Percutaneous autologous stem cell enriched marrow concentrate injection for treatment of cases of impaired fracture healing with implant in situ: A cost-effective approach in present Indian scenario

Background: The objective of present study is to investigate the feasibility of proposed methodology in present Indian scenario, to enhance fracture repair in cases of impaired healing with the implant in situ using autologous bone marrow concentrate. During critical analysis, the existing study also aimed to assess the outcome (both objective and subjective) as well as to document complications specific to the proposed therapy if any. Materials and Methods: First the marrow is aspirated from posterior iliac crests. After that Ficoll-Paque technique of density gradient separation for the isolation of mononuclear cell populations enriched with stem cells is employed. Later, the concentrate is injected into critical-sized defects of eight patients with stable fracture delayed/nonunion via fluoroscopic guidance. New bone formation was evaluated by X-rays in two standard planes (anteroposterior (AP)/lateral). Level of statistical significance was set at a P < 0.05. Result: The critical osseous defect reached radiographic observable union by a mean of 12.28 ± 1.38 weeks. A distance of 5 mm or less between the fractures′ ends resulted in healing in seven cases (87.5%). The results of the Likert four-point scale showed that majority were very satisfied with the outcome of the procedure (Cronbach′s alpha coefficient (follow-up): 0.93 (6 week); 1.0 (1 year)). There were no adverse events reported during the procedure. Conclusion: Our preliminary results indicate that the approach proposed is feasible and effective in the management of stable (implant in situ) fracture with impaired healing. In context of its cost-effectiveness, we recommend to follow proposed methodology in present Indian scenario