Standardized procedure managing limb reconstruction and post traumatic complications: Acute shortening-relengthening and multipotent stem cells

Circular External Fixation (CEF) is a complex and long-term treatment used to manage bone gaps and limb reconstructions after post traumatic complications. The purpose of this study is to introduce an innovative management protocol to reduce the time of illness. A multicentric retrospective study including patients treated with CEF for post traumatic complications was conducted. In Group A were enrolled patients with a bone gap managed with bifocal acute shortening and relengthening (Bifocal ASR) and infiltrated with multipotent stem cells (MSC) at a selected time between 60 and 90 days after the frame application. In Group B patients with bone gaps were managed by bone transport (BT) without cell infiltration. Radiological and clinical outcomes have been collected at a minimum 1-year follow-up. 23 patients were enrolled. At the final follow-up, 3 patients in Group B had docking point problems, 1 case of acquired deformity, 3 delays in bone healing and 7 patients needed another surgical procedure before the removal of the frame. Group A achieved a radiographic union and stable clinical test in an average of 5 months, Group B in 9 months. The average of time between the application of the external fixation and the frame removal was 6,1 months for Group A and 11 months for Group B. A treatment protocol for patients with bone gap managed with CEF with Bifocal ASR technique and infiltration of MSC in a set time, allows to achieve a healing and removal of the fixator more quickly.