- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00512434
Percutaneous Autologous Bone-marrow Grafting for Open Tibial Shaft Fracture (IMOCA)
Injection of Concentrated Autologous Bone-marrow (IMOCA) and Bone Union of Open Tibial Shaft Fracture: Randomized Study to Assess Efficiency of IMOCA in Addition to Standard of Care.
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.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed 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.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Angers, France, 49933
- UH Angers
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Besancon, France, 25030
- UH Besançon Jean Minjoz
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Brest, France, 29200
- UH Brest Cavale Blanche
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Clermont Ferrand, France, 63 000
- UH Clermont Ferrand Gabriel Montpied
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Grenoble, France, 38043
- UH Grenoble Michallon Hospital
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Grenoble, France, 38434
- UH Grenoble South Hospital
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Nancy, France, 54000
- UH Nancy Central Hospital
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Nantes, France, 44
- UH Nantes Hôtel Dieu
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Paris, France, 75013
- UH Pitié Salpétrière AH HP
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Tours, France, 37 044
- UH Tours CHRU Trousseau
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Tours, France
- UHTours
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
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 Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control in arm fields
Standard treatment Intervention no'Osteosynthesis'
|
Nail or external fixator Intervention 'Osteosynthesis'
|
Experimental: IMOCA
Intervention 'Osteosynthesis' Percutaneous autologous bone-marrow grafting - surgical technique (ref: Hernigou Ph et al J Bone Joint Surg Am ,2006; 88 (sup 1 part 2): 322-327
|
Nail or external fixator Intervention 'Osteosynthesis'
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve month post fracture.
Time Frame: one year
|
one year
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Relation between the number of the progenitor available injected with concentrated bone marrow aspirated and the rate of bone union.
Time Frame: one year
|
one year
|
Comparison of the rate of complications between the 2 groups.
Time Frame: one year
|
one year
|
Economic impact study.
Time Frame: one year
|
one year
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PHRN/06/PR/IMOCA
- ID RCB 2007 - A00032 - 51 (Other Identifier: AFSSAPS)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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