Percutoneous Autogenous Bone Marrow Grafting for the Management of Nonunion of Fractures

Objective To investigate the effect of autogenous hone marrow grafting in the management of nonunion of fractures. Methods Thirty-one patients were treated for nonunion of fractures. There were 7 of the humerus, 12 the carpal scaphoid, 5 the femur and 7 the tibia. The average age of the patients was 27 years (range 18 -- 77 years). The average time from nonunion to percutaneous bone marrow grafting was 13 months (range 7 -- 48 months). The operation was performed under local or general anesthesia. A marrow needle was inserted into the site of the nonunion under the X -- ray, and a total of 10 -- 50 ml of bone marrow was aspirated from the anterior or posterior iliac crest and was injected immediately into the site of nonunion, the limb was then immobilized. During the operation, a total of 10 -- 15 ml of hone marrow was injected into the carpal scaphoid only once, while a total of 30 -- 50 ml of hone marrow was injected into the long bones, and the procedure was repeated after 3 -- 4 weeks. Results Twenty-six of the 31 fractures had union in 7 (5 -- 9) months. All of the 12 carpal scaphoid were healed. Failure occurred in 5 cases, and there was no other complication in this group. Conclusion Percutaneous autogenous bone marrow grafting can play a role in osteogenesis at the site of nonunion. It is a method of choice for the treatment of nonunions of the carpal scaphoid and those fracture nonunions with poor local conditions contraindicated to open surgery.