A Comparative Study of in Vivo Effect of Percutaneous Bone Marrow Injection vs Without Injection on Union of Open Tibial Shaft Fractures With External Fixator

Abstract

Background : Open tibial fractures are notorious fractures because the open wound leaves us with limited options and means multiple operations with long intervals for the patient. The usual method of treatment of contaminated, late presenting and complicated fractures is a temporary external fixator followed by conversion into a costly definitive procedure once the wound has healed. The secondary definitive procedure also means extra cost in an already economically stressed patient.In our set up we have to often let patients leave with a plaster cast after removing the external fixator for economic constrains. Per cetaceous autologous bone marrow injection while the patient is on external fixator is one alternative that we have tried to deal with this problem hoping for a primary union without any costly intervention. Materials and methods : We had 42 cases of open tibial fractures which were treated with external fixator and per cutaneous bone marrow injection while 38 other cases which were used as control with only the external fixator and no injections. We included open fractures of only Gustilo Anderson type II,IIIA and B for our study. Study was conducted between period of June 2012 and December 2013 at SBKS medical college . Results : In group one, 34 of the 42 patients had a radiological union before 12 weeks while another 2 in 16 weeks. For group 2 , only 16 of the 38patients had radiological union at 12 weeks and no more at 16 weeks. The average time of union for group 1 was 10 weeks while of group 2 was 12 weeks .Function of the union cases of both the groups was similar in all aspects including distance of walking and ability to carry out daily activities. Conclusion : Per cutaneous autologous bone marrow injections are cheap , easily available and successful alternative to a secondary procedure for open tibial fractures on external fixators.