title: Percutaneous injection of bone marrow mesenchymal stem cells for ankle non-unions decreases complications in patients with diabetes.
abstract: OBJECTIVE
  Clinical studies in diabetic patients have demonstrated that there is a high incidence of complications in distal tibia and ankle fracture treatments. One strategy to mitigate issues with wound healing and infection in diabetic patients is to use a percutaneous technique in which autologous, bone marrow-derived, concentrated cells are injected at the site of non-unions.
  
  
  METHODS
  Eighty-six ankle non-union in diabetic patients were treated with bone marrow mesenchymal stem cells (BM-MSCs) delivered in an autologous bone marrow concentrate (BMC). Clinical outcomes of the 86 diabetic non-union patients treated with BMC were compared with 86 diabetic matched non-unions treated with a standard bone iliac crest autograft.
  
  
  RESULTS
  Treatment with BMC promoted non-union healing in 70 among 86 diabetic patients (82.1 %) with a low number of complications. Of the 86 diabetic patients treated with iliac bone graft, 53 (62.3 %) had healing; major complications were observed: 5 amputations, 11 osteonecroses of the fracture wound edge and 17 infections.
  
  
  CONCLUSIONS
  In diabetic patients with ankle non-unions, treatment with BM-MSCs from bone marrow concentrate may be preferable in view of the high risks of major complications after open surgery and iliac bone grafting, and improved healing rates compared with standard iliac bone autograft treatment.
authors: Department of Orthopaedic Surgery, Henri-Mondor Hospital, University of Paris, Créteil Cedex, France, philippe.hernigou@wanadoo.fr.
authors: Philippe
authors: P
authors: Hernigou
authors: Isaac
authors: I
authors: Guissou
authors: Yasuhiro
authors: Y
authors: Homma
authors: Alexandre
authors: A
authors: Poignard
authors: Nathalie
authors: N
authors: Chevallier
authors: Helene
authors: H
authors: Rouard
authors: Charles Henri
authors: CH
authors: Flouzat Lachaniette
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle; D016512:Ankle Injuries / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D016025:Bone Transplantation; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005599:Fractures, Ununited / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D015994:Incidence; D007267:Injections; D045164:Mesenchymal Stem Cell Transplantation; D008875:Middle Aged; D013048:Specimen Handling / Q000009:adverse effects; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing