Abstract
BackgroundNonunions of the tibia represent challenging orthopedic problems, which require the surgeon to analyze numerous factors and choose an appropriate treatment. This article presents a case report of tibia and fibula fracture patient who failed the internal fixation surgery and successfully recovered after one course of percutaneous autologous platelet lysates injection.Case descriptionThe patient received an internal nickelclad breakage at 9 months post-surgery but reluctant to accept a second surgery, then autologous platelet lysates (APL) injection which is a less invasive method was recommended. The injections were carried once a week for three times. Radiologic evaluation was conducted every month until recovery.Discussion and evaluationTo the best of our knowledge, this is the first reported case of tibia delayed union with breakage of the plate resolved with APL injection. Improved clinical evidence was observed at 4 and 6 months after injection. The patient got good bony union at 8 months post-injection. The patient didn’t feel any discomfort postinjection, no complications such as infection, refracture etc. were observed.ConclusionsAPL percutaneous injection could be a new therapeutic option for the treatment of nonunion or delayed healing fractures.
Highlights
Nonunions of the tibia represent challenging orthopedic problems, which require the surgeon to analyze numerous factors and choose an appropriate treatment
To the best of our knowledge, this is the first reported case of tibia delayed union with breakage of the plate resolved with autologous platelet lysates (APL) injection
Bone non-union was defined by US Food and Drugs Administration (FDA) as radiographically visible fracture line after 9 months since injury and delayed union was clinically defined as a fracture with no signs of healing for three consecutive months (Megas 2005)
Summary
Nonunions of the tibia represent challenging orthopedic problems, which require the surgeon to analyze numerous factors and choose an appropriate treatment. This article presents a case report of tibia and fibula fracture patient who failed the internal fixation surgery and successfully recovered after one course of percutaneous autologous platelet lysates injection. Case description: The patient received an internal nickelclad breakage at 9 months post-surgery but reluctant to accept a second surgery, autologous platelet lysates (APL) injection which is a less invasive method was recom‐ mended. Nonunion or delayed union has been one of Recent advances in cellular and molecular biology have emphasized the role of specific growth factors and cytokines in bone fracture healing (Simpson et al 2006). The activated platelet could release a series of growth factors and cytokines that act synergistically to facilitate MSC attachment, proliferation and differentiation, while the potential effects of APL on bone regeneration need to be investigated. The exact amounts of key factors such as PDGF-BB, TGFβ1, EGF, IGF-1 need to be detected and APL preparation
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