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Title: Tratamento de pseudoartrose diafisária de fêmur com infiltração de concentrado autólogo de células mononucleares de medula óssea
Other Titles: The effect of autologous concentrated bone marrow grafting on the healing of femoral shaft nonunions
Keywords: Concentrado de células mononucleares;  Fratura diafisária femoral;  Haste intramedular;  Consolidação de fraturas;  Pseudartrose;  Concentrate mononuclear cells;  Femoral shaft fracture;  Intramedullary nailing;  Fracture healing;  Pseudoarthrosis;  MEDICINA;  CIÊNCIAS MÉDICAS;  Pseudo-artrose;  Fratura do fêmur;  Células sanguíneas
Issue Date: 11-Nov-2013
Abstract: Diaphyseal fractures of the femur are common in young adults secondary to high-energy trauma and as the result of traffic accidents and urban violence. The treatment of this type of fracture is the fixation with locked intramedullary nail (IM nail) to maintain the length, alignment and rotation of the femur. Despite the advances provided by the use of IM nail pseudoarthrosis indices remain around 13.6%. Considering the current knowledge of the biological mechanisms involved in bone healing, percutaneous injection of autologous bone marrow has been considered as an option to promote a supplementary osteogenic stimulus in the site of pseudoarthrosis. Thus, this study evaluated the bone healing after treatment with local infiltration of concentrated autologous bone marrow mononuclear cells (BMMNCs) in 16 patients with pseudoarthrosis of the femoral shaft treated with IM nail. The procedure was considered safe and induced new bone formation in all patients, though the magnitude of the response was not uniform. Clinical and radiological union was observed between three and eight months after treatment in eight patients who received a cell concentrate enriched with a large number of BMMNCs. The progress of bone healing for a period of up to eight months after cell infiltration may suggest that BMMNCs are able to restore the biology of the local microenvironment and the bone turnover in the pseudoarthrosis site. Another outcome of this study was the observation that the genetic predisposition to nonunion, characterized by polymorphisms of BMP4, FGFR1 and FAM5C genes, did not influence the response to the treatment with BMMNCs. Further studies on a larger scale clinical trial, to further investigate this type of treatment might confirm our hypothesis that the local biology is of crucial importance in the healing process of pseudoarthrosis
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