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

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.

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Role of prophylactic autologous bone marrow aspirate injection in accelerating union and rehabilitation in long bone fractures in surgically unfit patients

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i1e.44 ◽

2017 ◽

Vol 3 (1e) ◽

pp. 278-281

Author(s):

Dhruv Sharma ◽

◽

Kuljit Kumar ◽

Keyword(s):

Bone Marrow ◽

Bone Marrow Aspirate ◽

Bone Fractures ◽

Autologous Bone Marrow ◽

Long Bone ◽

Long Bone Fractures ◽

Unfit Patients ◽

Autologous Bone

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

The Egyptian Orthopaedic Journal ◽

10.4103/1110-1148.182310 ◽

2015 ◽

Vol 50 (4) ◽

pp. 249

Author(s):

WaleedMohamed Ewais

Keyword(s):

Bone Marrow ◽

Bone Fractures ◽

Autologous Bone Marrow ◽

Delayed Union ◽

Long Bone ◽

Long Bone Fractures ◽

Autologous Bone

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Pediatric long bone fractures treated by elastic intramedullary nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214175 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1095

Author(s):

Manoj P. Gupta ◽

Lokraj Chaurasia ◽

Sanjeet Kumar Jha

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Medical Records ◽

Bone Fractures ◽

Long Bone ◽

High Morbidity ◽

Long Bone Fractures ◽

The Mean ◽

Elastic Intramedullary Nailing ◽

Mean Time

Background: Pediatric long bone fractures can have a high morbidity and long term disability among the survivors. The present study was aimed to study the clinical outcomes of children with long bone fractures managed by elastic intramedullary nail.Methods: We retrospectively reviewed the medical records of children (aged 2 to 15 years) who were admitted and treated for unilateral femoral, tibial or forearm fractures with elastic intramedullary nail from January 2018 till February 2020. All were managed with elastic intramedullary nailing. The union times and complications were noted from the medical records.Results: Femoral, tibial and forearm bones were involved in 15 patients each (33.3%). Road traffic accident was reported by 31%) and physical abuse by one case (2%). The mean time of union was 10 weeks, ranging from 6 to 12 weeks. The mean time for union of the femur and tibia was 11.54 and 11.34 weeks respectively. It was significantly lower for forearm (6.67 weeks, p value <0.05). Two patients reported of bursitis and impingement, which were resolved after nail removal. One case had limb length discrepancy of about 0.5 cm in femur fracture, which was not impairing functional activity. Functional status was assessed based on Flynn criteria was found to be excellent in 36%, good in 44% and fair in 20%.Conclusions: The results of the present study show that titanium elastic nail (TEN) is an effective treatment modality for managing pediatric long bone fractures. We recommend the use of TEN in managing long bone fractures in children.

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Grafting Long Bone Fractures With Demineralized Bone Matrix Putty Enriched With Bone Marrow: Pilot Findings

Orthopedics ◽

10.3928/01477447-20061001-07 ◽

2006 ◽

Vol 29 (10) ◽

pp. 939-941 ◽

Cited By ~ 20

Author(s):

Ronald W. Lindsey ◽

Kalia K. Sadasivian ◽

George W. Wood ◽

Harrison A. Stubbs ◽

Jon E. Block

Keyword(s):

Bone Marrow ◽

Bone Fractures ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Long Bone ◽

Long Bone Fractures ◽

Demineralized Bone

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Efficacy of Autologous Bone Marrow Concentrate for Knee Osteoarthritis with and without Adipose Graft

BioMed Research International ◽

10.1155/2014/370621 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 83

Author(s):

Christopher Centeno ◽

John Pitts ◽

Hasan Al-Sayegh ◽

Michael Freeman

Keyword(s):

Bone Marrow ◽

Knee Osteoarthritis ◽

Autologous Bone Marrow ◽

Pain Scale ◽

Bone Marrow Concentrate ◽

Knee Oa ◽

Percentage Improvement ◽

Treatment Type ◽

The Mean ◽

Autologous Bone

Introduction.We investigated the use of autologous bone marrow concentrate (BMC) with and without an adipose graft, for treatment of knee osteoarthritis (OA).Methods.Treatment registry data for patients who underwent BMC procedures with and without an adipose graft were analyzed. Pre- and posttreatment outcomes of interest included the lower extremity functional scale (LEFS), the numerical pain scale (NPS), and a subjective percentage improvement rating. Multivariate analyses were performed to examine the effects of treatment type adjusting for potential confounding factors. The frequency and type of adverse events (AE) were also examined.Results.840 procedures were performed, 616 without and 224 with adipose graft. The mean LEFS score increased by 7.9 and 9.8 in the two groups (out of 80), respectively, and the mean NPS score decreased from 4 to 2.6 and from 4.3 to 3 in the two groups, respectively. AE rates were 6% and 8.9% in the two groups, respectively. Although pre- and posttreatment improvements were statistically significant, the differences between the groups were not.Conclusion.BMC injections for knee OA showed encouraging outcomes and a low rate of AEs. Addition of an adipose graft to the BMC did not provide a detectible benefit over BMC alone.

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Recovery of Viable CD34+ Cells from Cryopreserved Haemopoietic Stem Cell Products.

Blood ◽

10.1182/blood.v104.11.5018.5018 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5018-5018

Author(s):

Mary M. Sartor ◽

Frances Garvin ◽

Vicki Antonenas ◽

Melina Webb ◽

Kenneth F. Bradstock

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Cell Count ◽

Adult Stem Cell ◽

Autologous Bone Marrow ◽

Freeze Thaw ◽

Cd34 Cells ◽

Significant Difference ◽

The Mean ◽

Autologous Bone

Abstract The recovery of viable CD34+ cells reinfused into patients at the time of autologous or allogeneic transplantation is clinically an important variable, which can determine graft success or failure. In this study we analyse the recovery of viable CD34+ cells /kg pre and post cryopreservation on a total of 86 autologous stem cell products from adult and paediatric patients as well as 4 cryopreserved stem cell products from allogeneic donors. CD34 enumeration was performed on all samples pre and post cryopreservation using a novel in-house no-lyse CD34 assay (previously described ASH 2003 abstract no.1685). Cells were labelled with CD45, CD34 and 7AAD in TRUCOUNT tubes using a modified single platform ISHAGE protocol. The absolute number of viable CD34 + cells per Kg was determined. For the 77 PBSC harvest samples the mean viable CD34+ cell count was 6.0 x10^6/Kg (range 0.3 – 25.2 x 10^6/Kg) before freezing. For post thaw samples the mean viable CD34+ cell count was 5.5 x 10^6/Kg (range 0.2 – 24.6 x 10^6/Kg). The median recovery was 95% (range 48–124%). This represents a median loss post freeze/thaw of 5%. Further analysis showed a median recovery of 90% for NHL (range 48–119%, n=34), 87% for MM (range 56–115%, n=12), 92.5% for acute leukaemia (range 71–124% n=8) and 97% for non-hematological malignancies (range 50–120% n=21). There was no significant difference in the recovery of viable CD34+ cells within the four groups of malignancies (p>0.17 for all groups tested). Similarly, autologous bone marrow collections (n=9) also showed a good recovery of viable CD34+ cells post thaw. The median viable CD34+ cell count was 8.1x10^6 /Kg (range 0.6–30.3x10^6/kg) pre-cryopreservation, compared to a median viable cell count of 6.5 x10^6/Kg CD34+ cells (range 0.6–26x10^6/Kg) post thaw, this represents a median recovery of 90% viable CD34+cells from autologous bone marrow collections. There was no significant difference in the recovery of viable CD34+ cells from autologous PBSC harvests and autologous bone marrow collections (p=0.169). We also compared the recovery of viable CD34+ cells post thaw between adult and pediatric stem cells collections. The median recovery of viable CD34+ cells from 56 adult stem cell products post thaw was 91% (range 48–120%), compared to a median recovery of 96.5% (range 50–124%) viable CD34+ cells from 30 pediatric stem cell products (p=0.06). Interestingly the greatest loss occurred in allogeneic donors, where viable CD34+ counts on fresh samples averaged 5.7 x 10^6/Kg (range 3.1–11.8 x 10^6/Kg, n=4), whereas post freeze/thaw averaged 2.2 x 10^6/Kg (range 1.2–3.3 x 10^6/Kg). Representing a mean loss of 58% of CD34+ cells. Twenty-nine patients were transplanted with a median number of 3.8x10^6 viable CD34+ cells per Kg (range 1.8–18.4x10^6/Kg), The median time to neutrophil and platelet engraftment was 12 days (range 10–18) and 14 days (range 8–65) respectively. Assaying the viability of CD34+ cells post cryopreservation may identify patients at risk of poor haematological recovery that could benefit from further stem cell collections.

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Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20031033-9 ◽

2003 ◽

Vol 10 (3) ◽

pp. 3-9

Author(s):

V A Sokolov ◽

E I Byalik ◽

V A Sokolov ◽

E I Byalik

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Early Period ◽

Functional Results ◽

Fat Embolism ◽

Long Bone ◽

Long Bone Fractures ◽

Embolism Syndrome ◽

Urgent Operation

Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is performed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be performed on 3-10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

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