الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
10 Objectives: The goal of this study was to report the role of bone marrow injection in treatment of nonunited long bones fractures and to evaluate the relationship between bony union and bone marrow.Background: bone marrow injection has been used for the management of fracture nonunion since a long period of time. Patient unfit for open grafting, safe, use osteogenic cells, no complications in graft site and can prevent nonunion development are always the main advantages for this technique. Other advantages include: it is simple, quick, inexpensive and causes minimal surgical trauma.Materials & Methods: from November 2009 to February 2013, 20 patients, 16 males and 4 female, mean age 36.5 years, suffering from nonunited lower limb fractures and were treated in orthopedic department, El-Menufiya University Hospital by bone marrow injection in site of fracture nonunion .Intervention: A total of 40–80 mL of bone marrow aspirated from the anterior iliac crest and injected in and around the nonunion site under fluoroscopic guidance.Measurements: Healing at the injury site was evaluated using clinical and radiographic criteria. Measures included Calori et al (1) nonunion scoring system.Results: Final result (healing rate after marrow injection) from the 20 patients who had bone marrow injection for delayed union and non union, 16 (80%) patients achieve union and 4 (20%) patients failed to achieve union. Out of the 4 patients who are not healed, 1 patient had received three bone marrow injections, while 3patient had received 4 bone marrow injections. Overall results were excellent in 13 patients, good in 3, fair in 1 and poor in 3 patients. Union occurred in 16 patients. The mean healing time for healed patients after bone marrow injection (according to X-ray data) was (85.875) days (SD ±2.927). The results were affected by the age, sex, smoking , site of nonunion, number of injections, type of fracture (open or closed ) and presence or history of infection.Conclusions: In our study, the patient’s age, time between initial injury and marrow injection, male gender and smoking were inversely proportional to healing after bone marrow injection. And the number of marrow injections increases with increasing patient’s age, time between initial injury and marrow injection, and smoking. We recommend that patients should attempt smoking cessation therapy before consideration for elective orthopaedic treatment.