Abstract
Distal tibial and fibular fractures, particularly in patients with comorbidities, heal slowly and have a high incidence of postoperative nonunion and infection. Autologous concentrated bone marrow aspirate (cBMA) and platelet-rich plasma (PRP) increase osteogenic potential of demineralized bone matrix (DBM). The purpose of this case series was to evaluate the efficacy of cBMA, PRP, DBM in conjunction with the Ilizarov fixator as compared to DBM and the Ilizarov fixator alone in expediting fracture healing. Ten patients (mean age 52.9 years) were in the cBMA Group, and 10 patients (mean age 54 years) were in the Control Group. Comorbidities included diabetes, obesity, smoking, and renal disease. Radiographs showed a significant difference in the rate of complete healing in the cBMA Group at 16 ± 1.6 weeks post-surgery as compared to 24 ± 1.3 weeks in the Control Group (P < 0.001). No differences were observed between groups in infection rate or nonunions. We conclude that the Ilizarov fixator combined with DBM, cBMA, and PRP expedites fracture healing of the distal tibia and fibula in patients with significant comorbidities.
Highlights
Distal tibial and fibula fractures can be treated successfully with the Ilizarov fixator [1]
We conclude that the Ilizarov fixator combined with demineralized bone matrix (DBM), concentrated bone marrow aspirate (cBMA), and platelet-rich plasma (PRP) expedites fracture healing of the distal tibia and fibula in patients with significant comorbidities
In the cBMA Group, eight of 10 patients showed complete bone healing when the external fixator was removed at approximately 16 weeks post-surgery (Fig. 4)
Summary
Distal tibial and fibula fractures can be treated successfully with the Ilizarov fixator [1]. Patients who are experiencing soft-tissue loss, comorbidities, and chronic infection increase the complexity of these cases. The classic Ilizarov technique has several advantages when treating patients with various comorbidities [4] With this technique, the reduction and fixation of the fracture is performed with minimal soft-tissue exposure and blood loss and the fixation stable enough to allow weightbearing soon after surgery. The external fixator gives the surgeon the opportunity to adjust the alignment and compress or distract during or after surgery. These factors improve the success rate of the Ilizarov method in fracture repair and contribute a positive effect on patient quality of life [5]
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