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Case Reports
. 2020 Nov;14(3):166-169.
doi: 10.5704/MOJ.2011.026.

Massive Tibial Bone Regeneration with Autologous Peripheral Blood Stem Cells using Ilizarov Bone Transport: A Case Report

K Y Saw  1 , R Gill  1 , T C Low  1
Affiliations
Case Reports

Massive Tibial Bone Regeneration with Autologous Peripheral Blood Stem Cells using Ilizarov Bone Transport: A Case Report

K Y Saw et al. Malays Orthop J. 2020 Nov.

Abstract

This is a case report of a Gustilo-Anderson Type IIIB comminuted open right tibial fracture with massive bone loss, complicated by methicillin-resistant Staphylococus aureus (MRSA) infection. Non-viable and contaminated bony fragments were removed and infected bone resected. Soft tissue coverage and antibiotics were effective against the MRSA infection. A unifocal bone transport with the Ilizarov method regenerated 13cm of the missing tibia. Autologous peripheral blood stem cells (PBSC) injections into the osteogenesis site boosted bone regeneration and consolidation with a shortened Bone Healing index (BHI) of 23 days/cm.

Keywords: Bone Healing index; Ilizarov; bone regeneration; massive bone loss; peripheral blood stem cells.

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Figures

Fig. 1:
Fig. 1:
(a) Radiographs with anteroposterior (b) and lateral views of the right tibia showing severe comminuted fracture of the middle third of the tibia.
Fig. 2:
Fig. 2:
(a) Bone transport at five months showing distraction osteogenesis over the distal half of the right tibia, lower horizontal Schanz screw inserted just above the ankle joint with yellow arrow indicating the direction of bone transport from the ankle corticotomy site; (b) Endoscopic view from the posterior aspect of the tibia following soft tissue release with red arrow at the junction of the corticotomy and the edge of bone regeneration; and (c) Endoscopic view from the posterior aspect of the regenerating bone with red arrow at the middle section of the distraction osteogenesis showing spongy nature of the regenerated bone.
Fig. 3:
Fig. 3:
(a) Anteroposterior and (b) lateral radiographs of the right tibia at seven months following bone transport with the Ilizarov method. Red arrows showing multiple drilling over the docking site performed two months previously with injections of peripheral blood stem cells to enhance callus formation. Yellow arrow indicating the direction of bone transport from the ankle corticotomy site, showing 13cm of bone regeneration over the distal half of the tibia. Similar views (c) and (d) at 15 months, showing bone healing at the docking site and further consolidation of the regenerated bone.
See this image and copyright information in PMC

References

    1. Saw KY, Anz A, Jee CSY, Merican S, Ng CSR, Roohi SA et al. Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: A randomized controlled trial. Arthroscopy. 2013;29:684–94. doi: 10.1016/j.arthro.2012.12.008. - DOI - PubMed
    1. Saw KY, Jee CSY. From. ‘blade runner’ to ‘stem-cell player’ and beyond. Bone Joint 360. 2013;2(1):6–11. doi: 10.1302/20480105.21.360106. - DOI
    1. Yang Y, Lin S, Wang B, Gu W, Li G. Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis. Bone Jt Res. 2017;6(6):385–90. doi: 10.1302/2046-3758.66.BJR-2017-0023. - DOI - PMC - PubMed
    1. Saw A, Manimaran S, Faizal S, Bulgiba AM. Use of radiographic densitometry to predict the bone healing index in distraction osteogenesis. Malays Orthop J. 2008;12(1):44–8.
    1. Alkenani NS, Alosfoor MA, Al-Araifi AK, Alnuaim HA. Ilizarov bone transport after massive tibial trauma: case report. Int J Surg Case Rep. 2016;28:101–6. doi: 10.1016/j.ijscr.2016.08.040. - DOI - PMC - PubMed

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