Can The Patient’s Bone Marrow Heal a Fracture Non-union?

By Chris Centeno, MD /

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There’s nothing worse than having a fracture and waiting for months for it to heal only to find out it’s not healing. That’s what happened to a recent patient I treated in Grand Cayman. While his orthopedic surgeon wanted to pull the trigger on a second big surgery, he opted to use his own bone marrow instead.

How Do Fractures Heal?

If you have a fracture, the liquid bone marrow in the bone seeps into the gap and forms a clot. In that bone marrow are all sorts of cells including mesenchymal stem cells (MSCs) and hematopoietic stem cells, macrophages, platelets, white blood cells, etc… The research shows that the more MSCs you have, the better your fracture will heal and the lack of these important stem cells is likely why many fractures don’t heal (1).

Can You Help Fractures Heal with an Injection?

Fracture healing by injecting bone marrow into the damaged area is not new. In fact, a physician in Paris began doing this work in the early 2000s. Regenexx published a paper that used culture-expanded mesenchymal stem cells to do the same thing way back in 2011 (2).

How does this work? By supplementing the number of stem cells in the non-healing fracture. These cells then produce bone-forming cells which then produce bone.

My Patient from This Week

My patient fractured his femur on a boat, had the hardware you see above placed into his fracture, and went back to activity quickly. In fact, he had no idea he had a fracture that wasn’t healing properly until some follow-up x-rays. Meaning the rodding system was so good at holding things together that he was fully participating in cross-fit work-outs without pain.

When the delayed healing of the fracture was identified, he was told that he should have another surgery involving compression plating to bring the fractured pieces together. That’s when he began to look at other options. I saw him last week to perform a bone marrow concentrate procedure by injecting that healing mix into these gaps. Those images are on the right above. Given the size of these gaps, I have asked one of my partners from Colorado to re-inject his cultured cells plus demineralized bone into this fracture next month.

The upshot? Fracture non-union is not a welcome surprise. Just when you think you’re out of the deep end of your fracture, you find out that it’s not healing normally which places you in a whole other world of more surgeries. Or, maybe not? You may do just fine with injections of your own concentrated bone marrow into the spot that’s not healing!

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  1. Hernigou, Ph., MD; Poignard, A., MD; Beaujean, F., MD; Rouard, H., MD Percutaneous Autologous Bone-Marrow Grafting for Nonunions:
    Influence of the Number and Concentration of Progenitor Cells. JBJS: July 2005 – Volume 87 – Issue 7 – p 1430-1437
  2. Centeno, et al. A Case Series of Percutaneous Treatment of Non-Union Fractures with Autologous, Culture Expanded, Bone Marrow Derived, Mesenchymal Stem Cells and Platelet LysateJ Bioengineer & Biomedical Sci 2011, S2

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Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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