Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

Abstract

Abstract-Delayed union or nonunion of bone fracture is becoming less frequent, but still remains a challenging clinical problem. Autologous cancellous bone grafting that is the gold standard method, often involves donor site morbidities and complications. Once these fractures have been mechanically stabilized, other local factors should be investigated to promote delayed healing. The purpose of this study was to evaluate the initial outcome of the percutaneous injection of autologous bone marrow after concentration for the treatment of delayed or nonunion. Our subjects included 10 patients (3 female, 7 male) with an average age of 28 years. All fractures were mechanically stabilized after accident.Delayed or nonunion affected the femur in 2 patients, the tibia in 5 patients, the humerus in 2 patients, and the ulna in 1 patient. Bone marrow aspirates were obtained from both the posterior superior iliac crest. Bone marrow aspiration concentrate was produced via density gradient centrifugation. Trocars were inserted in the delayed or nonunion gap under fluoroscopic guidance. The bone marrow aspiration concentrate was injected slowly. All of 10 delayed or nonunion healed after treatment with percutaneous injection of autologous bone marrow. The mean time for new bone formation was 3.3 months, for clinical union was 5.2 months, and for radiological union was 11.8 months. The result of current study is encouraging in the initial outcome and percutaneous bone marrow implantation could be an effective and safe treatment for delayed or nonunion.

Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

“…15 Hau et al reported a 100% union rate in their study with all 10 patients achieving good bone union at the fracture site. 16 We had a union rate of 93.3% in our study. A review of literature of other studies also showed good union rates following bone marrow infection which compares well with that of our study.…”

To study the union rates and complications of percutaneous bone marrow injection in delayed union of long bone fractures: A prospective study

“…There was no sign of infection or hematoma growth at the aspiration site. Persistent discomfort has not been reported after iliac crest bone marrow aspiration [26] .…”

Study of efficacy of bone marrow injection in delayed union of fractures of lower limb

“…Year Outcome Sim et al [11] 1992 9/11 (81.8%) Bhargava et al [8] 2007 25/28 (89.3%) Elsattar et al [22] 2014 16/20 (80%) Connolly et al [23] 1991 18/20 (90%) Sahu [24] 2018 82/93 (88%) Singh et al [2] 2013 10/12 (83.3%) Thua et al [25] 2015 10/10 (100%) Hernigou et al [14] 2006 88.3% Sugaya et al [26] 2014 76% Present study 2023 28/30 (93.3%)…”