DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20180682

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

Yeshwanth Subash

Abstract


Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.

Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.

Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union.

Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results.


Keywords


Bone marrow, Injection, Delayed union, Nonunion

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References


Boyd HB, Lipinski SW, Wiley JH. Observations on nonunion of the shafts of the long bones, with a statistical analysis of 842 patients. J Bone Joint Surg 1961;43:159.

Canale ST, Beaty JH. Campbell’s operative orthopaedics. Delayed union and nonunion of fractures. Chapter 56. 11th edition. 3530-3532.

Adams JC. Outline of fractures. 81st ed. UK: Churchill Livingstone; 1983: 55–56.

Bigham-Sadegh A, Oryan A. (2014). Basic concepts regarding fracture healing and the current options and future directions in managing bone fractures. Int Wound J. 2015;12(3):238-47.

Romano CL, Romano D, Logoluso N. Low-intensity pulsed ultrasound for the treatment of bone delayed union or nonunion: a review. Ultrasound Med Biol. 2009;35:529–36.

Gomez-Barrena E, Rosset P, Muller I, Giordano R, Bunu C, Layrolle P, et al. Bone regeneration: stem cell therapies and clinical studies in orthopaedics and traumatology. J Cell Mol Med. 2011;15:1266–86.

Phemister DB. Treatment of ununited fractures by onlay bone grafts without screws or tie fixation and without breaking down of fibrous union. J Bone Joint Surg. 1947;29:946-60.

Goujon E. Recherches experimentales sur les proprietes physiologiques de la moelle des os. J de L'Anat. et de La Physiol. 1869;6:399–412.

McGaw WH, Harbin M. The role of bone marrow, an experiment study of bone marrow and endosteal transplants and endosteum in bone regeneration. J. Bone Joint Surg [Am]. 1934;16:816-82.

Herzog K. Verlangerungosteotomic unter vernen dungdes percutangezielt veriegelten Markangels. Unfalltreikunde. 1951;42:226-30.

Beresford JN. Osteogenic stem cells and the stromal system of bone and marrow. Clin Orthop Relat Res. 1989;240:270-80.

Owen M, Friedenstein AJ. Stromal stem cells: marrow-derived osteogenic precursors. Ciba Found Symp. 1988;136:42-60.

Reichert P, Rutowski R, Gosk J. Treatment of delayed union of long bones by percutaneous injection of Autologous stem cells. Adv Clin Exp Med. 2007;16(1):43-8.

Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injections for delayed or non-union of bones. J Orthopaedic Surg. 2013;21(1):60-4.

Elsattar TA, Alseedy AI, Khalil AA. Bone marrow injection in treatment of long bone nonunion. Menoufia Med J. 2014;27:632-5.

Le Thua TH, Nhat Pham D, Bao Le QN, Nguyen PH, Hoa Phan TT, Phan HD, et al. Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection. Biomed Res Therapy. 2015;2(11):389-95.

17.Shenoy RM, Pinto D, Dinesh KVN, Chandra G. Osteoinduction using autologous bone marrow in difficult orthopaedic problems – a clinical study. Int J Biomed Advance Res. 2014;5(6):288-91.

Kitoh H, Kitakoji T, Tsuchiya H, Mitsuyama H, Nakamura H, Katoh M, Ishiguro N. Transplantation of marrow-derived mesenchymal stem cells and platelet rich plasma during osteogenesis – a preliminary result of these cases. Bone. 2004;35:892-8.

Garg NK, Gaur S, Sharma S. Percutaneous autogenous bone marrow grafting in 20 cases of ununited fracture. Acta Orthop Scand. 1993;64:671-2.

Khanal GP, Garg M, Singh GK. A prospective randomized trial of percutaneous marrow injection in a series of closed fresh tibial fractures. Int Orthopaedics. 2004;28(3):167-70.

Connolly JF, Guse R, Tiedman J, Dehne R. Autologous marrow injection as asubstitute for operative grafting of tibial non unions .Clin Orthop Relat Res. 1991;(226):259-70.

Braly HL, O’Connor DP, Brinker MR. Percutaneous autologous bone marrow injection in the treatment of distal meta-diaphyseal tibial nonunions and delayed unions. J Orthop Trauma. 2013;27(9):527-33.

Reynders P, Broos P. Percutaneous injection of autogenous bone marrow in delayed union of tibia and femur. J Bone Joint Surg. 2004;86-90.