ABSTRACT
INTRODUCTION: Most patients with congenital pseudoarthrosis of tibia (CPT) do not have promising outcomes despite multiple attempts using conventional surgeries. The combination of umbilical cord-derived mesenchymal stem cells and conditioned medium (secretome) contains major components pivotal for the enhancement of fracture healing. The purpose of this study was to address fracture healing in CPT cases that were treated using the combined implantation of umbilical-cord mesenchymal stem cells (UC-MSCs) and secretome. MATERIALS AND METHODS: From 2016 to 2017, six patients with CPT who were treated by one senior pediatric orthopedic consultant at a single center (3 girls and 3 boys; mean age of 5.8 years) were included in this case series. A combined procedure including resection of hamartomatous fibrotic tissue, implantation of MSCs and secretome, and fixation using a locking plate and screws was performed. Patients were followed up for a mean of 29 months. Leg-length discrepancy, refracture rate, functional outcome, and radiological outcomes were assessed preoperatively, immediately postoperatively and at the final follow-up. RESULT: Five out of 6 (83%) of the patients experienced primary union. One patient experienced refracture; however, 8 months later, after another implantation and reconstruction were performed, union eventually occurred. Significant functional improvement was achieved after at least 1 year of follow-up. CONCLUSION: This case series suggests that the combination of secretome and UC-MSCs is a potential treatment for CPT, it highlights the efficacy of the combined procedure in treating CPT and in achieving satisfying results. A larger number of subjects and longer follow-up are required for further study.
Subject(s)
Ilizarov Technique , Mesenchymal Stem Cells , Pseudarthrosis , Child , Male , Female , Humans , Child, Preschool , Tibia/surgery , Pseudarthrosis/surgery , SecretomeABSTRACT
INTRODUCTION: Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19. PRESENTATION OF CASE: This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination. CONCLUSIONS: We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study.
ABSTRACT
INTRODUCTION: Vertebral body defects (VBDs) are one of the most frequent orthopaedic disorders. Such defects often require bone grafts or fusion procedures; however, both procedures often fail due to various factors. Mesenchymal stem cells (MSCs) have been used as a potential therapy to fill bone voids in bone defects, and they may be a potential treatment for VBDs. We reported VBDs treated with MSCs combined with hydroxyapatite scaffolds. PRESENTATION OF CASE: A 27-year-old female presented with recurrent back pain. She had a history of decompression and stabilization procedure one year ago after diagnosed with spinal tuberculosis. Initially, she felt back pain that intensifies with activity and relieved with rest. She noticed that the pain begun when once she heard a crack sound on her back while trying to get up from sitting position. There was no history of numbness or tingling sensation. There were no walking problems. Other functions, including micturition and defecation, were within normal limits. The patient firstly underwent lumbotomy procedure, and the images were all confirmed with fluoroscopy X-ray. The vertebrae went debridement, and finally, the bone defect was filled with 20 millions of umbilical cord-mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite in 2 cc of saline. DISCUSSION: At three months postoperative, the patient could walk and had no pain. At six months of follow-up, no complications occurred. We also did not see any signs of neoplasm formation, which is consistent with previous studies that used MSCs for orthopaedic treatment. Moreover, no significant bone deformation or spinal cord compression was observed, which suggested the safety of the transplantation procedure. CONCLUSIONS: We found that MSCs combined with hydroxyapatite represents a potential therapy for bone regeneration in VBD. Further clinical studies are required to investigate the safety and efficacy of this combination of therapy in VBDs.
