Journal Article

The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial

Goedegebuure, Simon, Weel, Hanneke, Mallee, Wouter H., Blankevoort, Leendert, Kennedy, John G., van Dijk, C. Niek, Goslings, J. Carel, Kerkhoffs, Gino M. M. J.

2015

Overview

Background Fifth metatarsal (MT-V) stress fractures often exhibit delayed union and are high-risk fractures for non-union. Surgical treatment, currently considered as the gold standard, does not give optimal results, with a mean time to fracture union of 12-18 weeks. In recent studies, the use of bone marrow cells has been introduced to accelerate healing of fractures with union problems. The aim of this randomized trial is to determine if operative treatment of MT-V stress fractures with use of concentrated blood and bone marrow aspirate (cB + cBMA) is more effective than surgery alone. We hypothesize that using cB + cBMA in the operative treatment of MT-V stress fractures will lead to an earlier fracture union. Methods/Design A prospective, double-blind, randomized controlled trial (RCT) will be conducted in an academic medical center in the Netherlands. Ethics approval is received. 50 patients will be randomized to either operative treatment with cB + cBMA, harvested from the iliac crest, or operative treatment without cB + cBMA but with a sham-treatment of the iliac crest. The fracture fixation is the same in both groups, as is the post-operative care.. Follow up will be one year. The primary outcome measure is time to union in weeks on X-ray. Secondary outcome measures are time to resumption of work and sports, functional outcomes (SF-36, FAOS, FAAM), complication rate, composition of osteoprogenitors in cB + cBMA and cost-effectiveness. Furthermore, a bone biopsy is taken from every stress fracture and analysed histologically to determine the stage of the stress fracture. The difference in primary endpoint between the two groups is analysed using student’s t -test or equivalent. Discussion This trial will likely provide level-I evidence on the effectiveness of cB + cBMA in the operative treatment of MT-V stress fractures. Trial registration Netherlands Trial Register (reg.nr NTR4377 )

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Biopsy / Bone marrow / Bone Marrow Transplantation - economics / Bone Marrow Transplantation - methods / Bone Screws / Bone Transplantation / Care and treatment / Cost-Benefit Analysis / Cumulative Trauma Disorders - therapy / Double-Blind Method / Epidemiology / Fracture Fixation, Internal - economics / Fracture Fixation, Internal - methods / Fracture Healing / Fractures / Fractures, Malunited - epidemiology / Fractures, Stress - diagnostic imaging / Fractures, Stress - surgery / Fractures, Stress - therapy / Humans / Informed consent / Internal fixation in fractures / Internal Medicine / Medical ethics / Medicine / Medicine & Public Health / Mesenchymal Stem Cell Transplantation - economics / Mesenchymal Stem Cell Transplantation - methods / Metatarsal Bones - diagnostic imaging / Metatarsal Bones - injuries / Metatarsal Bones - pathology / Metatarsal Bones - surgery / Orthopedics / Patient outcomes / Patient Selection / Patients / Postoperative Complications - epidemiology / Prospective Studies / Radiography / Recovery of Function / Rehabilitation / Research Design / Rheumatology / Skin & tissue grafts / Sports Medicine / Stem cells / Stress fractures / Study Protocol / Surgery