Autologous platelet gel for delayed union of tibial shaft treated with intramedullary nailing

Abstract

Early recognition of a potential nonunion followed by early intervention reduces the ultimate time to union, and lessens the frustration for both patient and surgeon. The aim of this study was to evaluate the efficacy of treatment with autologous platelet gel (PG), rich in growth factors, in the treatment of delayed unions of tibial shaft fractures treated with locked intramedullary nailing. We treated 15 atrophic delayed unions of unstable tibial shaft fractures, stabilized with locked intramedullary nail. The mean time between the acute treatment of the fracture and PG application was 151 days. PG was injected into the site of unhealed fracture during closed surgery. The planned treatment programme was 3 radio-guided applications of PG at intervals of 3–4 weeks. Clinical and radiological evaluations 2, 4 and 6 months after the first application of PG showed gradual improvement of the clinical picture and progressive formation of bone callus. In almost all cases there were clinical and radiological improvements and it was possible to remove the synthesis aid an average of 12 months after the start of the therapeutic programme.