title: Percutaneous grafting with bone marrow autologous concentrate for open tibia fractures: analysis of forty three cases and literature review.
abstract: OBJECTIVE
  Tibial fractures are the most common lower limb fractures. Some criteria such as open fractures and increasing open stage are known to be associated with high delayed union and pseudarthrosis rate. In cases of delayed or nonunion, classical treatment is autologous cancelous bone graft which is associated with high morbidity rate. The ideal treatment would be a percutaneous harvesting and grafting technique. As bone marrow autologous concentrate (BMAC) presents both advantages, we evaluated this technique from 2002 to 2007.
  
  
  METHODS
  This was a retrospective study of 43 cases of open tibial fractures with initial surgical treatment. The criteria of inclusion were open fracture and nonunion, delayed union or suspicion of delayed union.
  
  
  RESULTS
  In 23 cases (53.5 %) BMAC was successful. The success group had received significantly more CFU-F than the failure group (469 vs 153.10(3), p = 0.013). A threshold of 360.10(3) CFU-F grafted could be established over which there was 100 % success. BMAC done before 110 days after fracture had 47 % success and BMAC done since 110 days after fracture had 73 % success. BMAC success rate decreased with increasing initial fracture skin open stage. There was no BMAC success in cases of a fracture with a remaining gap of more than 4 mm. We had no complications with the technique at the iliac harvesting zone and tibia injection point.
  
  
  CONCLUSIONS
  BMAC is a technique that should be considered as one of the different alternatives for management of long-bone delayed and nonunion because of its effectiveness, low complication rate, preservation of bone stock and low cost.
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologique 2, Hôpital Trousseau, Université François-Rabelais de Tours, CHU de Tours, 37044, Tours cedex 09, France.
authors.forename: Louis-Romée
authors.initials: LR
authors.lastname: Le Nail
authors.forename: Julien
authors.initials: J
authors.lastname: Stanovici
authors.forename: Joseph
authors.initials: J
authors.lastname: Fournier
authors.forename: Marie
authors.initials: M
authors.lastname: Splingard
authors.forename: Jorge
authors.initials: J
authors.lastname: Domenech
authors.forename: Philippe
authors.initials: P
authors.lastname: Rosset
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016026:Bone Marrow Transplantation / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D017759:Fractures, Malunited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000166:cytology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Indian J Orthop. 2007 Jan;41(1):67-71
references.pmid: 21124686
references.citation: J Hand Surg Am. 2007 May-Jun;32(5):647-50
references.pmid: 17482003
references.citation: Biomaterials. 2008 Oct;29(29):3973-82
references.pmid: 18639333
references.citation: J Bone Joint Surg Br. 2008 Dec;90(12):1617-22
references.pmid: 19043134
references.citation: J Orthop Res. 2001 Jan;19(1):117-25
references.pmid: 11332607
references.citation: J Bone Joint Surg Am. 2006 Sep;88 Suppl 1 Pt 2:322-7
references.pmid: 16951103
references.citation: Indian J Med Sci. 2001 Jun;55(6):326-36
references.pmid: 11885510
references.citation: J Trauma. 1984 Aug;24(8):742-6
references.pmid: 6471139
references.citation: J Bone Joint Surg Am. 2004 Jun;86(6):1153-60
references.pmid: 15173287
references.citation: J Bone Joint Surg Br. 2009 Aug;91(8):987-96
references.pmid: 19651823
references.citation: Nihon Geka Hokan. 1998 Mar 1;67(1):10-7
references.pmid: 10401231
references.citation: J Bone Joint Surg Am. 2006 Jan;88(1):206-16
references.pmid: 16425471
references.citation: J Bone Joint Surg Br. 2001 Jan;83(1):62-8
references.pmid: 11245540
references.citation: Clin Orthop Relat Res. 1991 May;(266):259-70
references.pmid: 2019059
references.citation: Clin Orthop Relat Res. 1989 Mar;(240):270-80
references.pmid: 2645077
references.citation: J Orthop Surg (Hong Kong). 2013 Apr;21(1):60-4
references.pmid: 23629990
references.citation: Injury. 2007 May;38 Suppl 2:S77-84
references.pmid: 17920421
references.citation: J Bone Joint Surg Am. 2002 Dec;84(12):2123-34
references.pmid: 12473698
references.citation: Int Orthop. 2011 Sep;35(9):1271-80
references.pmid: 21698428
references.citation: J Bone Joint Surg Am. 1989 Jun;71(5):684-91
references.pmid: 2732257
references.citation: Eur J Orthop Surg Traumatol. 2014 Jul;24(5):671-8
references.pmid: 24275891
references.citation: Clin Orthop Relat Res. 2005 Sep;438:221-32
references.pmid: 16131895
references.citation: J Orthop Trauma. 2007 Mar;21(3):153-7
references.pmid: 17473750
references.citation: Int Rev Cytol. 1976;47:327-59
references.pmid: 11195
references.citation: Singapore Med J. 1993 Oct;34(5):412-7
references.pmid: 8153688
references.citation: Acta Orthop Scand. 1993 Dec;64(6):671-2
references.pmid: 8291415
references.citation: Clin Orthop Relat Res. 1990 Jul;(256):280-5
references.pmid: 2364614
references.citation: Clin Orthop Relat Res. 1995 Apr;(313):8-18
references.pmid: 7641502
references.citation: Spine (Phila Pa 1976). 2003 Jan 15;28(2):134-9
references.pmid: 12544929
references.citation: Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S86-104
references.pmid: 20407355
references.citation: Injury. 2005 Jan;36(1):203-6
references.pmid: 15589942
references.citation: J Orthop Trauma. 1998 Jan;12(1):1-7
references.pmid: 9447512
references.citation: Cytotherapy. 2013 May;15(5):571-7
references.pmid: 23415918
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1997;83(6):495-504
references.pmid: 9587614
references.citation: Einstein (Sao Paulo). 2013 Jan-Mar;11(1):122-7
references.pmid: 23579757
references.citation: J Bone Joint Surg Am. 2005 Jul;87(7):1430-7
references.pmid: 15995108
references.citation: J Bone Joint Surg Br. 2005 Jul;87(7):896-902
references.pmid: 15972899
references.citation: Indian J Orthop. 2009 Jan;43(1):40-5
references.pmid: 19753178
references.citation: J Bone Joint Surg Br. 1984 Aug;66(4):573-9
references.pmid: 6378916
references.citation: J Bone Joint Surg Am. 2006 Jun;88(6):1258-65
references.pmid: 16757759
references.citation: J Bone Joint Surg Am. 2001;83-A Suppl 1(Pt 2):S151-8
references.pmid: 11314793
references.citation: J Orthop Trauma. 2013 Sep;27(9):527-33
references.pmid: 23443050
references.citation: J Orthop Trauma. 2001 Aug;15(6):415-23
references.pmid: 11514768
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1997;83(1):33-40
references.pmid: 9161546
references.citation: Int Orthop. 2014 Mar;38(3):635-47
references.pmid: 24352822
references.citation: J La State Med Soc. 1997 Jun;149(6):200-6
references.pmid: 9188244
references.citation: Injury. 2007 Mar;38 Suppl 1:S75-80
references.pmid: 17383488
references.citation: J Orthop Trauma. 2003 May;17(5):353-61
references.pmid: 12759640
references.citation: J Orthop Trauma. 2004 Feb;18(2):96-101
references.pmid: 14743029
references.citation: Bull Hosp Jt Dis. 1997;56(1):63-72
references.pmid: 9063607
references.citation: J Orthop Trauma. 2000 Mar-Apr;14(3):187-93
references.pmid: 10791670
references.citation: Clin Orthop Relat Res. 1986 Jul;(208):300-12
references.pmid: 3522026
references.citation: Clin Orthop Relat Res. 1998 Oct;(355 Suppl):S257-66
references.pmid: 9917645
references.citation: Spine J. 2009 Nov;9(11):886-92
references.pmid: 19540168
references.citation: J Bone Joint Surg Am. 2013 Dec 18;95(24):2215-21
references.pmid: 24352775
references.citation: Spine (Phila Pa 1976). 2001 Jul 1;26(13):1473-6
references.pmid: 11458153
references.citation: Biomed Mater Eng. 2009;19(4-5):277-81
references.pmid: 20042794
references.citation: Injury. 2001 Jan;32(1):61-5
references.pmid: 11164405