Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions

Abstract

Objectives: The purpose of this study was to compare bone marrow aspirate concentrate (BMAC) with cancellous allograft to iliac crest bone graft (ICBG) in the treatment of long bone nonunions. Design: Retrospective cohort study. Setting: A single level I trauma center. Patients: 26 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and BMAC, compared to 25 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and ICBG. Intervention: Open repair of long bone nonunion using either autologous ICBG or BMAC with cancellous allograft. Main outcome measure: Nonunion healing, radiographically measured by the modified Radiographic Union Score for Tibia (mRUST) score. Secondary outcomes included risk factors associated with failed repair. Results: The union rates for the BMAC and ICBG cohorts were 75% and 78%, respectively ( P = .8). Infection was the only risk factor of statistical significance for failure. Conclusion: In this study, we found no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft. BMAC and allograft led to 75% successful healing in this series. Given the heterogeneity of the control group and loss to follow-up, further prospective investigation should be conducted to more rigorously compare BMAC to ICBG for nonunion treatment. Level of evidence: III, retrospective cohort.

Otojen kemik iliği enjeksiyonunun uzun kemik kaynamamış kırıklarına etkisi

“…The union rates for these applications vary between 79-88 %. It is not possible to apply these methods in all hospitals due to the costs involved and the requirement for additional devices 3,[15][16][17] . It is also necessary to carry out prospective comparative studies with similar non-union groups to put forth its superiority over standard bone marrow.…”

“…However, this application requires the opening up of the fracture region in addition to pain, infection, hematoma, peripheral nerve injury at the donor site. This may result in the devascularization of fracture tips and additional trauma 3 .…”

The top three unanswered questions in the management of open fractures

“…Bone marrow aspirate concentration (BMAC) has recently gained increased popularity as an alternative to iliac crest bone grafting. [ 52 ] This utilizes a minimally invasive technique to harvest osteogenic mesenchymal stem cells in bone marrow. [ 53 – 56 ] In an animal long bone model, the utilization of BMAC has demonstrated increased bone formation, higher torsional strength, and earlier bone healing when compared with control groups.…”

Injectable Bacteria-Sensitive Hydrogel Promotes Repair of Infected Fractures via Sustained Release of miRNA Antagonist

“…Bone marrow stromal cells (BMSCs), characterized by excellent osteogenic differentiation potential, play an important role in the process of fracture healing and can be used as an alternative treatment for fracture nonunion. − Previous studies have explored multiple regulatory mechanisms involved in the osteogenic differentiation of BMSCs, but the mechanism through which BMSC osteogenic differentiation is involved in the delayed healing of fractures remains unclear and requires further investigation.…”