emerging Trends in Cell and Gene Therapy. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-417-3_14
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DOI: https://doi.org/10.1007/978-1-62703-417-3_14
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