J.NG1, E.B.K.KWEK2, R.KUNNASEGARAN1
Tan Tock Seng Hospital1, Woodlands Health2
Non-union of long bones is a common challenge in the treatment of fractures. Bone grafting is commonly used to treat atrophic non-union, but mechanical displacement of the graft may occur, which may result in delay or failure of treatment.
Fibrin glue has demonstrated positive results in management of bone defect in neurosurgery and oromaxillary facial surgery, however there has yet to be any study on its effects in orthopaedics long bone fractures.
We conducted a prospective randomized control trial at single tertiary center involving adult patients with long bone fractures that had undergone non-union and requiring bone grafting only. Autologous iliac crest bone graft was applied to the debrided non-union site, with additional fibrin glue applied for the intervention arm. Patients were followed-up with serial radiographs until clinical and radiographical union.
10 patients (3 male, 7 female), of mean age 41.7 (19 – 63) were recruited over 5 years, with 1 drop out. 8 out of 9 fractures united after treatment. 1 patient underwent hypertrophic non-union requiring re-fixation and bone grafting. There was no difference in the time to union for patients in the fibrin glue group (19.5 weeks) with the control group (18.75 weeks) (p=0.86). There were no complications sustained from usage of fibrin glue.
Fibrin glue appears to be a safe adjunct for treatment of non-union of long bone fractures across varying fracture sites and helps facilitate provisional fixation of bone autograft without impeding rates of union.