Multidirectional percutaneous drilling and autologous bone marrow injection for the treatment of femoral diaphyseal nonunions: a prospective interventional study

Abstract

Background: To examine the outcomes of multidirectional percutaneous drilling and autologous concentrated bone marrow (BM) transplantation for atrophic femoral diaphyseal nonunion characterized by intact hardware and mechanical stability at the nonunion site.

Methods: Fourteen patients (22-63 years of age) were admitted to our hospital with atrophic femoral diaphyseal nonunion. All patients were treated with a combination of multidirectional percutaneous drilling and autologous concentrated BM transplantation. Radiographic evaluation was conducted every month after transplantation until bone healing was achieved.

Results: Bony union was achieved in 13 of the 14 patients (92.9%) after an average of 3.9 months (range: 2.5-6 months). The average radiographic union scale in tibial (RUST) scale score improved significantly from the preoperative period (6.15±1.21) to follow-up (11.23±0.73; P<0.05). The mean follow-up after transplantation was 31.4±9.5 months (range: 18-50 months). At the final follow-up, the quality of function had improved significantly, allowing a return to normal activities.

Conclusion: Combined multidirectional percutaneous drilling and autologous concentrated BM transplantation is an easy, safe, inexpensive, and efficacious method to treat atrophic femoral diaphyseal nonunion characterized by intact hardware and mechanical stability at the nonunion site.Trial registration number: ISRCTN29808592.

Keywords: autologous bone marrow injection; femoral diaphyseal fracture; multidirectional percutaneous drilling; nonunion.

Figure 1

The steps of the procedure. (A) Fracture nonunion; (B) multiple drilling of the nonunion site from different angles; (C) autologous bone marrow grafting.

Figure 2

Intraoperative photographs of a patient with femoral shaft nonunion. (A) The drilling process; (B and C) fluoroscopy during drilling; (D) fluoroscopy-guided placement of the tip of a concentrated bone marrow (BM) syringe needle in the nonunion gap.

Figure 3

BM transplantation of a 44-year-old male patient. (A and B) Postoperative result immediately after multidirectional percutaneous drilling and autologous concentrated bone marrow (BM) transplantation in a 44-year-old male patient; (C and D) 1 month postoperatively; (E and F) bony union, achieved 3 months postoperatively; (G and H) complete remodeling of the callus obtained at 19 months postoperatively.

Figure 4

Bone marrow (BM) transplantation of a 25-year-old female patient. (A and B) Radiographs of femoral shaft nonunion in a 25-year-old female patient; (C and D) postoperative result immediately after multidirectional percutaneous drilling and autologous concentrated BM transplantation; (E and F) 1 month postoperatively; (G and H) bony union, achieved 4 months postoperatively; (I and J) radiological results after removal of the intramedullary nail.

Figure 5

Analysis of the RUST score between preoperative and postoperative follow-up. Each bar represents the mean ± SD. *P=0.000, P<0.05. Abbreviation: RUST, radiographic union scale in tibial.