The application of bone marrow aspirate concentrate (BMAC) enrich in stem cells, growth factors and other active substances for the scaphoid delayed union treatment

Despite a steady progress in diagnostic and surgical methods, fractures and scaphoid nonunion disorders continue to pose a serious therapeutic problem. According to various sources, the cause of these problems are mainly delays in diagnosis of fractures, and errors made during proper and adequate treatment. Some author claims that delays ranging from a few weeks to a few dozen months affect 30 to 60% of fractures. This article reports the efficacy of percutaneous autologous bone marrow aspirate concentrate enrich in stem cells and others active substances injection as a minimally invasive method for the treatment of delayed unions of scaphoid bone, preventing open grafting techniques. 7 patients diagnosed with delayed union of non-dislocated fractures of the scaphoid bone participated in this study. Bone marrow has been aseptically harvested from the iliac crest bone and centrifugated. The fissure was cleaned out in a miniinvasive way and 6 ml of BMAC, which was supplemented with 0,6 ml of thrombin, in order to obtain a gel, was administered into the gap. After the surgery, the carpus was immobilized by use of a plaster splint for 8 weeks. One patient did not attend more than 1 from 6 routine outpatient visits and was excluded from statistical analyses. In 5 patients after 12 weeks from administration of the BMAC we achieved a bone union. In our study we could not reach total restoration of cancellous scaphoid bone, what was identified in CT at 12 week after the percutaneous BMAC injection. However, we achieved pain relief and bone fragments stabilization in all union cases, what it will prevent further arthrosis and other degenerative bone damage. This is our early experience with the use of BMAC as biologic treatment for delayed union of the scaphoid bone. To our knowledge, this is the first study looking at the effect of percutaneous BMAC delivery to the fracture site in delayed union. We believe that BMAC enrich in stem cells, growth factors and other active substances grafting can be an effective and safe method for the treatment of scaphoid bone healing disturbances. Moreover, in our opinion this percutaneous injection method should be used in all non-dislocated fractures of the scaphoid bone to decrease the risk of develop of non-union, degenerative changes, avascular necrosis or instability and loss of wrist coordination.