Fixed intramedullary nailing and percutaneous autologous concentrated bone-marrow grafting can promote bone healing in humeral-shaft fractures with delayed union

Garnavos, Christos; Mouzopoulos, Georgios; Morakis, Emmanouil

doi:10.1016/j.injury.2009.08.003

Cited by 34 publications

(18 citation statements)

References 32 publications

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“…10 Very recently, other authors have demonstrated beneficial effects on bone healing in patients with bone cysts, osteo-necrosis and non-unions with the transplantation of BMAC. 5,10,11,13,26 To the knowledge of the authors, the procedure has not been described for distraction osteogenesis.…”

Section: Discussionmentioning

confidence: 99%

Regenerate augmentation with bone marrow concentrate after traumatic bone loss

et al. 2012

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Distraction osteogenesis after post-traumatic segmental bone loss of the tibia is a complex and time-consuming procedure that is often complicated due to prolonged consolidation or complete insufficiency of the regenerate. The aim of this feasibility study was to investigate the potential of bone marrow aspiration concentrate (BMAC) for percutaneous regenerate augmentation to accelerate bony consolidation of the regenerate. Eight patients (age 22–64) with an average posttraumatic bone defect of 82.4 mm and concomitant risk factors (nicotine abuse, soft-tissue defects, obesity and/or circulatory disorders) were treated with a modified Ilizarov external frame using an intramedullary cable transportation system. At the end of the distraction phase, each patient was treated with a percutaneously injection of autologous BMAC into the centre of the regenerate. The concentration factor was analysed using flow cytometry. The mean follow up after frame removal was 10 (4–15) months. With a mean healing index (HI) of 36.9 d/cm, bony consolidation of the regenerate was achieved in all eight cases. The mean concentration factor of the bone marrow aspirate was 4.6 (SD 1.23). No further operations concerning the regenerate were needed and no adverse effects were observed with the BMAC procedure. This procedure can be used for augmentation of the regenerate in cases of segmental bone transport. Further studies with a larger number of patients and control groups are needed to evaluate a possible higher success rate and accelerating effects on regenerate healing.

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Section: Discussionmentioning

confidence: 99%

Regenerate augmentation with bone marrow concentrate after traumatic bone loss

et al. 2012

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“…4,9,10,12,[15][16][17][18][19]42 Few seem to have included patients with nonunions of the distal tibial metaphysis. Because of the relatively small patient samples typically available for studies of nonunions, many reports on percutaneous autologous bone marrow injection combine cases that may vary considerably with respect to diagnosis (eg, nonunion, delayed union, poor regenerate in limb lengthening), long bones included (eg, tibia, femur, humerus), anatomical location (eg, metaphysis vs diaphysis), surgical fixation or other treatments in conjunction with the marrow injection, and the presence, quality, and quality of the existing internal fixation hardware.…”

Section: Figurementioning

confidence: 99%

Percutaneous Autologous Bone Marrow Injection in the Treatment of Distal Meta-diaphyseal Tibial Nonunions and Delayed Unions

Braly

O’Connor

Brinker

2013

Journal of Orthopaedic Trauma

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“…The benefits of cBMA as an adjunctive therapy has also been demonstrated in the treatment of upper extremity long bone nonunion. Garnavos et al[27] described successfully using a minimal invasive approach by injecting cBMA to address humeral diaphyseal fractures, thereby avoiding potential complications associated with the conventional compression plating technique for treating humeral nonunions. Hernigou et al[29] utilized the same minimally invasive technique to treat diabetic ankle fractures nonunion.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

Gianakos¹,

Sun²,

Patel³

et al. 2017

WJO

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AIMTo examine the evidence behind the use of concentrated bone marrow aspirate (cBMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cBMA in these biologic environments; and provide the level and quality of evidence substantiating the use of cBMA in the clinical setting.METHODSWe conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cBMA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cBMA preparation, cBMA concentration, study methods, outcomes, and level of evidence and reported the results in tables and text.RESULTSA total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36 (86%) studies reported the method of centrifugation and preparation of cBMA with 15 (42%) studies reporting either a cell concentration or an increase from baseline. Variation of cBMA application was seen amongst the studies evaluated. Twenty-one of 36 (58%) were level of evidence IV, 12/36 (33%) were level of evidence III, and 3/36 (8%) were level of evidence II. Studies evaluated full thickness chondral lesions (7 studies), osteochondral lesions (10 studies), osteoarthritis (5 studies), nonunion or fracture (9 studies), or tendon injuries (5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cBMA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cBMA. Enhanced healing rates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cBMA as an adjunctive treatment in tendon repair.CONCLUSIONThe current literature demonstrates the potential benefits of utilizing cBMA for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. This study also demonstrates discrepancies between the literature with regards to various methods of centrifugation, variable cell count concentrations, and lack of standardized outcome measures. Future studies should attempt to examine the integral factors necessary for tissue regeneration and renewal including stem cells, growth factors and a biologic scaffold.

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Fixed intramedullary nailing and percutaneous autologous concentrated bone-marrow grafting can promote bone healing in humeral-shaft fractures with delayed union

Cited by 34 publications

References 32 publications

Regenerate augmentation with bone marrow concentrate after traumatic bone loss

Regenerate augmentation with bone marrow concentrate after traumatic bone loss

Percutaneous Autologous Bone Marrow Injection in the Treatment of Distal Meta-diaphyseal Tibial Nonunions and Delayed Unions

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

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