Autologous marrow injection in the treatment of delayed and non-union in long bones

A retrospective study of the use of autologous bone marrow injection for the treatment of delayed and non-union of long bones in an Orthopaedic Department, Singapore General Hospital from 1990-1991 is presented. There were 10 patients with 11 fractures (8 tibia and one each of humerus, femur and radius-ulna) available for study. Percutaneous injection of autologous marrow alone was used to stimulate healing of delayed and non-unions treated initially by plating, external fixation and in one case, by plaster cast. Marrow injection stimulated a callus formation sufficient to unite 9 of the fractures. The median time to clinical union was 10 weeks (range 4-23 weeks) and radiological union 17 weeks (range 9-29 weeks). Most patients had discomfort at the donor and injected sites for one to two days. There was one case of infection but none of the significant donor site morbidity was associated with standard open autologous grafting. Bone marrow injection was effective in stimulating bony union, with numerous advantages and considerably lower morbidity compared with standard open autologous grafting. Shorter inpatient stay was a significant feature.