CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1511722
This article is part of the Research TopicMultidisciplinary Insights into Distal Tibiofibular Joint Injuries: An Integrative Analysis of Surgical Techniques, Rehabilitation Protocols, and Podiatric InterventionsView all articles
Based on the Diamond Theory, Successful Treatment of Stubborn Tibial Nonunion After Six Surgeries Using PRP-Augmented Therapy: A Case Report and Literature Review
Provisionally accepted
- 1The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, China
- 2Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
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Background: The treatment of stubborn tibial nonunion remains a significant challenge. This case report describes a patient who underwent six surgeries and was treated using a stepwise surgical approach based on the diamond theory. The application of platelet-rich plasma (PRP) enhanced autologous iliac bone grafting combined with locked compression plate fixation ultimately achieved successful healing. This study also reviews relevant literature to explore the treatment experiences and outcomes of similar cases.Patient and Methods: A middle-aged Asian male with severe heart disease underwent five failed surgeries, including two autologous bone graft procedures. Clinically, he presented with right calf pain, poor soft tissue condition on the anterior medial tibia, and signs of nonunion. During the sixth surgery, we applied a stepwise surgical procedure based on the diamond theory, achieving excellent clinical and bone healing, as well as satisfactory limb function at a follow-up of 11.3 months post-operation.We utilized a stepwise surgical procedure based on the diamond theory: locked compression plate internal fixation, PRP-enhanced structural autologous iliac bone grafting, and bioactive center creation techniques, providing a strong and stable mechanical and superior biological environment for the nonunion site.
Keywords: Diamond theory, stubborn tibial fracture nonunion, Fracture nonunion, Platelet-Rich Plasma, case reports
Received: 15 Oct 2024; Accepted: 10 Apr 2025.
Copyright: © 2025 Wang, Wu, Peng, Wang, Mo and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Feng Wu, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, China
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