Cell injections accelerate fracture healing, according to recent study

The injection of bone-building cells has proven to help long bone fractures heal faster, according to research recently published in BMC Musculoskeletal Disorders.

According to researchers from Korea, osteoblast cells cultured from a patient’s own bone marrow can be injected into the fracture area and speed up the healing process.

“The cultured osteoblast injection group showed fracture healing acceleration of statistical significance, and there were no specific patient complications when using this treatment,” corresponding study author Seok-Jung Kim, MD, from the Catholic University College of Medicine in Seoul, said in a press release. “Cultured osteoblast injection should be considered a successful treatment option for long bone fractures.”

Sixty-four patients with long bone fractures participated in the study. They were randomly divided into two groups, with 31 allocated to receive the treatment and 33 left to heal normally as a control.

Between May 2006 and January 2008, 64 patients were included in the study. Of these, 31 were randomly allocated to receive the treatment and 33 were left to heal normally as a control group. Fractures were typically simple: transverse or oblique in nature. There were no significant age, sex or body-shape differences between the two groups. Injections occurred under local anesthesia.

Modified callus formation scores were used to evaluate the efficacy of the injections. No callus formation yielded 0 points, slight formation produced 1 point and bridging formation yielded 2 points. The investigators used anteroposterior radiographs to evaluate the medial and lateral cortices. Lateral radiography was used to evaluate the anterior and posterior cortices. Evaluation of the callus formation scores was left up to two radiologists who were, up to that point, not involved in the study’s processes, accorduing to the press release.

The investigators averaged the differences in callus information scores, measuring between the initial injection of the osteoblast and 1 month and, subsequently, between the initial injection of the osteoblast and 2 months. Final average callus scores between the experimental and control groups were found to be 7.1 and 5.8, respectively.

“We believe that an osteoblast transplant that achieves bone union may be a successful alternative to autologous bone transplant,” Kim said in the press release. “In addition, if such osteoblast transplants could be used for all fracture patients, not only an early return to their daily routine but also the prevention of complications following surgery, such as delayed union and nonunion, could also be anticipated.”

According to Kim, the research could lead to a significant change in the way orthopaedic surgeons view fracture treatment, should the cell culturing process become common practice.

“When a patient is admitted for a routine fracture operation, a small amount of the bone marrow can be simultaneously aspirated for the culturing of the osteoblast during the procedure,” Kim told Orthopaedics Today Europe. “After the operation, the cultured osteoblast can be injected into the fracture site when needed under local anesthesia, as long as a callus formation is not evident.”

He added: “With this injection, it can be strongly cased that the terms ‘delayed union’ or ‘nonunion’ will no longer need to be considered. In a modern society that places time as a premium, the techniques of an operation must always adapt to provide the very best results with a minimum impact to the treated patient.”

Kim also told Orthopaedics Today Europe that an expansion of treatments using osteoblast is the next logical step. He and his colleagues are currently preparing clinical trials for avascular necrosis, nonunion and distraction osteogenesis, and they reported very positive results using the osteoblast treatment.

Reference:
Kim JS, Shin YW, Yang KH. A multi-center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast (Ossron) injection to treat fractures. BMC Musc Disorders. Feb. 12, 2009.