Investigating the Effect of Intra-articular Platelet-Rich Plasma Injection on Union: Pain and Function Improvement in Patients with Scaphoid Fracture

Abstract

Introduction Fracture of the scaphoid bone is the most common fracture of the carpus. However, the fracture union occurs late or may not heal. Sometimes, fracture healing requires prolong immobilization. Because of potential for joint stiffness, muscle atrophy, or the inability to use the hand during and after prolonged immobilization, there is great incentive to develop therapies that will accelerate bone healing and allow a quick return to work. To date, the effect of platelet-rich plasma (PRP) on scaphoid fracture has not been studied. We aimed to assess the effect of intra-articular PRP injection on union: pain, range of motion, and function in patients with scaphoid fracture. Hypothesis Union: pain reduction and functional improvement can be noticed after PRP use in scaphoid fracture. Materials and Methods A randomized controlled trial was designed with 14 patients with scaphoid fractures (Herbert type B2). Casting was done for them. Seven patients received intra-articular autologous PRP. Patients were followed up 2 weeks after casting using radiography and then at 2 months using radiography and computed tomography (CT) scan to check bone healing. Then patients were followed up for 3 and 6 months and after evaluation of healing by CT scan, the patient-rated wrist evaluation questionnaire was completed and the range of motion of the wrist was measured. Results Analysis revealed significant improvement in pain at rest, as well as during specific and usual activities following PRP injection in the case group. However, no statistically significant difference in wrist motion including radial and ulnar deviation, flexion, and extension was found in 6 months follow-up except some improvement in ulnar deviation after 3 months. However, this study showed that scaphoid union occurred earlier in the case group, but it was not statistically significant. Conclusion PRP may have a significant effect on pain reduction at rest and amount of difficulty in functions including specific and usual activities in patients with scaphoid fractures. Level of Evidence This is a level III, therapeutic trial.

Comparison of Shape Memory Staple and Gelled Platelet-Rich Plasma versus Shape Memory Staple alone for the Treatment of Waist Scaphoid Nonunion: A Single-Center Experience

“…Our study demonstrates that staple is useful in treating waist SNUs and that GPRP is useful to improve healing, which is in agreement with other studies on bone healing. 8 9 10 12 13…”

“… 10 There is no consensus on the benefit of PRP apposition in fracture healing. 11 Evidence on the use of PRP in SNU is still lacking, 12 although its application has been already investigated applied on a bone graft. 13 The aim of the study was to investigate the role of gelled PRP (GPRP) in patients with SNU (later than 6 months from fracture diagnosis or fracture occurrence) treated surgically with staple osteosynthesis, without bone autograft.…”

Comparative efficacy of treatments for patients with knee osteoarthritis: a network meta-analysis

“…Meanwhile, based on the SUCRA results of this NMA, PRP was another effective regime, as it ranked the first in pain reduction (0.691) and the second in stiffness (0.603), physical function (0.608), and total scores (0.624). A RCT study found that compared with therapeutic exercise alone, PRP injections and therapeutic exercise combination treatment could be more effective in reducing pain and improving stiffness as well as quality of life [ 32 ]. Another prospective, double-blind RCT supported that PRP injections had a better short-term effectiveness than placebos in the reduction of pain and stiffness and the improvement of knee function in early knee OA [ 33 ].…”

In Vitro Studies on the Degradability, Bioactivity, and Cell Differentiation of PRP/AZ31B Mg Alloys Composite Scaffold

“…Once the cells are cultured in the environment with PRP, the fibrin and a variety of growth factors released from platelets have synergistic effect on cells' behavior. Namazi and Kayedi [ 23 ] indicated PRP may have a significant therapeutic effect on pain relief at rest and alleviate function difficulties including specific and usual activities in patients with scaphoid fractures in a study with 14 patients enrolled. Ghaffarpasand et al [ 24 ] determined that application of PRP along with autologous bone graft in the site of nonunion of long bone after intramedullary nailing or ORIF resulted in high cure rate, short duration of healing, low rate of limb shortening, and mild postoperative pain.…”