Percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate and platelet rich plasma for treatment of delayed fracture union

Abstract

Objective To evaluate the clinical efficacy of percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate (cBMA) and platelet rich plasma (PRP) in the treatment of delayed fracture union. Methods A retrospective study was performed on the clinical data of 34 patients with delayed fracture union who had been treated at Department of Orthopaedics, Luoyang Zhenggu Hospital of Henan Province from April 2014 to February 2017. They were 26 males 8 females, aged from 18 to 63 years (average, 36.7 years). There were 15 femoral, 11 tibial, 5 humerus and 3 ulnar fractures. According to the Weber-Crech classification, 14 cases belonged to the type of rich blood supply-active end hypertrophy and 20 to the type of poor blood supply and malnutrition. There were 28 closed and 6 open fractures. Of this cohort, 21 cases had their primary fixation, 7 had revision once, 4 had revision twice, and 2 had revision more than thrice; 19 cases had intramedullary fixation, 12 had plate fixation and 3 had external fixation. Autologous iliac bone grafting was performed previously in 19 cases. Kirschner wire was used under fluoroscopy to pierce percutaneously the cortical bone at fracture ends; bone marrow blood and peripheral venous blood were collected to prepare autologous cBMA and PRP which were to be injected locally at the fracture ends after mixture. At the last follow-up, the patients were evaluated by visual analogue scale (VAS), SF-36 health survey summary scores and modified Radiographic Union Score for Tibia (RUST). Results The patients were followed up for 12 to 42 months (average, 21.5 months). Thirty-one patients healed after surgery, yielding a healing rate of 91.2%. The healing time averaged 5.3 months (from 4 to 10 months). No patient reported such complications as infection or neurovascular injury. At the last follow-up, the VAS scores of the 34 patients were 1.3±0.6 points, significantly lower than the preoperative 5.4±3.6 points (P<0.05); the postoperative SF-36 scores 74.8±16.5 points, significantly increased than the preoperative 44.8±15.6 scores (P<0.05); the RUST scores 3.3±0.4 points, significantly higher than the preoperative 1.6±0.8 points (P<0.05). Conclusions Minimally invasive percutaneous piercing of K-wire on the cortical bone at the fracture ends may result in fluid leakage and restart bone healing process. At the same time, local injection of autologous cBMA and PRP may increase the number and concentration of local bone marrow mesenchymal stem cells and growth factors, promoting fracture healing. Key words: Fractures, bone; Bone marrow; Platelet-rich plasma; Surgical procedures, minimally invasive; Delayed healing