Autologous platelet-rich plasma in the delayed union of long bone fractures - A quasi experimental study

Rajni Ranjan; Rakesh Kumar; Madhan Jeyaraman; Arunabh Arora; Sudhir Kumar; Arulkumar Nallakumarasamy

doi:10.1016/j.jor.2022.12.013

Autologous platelet-rich plasma in the delayed union of long bone fractures - A quasi experimental study

J Orthop. 2022 Dec 31:36:76-81. doi: 10.1016/j.jor.2022.12.013. eCollection 2023 Feb.

Authors

Rajni Ranjan¹, Rakesh Kumar¹, Madhan Jeyaraman^{2

3

4}, Arunabh Arora¹, Sudhir Kumar¹, Arulkumar Nallakumarasamy^{4

5}

Affiliations

¹ Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India.
² Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India.
³ Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India.
⁴ Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, India.
⁵ Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Abstract

Introduction: Fractures of long bones unite without any complication except for 2%-10% which may lead to delayed or non-union of the fracture. Management of delayed union of fractures poses a great challenge for orthopaedic surgeons. Platelet-rich plasma (PRP) is an autologous blood-derived biological agent, which delivers growth factors, cytokines, and bio-micro molecules at supraphysiologic concentrations at the site of tissue injury, thus potentiating the body's healing efforts. Various studies and research have proved the osteogenic activity of PRP. The growth factors present in the PRP induce the locally available resilient progenitor or stem cells and convert the atrophic environment into a trophic environment.

Materials and methods: We investigated the safety and efficacy of autologous PRP injection in the delayed union of long bone fractures. A total of 25 cases of delayed union of long bone fractures were augmented with 3 doses of autologous PRP at 3 weekly intervals and were followed up for 12 months. All the cases were documented with pre-and post-procedural and 12th -month visual analog score (VAS) and Warden's score.

Results: Out of 25 cases, 21 (84.00%) cases showed good union of fracture with adequate callus formation by 10-12 weeks with 3 doses of autologous PRP injections. The mean pre-procedural VAS and Warden's score at the final follow-up showed statistically significant results (p < 0.05). No other complications were noted due to autologous PRP application among the study participants during the study period except for 3 cases (2 cases of non-union, and 1 case of implant failure).

Conclusion: Results of the current study suggest that autologous injection of PRP might be a safe and effective therapeutic tool for the management of delayed union of long bone fractures.

Keywords: Delayed union; Orthobiologics; Platelet-rich plasma.