title: The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing.
abstract: The aim of this study was to assess the union rates in a series of patients with failed femoral shaft aseptic non-union who were treated with percutaneous concentrated autologous bone marrow grafting. Bone marrow harvesting and cell injection were performed under general anaesthesia in a single surgical procedure. Radiographic union was diagnosed in fractures with a score ≥ 10 according to the radiographic union scale in tibial fractures (RUST) and confirmed by clinical examination. Eight out of 16 patients progressed to consolidation (RUST score ≥ 10). Radiographic evidence of fracture union was observed at an average of 4.75 ± 1.75 months (range 3 to 8 months). All eight patients who did not progress to union within 12 months following the cell grafting procedure had a RUST score ≤ 10 (range 4 to 9). There were no differences in age, number of previous surgeries, duration of nonunion and preoperative RUST score between the patients that developed solid union and those with failed consolidation. However, a relationship between the number of osteoprogenitors injected and the rate of union was noted, 20.2 ± 8.6 × 10(8) versus 9.8 ± 4.3 × 10(8), p<0.005, between the patients with and without union, respectively. The efficacy of percutaneous autologous concentrated bone marrow grafting seems to be related to the number of osteoprogenitors available in the aspirates. Optimisation of the aspiration technique and concentration process is of paramount importance to increase the incidence of a successful outcome.
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil. Electronic address: jomatheus@uol.com.br.
authors.forename: João Antonio Matheus
authors.initials: JA
authors.lastname: Guimarães
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Maria Eugenia L
authors.initials: ME
authors.lastname: Duarte
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Marco B Cury
authors.initials: MB
authors.lastname: Fernandes
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Verônica F
authors.initials: VF
authors.lastname: Vianna
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Tito H N
authors.initials: TH
authors.lastname: Rocha
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Bonfim
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Priscila L
authors.initials: PL
authors.lastname: Casado
authors.affiliation: School of Medicine, Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Isabel C C
authors.initials: IC
authors.lastname: do Val Guimarães
authors.affiliation: Epidemiology and Biostatistics, Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Luis G Coca
authors.initials: LG
authors.lastname: Velarde
authors.affiliation: Institute of Health Sciences, Federal University of Rio de Janeiro, Brazil.
authors.forename: Hélio S
authors.initials: HS
authors.lastname: Dutra
authors.affiliation: School of Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000706:statistics & numerical data*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010012:Osteogenesis; D012086:Reoperation / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Bone marrow grafting; Femoral shaft fracture; Fracture healing; Intramedullary nailing; Non-union