Table 1.
The effectiveness of bone marrow (BM) injections for nonunions
| First author/year | Number of nonunions | Type | Mean age (y), n (range) | United, n (%) | Time to union (months), n (range) | Comments |
|---|---|---|---|---|---|---|
| Healey/1990 [45] | 8 | Femur 8 | 27 (6–60) | 5 (62.5) | 4.95 (1–9) | Nonunion occurred after reconstruction for lower limb cancer resection |
| 50 ml percutaneous injection | ||||||
| Connolly/1991 [18] | 10 | Tibia 10 | 30 (18–82) | 8 (80) | 6.7 (5–10) | 100–150 ml of BM aspirated and injected |
| Fractures were immobilised by cast | ||||||
| Garg/1993 [32] | 20 | Tibia 15 | 35 (18–65) | 17 (85) | 5 (3–7) | Percutaneous injection of 15–20 ml of BM |
| Humerus 3 | ||||||
| Ulna 2 | ||||||
| Sim/1993 [102] | 11 | Tibia 8 | 38 (19–62) | 9 (81) | 2.5 (1–5.75) | Percutaneous injection of 50–200 ml of BM |
| Femur 1 | ||||||
| Humerus 1 | ||||||
| Ulna 1 | ||||||
| Garg/1995 [33] | Case report | Tibia | 12 | 1 (100) | 18 | ∼20 ml of BM were aspirated and injected in pseudoarthrosis while limb was placed in cast |
| After 3 weeks the procedure was repeated | ||||||
| Matsuda/1998 [69] | 7 | Femur | 53 (24–70) | 4 (57) | na (5–9) | Percutaneous technique with injection of 150 ml of BM |
| Two infections encountered resulting in failed union | ||||||
| Sebecic/1999 [99] | Case report | Tibia 1 | 44 | 1 (100) | 5 | 150 ml injected and immobilisation achieved by external fixation |
| Siwach/2001 [103] | 72 | Tibia 42 | 41.2 (26–56) | 68 (94) | na | A maximum of 30 ml of BM aspirated and injected percutaneously at nonunion site |
| Femur 8 | The procedure was repeated where required after 4–6 weeks after initial injection | |||||
| Humerus 12 | ||||||
| Forearm 10 | ||||||
| Wang/2001 [113] | 56 | Tibia | na (19–72) | 53 (94) | na | BM aspirated and injected percutaneously at nonunion site |
| The procedure was repeated every month 2–3 times | ||||||
| Wilkins/2003 [115] | 69 | Tibia 36 | 42 (15–81) | 61 (88) | 8.1 (2–36) | Percutaneous technique with BM combined with allograft demineralised bone matrix |
| Femur 16 | ||||||
| Humerus 4 | ||||||
| Others 13 | ||||||
| Goel/2005 [38] | 20 | Tibia 20 | 37.5 (24–60) | 15 (75) | 3.5 (1.5–5.5) | A maximum of 15 ml of BM was aspirated and percutaneously injected |
| Hernigou/2005 [47] | 60 | Tibia 60 | 40 (18–78) | 53 (88) | 3 (1–4) | An average of 306 ± 24 ml was aspirated, concentrated to 20 ml and percutaneously injected |
| Tetreault/2007 [107] | Case report | Clavicle | 39 | 1 (100) | na (within 12) | Percutaneous injection of 10 ml of BM |
na not available
Level of Evidence: All presented studies are 2C except case reports which are 1C