Abstract
The treatment of relapsing pseudoarthrosis of ulna presents quite a lot of perplexities as regards the surgical strategy to follow which means of synthesis to solve the biomechanical problems (lack of favourable loading stimuli and, on the contrary, presence of unfavourable torsional strengths due to the movement of pronosupination of the forearm),and how to interact in order to favour the restoration of osteogenesis (homologous or autologous bone graft, vascularized or not, bone substitutes, employment of autologous growth factors, of morphogenetic proteins (BMP),and of autologous staminal cells).
The authors report about 4 particular cases of relapsing pseudoarthrosis of the ulna previously treated with autologous bone grafts but with no recovery.
In order to activate osteogenesis, the authors have employed a graft of autologous bone enriched with platelet derived growth factors + adult mesenchymal stem cells from drawing from the iliac wing. The osteosyntesis has been carried out in 3 cases with endomidollar locked nail and, in one case, with external fixation.
All the four cases have reached prompt lasting clinical recovery (following up from 8 to 28 month) and Rx precocious evidence of osteointegration of the grafts independently from the synthesis means.
The limited casuistry does not enable us to report any comparable statistical data.
The authors think that association of AGF + adult mesenchymal stem cells can be determinant and encouraging and, thanks to the results, they suggest its spreading.
Correspondence should be addressed to Ariella Neustadt at Studio EGA, Professional Congress Organisers, Viale Tiziano, 19 - 00196, Rome - Italy.
