title: Percutaneous autologous concentrated bone marrow grafting in the treatment for nonunion.
abstract: The purpose of this study was to evaluate the clinical and radiographic treatment effects of percutaneous autologous concentrated bone marrow grafting in nonunion cases and to evaluate the effectiveness of this grafting procedure. We enrolled 17 cases those had atrophic changes due to continuous nonunion for over 9 months after injury and had undergone low-intensity pulsed ultrasound treatment for more than 3 months. The site of nonunion was the femur in 10 cases, the tibia in 5 cases, the humerus in 1 case, and the ulna in 1 case. They underwent percutaneous autologous concentrated bone marrow grafting and continued low-intensity pulsed ultrasound stimulation treatment after grafting. Patients were evaluated using the visual analogue scale for pain at immediately before the procedure, 3, 6, and 12 months after grafting. Plain radiographs of the affected site were taken and evaluated about the healing of the nonunion site at each clinical evaluation. As quantitative assessment, CT scans were undertaken before the procedure and 6 months after grafting. The visual analogue scale pain score was reduced consistently after grafting in all patients. About the healing at the nonunion site, 11 and 13 cases of bone union were observed at 6 and 12 months after grafting. The mean volume of callus formation based on CT images was 4,147 (262-27,392) mm3 total between grafting and 6 months. Percutaneous autologous concentrated bone marrow grafting is an effective procedure for the treatment of patients with nonunion.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugaya
authors.forename: Hajime
authors.initials: H
authors.lastname: Mishima
authors.forename: Katsuya
authors.initials: K
authors.lastname: Aoto
authors.forename: Meihua
authors.initials: M
authors.lastname: Li
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Sakai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Akaogi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Ochiai
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000534:rehabilitation; D003131:Combined Modality Therapy; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous / Q000379:methods / Q000534:rehabilitation; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D014464:Ultrasonic Therapy / Q000379:methods; D055815:Young Adult