Treatment of pseudoarthrosis of the upper limb using expanded mesenchymal stem cells: a pilot study

BACKGROUND : In orthopedic field is growing interest in the use of stem cells: this mesenchymal multipotent line (MSCs) can lead to differentiation into osteocytes and thus the formation of bone tissue. In literature appli - cations of this line are described in injuries of tendons and ligaments, small bony avulsions, nonunion fractures and cartilage defects. AIM: Utilize MSCs expanded in laboratory in case of atrophic pseudoarthrosis of the upper limb. MATERIALS AND METHODS: We obtain the amount of cell necessary for the implant by the col - laboration with the UO Haematological Department. For the procedure we make a blood sample from the iliac crest bone marrow and a subse - quent phase of selection and cultivation of mes - enchymal line for 3 weeks, to get a sufficient amount of tissue to be used, which is presented at the time of surgery on a scaffold made by au - tologous plasma gel and CaCl 2. We reassessed our experience in 8 different types of upper limb fractures result in pseudarthro - sis and delayed of consolidation: 4 women and 4 men, average 44 years old followed with a follow- up of 50.3 months. In all cases the site of non-union has been revi - talized (by microfractures and drilling) and a syn - thesis was performed with a rigid plate. So we fill the bone gap with autologous bone and mes - enchymal stem cells expanded in the laboratory. RESULTS: We have a radiographic healing in 8 cases and no adverse events were highlighted. CONCLUSIONS: Using this cells line we ob - tained encouraging but certainly not conclusive impressions, according to the limited number of cases and lack of adequate comparative studies. In tissue engineering are also certainly needed further investigations and developments .