Percutaneous autologous bone marrow injection as a substitute for operative grafting in delayed union and nonunion of long bone fractures

Abstract

Background Cells aspirated from bone marrow have been shown to provide stimulus for osteogenesis in animal experiments and in clinical evaluation of bone graft and bone substitutes. Despite this osteogenic characteristic, the clinical use of marrow as an osteogenic source has remained limited. The marrow is harvested by means of needle aspiration from the patient's pelvic bone and is then injected percutaneously at the nonunion site. This method offers the advantage of treating fracture-healing problems without operative exposure of either the donor or the recipient site. Aim of the work The purpose of this study was to ascertain the osteogenic potential of autologous bone marrow injection and its effectiveness in the management of delayed union and nonunion. Patients and methods Autologous marrow injection was used to stimulate healing in 21 patients with delayed union and nonunion of fracture of the long bones. Of these 21 cases, two patients had fracture shaft femur, one had fracture shaft humerus, and 18 patients had tibial shaft fractures during the period from January 2008 to April 2010 at Tanta University Hospital. Surgical technique Bone marrow aspirated from the posterior iliac crest was injected at the fracture site two to three times with an interval of 3 weeks. Results Marrow stimulated callus formation sufficient to unite 18 of 21 cases of delayed unions and nonunions immobilized with cast or intramedullary nails. Conclusion Bone marrow injection was as effective as open autogenous grafting but with considerably less complications. Thus, the technique provides a reliable source of osteogenic stem cells with numerous advantages compared with standard open grafting techniques.