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

Figures & data

Table 1 Patient characteristics

Case	Sex	Age	Initial injury	Initial treatment	Time since injury (months)	Comorbidities
1	Male	44	Open	Plate	10	None
2	Male	25	Closed	IMN	13	Tobacco use
3	Male	30	Closed	IMN	19	Tobacco use
4	Female	28	Closed	IMN	18	None
5	Female	28	Closed	Plate	10	None
6	Male	38	Open	Plate	10	None
7	Male	22	Closed	IMN	17	Tobacco use
8	Male	29	Closed	IMN	11	None
9	Female	38	Closed	IMN	16	None
10	Male	63	Closed	Plate	10	Tobacco use
11	Male	39	Open	Plate	9	None
12	Female	42	Closed	Plate	9	Tobacco use/DM
13	Female	25	Closed	IMN	11	None
14	Male	22	Closed	IMN	9	None

Abbreviations: IMN, intramedullary nailing; DM, diabetes mellitus.

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.