Percutaneous Autologous Bone Marrow Injection Research Articles

Percutaneous autologous bone marrow injection in the treatment of delayed union of long bone fractures after definitive fixation

The purpose of this study was to assess the results of percutaneous autologous bone marrow injection in the treatment of delayed union of long bone fractures after definitive fixation. It has been a gruelling job for the orthopaedic surgeons to deal with the delayed union after definitive fixation due to the lack of patient compliance for reoperation like classical bone grafting technique for delayed union and non-union, unfavourable fracture site morphology for external compression, post-operative surgical wound issues etc., The percutaneous autologous bone marrow injection is a reasonable choice in this scenario for the treatment of Delayed union of long bone fractures after definitive fixation. The study was performed in the department of orthopaedics Assam Medical College and Hospital, Dibrugarh, Assam, India for a period of 2 years from July 2019 to June 2021. A total of 23 patients were taken with delayed union of long bone fractures after definitive fixation. These 23 patients were treated with percutaneous autologous bone marrow injection and followed up for 6 months. The results were evaluated on the basis of clinico-radiological criteria of union, and found to be excellent in 60.86% (14/23), good in 17.39% (4/23) and poor in 21.73% (5/23) cases. The percutaneous autologous bone marrow injection provides cellular stimulation and promotes fracture healing without the necessity for opening the fracture site. Hence it is an effective method to bring about successful outcome of delayed union of long bone fractures after definitive fixation without adding any significant complication to the patient and the fracture site.

Minimally Invasive Technique For Delayed union Or Nonunion #Tibia: The Use Of Percutaneous Autologous Bone Marrow Injection

Minimally Invasive Technique For Delayed union Or Nonunion #Tibia: The Use Of Percutaneous Autologous Bone Marrow Injection

Less invasive treatment for delayed or nonunion: The use of percutaneous autologous bone marrow injection

Less invasive treatment for delayed or nonunion: The use of percutaneous autologous bone marrow injection

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

<p class="abstract"><strong>Background:</strong> 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<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> 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<span lang="EN-IN">.</span></p>

CORRECTION: Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

CORRECTION: Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

Bone marrow injection for the treatment of bone cysts before skeletal maturity

Background Bone cysts are benign, osteolytic, fluid-filled bone lesions mostly seen before skeletal maturity. Various treatment modalities with variable outcomes have been described in the literature, but there is no consensus as regards the best procedure. Traditional bone grafting techniques have given way to newer cellular therapies that are potentially less invasive and have a lower complication rate and faster recovery time. The percutaneous method can be used with different materials such as bone marrow (BM) or bone substitutes to optimize results. BM contains the osteoprogenitor cells, various bone morphogenetic proteins, growth factors, and other signaling molecules that provide the appropriate environment for bone formation and remodeling. Aim The aim of this study was to evaluate the role of autologous BM injection in the treatment of different types of bone cysts in children below the age of skeletal maturity as regards the healing time, the occurrence of pathological fractures, and recurrence after healing. Patients and methods Totally, 20 patients with accidentally discovered, uncomplicated bone cysts of different types were included in this prospective case series study. All patients were below the age of skeletal maturity. Patients were evaluated clinically and radiologically before surgery. All cases were treated with three repeated injections (at 3 weeks’ intervals) of BM aspirated from their iliac crests and injected in the cystic lesions under image intensifier. Patients were followed up for a mean time of 26 months postoperatively. Results The results were successful in 18 patients (90% of the studied patients), with a mean healing time of 15.4 weeks. Totally, 15 cases (75% of the studied patients) had completely healed and were graded as Neer I, whereas three cases (15% of the studied patients) healed with small defects and were graded as Neer II, with good functional and radiological results. Only two cases (10% of the studied patients) had recurrence and were considered as failure (Neer IV). Conclusion The satisfactory clinical and radiographic results of this study support the use of percutaneous autologous BM injection as one of the treatment options in the management of cases with bone cysts of different types in patients below the age of skeletal maturity as an easy, safe, simple, and effective treatment method. Repeated injections improve healing rate and shorten the healing time.

Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

Delayed union or nonunion of bone fracture is becoming less frequent, but still remains a challenging clinical problem. Autologous cancellous bone grafting that is the gold standard method, often involves donor site morbidities and complications. Once these fractures have been mechanically stabilized, other local factors should be investigated to promote delayed healing. The purpose of this study was to evaluate the initial outcome of the percutaneous injection of autologous bone marrow after concentration for the treatment of delayed or nonunion. Our subjects included 10 patients of delayed or nonunion fracture (3 female, 7 male) with an average age of 28 years. All fractures were mechanically stabilized after accident. Delayed or nonunion affected the femur in 2 patients, the tibia in 5 patients, the humerus in 2 patients, and the ulna in 1 patient. Bone marrow aspirates were obtained from both the posterior superior iliac crest. Bone marrow aspiration concentrate was produced via density gradient centrifugation. Trocars were inserted in the delayed or nonunion gap under fluoroscopic guidance. The bone marrow aspiration concentrate was injected slowly. As results, all of 10 delayed or nonunion healed after treatment with percutaneous injection of autologous bone marrow. The mean time for new bone formation was 3.3 months, for clinical union was 5.2 months, and for radiological union was 11.8 months. The current study is encouraging in the initial outcome and percutaneous bone marrow implantation could be an effective and safe treatment for delayed or nonunion.

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

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.

Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases.

Non-union of long bones is still a current problem in traumatology. Although corticocancellous bone autograft remains the usual procedure for the treatment of non-union, innovative therapies such as, percutaneous autologous concentrated bone marrow grafting (PABMG), are now appearing. Over a period of 8 years, 45 non-union of long bones were treated by PABMG in the Department of Orthopaedic and Traumatologic Surgery (University Hospital of Nancy, France): 26 tibiae, 16 femurs, 3 humeri. Efficiency was evaluated by clinical criteria: full weight-bearing without pain, absence of motion at non-union site, and radiological criteria: healing of 3 corticales out of 4. Eighteen out of 28 non-unions at the tibia were healed (69%), 10 at the femur (63%), but none was noticed at the humerus. Some pejorative prognosis factors were noted such as: tobacco, alcohol abuse, diabetes and history of infection at the fracture site. An earlier grafting improved the success rate. The number of CFU-F (Colony Forming Unit Fibroblastic) affected the healing time more than the healing rate. The procedure, even though a little invasive, enables the healing of non-union in two out of three cases with less morbidity than conventional procedures. This procedure fits perfectly into the therapeutic arsenal of non-union.

Percutaneous Autologous Bone Marrow Injection in the Treatment of Distal Meta-diaphyseal Tibial Nonunions and Delayed Unions

To report the outcomes of percutaneous autologous bone marrow injection for nonunion or delayed union of the distal tibial metaphysis in patients with prior plating. Consecutive case series. Tertiary center. Eleven consecutive patients (aged 24-51 years) were referred to us with a nonunion or delayed union of the distal tibial metaphysis after open reduction and internal fixation (plates and screws) at the time of fracture. The average time from initial injury to nonunion or delayed union and bone marrow treatment was 8 months (range, 3-20 months). A total of 40-80 mL of bone marrow aspirated from the posterior iliac crest and injected in and around the nonunion or delayed union site under fluoroscopic guidance. Healing at the injury site was evaluated using clinical and radiographic criteria, including computed tomography. Measures included American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), Brief Pain Inventory, and Short Form 12 Physical Component Summary. Nine of the 11 patients attained bony union within 6 months of bone marrow injection. Six of these 9 patients who were followed-up an average of 4.4 years (range, 1.3-8.2 years) after the injection reported significant (P < 0.05) improvements in Lower Limb Core Scale (59.9-89.7), pain intensity (2.9-1.7), pain interference (4.6-2.3), and Short Form 12 Physical Component Summary (29.5-46.6) and 5.6 years improvement in quality-adjusted life years. Percutaneous autologous bone marrow injection is a minimally invasive, safe, and inexpensive treatment option for distal metaphyseal tibial nonunions or delayed unions after internal fixation and should be considered when the retained hardware seems to be intact and stable. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Autologous bone marrow graft and treatment of delayed and non-unions of long bones: Technical aspects

This article reports the technique of percutaneous autologous bone marrow injection as a minimally invasive method alternative to open grafting techniques in the treatment of delayed unions and non-unions. Despite continuous advances in the treatment of long bone fractures, disturbances of healing processes remain a difficult challenge for orthopaedic surgeons. Percutaneous administration of substances with osteoinductive and osteogenic properties offers the advantage of decreased morbidity associated with the classic open grafting techniques. This makes it worth exploring before embarking on more extensive open surgery. The authors present the main technical stages of the percutaneous bone marrow grafting (bone marrow aspiration, concentration, intra-osseous re-injection and post-operative protocol) with a short literature review about this topic.

Percutaneous autologus bone marrow injection in the treatment of delayed or nonunion

Background:Bone marrow is a source of osteoprogenitor cells that are key elements in the process of bone formation and fracture healing. The purpose of the study was to ascertain the osteogenic potential of autologous bone marrow grafting and its effectiveness in the management of delayed union and nonunion.Materials and Methods:Twenty-eight patients with delayed union and three with nonunion of fracture of the long bones were treated with this procedure. Of these 28 cases, two patients had fracture shaft femur, one had fracture shaft ulna and 25 patients had tibial shaft fractures. The average time duration between procedure and injury was 25 weeks (range 14-53 weeks). The bone marrow was aspirated from the anterior iliac crest and injected percutaneously at the fracture site. The procedure was carried out as an outpatient procedure. All but five cases required one injection of bone marrow.Results:Union was observed in 23 cases. The average time of healing after the procedure was 12 weeks (range 7-18 weeks).Conclusion:The technique of percutaneous autologous bone marrow injection provides a very safe, easy and reliable alternative to open bone grafting, especially for early intervention in fracture healing process.