Bone Marrow Injection in Fracture of Femoral Neck

Femoral neck fractures are serious injuries associated with a high risk of complicationsand represent an important challenge in orthopedic practice. Treatment decisions dependon several factors, including the patient's age, physiological status, activity level,associated comorbidities, and fracture displacement. In younger patients and in thosewith nondisplaced or minimally displaced fractures, internal fixation is generallypreferred because preservation of the native femoral head and hip joint is an importanttreatment goal.Femoral neck fractures in young patients are usually caused by severe trauma and,although relatively uncommon, are associated with a high incidence of complications.Avascular necrosis (AVN) and late segmental collapse have been reported as majorcomplications following these injuries, with particularly high complication ratesdescribed in young patients. Patients with subcapital fractures appear to be moresusceptible to these complications. The high risk of AVN is related to the vulnerableblood supply of the femoral head, making preservation of femoral head vascularity a majorconcern in the treatment of femoral neck fractures.For younger and active patients with displaced femoral neck fractures, anatomic reductionfollowed by stable internal fixation is considered essential, while internal fixation isalso recommended for ambulatory patients with nondisplaced fractures to prevent secondarydisplacement. However, despite appropriate internal fixation, complications such asosteonecrosis and nonunion may still occur. The reported rate of osteonecrosis isapproximately 10‐30%, while nonunion has been reported in 8.9‐30% of cases. Thesecomplications can lead to prolonged disability and may ultimately require additionalsurgical treatment.Autologous bone grafting has traditionally been used to augment bone regeneration incases of osteonecrosis and nonunion, but its use may be associated with donor‐sitecomplications, including pain, bleeding, and infection. Consequently, biologicalapproaches that can enhance fracture healing without the morbidity associated with bonegraft harvesting have attracted increasing interest.Bone marrow(BM) represent a potential alternative biological approach because theycontain cell populations with osteogenic and angiogenic potential. Autologous BMtransplantation offers several potential advantages, including relatively rapidisolation, avoidance of prolonged cell expansion, preservation of early progenitorcharacteristics, and the ability to use the cells without a prolonged delay betweenharvesting and treatment. Previous studies have also suggested beneficial effects ofautologous BM in the treatment of femoral head osteonecrosis.Because prevention of osteonecrosis and nonunion is preferable to treating thesecomplications after they have developed, biological augmentation at the time of fracturefixation may represent a promising strategy. Therefore, combining stable internalfixation with an autologous biological treatment may provide a potential approach toimproving fracture healing and reducing the risk of complications in patients withfemoral neck fractures.