Year: 2026 | Month: May | Volume: 13 | Issue: 5 | Pages: 279-285
DOI: https://doi.org/10.52403/ijrr.20260523
Effect of Autologous Medullary Grafting on Transforming Growth Factor Beta-1 (TGF-β1) Levels and Radiographic Union Score Femur in Patients Undergoing ORIF Plate-Screw for Femoral Fractures Compared to Those Without Medullary Grafting
Putu Bihan Surya Kinanta1, I Gusti Ngurah Wien Aryana2, Made Bramantya Karna2
1Resident of Orthopaedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
2Orthopaedic and Traumatology Surgeon, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
Corresponding Author: Putu Bihan Surya Kinanta
ABSTRACT
This study aimed to evaluate the effect of autologous medullary grafting on Transforming Growth Factor Beta-1 (TGF-β1) levels and the Radiographic Union Score for the Femur (RUSF) in patients undergoing open reduction and internal fixation (ORIF) with a plate-screw construct for femoral fractures, compared to those treated without medullary grafting. A comparative analytic observational study with a case-control design was conducted at RSUP Prof. Dr. I.G.N.G. Ngoerah, Denpasar, Bali, from September to November 2025. A total of 36 patients with femoral fractures undergoing ORIF were divided into two equal groups (n=18 each): a case group receiving autologous medullary grafting and a control group receiving no graft. Serum TGF-β1 levels and RUSF scores were assessed at three months postoperatively. Statistical analysis was performed using the Mann-Whitney U test, with a p-value <0.05 considered significant. The medullary graft group demonstrated significantly higher median serum TGF-β1 levels (324.71 ng/mL; range 22.77–678.77) compared to the non-graft group (24.91 ng/mL; range 6.70–76.36), with a p-value <0.001. Similarly, the median RUSF score was significantly higher in the graft group (10.00; range 9.00–12.00) than in the non-graft group (8.11; range 6.00–10.00), p = 0.001. All patients (100%) in the medullary graft group achieved good radiographic union, compared to only 44.4% in the non-graft group. The use of autologous medullary grafting in femoral fracture ORIF with plate-screw fixation is associated with significantly higher TGF-β1 levels and improved radiographic union scores at three months post-surgery. These findings suggest that medullary grafting enhances biological and radiological fracture healing, representing an effective and cost-efficient adjunct, particularly in resource-limited healthcare settings.
Keywords: Autologous medullary grafting, femoral fracture, ORIF, TGF-β1, Radiographic Union Score Femur (RUSF)
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