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.