Is platelet-rich plasma injection an effective choice in cases of non-union?

PURPOSE OF THE STUDY By the expression of several growth factors from activated thrombocytes, the application of Platelet Rich Plasma (PRP) stimulates angiogenesis and regeneration thus stimulating recovery through cell differentiation. This study aimed to evaluate the effects of PRP injection on patients who had undergone surgery for fracture and in whom delayed union or nonunion had been determined. MATERIAL AND METHODS The study comprised 20 patients (male 17, female 3; median age 33.5 range 15-77) who had undergone lower extremity fracture surgery and were diagnosed with aseptic delayed union (8 patients) or non-union (12 patients). Blood taken from the patients was centrifuged to separate PRP, which was then activated by calcium chloride. The prepared PRP was injected into the fracture line under fluoroscopy guidance for totally three times once a week. The application of PRP was made at median 6 (range 6-8) months after fracture surgery. All patients were followed-up with clinical examinations and radiographs over a median period of 11 (range 8-12) months. RESULTS Fracture union was achieved in six patients at median 15 (range 8-24) weeks. There was non-union of the fracture in eleven patients during the follow-up period and these patients underwent revision surgery. Sufficient union was not determined radiologically and clinically in three patients. Fracture union was achieved in six of eight patients in the delayed union group. There was no patient in the non-union group with fracture union. CONCLUSIONS Fracture healing is a process affected by many factors. Although PRP has been reported in literature to be a biological treatment which increases healing, adequate healing was not determined in the treatment of non-union with PRP injection. However, in selected patients determined with delayed union, PRP injection can be recommended in non-surgical treatment.