Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series.

Dvir Benshabat,Oleg Dolkart,Ofir Chechik,Eran Maman,Itay Ashkenazi,Raphael Krespi,Shai Factor,Amal Khoury

doi:10.3390/jcm10204749

Abstract

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.

Highlights

Clavicle fractures comprise 2.6–5.0% of all fractures in adults, with an annual incidence of 36.5 per 100,000
Most closed middle-third and distal clavicle fractures in adults have been treated conservatively; with conservative treatment, the risk for nonunion can reach as high as 44% for distal-third fracture, while the risk for symptomatic nonunion can reach as high as 24% for midshaft fractures [6,7,8,9,10,11]
This study focuses on the proposition that treating clavicle fracture nonunion with open reduction and internal fixation with supplementation of Bone marrow aspirate concentrate (BMAC) will result in high rates of union, satisfactory functional and pain scores, and minimal donor site pain and/or complications

Summary

Introduction

Clavicle fractures comprise 2.6–5.0% of all fractures in adults, with an annual incidence of 36.5 per 100,000. The commonly accepted indication for surgical treatment is a displaced type 2 (Neer classification) fracture with surgical treatment showing higher rates of radiographic union; outcomes of this treatment have not shown superiority over nonsurgical treatment. In both midshaft and distal fractures, no surgical technique has been shown to be superior [6,12]

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