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International Orthopaedics
Published in: International Orthopaedics 7/2016

01-07-2016 | Original Paper

Osteogenic progenitors in bone marrow aspirates have clinical potential for tibial non-unions healing in diabetic patients

Authors: Charles Henri Flouzat-Lachaniette, Clemence Heyberger, Charlie Bouthors, François Roubineau, Nathalie Chevallier, Helene Rouard, Philippe Hernigou

Published in: International Orthopaedics | Issue 7/2016

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Abstract

Purpose

There is a significantly higher incidence of delayed unions, non-unions, and increased healing time in diabetic patients compared with non-diabetic patients. Studies suggest that diabetics suffer from deficiencies of pancreatic stem/progenitor cells, and a clinically relevant question arises concerning the availability and functionality of progenitor cells obtained from bone marrow of diabetics for applications in bone repair.

Methods

We have evaluated the cellularity and frequency of osteogenic mesenchymal stem cells (MSCs) in bone marrow from 54 diabetic patients (12 with type 1 and 42 with type 2) with tibial non-unions. These patients were treated with bone marrow MSCs (BM-MSCs) delivered in an autologous bone marrow concentrate (BMC). Clinical outcomes and marrow cellularity were compared to 54 non-diabetic, matched patients with tibial non-unions also treated with BMC.

Results

After adjusting for age and sex, no differences were identified with respect to bone marrow cellularity and MSC number among the diabetic and non-diabetic groups and both groups received approximately the same number of MSCs on average. BMC treatment promoted non-union healing in 41 diabetic patients (76 %) and 49 non-diabetic patients (91 %), but the non-diabetic patients healed more quickly and produced a larger volume of callus.

Conclusion

We recommend that diabetic patients be treated with an increased number of progenitor cells by increasing the bone marrow aspiration volume. We also anticipate a need to extend the time of casting and non-weight bearing for diabetic patients as compared with non-diabetic patients.
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Metadata
Title
Osteogenic progenitors in bone marrow aspirates have clinical potential for tibial non-unions healing in diabetic patients
Authors
Charles Henri Flouzat-Lachaniette
Clemence Heyberger
Charlie Bouthors
François Roubineau
Nathalie Chevallier
Helene Rouard
Philippe Hernigou
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 7/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-3046-6

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