Role of bone marrow infiltration in management of delayed union of long bones fracture


  • Sanjay Kumar Meena Spine Fellow ISIC, Dehli, India
  • Naveen Goyal Consultant Orthopaedics, Shreeji Hospital, Kota, Rajasthan, India
  • Devendra Tetarwal S.R., Govt Medical College, Kota, Rajasthan, India
  • Bharat Sharma Department of Orthopaedics, Government Medical College, Pali, Rajasthan, India



Bone marrow, Delayed Union in Tibia, Femur, Iliac crest, Jamshidi needle, Syringe


Background: Usually delayed union of fracture long bones are managed by putting a bone graft at fracture site , but bone grafting have donor site complication like scar, infection ,hernia ,gait disturbance , cosmetic problem, as well as recipient site complication like soft tissue trauma , de-vascularisation of fracture fragment. Bone marrow infiltration is a minimally invasive method done percutaneously. It is easy, safe procedure with no associated complications that may occur in bone grafting.

Methods: This prospective study was conducted in the Department of orthopedics, Government Medical College, Kota from June 2011 to November 2013 to evaluate the efficacy of percutaneous bone marrow infiltration in cases of delayed union of long bones. 27 patients included in study with 28 bones, as one patient has given bone marrow injection in two bones (tibia & femur), so the cases included in study counted as 28 cases. The mean age of this study was 38.28 years, ranging from 18 years to 75 years.  All cases were follow up after 4 to 6 weeks and thereafter one month interval. Final follow up was taken when fracture site shows clinical and radiological sign of union.

Results: Out of 23 united cases 19 had excellent results and 04 cases had good results. The five cases which fail to unite were taken as poor results.

Conclusions: Bone marrow infiltration is a minimally invasive, safe bone graft substitute for delayed union of long bones and have less complications.

Author Biography

Sanjay Kumar Meena, Spine Fellow ISIC, Dehli, India

felloship in spine in indian spine injury  centre dehli


Noshi T, Yoshikawa T, Dohi Y, Ikeuchi M, Horiuchi K, Ichijima K, et al. Recombinant human bone morphogenetic protein‐2 potentiates the in vivo osteogenic ability of marrow/hydroxyapatite composites. Artificial Organs. 2001;25(3):201-8.

Hernigou P, Poignard A, Manicom O, Mathieu G, Rouard H. The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Joint Surg. British volume. 2005;87(7):896-902.

Brighton CT, Hunt RM. Early histological and ultrastructural changes in medullary fracture callus. J Bone Joint Surg Br. 1991;73-A:832-47.

Jensen GS, Drapeau C. The use of in situ bone marrow stem cells for the treatment of various degenerative diseases. Medical Hypotheses. 2002;59(4):422-8.

Sen MK, Miclau T. Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions?. Injury. 2007;38(1):S75-80.

Nicoll EA. Fracture of the tibial shaft. J Bone Joint Surg. 1964;46:373-87.

Ellis H. The speed of healing after fracture of tibial shaft . J Bone Joint Surg. 1958;40B:42-6.

Wilkins RM, Chimenti BT, Rifkin RM. Percutaneous treatment of long bone nonunions: the use of autologous bone marrow and allograft bone matrix. Orthopedics. 2003;26(5):S549-54.

McGaw WH, Harbin M. The role of bone marrow and endostium in bone regeneration. An experimental study of bone marrow and endosteal transplants. J Bone Joint Surg. 1934;14:816-21.

Conolly JF, Guse R, Tiedeman J, Dehne R. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop. 1991;266:25970.

Paley D, Young MC, Wiley AM, Fornasier VL, Jackson RW. Percutaneous bone marrow grafting of fractures and bony defects. An experimental study in rabbits. Clin Orthopaed Related Res. 1986;(208):300-12.

Hernigou P, Poignard A, Beaujean F, Rouard H. Percutaneous autologous marrow grafting for nonunions. J Bone Joint Surg. 2005;87A:1430-37.

Padha V, Mahajan N, Kalsotra N, Salaria A, Sharma S. Role of percutaneous bone marrow injection in delayed union and non union. Internet J Orthoped Surgery. 2011;18.

Bhargava R, Sankhla SS, Gupta A, Changani RL, Gagal KC. Percutaneous autologous bone marrow injection in treatment of delayed union or nonunion. Indian J Orthop. 2007;41:67-71.

Burwell RG. The function of bone marrow in the incorporation of a bone graft. Clin Orthop. 1985;200:125-41.






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