Vol 35 | Issue 3 | September-December 2020 | page: 3-6 | Aman Saini, Sumit Kumar, Himanshu Bansal, Sanjeev Sareen
Authors: Aman Saini , Sumit Kumar , Himanshu Bansal , Sanjeev Sareen 
 Department of orthopaedics, Govt. Medical college and Hospital, Patiala, Punjab, India.
Address of Correspondence
Dr. Sumit Kumar.
Department of orthopaedics, Govt. Medical college and Hospital, Patiala, Punjab, India.
Context: Fracture heals by a specialized process in which bone regenerates by restoring the integrity of skeletal tissue. In non-union fracture healing cascade has ceased and it’ll not progress without an intervention. Autologous bone marrow grafts are regarded as gold standard for treating non-unions. Recently there has been a trend a towards lesser invasive techniques in which bone marrow can be aspirated from iliac bone by aspiration needle and is administered percutaneously at non union site.
Material and Methods: 30 cases of post-traumatic delayed union and non-union of fracture tibia with internal fixation having abnormal mobility without infection were included in the study. Baseline RUST scoring was calculated for each fracture and bone marrow aspirate injections were given at fracture site by percutaneous route.
Result: On the premise of final RUST and clinical analysis, union in 23(76.67%) fractures was achieved by autologous bone marrow injections by percutaneous route whereas 7(23.33%) cases did not responded even after three attempts of procedure. The complications of the procedure are negligible and it is safe. The mean time of radiological union in our study was fourteen weeks with a range of 11-22 weeks.
Conclusion: On the basis of our results and observations within the study we are able to conclude that autologous bone marrow injection is an efficient method compared to traditional open bone grafting with less invasive technique and be performed as out-patient procedure undern local anesthesia. It is cheap and safe with negligible complication rate at donor or recipient graft site.
Keywords: Non-Union, Fractures, Autologous, bone marrow, Tibia.
1. Thompson Z, Miclau T, Hu D, Helms JA. A model for intramembranous ossification during fracture healing. Journal of Orthopaedic Research 2002 Sep;20(5):1091-8.
2. Beck BR, Matheson GO, Bergman G, Norling T, Fredericson M, Hoffman AR, et al. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. The American journal of sports medicine. 2008 Mar;36(3):545-53.
3. Court-Brown C., Heckman J., McQueen M., Ricci W, Tornetta P, McKee M. (1975). Rockwood and Green’s fractures in adults. 8th ed. USA: wolterkluwer, pp.107-22.
4. Brashear HR. Diagnosis and prevention of non-union. JBJS. 1965 Jan 1;47(1):174-8.
5. Browner BD, Jupiter JB, Levine AM, Trafron PG, eds. Skeletal trauma Basic Science Management And Reconstruction. Philadelphia, PA:WB Saunders; 2003:507-604.
6. Frölke JP, Nulend JK, Semeins CM, Bakker FC, Patka P, Haarman HJ Viable osteoblastic potential of cortical reamings from intramedullary nailing. Journal of orthopaedic research. 2004 Nov;22(6):1271-5.
7. Guttarlapalli PG, ChallaS .Outcome of percutaneous bone marrow injection in delayed union and nonunion of long bone fracture. International Journal of Orthopedics;.2017: 16-19.
8. Gross JB, Diligent J, Bensoussan D, Galois L, Stoltz JF, Mainard D. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Bio- medical materials and engineering. 2015 Jan 1;25(s1):187-97.
9. Upadhyay S, Varma HS, Yadav V. Percutaneous autologous stem cell enriched marrow concentrate injection for treatment of cases of impaired fracture healing with implant in situ: A cost-effective approach in present Indian scenario. J Orthop Allied.2015;2016:18-29.
10. Sarmiento A. On the behaviour of closed tibial fractures:clinical/radiological correlations. Journal of orthopaedic trauma. 2000 Mar 1;14(3):199-205.
11. Phemister DB. Treatment of united fractures by onlay bone grafts without screw or tie fixation and without breaking down of the fibrous union. J bone koint Surg 1947; 29:946-60.
12. Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AH. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone & joint research. 2016 Apr;5(4):116-21.
13. Whelan DB, Bhandari M, Stephen D, et al. Development of the radiographic union score of tibial fractures for the accessment of tibial fractures healing after intramedullary fixation. J trauma 2010;68:629-32
14. Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injection for delayed or non-union of bones.21 J Orthop Surg.2013;21(1):60-4.
15. Padha V, Mahajan N, Kalsotra N, Salaria A, Sharma S.Role Of Percutaneous Bone Marrow Injection In Delayed Union And Non Union 2009;18:1-8
16. Bhutia KU, Bary AA, Singh AK, Singh AM, Raghuvanshi R, Hmar C. Role of percutaneous autologous bone marrow injection in treatment of delayed union and nonunion of long bones. Journal Of Dental And Medical Sciences. 2015;14:07-13.
17. Sahu R L.Percutaneous autogenous bone marrow injection for delayed union or non-union of long bone fractures after internal fixation.rev bras orthop .2018;53(6):668–673
18. Bhargava R, Sankhla S S, Gupta A, Changani RL,Gagal KC. Percutaneous autologous bone marrow injection in the treatment of delayed or non-union.Indian J Orthop. 2007 Jan-Mar; 41(1): 67–71.
19. Elsattar TA, Alseedy AI, Khalil AA. Bone marrow injection in treatment of long bone nonunion. Menoufia Med J 2014;27:632-5.
|How to Cite this Article: Saini A, Kumar S, Bansal H, Sareen S | Minimally Invasive Technique For Delayed union Or Nonunion #Tibia: The Use Of Percutaneous Autologous Bone Marrow Injection | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 3-6.