Percutaneous injection of autologous platelet gel accelerate healing in diabetic tibial non union: On going longitudinal study

• Published in: Injury 2024-06, Vol.55, p.111469, Article 111469
• Main Authors: Kulkarni, Raghavendra S., Kulkarni, SriRam R., Kulkarni, Ranjani R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Autologous bone marrow aspirate; Autologous platelets; Blood Platelets; Bone Marrow Transplantation - methods; Diabetes mellitus; Female; Fracture Healing - physiology; Fractures, Ununited - physiopathology; Fractures, Ununited - surgery; Fractures, Ununited - therapy; Gels; Healing of long bone non union; Humans; Longitudinal Studies; Male; Middle Aged; Percutaneous injection; Platelet-Rich Plasma; Tibial Fractures - physiopathology; Tibial Fractures - surgery; Tibial Fractures - therapy; Tibial non union; Transplantation, Autologous; Treatment Outcome
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111469

In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection. This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views. Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003). This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.