Efficacy of autologous percutaneous bone marrow graft injection for treatment of nonunion of the tibia

Traditional autologous bone grafting for nonunion is associated with many complications in both donor and recipient sites. This retrospective study investigated the efficacy of autologous percutaneous bone marrow graft injection for treatment of nonunion of the tibia in a series of patients. Fourteen adult patients with fractures of the tibia with nonunion were treated with autologous percutaneous bone marrow graft injection at our hospital from January 1996 to January 2000. There were ten male patients and four female patients. The average age of the patients was 26.5 years (range, 21 to 62 years). The duration of follow up averaged 1 year 8 months and ranged from 12 months to 4 years. The indications for the procedure was the presence of an established traumatic tibial nonunion. The nonunion was classified as hypertrophic in two patients and atrophic in 12 patients. The mean duration from injury to marrow injection was 1 year (range, 12 to 26 months). The mean duration from the last operation to bone marrow injection was 10.4 months (range, 7 to 16 months). The mean size of the bony defect was 6.5 mm (range, 3.0 to 36 mm). The mean time from injection of bone marrow to union of the fracture was 6 months (range, 3 to 10 months). Patients received marrow injected in volumes of 80 to 100 mL obtained using multiple punctures 1 to 2 cm apart along the iliac crest. The mean number of nucleated type cells in the aspirated marrow was 3.6×10⁴ /mm³ (range, 2.9 to 5.2×10⁴ /mm³). Four patients received repeated injections. Clinical and radiological union and recovery of pre-injury activity level was achieved in 12 of 14 cases (85.7%), and there were two cases with initial infected nonunion which failed to achieve union. Conclusions: The results of this study suggest that autologous percutaneous bone marrow graft injection is a simple, effective, and safe operative treatment for nonunion of the tibia. Tibial nonunion with an active infection is a contraindication for this procedure.