Ilizarov method in combination with autologous mesenchymal stem cells from iliac crest shows improved outcome in tibial non-union

Abstract

Autologous bone grafting and ilizarov technique are the preferred mode of treatment for bone nonunion, studies suggest that bone marrow derived mesenchymal stem cells can be effective in treatment of tibial non-union where there is length of bone defect. The current study investigates the beneficial clinical outcome of combining the ilizarov procedure with intraosseous injection of autologous mesenchymal stem cells. The open-label study enrolled 25 patients with infected tibial non-union at the Shanghai Fengxian District Central Hospital, Shanghai, China between April 2010 and July 2014. Patients were randomised to undergo the ilizarov procedure with ( = 11) or without ( = 13) intraosseous injection of bone marrow derived mesenchymal stem cells. All participants were followed prospectively until union was achieved (primary end point). The mean length of the bone defect in the Ilizarov group and Ilizarov group plus MSC group was 6.09 and 5.84 cm respectively. The mean time from the original injury to the time of the treatment for tibial non-union was 5-22 months (mean 13.5 months) for the Ilizarov group and 6-21 months (mean 13.5 months) for Ilizarov plus MSc group. All 24 patients were followed up for 12-34 months (mean 16 months). Both groups achieved the primary endpoint of stable union of the tibial fracture. No adverse events were observed in any of the group. Our study demonstrates that using autologous bone marrow derived mesenchymal stem cell as an add-on therapy to the ilizarov procedure shows significant clinical benefit in fixation of tibial non-union.

J-bone graft with double locking plate: a symphony of mechanics and biology for atrophic distal femoral non-union with bone defect

“…The llizarov technique has the advantage of restoring the anatomical location of the non-union and increasing the stability of bone healing, leading to early weight-bearing. However, this technique is associated with a high probability of complications such as infection and the need for multiple operations [36,37]. LCPs are favored due to their minimal trauma, small periosteal damage, and high stability [38].…”

The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

“…Schoenleber reported a mean of 0.875 complications per patient [3]. The study population evaluated by Zhang developed 0.2 complications per patient [4]. The mean number of complications per patient reported by Abuomira was 1.2 [5].…”

“…Nonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice [1][2][3][4]. Despite of this, they pose a serious therapeutic challenge for orthopedic surgeons [1-3, 5-11, 17, 18, 22].…”

“…1). All of these adversely affect the course of treatment and increase the risk of treatment failure [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. In nonunions of the tibia, the Ilizarov method helps achieve bone union, eliminate possible infections, equalize limb length, and correct any deformities that may have developed over the course of treatment [1-5, 7-12, 14-18, 20-22].…”

“…Some authors claim that bone transport combined with the use of external xators carries a higher risk of complications and yields worse outcomes in comparison with other methods of tibial nonunions treatment [2,5,11]. Most of the available analyses concern infected nonunions of the tibia [1,2,[6][7][8][9][10][11][12][13][15][16][17][18][19][20][21][22], whereas few reports discuss the treatment of tibia nonunion that is uncomplicated by infection [3,4,5,14].…”