Monotherapy vs. polytherapy in the treatment of forearm non-unions and bone defects.
OBJECTIVE
To determinate the efficacy of "polytherapy", a surgical technique that utilize all the components of the diamond concept (mesenchymal stem cells, bone morphogenetic proteins and scaffold) versus a "monotherapy", a surgical technique that utilize only one component of the diamond conceptin the treatment of severe forearm non-unions.


METHODS
We studied a database of 52 patients with 52 forearm non-unions; we classified the patients with the NUSS SCORE and we divided the patients in two group according to the treatment received. So we distinguished a group of patients treated according to the principles of "monotherapy" (33 patients) and a group of patients treated according to the principles of "polytherapy" (19 patients). The minimum follow up was 12 months.


RESULTS
In the monotherapy group 21/33 non-unions (63.64%) went on to develop a radiographic and clinical healing within a period of 12 months, the calculated DASH SCORE showed a mean value of 55.15 points. In the polytherapy group 17/19 (89.47%) nonunions went on to develop clinical and radiographic healing within 12 months, and the average DASH score showed a mean value of 45.47 points.


CONCLUSIONS
The polytherapy technique with the use of recombinant morphogenetic proteins, autologous MSCs and scaffold in the same surgical time appears to be an effective treatment for patients with severe forearm non-unions.
Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Milan, Italy. gmc@studiocalori.it
G M
GM
Calori
M
M
Colombo
E
E
Mazza
C
C
Ripamonti
S
S
Mazzola
N
N
Marelli
G V
GV
Mineo
D000293:Adolescent; D000328:Adult; D000368:Aged; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005543:Forearm Injuries / Q000503:physiopathology / Q000628:therapy*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D054457:Tissue Scaffolds; D014458:Ulna Fractures / Q000503:physiopathology / Q000628:therapy*
D019485:Bone Morphogenetic Proteins