title: Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect.
abstract: Infected, long bone non-unions present a significant clinical challenge. New and alternative therapies are needed to address this problem. The purposes of this study were to compare the number of circulating granulocyte-macrophage colony-forming units (CFU-GM) in the peripheral blood of polytraumatic patients with infected tibial non-unions and in the peripheral blood of control patients with the hypothesis that their number was decreased in polytraumatic patients; and to treat their infection without antibiotics and with local transplantation of bone marrow concentrated granulocytes precursors.
  
  
  
  Thirty (18 atrophic and 12 hyperthrophic ) infected tibial non-unions (without bone defect) that occurred after open fractures in polytraumatic patients were treated without antibiotics and with percutaneous injection of autologous bone marrow concentrate (BMC) containing granulocytes precursors (CFU-GM). CFU-GM progenitors were assessed in the bone marrow aspirate, peripheral blood, and fracture site of these patients. The number of these progenitors was compared with the CFU-GM progenitors of control patient samples (healthy donors matched for age and gender). Outcome measures were: timing of union, callus formation (radiographs and CT scan), and recurrence of clinical infection.
  
  
  
  As compared to control patients, the number of CFU GM derived colonies was lower at peripheral blood in patients with infected nonunions. The bone marrow graft injected in nonunions contained after concentration 42 621 ± 20 350 CFU-GM-derived colonies/cc. Healing and cure of infection was observed at six months for 25 patients and at one year follow up for 30 patients. At the median ten year follow-up (range: 5 to 15), only one patient had clinical recurrent infection after healing (between 6 months and last follow-up).
  
  
  
  The peripheral blood of these polytraumatic patients with infected nonunions had a remarkable decrease in CFU-GM-derived colonies as compared with normal controls. Local transplantation of concentrated CFU-GM-derived colonies aspirated from bone marrow allowed cure of infection and healing without antibiotics.
authors.affiliation: Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France. philippe.hernigou@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hernigou
authors.affiliation: Orthopaedic Surgeon, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Trousselier
authors.affiliation: Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubineau
authors.affiliation: Orthopaedic Surgeon, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: Charlie
authors.initials: C
authors.lastname: Bouthors
authors.affiliation: EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chevallier
authors.affiliation: EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Rouard
authors.affiliation: Orthopaedic Surgeon, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
authors.forename: Charles Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001850:Bone Diseases, Infectious / Q000097:blood / Q000209:etiology / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000379:methods*; D003114:Colony-Forming Units Assay; D005240:Feasibility Studies; D005260:Female; D017102:Fracture Healing; D005597:Fractures, Open / Q000097:blood* / Q000150:complications; D005599:Fractures, Ununited / Q000097:blood / Q000209:etiology*; D055014:Granulocyte-Macrophage Progenitor Cells / Q000637:transplantation*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007267:Injections; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D013978:Tibial Fractures / Q000097:blood* / Q000150:complications; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bone marrow; CFU-GM; Cell therapy; Granulocytes precursors; Infected nonunion