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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00512434
Other study ID # PHRN/06/PR/IMOCA
Secondary ID ID RCB 2007 - A0
Status Completed
Phase N/A
First received
Last updated
Start date September 2007
Est. completion date September 2013

Study information

Verified date October 2018
Source University Hospital, Tours
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The treatment of open tibial shaft fracture is often complicated by delayed union or non-union. The objective of this study is to evaluate the efficacy of autologous concentrated bone-marrow to accelerate healing of open tibial shaft fractures and to reduce the need for secondary intervention.

In a prospective, randomized, controlled, single-blind study, 186 patients with an open tibial will be randomized to receive either the standard of care (fixation by nail or external fixator and routine soft-tissue management), or the standard of care with percutaneous injection, one month after fracture, of autologous concentrated bone-marrow. Randomization will be stratified by severity of the open wound. The primary outcome measure will be the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months post-fracture.


Description:

This study will be conducted at 13 University Hospitals in France. The protocol has been approved by the institutional review board. After written informed consent, patients will be randomized, in the days after the fracture in 2 groups of 93 patients : 1) the control group (standard of care only: fixation by nail or external fixator and routine soft-tissue management) and 2) the study group (standard of care with percutaneous injection, one month after fracture, of autologous concentrated bone-marrow). Randomization will be stratified by severity of the open wound and by center. For the wound, strata A comprise Gustilo-Anderson types I, II and III-A and strata B, type III-B.

For the study group, the injection is scheduled at 1 month ± 5 days after the fracture. The techniques have been described by Hernigou (J Bone Joint Surg Am, 2006; 88(sup 1 part 2): 322-327). There are 3 steps: marrow aspiration (300 - 500 g) from iliac crest under general anesthesia, centrifugation in cell therapy unit to obtain a concentrated buffy coat of about 50 ml containing progenitor cells and other mononuclear cells, percutaneous injection in the fracture site of 20-30 ml of the buffy coat under fluoroscopy control.

Apart from the injection, the standard of care is the same for the 2 groups. Patients will be followed for 12 months, with assessments at 1, 2, 3, 6, 9 and 12 months.

All analysis will be based on the intent to treat the population. The primary outcome measure will be the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months post fracture. An independent panel of surgeons will evaluate all secondary procedure with the potential of promoting fracture-healing.

An independent evaluation of fracture union will be conducted by a radiology panel blinded to treatment allocation and all other patient data.

An outcome will be considered to be successful when the fracture heal, according to the investigator, without secondary intervention and is radiographically united during patient follow-up.


Recruitment information / eligibility

Status Completed
Enrollment 85
Est. completion date September 2013
Est. primary completion date September 2012
Accepts healthy volunteers No
Gender All
Age group 17 Years and older
Eligibility Inclusion Criteria:

- Age 17 years or more

- Open tibial shaft fracture with Gustilo-Anderson type I, II, III A or B

- Written informed consent

- Affiliated to French Social Security

Exclusion Criteria:

- Circumferential bone loss

- Vascular or nerve injury

- Injury, other than tibial fracture, interfering with weight bearing

- Infection (skin, soft-tissue or bone)

- Disease or treatment interfering with bone union: head injury with coma, pathologic fracture

- Medical history on iliac wing contraindicating bone-marrow aspiration

- Corticoid or immunosuppressive therapy more than one week

- Pregnancy at the day of inclusion in study

- History of positive serology for HIV1+2, HBs, HCV

- Adult in the care of a guardian

- Impossibility to meet at the appointments for the follow-up

Study Design


Related Conditions & MeSH terms


Intervention

Procedure:
Osteosynthesis
Nail or external fixator Intervention 'Osteosynthesis'

Locations

Country Name City State
France UH Angers Angers
France UH Besançon Jean Minjoz Besancon
France UH Brest Cavale Blanche Brest
France UH Clermont Ferrand Gabriel Montpied Clermont Ferrand
France UH Grenoble Michallon Hospital Grenoble
France UH Grenoble South Hospital Grenoble
France UH Nancy Central Hospital Nancy
France UH Nantes Hôtel Dieu Nantes
France UH Pitié Salpétrière AH HP Paris
France UH Tours CHRU Trousseau Tours
France UHTOURS Tours

Sponsors (1)

Lead Sponsor Collaborator
University Hospital, Tours

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve month post fracture. one year
Secondary Relation between the number of the progenitor available injected with concentrated bone marrow aspirated and the rate of bone union. one year
Secondary Comparison of the rate of complications between the 2 groups. one year
Secondary Economic impact study. one year
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