AUTOLOGOUS BONE-MARROW GRAFT FOR PATIENTS PRESENTING NON UNIONS

Purpose This Study characterizes the bone marrow from 35 non union sit es, not only with respect to the medullary stroma but also the hematop oietic compartment. In this Study, we looked for systemic anomalies wh ich could explain susceptibility to non union. We also compare the in vitro activity of bone marrow taken from non union sites with that of samples taken from the iliac crest, of the same patient. Material and methods We included 6 groups: 26 cases of post-traumatic non union. 2 cases of non union following arthrodesis of the knee for infected pros thesis, 1 case of a non union of a tibiotarsal arthrodesis. 4 cases of regenerated Illizarov extensions, which showed no evidence of ossific ation three months after operation, 2 cases of patients suffering from congenital abnormalities. Samples were taken from a population of 30 << bone marrow donors >>, to act as controls for the iliac crest sampl es. Results Cell density in the iliac crest bone marrow of non union p atients is significantly lower than that of controls (p < 0.01). In th e hematopoietic compartment of the bone marrow, the number of progenit ors (GM-CFU) obtained after culture of iliac crest bone marrow is cons istently lower for patients presenting a non union than for controls ( p < 0.01). Only infection of non union site (4 cases) seems to be asso ciated with an increase in GM-CFU in the iliac crest. The difference i n the average number of F-CFU obtained after culture of bone marrow fr om non union patients and from controls is lower but is nevertheless s ignificant. 14 of the non union patients have less than half the F-CFU observed as normal in controls and 10 of them yielded less than one q uarter. Out of these ten patients, in whom non union was associated wi th a marked abnormality in the number of F-CFU in the iliac crest (les s than one quarter of the total obtained from controls), in 8 cases we re other factor or disease which could account for the abnormality suc h as age (2 cases), clear alcoholic intoxication (1 case), heavy smoki ng (2 cases), history of chemotherapy (2 cases), and Lobstein's diseas e (1 case). The values found in non union sites and extension regenera ted fibrous tissue suggest that there are relatively few F-CFU to diff erentiate into fibroblasts. In 12 out of 35 patients studied, the bone marrow generated no F-CFU. Same patients have abnormal low levels Of F-CFU obtainable from their iliac crest bone marrow. The number of GM- CFU in fracture site is also extremely low. No local increases in GM-C FU levels are seen in septic focuses. The population of F-CFU and-GM-C FU vary with time, in the same patient, at the same Site of aspiration . Higher levels of osteogenic activity are seen at the begining of ext ension. Conclusion This study suggests that problems related to consol idation may be linked with an overall reduction of bone marrow progeni tor cells, as a result of some general physiological problem (chemothe rapy, smoking, alcoholic poisoning).