Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
International Orthopaedics
Erschienen in: International Orthopaedics 8/2015

01.08.2015 | Original Paper

Percutaneous injection of bone marrow mesenchymal stem cells for ankle non-unions decreases complications in patients with diabetes

verfasst von: Philippe Hernigou, Isaac Guissou, Yasuhiro Homma, Alexandre Poignard, Nathalie Chevallier, Helene Rouard, Charles Henri Flouzat Lachaniette

Erschienen in: International Orthopaedics | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Clinical studies in diabetic patients have demonstrated that there is a high incidence of complications in distal tibia and ankle fracture treatments. One strategy to mitigate issues with wound healing and infection in diabetic patients is to use a percutaneous technique in which autologous, bone marrow-derived, concentrated cells are injected at the site of non-unions.

Methods

Eighty-six ankle non-union in diabetic patients were treated with bone marrow mesenchymal stem cells (BM-MSCs) delivered in an autologous bone marrow concentrate (BMC). Clinical outcomes of the 86 diabetic non-union patients treated with BMC were compared with 86 diabetic matched non-unions treated with a standard bone iliac crest autograft.

Results

Treatment with BMC promoted non-union healing in 70 among 86 diabetic patients (82.1 %) with a low number of complications. Of the 86 diabetic patients treated with iliac bone graft, 53 (62.3 %) had healing; major complications were observed: 5 amputations, 11 osteonecroses of the fracture wound edge and 17 infections.

Conclusions

In diabetic patients with ankle non-unions, treatment with BM-MSCs from bone marrow concentrate may be preferable in view of the high risks of major complications after open surgery and iliac bone grafting, and improved healing rates compared with standard iliac bone autograft treatment.
Literatur
1.
Hernigou P, Poignard A, Beaujean F, Rouard H (2005) Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am 87:1430–1437PubMedCrossRef
2.
3.
Lechner A, Habener JF (2003) Stem/progenitor cells derived from adult tissues: potential for the treatment of diabetes mellitus. Am J Physiol Endocrinol Metab 284:E259–E266PubMedCrossRef
4.
Volarevic V, Arsenijevic N, Lukic M, Stojkovic ML (2011) Concise review: mesenchymal stem cell treatment of the complications of diabetes mellitus. Stem Cells 29:5–10PubMedCentralPubMedCrossRef
5.
Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79PubMedCrossRef
6.
Boddenberg U (2004) [Healing time of foot and ankle fractures in patients with diabetes mellitus: literature review and report on own cases]. Zentralbl Chir 129:453–459PubMedCrossRef
7.
Flynn JM, Rodriguez-del Rio F, Pizá PA (2000) Closed ankle fractures in the diabetic patient. Foot Ankle Int 21:311–319PubMed
8.
Ganesh SP, Pietrobon R, Cecilio WA, Pan D, Lightdale N, Nunley JA (2005) The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am 87:1712–1718PubMedCrossRef
9.
Gandhi A, Liporace F, Azad V, Mattie J, Lin SS (2006) Diabetic fracture healing. Foot Ankle Clin 11:805–824PubMedCrossRef
10.
McCormack RG, Leith JM (1998) Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Br 80:689–692PubMedCrossRef
11.
Jones KB, Maiers-Yelden KA, Marsh JL, Zimmerman MB, Estin M, Saltzman CL (2005) Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg (Br) 87:489–495CrossRef
12.
Cofield RH, Morrison MJ, Beabout JW (1983) Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle 4:15–22PubMedCrossRef
13.
Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR (1997) The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc 87:272–278PubMedCrossRef
14.
Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL (1999) Clinical examination for the detection of protective sensation in the feet of diabetic patients International Cooperative Group for Clinical Examination Research. J Gen Intern Med 14:418–424PubMedCentralPubMedCrossRef
15.
Fabrin J, Larsen K, Holstein PE (2000) Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care 23:796–800PubMedCrossRef
16.
American Diabetes Association (2003) Peripheral arterial disease in people with diabetes. Diabetes Care 26:3333–3341CrossRef
17.
Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D, American Diabetes Association (2005) Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 28:956–962PubMedCrossRef
18.
Follak N, Kloting L, Wolf E, Merk H (2004) Delayed remodeling in the early period of fracture healing in spontaneously diabetic BB/OK rats depending on the diabetic metabolic state. Histol Histopathol 19:473–486PubMed
19.
Lu H, Kraut D, Gerstenfeld LC, Graves DT (2003) Diabetes interferes with the bone formation by affecting the expression of transcription factors that regulate osteoblast differentiation. Endocrinology 144:346–352PubMedCrossRef
20.
Follak N, Klöting I, Merk H (2005) Influence of diabetic metabolic state on fracture healing in spontaneously diabetic rats. Diabetes Metab Res Rev 21:288–296PubMedCrossRef
21.
Kayal RA, Tsatsas D, Bauer MA, Allen B, Al-Sebaei MO, Kakar S, Leone CW, Morgan EF, Gerstenfeld LC, Einhorn TA, Graves DT (2007) Diminished bone formation during diabetic fracture healing is related to the premature resorption of cartilage associated with increased osteoclast activity. J Bone Miner Res 22:560–568PubMedCentralPubMedCrossRef
22.
Johnson JE (1998) Operative treatment of neuropathic arthropathy of the foot and ankle. J Bone Joint Surg Am 80:1700–1709
23.
Jones KB, Maiers-Yelden KA, Marsh JL, Zimmerman MB, Estin M, Saltzman CL (2005) Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg (Br) 87:489–495CrossRef
24.
Ganesh SP, Pietrobon R, Cecilio WA, Pan D, Lightdale N, Nunley JA (2005) The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am 87:1712–1718PubMedCrossRef
25.
Gandhi A, Liporace F, Azad V, Mattie J, Lin SS (2006) Diabetic fracture healing. Foot Ankle Clin 11:805–824PubMedCrossRef
26.
Costigan W, Thordarson DB, Debnath UK (2007) Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int 28:32–37PubMedCrossRef
27.
Mueller SM, Glowacki J (2001) Age-related decline in the osteogenic potential of human bone marrow cells cultured in three-dimensional collagen sponges. J Cell Biochem 82:583–590PubMedCrossRef
28.
Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19:117–125PubMedCrossRef
29.
Bartsch T, Brehm M, Zeus T, Kogler G, Wernet P, Strauer BE (2007) Transplantation of autologous mononuclear bone marrow stem cells in patients with peripheral arterial disease (the TAM-PAD study). Clin Res Cardiol 96(12):891–899PubMedCrossRef
30.
Chochola M, Pytlik R, Kobylka P, Skalicka L, Kideryova L, Beran S, Varejka P, Jirat S, Koivanek J, Aschermann M et al (2008) Autologous intra-arterial infusion of bone marrow mononuclear cells in patients with critical leg ischemia. Int Angiol 27(4):281–290PubMed
31.
De Vriese AS, Billiet J, Van Droogenbroeck J, Ghekiere J, De Letter JA (2008) Autologous transplantation of bone marrow mononuclear cells for limb ischemia in a caucasian population with atherosclerosis obliterans. J Intern Med 263(4):395–403PubMedCrossRef
32.
Blotter RH, Connolly E, Wasan A, Chapman MW (1999) Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int 20:687–694PubMedCrossRef
33.
Ebihara Y, Ishikawa K, Mochizuki S, Tanaka R, Manabe A, Iseki T, Maekawa T, Tsuji K (2014) Allogeneic stem cell transplantation for patients with acute myeloid leukaemia developing from severe congenital neutropenia. Br J Haematol 164(3):459–461. doi:10.​1111/​bjh.​12638 PubMedCrossRef
34.
Mei S, Haitsma J, Dos Santos C et al (2010) Mesenchymal stem cells reduce inflammation while enhancing bacterial clearance and improving survival in sepsis. Am J Respir Crit Care Med 182:1047–1057PubMedCrossRef
35.
36.
Holmes GB Jr, Hill N (1994) Fractures and dislocations of the foot and ankle in diabetics associated with Charcot joint changes. Foot Ankle Int 15:182–185PubMedCrossRef
37.
Jani MM, Ricci WM, Borrelli J Jr, Barrett SE, Johnson JE (2003) A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int 24:838–844PubMed
38.
Loder RT (1988) The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 232:210–216PubMed
39.
Perry MD, Taranow WS, Manoli A 2nd, Carr JB (2005) Salvage of failed neuropathic ankle fractures: use of large-fragment fibular plating and multiple syndesmotic screws. J Surg Orthop Adv 14:85–91PubMed
40.
Pinzur MS, Noonan T (2005) Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int 26:545–549PubMed
41.
Schon LC, Marks RM (1995) The management of neuroarthropathic fracture dislocations in the diabetic patient. Orthop Clin N Am 26:375–392
42.
Schon LC, Easley ME, Weinfeld SB (1998) Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res 349:116–131PubMedCrossRef
43.
44.
Le Nail LR, Stanovici J, Fournier J, Splingard M, Domenech J, Rosset P (2014) Percutaneous grafting with bone marrow autologous concentrate for open tibia fractures: analysis of forty three cases and literature review. Int Orthop 10.1007/s00264-014-2342-x(9):1845–1853CrossRef
45.
46.
47.
Metadaten
Titel
Percutaneous injection of bone marrow mesenchymal stem cells for ankle non-unions decreases complications in patients with diabetes
verfasst von
Philippe Hernigou
Isaac Guissou
Yasuhiro Homma
Alexandre Poignard
Nathalie Chevallier
Helene Rouard
Charles Henri Flouzat Lachaniette
Publikationsdatum
01.08.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 8/2015
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2738-2

Weitere Artikel der Ausgabe 8/2015

International Orthopaedics 8/2015 Zur Ausgabe

Original Paper

Impact and alternative metrics for medical publishing: our experience with International Orthopaedics

Original Paper

Cementless femoral revision in patients with a previous cemented prosthesis

Review Article

Alterations of tendons in diabetes mellitus: what are the current findings?

ORTHOPAEDIC HERITAGE

Prof. Ioan Jianu: founding member of SICOT

Original Paper

Pre-operative education prior to elective hip arthroplasty surgery improves postoperative outcome

Original Paper

Quantification of tibial bone loss in antegrade versus retrograde tunnel placement for anterior cruciate ligament reconstruction

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise