PMC5122524_01
Preoperative radiograph (a) and radiograph immediately after incision reduction and internal fixation surgery (b) at the first visit to another hospital
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Fig1
Initial treatment involved incision reduction and a metal plate internal fixation surgery was performed (Fig. 1).
Anteroposterior radiographs of tibia and fibula fracture in 4 months (a), 6 months (b) and 7 months (c) after surgery. Lateral radiograph (d) taken 7 months after surgery showing the nickelclad breakage
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Fig2
After 4 months, the radiographs revealed clearly fibula osseous collection and the fibula fracture almost healed, but minimal callus formation was seen and there was a gap in the tibia fracture site (Fig. 2a). However, through radiologic assessment, no signs of healing in the tibia were observed (Fig. 2b).  Radiography revealed tibia fracture stump sclerosis and the breakage of the nickelclad, and tibia non-union was diagnosed (Fig. 2c, d).
The APL injection and position fixing (a), radiographs of tibia fracture at 2 months (b), 4 months (c) and 6 months (d) after injection
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Fig3
After the dissection and brisement of fibrous scar tissue and sclerotic tissue, a disposable needle was inserted perpendicularly into periosteum at the gap of delayed union under fluoroscopic guidance, and then 5 mL of the buffered APL was injected into the area of abnormality (Fig. 3a). 