Abstract | March 23, 2023

Bone Marrow Aspirate with Allograft Cancellous Chips versus Autologous ICBG or RIA in the Treatment of Long Bone Nonunions

Kristin Chancellor, BS, ms

David A. Patch, MD, Orthopedic Surgery, PGY1, UAB, Birmingham, AL; Alexander K. Mihas, BS, Research Fellow, UAB, Birmingham, AL; Logan A. Reed, BS, Research Fellow, UAB, Birmingham, AL; Wesley R. Stroud, MD, Orthopedic Surgery, UAB, Birmingham, AL; Clay A. Spitler, MD, Orthopedic Surgery, UAB, Birmingham, AL; Jonathan H. Quade, MD, Section Chief of Orthopedic Trauma Surgery, UAB, Birmingham, AL

Learning Objectives

  1. To review two alternative methods of bone grafting and how they compare to the gold standard autologous iliac crest bone grafting
  2. To analyze factors that put patients at risk for nonunion
  3. To review the cellular makeup of the 3 types of bone grafting presented in this paper

Background: The use of bone grafting in cases of nonunion is predicated on promoting bone healing through osteoconductive, osteoinductive, and/or osteogenic effects.(1) Despite the advantages of autologous iliac crest bone grafting (ICBG), donor-site morbidity remains a significant concern.(2) As a result, alternative bone grafting methods have gained popularity.(4) Objective: To assess union rates between bone marrow aspirate with allograft cancellous chips (BMA-ACC) compared to autologous iliac crest bone grafting (ICBG) and the reamer-irrigator-aspirator (RIA) system in the treatment of long bone nonunion. We hypothesized that the combination of BMA-ACC would have higher union rates with less complications.

Design: Retrospective cohort study. Setting: Academic Level 1 trauma center. Participants: Patients 18 and older who underwent primary bone grafting technique using BMA-ACC, autologous ICBG, or RIA for the treatment of long bone nonunion. Main outcomes: The primary outcome of interest was union. Secondary outcomes of interest were acute donor site complications, operative time, length of stay, rate of transfusion, and unplanned reoperations. Results: A total of 112 patients were included in the study, with 27 patients in the BMA-ACC group, 43 patients in the autologous ICBG group, and 42 patients in the RIA group. BMA-ACC, autologous ICBG group, and RIA groups did not differ significantly between rates of union (88.9% vs 72.1% vs 83.3%, p=0.18). The autologous ICBG group was most associated with acute donor site complications (19.0%) compared to the BMA-ACC and RIA groups (0.0% vs 4.8%, p=0.01). Average operative time was shorter in the BMA-ACC group compared to the autologous ICBG and RIA groups (146.1 ± 54.8 vs. 173.1 ± 88.6 and 178.9 ± 88.6 minutes), but this difference was not significant (P=0.23). Overall, there were no significant differences in operative time, length of stay, rate of transfusion, or unplanned re-operations among the groups. Conclusion: In the present study, primary treatment of long bone nonunion with BMA-ACC had comparable union and complication rates to bone grafting performed with autologous ICBG or RIA. Given the well-established complications associated with traditional autograft harvest, BMA-ACC may offer a less morbid alternative.

 

  1. Lin K, VandenBerg J, Putnam SM, et al. Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions. OTA Int. open access J. Orthop. trauma. 2019 Mar;2(1):e012. 2. Calori GM, Colombo M, Mazza EL, et al. Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury. 2014 Dec;45 Suppl 6:S116-20. 3. Trung Hau Le Thua, Duc Phu Bui, Duy Thang Nguyen, Dang Nhat Pham, Quy Bao Le, Phan Huy Nguyen, Ngoc Vu Tran, Phuoc Quang Le, Willy D. Boeckx A t DM. Autologous Bone Marrow Stem Cells combined with Allograft Can-cellous Bone in Treatment of Nonunion. Biomed. Res. Ther. 2015;2(12):409-(DOI 10.7603/s40730-015-0029-6). 4. Dawson J, Kiner D, Gardner W 2nd, et al. The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications. J. Orthop. Trauma. 2014 Oct;28(10):584–590.

 

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