Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report

Dilogo, Ismail Hadisoebroto; Primaputra, Muhammad Rizqi Adhi; Pawitan, Jeanne Adiwinata; Liem, Isabella Kurnia

doi:10.1016/j.ijscr.2017.03.002

Cited by 35 publications

(27 citation statements)

References 19 publications

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“…Stem cells from other sources might also be of value. For example, a case report on human CSD reconstruction with the Masquelet technique combined umbilical-cord-derived MSCs, BMP2, and hydroxyapatite (Dilogo, Primaputra, Pawitan, & Liem, 2017). Successful bone healing was observed with the formation of new bone in 12-cm defects (Dilogo et al, 2017).…”

Section: Mesenchymal Stem Cellsmentioning

confidence: 99%

The Masquelet technique: Current concepts, animal models, and perspectives

Klein

Monet

Barbier

et al. 2020

J Tissue Eng Regen Med

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Bone reconstruction within a critical‐sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two‐step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo‐formation of a tissue called “induced membrane.” This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain‐Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction.

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Section: Mesenchymal Stem Cellsmentioning

confidence: 99%

The Masquelet technique: Current concepts, animal models, and perspectives

Klein

Monet

Barbier

et al. 2020

J Tissue Eng Regen Med

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“…Previously, we administered allogeneic UC-MSCs for infected non-union femoral shaft fracture with a 12 cm bone defect. 15 There was a reduction of VAS, from a median of 1 (0-6) to 0 (0-4), and increase in mean LEFS/DASH of 56.25 ± 10.71 to 65 ± 22.72 in one year of follow-up. In an animal model, Qu et al found that the administration of UC-MSCs resulted in disappearance of fracture line at eight weeks.…”

Section: Discussionmentioning

confidence: 82%

“…These factors enhance migration and recruitment of osteoprogenitor cells (osteoblasts) to the implantation site and assists in upregulation of cell proliferation and differentiation. 15,35 Besides, these factors also aid in angiogenesis, in order to fulfill oxygen and nutritional requirements during fracture healing. 35 In comparison from other types of stem cells, MSC poses a shallow risk when implanted.…”

Section: Discussionmentioning

confidence: 99%

“…10−13 Stem cells derived from umbilical cord and adipose tissue have attracted researchers as the accretion is not as invasive; therefore, may avert donors from the previously mentioned drawbacks. 14,15 Adipose-derived stem cells (ADSCs) and umbilical cord mesenchymal stem cells (UC-MSCs) were shown to aid in osteogenesis and fracture healing as demonstrated in the previous studies. 14−17 This study is aimed to investigate the efficacy of allogeneic MSC implantation, regardless of the origin, in treating non-union of the long bones.…”

Section: Introductionmentioning

confidence: 86%

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Incomplete Eradication of Persistent Infection May Impede Union: Our Experience in Treating Fracture Non-Unions with Allogenic MSC

Dilogo¹,

Hanitya

Pawitan³

et al. 2020

Preprint

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Introduction : Non-union remains a major clinical challenge for orthopaedic surgeons, as the treatments are associated with risks for complications, and sometimes multiple surgeries are required. Mesenchymal stem cells (MSCs) have been found to aid in osteogenesis and fracture healing; however, the number of studies on MSC application for treating non-unions is still sparse. We present a translational study of 8 subjects treated with MSC implantation, along with those considered as standard treatments in treating non-unions. To our knowledge, this is the most extensive clinical study on the use of MSCs to treat fracture non-unions. Methods: We performed 20x10 6 units of MSC implantations derived from adipose tissue, bone marrow, and umbilical cord on subjects diagnosed with fracture non-union of the long bone, along with internal fixation and hydroxyapatite-calcium sulphate (HA-CaSO 4 ) pellets. We excluded pathological fractures, subjects with immunological deficiencies (type II diabetes mellitus, and HIV/AIDS), and subjects with a history of immunosuppressive therapies. All subjects were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) or Lower Extremities Functional Scale (LEFS), and visual analog score (VAS). Serial radiological images were also assessed using Tiedeman and Lane-Sandhu scoring to determine union. Follow up assessments were performed every three months for at least 12 months or until clinical and radiological union was achieved. Results: Four (50%) out of eight subjects developed union in a median of five (3-12) months. There was a reduction of VAS, from a median of 1 (0-6) to 0 (0-4), and an increase in mean LEFS/DASH of 56.25 ± 10.71 to 65 ± 22.72. However, the infection was identified in 3 (37.5%) subjects. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in two (25%) subjects, while one was infected with Escherichia coli . No other adverse events occurred during the follow-up period. Conclusion: Allogenic MSC implantation can be used as a potential and safe therapy for fracture non-union. However, the presence of infection may interfere with bone healing; thus, thorough eradication of infection must be ensured to achieve fracture union. Further clinical studies are required to investigate the safety and efficacy of allogeneic MSC implantation.

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“…2 In Cipto Mangunkusumo Hospital (RSCM), other studies, which are using stem cells are ongoing, such as studies on osteoarthritis, spinal cord injury, 3 rd degree burn wound, and near blind glaucoma. For the future, stem cell therapy studies for other various conditions, which have been proven in animals, are being established; therefore, stem cell therapy and stem cell related products might become an option for ESRD in the future.…”

mentioning

confidence: 99%