Platelet-rich plasma versus exchange intramedullary nailing in treatment of long bone oligotrophic nonunions

Abstract

Percutaneous PRP application significantly affected union rate, but no significant difference found when compared to EIN in the treatment of oligotrophic nonunions after intramedullary nailing of long bone fractures. PRP can be applied as a minimally invasive and safe method of saving resources in medical care instead of EIN.

The Use of Platelet-Rich Plasma (PRP) for the Management of Non-union Fractures

“…This is followed by centrifugation and activation of the platelets via a chemical agent [13]. Frequently used activators include calcium chloride [13][14][15][16][17][18][19] and bovine [17,20] or autologous thrombin [15,21,22]. Thrombin forms a gel-like substance, from which the PRP can be extracted and directly applied to the patient intravenously [14,17,23].…”

“…Clinical trials have investigated the effect of PRP on nonunion healing alone [14,21,24,25] and in combination with other forms of treatment such as the use of mesenchymal stem cells (MSCs) [26,27], internal fixation and/or nailing [16,19,23,[28][29][30]. When using PRP in isolation to treat a non-union, the therapeutic benefit is divided; in some instances, PRP has been deemed successful in achieving bony union at the fracture site [24,25,31] within 11 months of initial injury or surgery [17].…”

“…During preparation, the process of centrifugation is utilised for concentrating platelets in all literature. However, the rates of centrifugation differ between studies, ranging from 3200 up to 5200 rpm [15,19,21,30], which leads to different relative forces depending on rotor length, while other studies do not state the rate [7,35]. Furthermore, centrifugation can potentially lead to the fragmentation of the platelets and the early release of growth factors which will ultimately reduce the bioactivity of the PRP [15].…”

“…Throughout the literature, this activator varies, with thrombin, calcium chloride and calcium gluconate being the most common. Thrombin is often combined with calcium chloride (CaCl 2 ) [19,20] or calcium gluconate [15,21] in an attempt to further increase activation of the platelets. In some literature, details regarding activator use are absent [31], with some studies using none at all [24].…”

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

“…In a prospective study, PRP for the treatment of 94 shaft fracture non-unions (35 of the tibia, 30 of the femur, 11 of the humerus, four of the radius, 12 of the ulna, two involving both radius and ulna) resulted in an 87% rate of union at 4 months [74]. In a randomized controlled trial, PRP injections were compared with exchange nailing after IMN, for the treatment of 29 diaphyseal oligotrophic non-unions of tibia and femur, showing superior healing rate in the PRP group compared with exchange nailing group (93% vs. 80%) [75]. Despite early promising results, at the moment, the grades of recommendation for PRP use in bone healing indicates conflicting or poor-quality evidence, and therefore, further investigation is needed [76].…”