Percutaneous administration of allogeneic bone-forming cells for the treatment of delayed unions of fractures: a pilot study.

BACKGROUND: Overall, 5-10% of fractures result in delayed unions or non-unions, causing major disabilities and a huge socioeconomic burden. Since rescue surgery with autologous bone grafts can cause additional challenges, alternative treatment options have been developed to stimulate a deficient healing process. This study assessed the technical feasibility, safety and preliminary efficacy of local percutaneous implantation of allogeneic bone-forming cells in delayed unions of long bone fractures. METHODS: In this phase I/IIA open-label pilot trial, 22 adult patients with non-infected delayed unions of long bone fractures, which failed to consolidate after 3 to 7 months, received a percutaneous implantation of allogeneic bone-forming cells derived from bone marrow mesenchymal stem cells (ALLOB; Bone Therapeutics) into the fracture site (50 × 106 to 100 × 106 cells). Patients were monitored for adverse events and need for rescue surgery for 30 months. Fracture healing was monitored by Tomographic Union Score (TUS) and modified Radiographic Union Score. The health status was evaluated using the Global Disease Evaluation (GDE) score and pain at palpation using a visual analogue scale. The presence of reactive anti-human leukocyte antigen (HLA) antibodies was evaluated. RESULTS: During the 6-month follow-up, three serious treatment-emergent adverse events were reported in two patients, of which two were considered as possibly treatment-related. None of the 21 patients in the per-protocol efficacy population needed rescue surgery within 6 months, but 2/21 (9.5%) patients had rescue surgery within 30 months post-treatment. At 6 months post-treatment, an improvement of at least 2 points in TUS was reached in 76.2% of patients, the GDE score improved by a mean of 48%, and pain at palpation at the fracture site was reduced by an average of 61% compared to baseline. The proportion of blood samples containing donor-specific anti-HLA antibodies increased from 8/22 (36.4%) before treatment to 13/22 (59.1%) at 6 months post-treatment, but no treatment-mediated allogeneic immune reactions were observed. CONCLUSION: This pilot study showed that the percutaneous implantation of allogeneic bone-forming cells was technically feasible and well tolerated in patients with delayed unions of long bone fractures. Preliminary efficacy evidence is supporting the further development of this treatment. TRIAL REGISTRATION: NCT02020590 . Registered on 25 December 2013. ALLOB-DU1, A pilot Phase I/IIa, multicentre, open proof-of-concept study on the efficacy and safetyof allogeneic osteoblastic cells (ALLOB®) implantation in non-infected delayed-union fractures.

Morel-Lavallée lesion associated with atypical skin damage: a case report.

A Morel-Lavallée lesion is a post-traumatic, soft tissue lesion that is little known and for which there is no standard treatment. This report describes the case of a 51-year-old man who presented with a large Morel-Lavallée lesion on the left calf that was not diagnosed on two visits to the emergency department. Given the deteriorating condition of the skin, we performed surgical drainage of the effusion because the skin was showing signs of major damage. Complications occurred following surgery, with cellulitis in the lower limb caused by Citrobacter Koseri, a gram-negative bacillus that is rarely implicated in soft tissue infections, and wound dehiscence. The purpose of our article is to present the difficulty involved in choosing the right treatment from among the many proposed in the literature, and to inform any practitioner working in an emergency setting about the existence of this often overlooked condition.

Internal Fixation of an Intertrochanteric Fracture after Resurfacing Arthroplasty: A Case Report.

INTRODUCTION: Periprosthetic fracture is the most common cause of reoperation after resurfacing arthroplasty. The majority of fractures associated with this kind of arthroplasty are mostly subcapital fractures. Inter- and sub-trochanteric fractures after resurfacing arthroplasty are rarely reported, and there is no consensus regarding the treatment of such fractures. CASE REPORT: We present the case of a patient in whom an intertrochanteric femoral fracture distal to a hip resurfacing implant was successfully managed by internal fixation with the use of a locking compression plate (LCP), after failed conservative management. We also discuss an in-depth literature review on the topic. CONCLUSION: We believe that osteosynthesis is a better option than arthroplasty in the management of such injuries. Due to technical issues discussed in our paper, we believe LCP to be an optimal fixation device.

Spontaneous posterior shoulder dislocation as the first symptom of a Charcot arthropathy.

Neuroarthropathy or Charcot disease is a destructive joint pathology. Upper limb involvement is unusual and often due to syringomyelia. We reported a patient with spontaneous posterior right shoulder dislocation. Thereafter, she presented a quick joint destruction evoking a Charcot shoulder disease after excluding infectious and rheumatologic diseases. Explorations of this Charcot disease lead to the discovery and treatment of syringomyelia. A conservative management of her shoulder neuro-arthropathy has been proposed to the patient. Shoulder involvement in Charcot disease is unusual: only 5% of cases. 18 cases have been reported in English literature. Two theories try to explain Charcot disease: neuro-vascular and neuro-traumatic. There is no efficient treatment for Charcot shoulder disease but it can be prevented by surgical treatment of syringomyelia. Charcot shoulder is a rare and morbid disease for which conservative treatment is recommended because of disappointing results of arthroplasty and arthrodesis.