Table 1

Clinical studies examining the efficacy of bone marrow injection for treatment of nonunions

Study

Study design

Results


Bhargava et al. [20] (2007)

Prospective cohort

Radiographic union rate: 82% (23/28)

Twenty-eight patients were treated after an average of 25 weeks after initial fracture (femur, ulna, tibia) with percutaneous BM injection that was performed in the office under radiographic control.

Average healing time: 12 weeks (range of 7 to 18 weeks)

Five out of 28 patients required two BM injections.

Average marrow volume injected: 50 to 90 mL

Goel et al. [15] (2005)

Prospective cohort

Radiographic union rate: 75% (15/20)

Twenty consecutive patients with established tibial nonunion (>24 weeks after initial injury) were treated with casting and BM injection under local anesthesia.

Average healing time: 14 weeks (range of 6 to 22 weeks)

Average number of BM injections: 2.3

A maximum of 15 mL of marrow was injected in one sitting.

Hernigou et al. [25] (2005)

Sixty patients with tibial nonunions were treated with autologous BM injections, which were performed under general anesthesia and radiographic guidance.

Radiographic union rate: ~88% (53/60)

Maximum concentrated marrow volume injected: 50 mL

All the nonunions that did not heal with BM injection had received fewer than 30,000 progenitors.

Wilkins et al. [29] (2003)

Prospectively followed cohort of 69 long bone nonunions (>6 months after initial injury) were treated with BM injection, which was performed under regional or general anesthesia and radiographic guidance.

Radiographic union rate: 88% (61/69)

Average healing time: 8.1 months (range of 2 months to 3 years)

Eight nonunions required two injections.

Demineralized bone matrix was used as a carrier.

Garg et al. [22] (1993)

Prospective cohort

Radiographic union rate: 85% (17/20)

Twenty consecutive patients with established long bone nonunion were treated with casting and BM injection.

Average healing time: 5 months (range of 3 of 7 months)

BM (15 to 20 mL) was injected twice with an interval of 3 weeks.

Sim et al. [21] (1993)

Retrospective study

Radiographic union rate: ~82% (9/11)

Eleven long bone nonunions were treated with autologous BM injection, which was performed under regional or general anesthesia under fluoroscopic guidance.

Median radiographic healing time: 17 weeks (range of 9 to 29 weeks)

Volume of marrow injected: 40 to 200 mL

Connolly et al. [18] (1991)

Case series

Radiographic union rate: 90% (18/20)

Twenty tibial nonunions were treated with autologous BM injection, which was performed under general anesthesia and radiographic guidance.

Median healing time: 5 months

Average marrow volume injected: 100 to 150 mL

Casting (n = 10) or intramedullary nail (n = 10) was used for immobilization.

Two out of 20 patients required two injections.


BM, bone marrow.

Virk and Lieberman Arthritis Research & Therapy 2012 14:225   doi:10.1186/ar4053