Medical Miracles - Cylindrical Akin Bunionectomy with Delayed Union:
Treatment with autologous platelet concentrate injection: A Case Report
Dr. Harvey Leflcowitz, D.P.M., D.A.B.P.S.
Formatted by Brandi Keyosky
43-year-old, healthy, black female presented complaining of painful bunions with excessively long proximal phalanx to the great toe. Previous surgery by another physician had included arthroplasty on the second and third toe with lateral deviation.
2/9/08 - (Figure 1) X-ray shows bunion deformity with excessively long proximal phalanx of the hallux.
3/28/07 - (Figure 2) Patient underwent hammertoe implants of two and three digits right foot along with cylindrical Akin osteotomy with K-wire fixation.
5/17/07 - (Figure 3) Review of recurrent x-ray reveals osteotomy and proximal phalanx still open and visible with delayed healing. K-wire is still intact.
Description of Procedure - 5/21/07:
APC utilizing SmartPfteP® System was performed. 3.5 cc of a huffy coat hemocytic tissue was procured and a hallux block was given to the affected hallux utilizing 3 cc of 1% Lidocaine. The plasma kit coagulate was then infused into the proximal phalanx of the delayed union under ultrasound guidance in order to apply the autologous platelet concentrate directly into the osteotomy and periosteotomy areas.
Patient Follow-up X-rays:
5/31/07 - One of the K-wires had been pulled on.
6/7/07 (Figure 4) Reveals bony bridging across the osteotomy site, and one of the K-wires was removed.
7/6/07 - (Figure 5) Follow-up x-ray, both K-wires removed with complete bony union without complication. Patient was kept in a surgical shoe during the post-APC healing.
APC releases growth factors that are necessary for bone healing. APC injection with ultrasound guidance should be considered as a treatment option in patients with delayed bone healing The Harvest SmartPReP® process for concentrating autologous platelet rich plasma is a fairly simple outpatient procedure.