Treating a Recalcitrant Non-union of the Radius Using Autogenous Bone, Equine Bone Paste, Equine Demineralized Bone Matrix, Platelet Rich Plasma, and Bone Marrow Aspirate. A Case Report

Introduction: Non-unions at forearms are usually challenging and difficult to treat. If additionally, an infection is present, reconstructive
surgery should be planned only after full debridement, antibiotic treatment, and confirmation, based on clinical observation and laboratory
tests that the infection has subsided. Bone grafting may be required for reconstruction. The use of autogenous bone calls for a second surgical
site with an increased risk of morbidity. Using bone substitutes may reduce the need for autogenous bone. Stimulating factors, such as bone
marrow concentrate (BMC) and demineralized bone matrix (DBM), may be used concomitantly with bone substitutes to facilitate bone
regeneration.
Case Report: The present report describes the case of a 38-year-old patient whose radius was fractured in a car accident. A first surgery involved
stabilizing the reduced fracture with a plate, but an infection developed, and the bone did not heal. 3 months later, a second surgery followed,
involving placing an antibiotic-filled spacer. This did not cure the infection, so the spacer was replaced 3 months later, and a second antibiotic
was added. The patient also began taking oral antibiotics. 6 months later, the patient underwent vascularized fibular grafting. However, the graft
did not integrate, and a non-union developed. A year later, the non-union was treated by grafting autogenous bone from the iliac crest, equine
bone substitute, and equine DBM, in conjunction with autologous BMC and platelet-rich plasma. At the 6-month follow-up, the bone structure
appeared to be successfully reconstructed.
Conclusion: A graft made of a combination of materials with both biological and physical properties can be used to foster bone regeneration
for the treatment of particularly challenging cases of non-unions.

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