Autologous bone marrow injection to stimulate bony union in delayed union or non-union of long and small bone.

AbstractBackground:Delayed union and non-union of fractures remain significant clinical problems despite advances in fixationtechniques. Conventional autologous bone grafting, while effective, is associated with donor site morbidity andinfection risks. Autologous bone marrow injection (ABMI) offers a minimally invasive biological alternativethat harnesses osteoprogenitor cells and growth factors to stimulate bone healing. This study aimed to evaluatethe effectiveness of percutaneous ABMI in promoting fracture union in cases of delayed and non-union of longand small bones.Methods:A retrospective study was conducted at the Department of Orthopedics, Northern Railway Divisional Hospital,New Delhi, from August 2017 to February 2019. A total of 24 patients (19 males, 5 females; mean age 41years) with delayed or non-union fractures were treated with percutaneous autologous bone marrowinjection under C-arm guidance. Bone marrow was aspirated from the proximal tibia (20–50 ml) and injectedat the fracture site under local anesthesia. Clinical and radiological assessments were performed at 6, 12, 16,and 20 weeks. Outcomes were graded as excellent, good, or poor based on the time to union andcomplications.Results:Of the 24 cases, 18 (75%) involved the tibia, 3 (12%) the ulna, and 1 (4%) each the humerus, clavicle, andmalleolus. The mean interval between injury and marrow injection was 22 weeks (range: 12–43 weeks). Unionwas achieved in 23 patients (96%), with 18 (75%) excellent, 5 (21%) good, and 1 (4%) poor results. Themean healing time was 14 weeks (range: 11–26 weeks). No major complications were reported, and minordonor-site discomfort resolved spontaneously.Conclusion:Percutaneous autologous bone marrow injection is a safe, effective, and cost-efficient technique forstimulating bone healing in delayed and non-union fractures of long and small bones. It can be performedunder local anesthesia as a day-care procedure with minimal morbidity. Early intervention during the delayedunion phase can significantly reduce the need for open grafting and improve patient outcomes.