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Bone fractures heal most of the time particularly well and without complications. The solidification takes rarely more than two to three months. The wound healing depends greatly on a good blood supply and needs several steps. These processes culminate in a new mass of heterogeneous tissue which is known as the fracture callus. Unfortunately, 2%-5% bone fractures cannot achieve a proper solidification and between the ununited fragments a scar tissue appears. This incorrect healing induces pain and even infections. When this situation persists more than 6 months, it is referred to as nonunion fracture, which will require some form of intervention to stimulate the natural healing process of the body. First of all, good surgical techniques with stable immobilization should be applied and local infection should be excluded. Then stimulation of the callus is required. Cell therapy with bone marrow cells has emerged as a promising new approach for bone regeneration. Animal studies as well as preliminary human studies have shown that Mesenchymal Stem Cells, a particular kind of stem cells isolated from the bone marrow, could induce callus formation when injected in the nonunion site of a broken bone.
In this study the investigators aim at determining whether Mesenchymal Stem Cells (MSC) isolated from the patient's bone marrow and injected in the nonunion site could be a safe and effective treatment for nonunion fractures. Patients will be randomized in two groups; one injected with Mesenchymal Stem Cell and the other injected with placebo. The investigators seek also to know how long it takes to develop the callus formation and whether there is a partial or a complete callus formation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mesenchymal Stem Cells | Experimental | 2 ml with 40 X 10E6 Mesenchymal Stem Cells (MSC) will be injected in the nonunion space of the bone fracture. MSC will be injected even if the number of available cells is lower than 40 X 10E6. The injection of MSC in the nonunion space will be performed percutaneously using a 3-mm trephine needle under fluoroscopic control and loco-regional or general anesthesia, as deemed appropriate by the anesthetist. |
|
| Culture medium without MSC. | Placebo Comparator | Culture medium used to resuspend the Mesenchymal Stem Cells. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mesenchymal Stem Cells | Biological | Mesenchymal Stem Cells. Dose= 40 X 10E6 in 2 ml. Frequency = one injection. If no evidence of a callus after 6 months a second injection can be proposed. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety of Mesenchymal Stem Cells injection in nonunion fractures. | Follow-up for revealing any significant immediate or late adverse effects. | 12 months |
| Proportion of patients receiving Mesenchymal Stem Cells that develop a partial or complete callus at 6 and 12 months, compared to patients receiving placebo. | Radiological evaluation of the callus by standard X-rays and computed tomography (CT). | 6 and 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients receiving Mensechymal Stem Cells that develop a partial or complete callus at 2, 3, 4, 8 and 10 months, compared to patients receiving placebo | Radiological evaluation of the callus by standard X-rays and computed tomography (CT). | 2, 3, 4, 8 and 10 months |
| Timing of development of a partial or complete callus in the 2 groups. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jean Philippe Hauzeur, MD, PhD | University of Liege | Principal Investigator |
| Yves Beguin, Prof, MD, PhD | University of Liege | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Liège University Hospital | Liège | 4000 | Belgium |
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| ID | Term |
|---|---|
| D005599 | Fractures, Ununited |
| D002145 | Callosities |
| ID | Term |
|---|---|
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D007642 | Keratosis |
| D012871 | Skin Diseases |
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| ID | Term |
|---|---|
| D003470 | Culture Media |
| ID | Term |
|---|---|
| D019995 | Laboratory Chemicals |
| D020313 | Specialty Uses of Chemicals |
| D020164 | Chemical Actions and Uses |
| D004864 | Equipment and Supplies |
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|
| Culture medium without MSC. | Other | 2 ml of culture medium. |
|
Time necessary for a partial or a complete callus formation. Radiological evaluation of the callus by standard X-rays and computed tomography (CT). |
| 12 months for one injection or 18 months when a second injection is needed |
| Patient evaluation of pain and global satisfaction. | This evaluation will be measured through a 100-mm Visual Analogue Scale at 2, 3, 4, 6, 8, 10 and 12 months in the 2 groups. | 12 months |
| Proportion of patients achieving different degrees of functional success. | The functional assessment will be evaluated in Mesenchymal Stem Cells treated and untreated patients by an orthopaedic surgeon and will include a 4-points scale:
| 2, 3, 4, 6, 8, 10 and 12 months |
| Incidence of adverse events and severe adverse events in the 2 groups. | Adverse events and serious adverse events will be continuously monitored . | 12 months for one injection and 18 months when a second injection is performed |
| Evaluation of early homing of Mesenchymal Stem Cells. | Indium radiolabeled Mesenchymal Stem Cells (MSC) will be visualized with a Siemens e-CAM dual head gamma camera: 10% of the total amount of MSC will be incubated with 200 µCi In-111-oxine. The radiolabelled cells will be mixed with the unlabelled ones. Twenty-four hours after injecting the cells into the target bone lesion, static images centered over the injection site and whole-body images will be acquired during 20 minutes. This will be performed with a Siemens e-CAM dual head gamma camera. | 24 hours |
| Value of [18F]-NaF PET scans for early prediction of the onset of the bone healing process. | PET Fluor kinetics could identify early and perhaps quantify the increase of bone forming in the treated area. Four [18F]-NaF PET scan studies will be performed: at baseline, as well as around days 7-9 (1 week), 27-33 (one month) and 83-97 (three months). | 3 months |
| D017437 |
| Skin and Connective Tissue Diseases |