Osteoinduction using autologous bone marrow in difficult orthopaedic problems A clinical study

Abstract

Background: Bone injury/insult heals by new bone formation a process termed as osteogenesis .When this regenerative process is deficient, healing is disturbed and need for osteoinduction arises. Various methods of osteoinduction in current practice are either extensive or expensive. Bone marrow as a natural source for osteoinduction was first described in the year 1869. The current study aims at evaluating the results of injection of bone marrow aspirate in its natural form without separating its contents, to induce osteogenesis in difficult orthopaedic problems. Methods: The procedure was carried out in the Operation theatre under sterile precautions. Bone marrow was aspirated from the iliac crest in all cases. A sternal puncture needle was used for aspiration and around 30 ml was injected immediately, directly into the fracture site on a previously placed needle with the help of image intensifier. All these fractures had a fixation device either externally or internally. There was no evidence of infection at the time of injection. Defective non unions were excluded from the study. Radiological assessment for union was done at an interval of 4 to 6 weeks. Number of injections given varied from 2 to 4 and interval between the injections varied from 4 to 6 weeks. Results: In a total number of 33 cases distributed as follows that is, 27 type 3 B, open tibial diaphyseal fractures with delayed union stabilized by external fixator, 1 closed tibial fracture with nonunion, 1 closed tibial fracture with implant failure, 2 humeral shaft fractures with plate osteosynthesis, 2 fracture shaft femur with internal fixation, all showed progressive callus and union within an average period of 12 to 18 weeks with 2 or 4 bone marrow injections.