Have you been diagnosed with a bony non-union?
Did you know there are certain bones in your body that if fractured (broken) or surgically fused (eg, joined together) may be difficult to mend or heal? It is true. One challenge in the field of orthopedics is the limited supply (or lack) of blood to tissues.
- Bone forming cells (osteoblasts) and cells that break down and resorb old bone (osteoclasts) are circulated through the blood, and are vital to healing bone and tissue.
- Sometimes a bone fracture may damage a nearby blood vessel, which may compromise healing.
Certain structures in an adult’s body do not have a blood supply. Examples include:
- Intervertebral discs, such as the discs in the low back (lumbar spine). Although, during the time a child is growing to maturity, endplates on the top and bottom of each disc provide some blood supply for disc nutrition.
- Joints (eg, knees)
The lack of a blood supply could explain the ubiquitous nature of disc degeneration in the spine, and the great prevalence of osteoarthritis developing in joints such as the hip and knee.
Millions of people experience bony fractures every year. The vast majority of people heal by non-operative treatment such as a cast, brace, or surgical intervention that treats the fracture using instrumentation—such as plates, screws, and interbody devices. In certain surgical procedures to treat spine disorders, fusion is performed. Fusion may involve harvesting some of the patient’s own bone (autograft) and/or using donor bone (allograft) to create a scaffold for new bone to grow and join two bones together permanently. Sometimes, the bone does not mend/grow together or heal properly—when this occurs it may be called a non-union.
Many cases of non-union can be treated using autogenous bone marrow concentrate with mesenchymal stem cells.
- Autogenous refers to the patient’s own bone marrow cells.
- Mesenchymal stem cells have the ability to differentiate into different types of cells, such as osteoblasts or cartilage.
The best clinical literature to support bone marrow grafting was authored by a French orthopedic surgeon, Felipe Hernigou, and published in The Journal of Bone and Joint Surgery.1 The use of autogenous bone grafts to help heal fractures is a standard of care in orthopedics. Typically, the bone graft is taken from the iliac wing; a part of the pelvis.
Hernigou et al’s paper reports on 60 patients with an established non-union of the tibial shaft (shinbone), who were treated with a percutaneous (through the skin) injection of autologous (patient’s) bone marrow concentrate with mesenchymal stem cells between 1990 and 2000.
All the patients were treated before the injection with either with an external fixator (fixation device outside the skin) or plaster cast immobilization. Bony union occurred in 53 of the 60 patients at an average of 12 weeks. The patients’ fractures that did not heal were due to a low mesenchymal cell count in their bone marrow concentrate.
Hernigou P, Poignard A, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am. 2005;87(7):1430-1437.