The Role of Platelet Rich Plasma in Delayed Union of Long Bones
The Role of Platelet Rich Plasma in Delayed Union of Long Bones
The Role of Platelet Rich Plasma in Delayed Union of Long Bones
ISSN: 2395-1958
IJOS 2019; 5(2): 14-17
© 2019 IJOS The role of platelet rich plasma in delayed union of
www.orthopaper.com
Received: 06-02-2019 long bones
Accepted: 10-03-2019
Dr. Ravish VN Dr. Ravish VN, Dr. Bharath Raju G and Dr. M Venugopal Reddy
Dept. of Orthopaedics,
Kempe Gowda Institute of
Medical Sciences, Bengaluru, DOI: https://doi.org/10.22271/ortho.2019.v5.i2a.03
Karnataka, India
Abstract
Dr. Bharath Raju G Objective: To assess functional outcome of infiltration of platelet rich plasma (PRP) in delayed union of
Associate Professor, long bones.
Dept. of Orthopaedics, Design: Prospective clinical study with 6 months of follow-up.
Kempe Gowda Institute of Methods: Clinically proven 25 patients of delayed union were included in study according to inclusion
Medical Sciences, Bengaluru, and exclusion criteria after getting written and informed consent, treated by autologous PRP infiltration
Karnataka, India
thrice 4 weeks apart, evaluation done clinically as well as radiologically (At baseline and 6 month
interval).
Dr. M Venugopal Reddy
Dept. of Orthopaedics, Results: Out of twenty five patients, union was achieved in 22 patients (88%) at the end of six months, 2
Kempe Gowda Institute of cases progressed to non-union and one patient was lost for follow-up.
Medical Sciences, Bengaluru, Conclusion: Platelet rich plasma infiltrated locally is effective in the treatment of delayed union of long
Karnataka, India bone fractures.
Introduction
Delayed union, by definition, is present when an adequate period of time has elapsed since the
initial injury without achieving bone union. Bone healing, or fracture healing is a proliferative
physiological process in which the body facilitates the repair of a bone fracture [1, 2, 3].
For normal fracture healing to occur a number of requirements must be met e.g.: Viability of
fragments (i.e. intact blood supply), mechanical rest this can be achieved by not moving and
external immobilization, e.g. cast or internal fixation and absence of infection. The process of
healing is different depending on the configuration of the fracture fragments and can be
divided into three main categories (i) spontaneous (indirect/secondary) healing, (ii) contact
(angiogenic/primary) healing (iii) gap healing [1, 3, 4]. Fracture healing is a complex
physiological process involving a coordinated interaction of hematopoietic and immune cells
within the bone marrow, in conjunction with vascular and skeletal cell precursors [5]. Several
different cytokines and growth factors play role in healing of a fracture [6]. Delayed union is a
fracture that requires more time than standard to heal but over time it shows progression
toward healing [7].
Average healing times of common fractures are as follows Phalanges (3 weeks),
metacarpals(4-6 weeks), Distal radius (4-6 weeks), Lower arm(8-10 weeks), Humerus (6-8
weeks), Femoral neck (12 weeks), Femoral shaft (12 weeks), Tibia (10 weeks) [1, 4]. Non-union
is defined by the United States Food and Drug Administration as established when a minimum
of nine months has elapsed since injury and the fracture shows no visible progressive signs of
healing for three months [4, 8]. Non-union is generally classified as hypertrophic, oligotrophic or
atrophic according to the radiological appearance [4, 8]. Atrophic non-union is characterized by
little or no callus and resorption in the bone ends while in oligotrophic and hypertrophic non-
union, blood flow is sufficient and an excessive amount of callus is seen. Insufficient
Correspondence mechanical stability is a reason which leads to non-union [9]. In the treatment of delayed union
Dr. Bharath Raju G or non-union, the biological and mechanical factors should be evaluated first. After achieving
Associate Professor, Dept. of
Orthopaedics, Kempe Gowda
mechanical stability with internal or external fixation, an attempt is made to achieve union
Institute of Medical Sciences, with grafts, growth factors or with physical means [7].
Bengaluru, Karnataka, India
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International Journal of Orthopaedics Sciences
Mechanism of PRP
Whenever any damage occurs, healing process takes place.
Healing occurs in three phases: Inflammation, proliferation
and remodeling [15]. Alpha granules of platelets contain Fig 2: Infiltration under C-Arm Guidance
various growth factors, such as Platelet-derived Growth
Factor (PDGF), Transforming Growth Factor Beta (TGF-β), Discussion
vascular endothelial growth factor, Insulin-like Growth In our study we used Modified RUS Scoring, which is based
Factor-1 (IGF-1), hepatocyte growth factor, and Fibroblast on the visibility of fracture line and presence or absence of
Growth Factor (FGF), which accelerate mitosis, callus on plain radiographs after a period of six months from
vasculogenesis, and differentiation [16]. PRP has an exclusive the initial infiltration of PRP.
combination, which helps in healing process through the There was a male predominance with 23 patients being male
concentration of inflammatory mediators [15]. PRP also has an accounting for 92% and 2 patients were female accounting for
antimicrobial effect, which helps in wound healing process. In 8%, which is in correlation with other studies. The injured
spite of its beneficial effects, PRP is less likely used by side in our study was right side in 13 patients (56%) and left
healthcare professionals because of its high cost [16]. side in 12 patients (44%).
month follow up was found to be 88% union, which is in Illustrations: Case No.1
correlation with the studies of Justynagolos et al, Deepak
Chaudhary et al, Stanton et al. and Say et al. where mean
duration after primary surgery was about 4.05 months, 4.8
months, 4 months and 7.2 months respectively and union was
seen in 81.8%, 88.3%, 90% and 30% cases respectively. Our
study deviates from Bielecki et al. studies where mean
duration after primary surgery was <11 months and efficacy
was 100%.
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International Journal of Orthopaedics Sciences
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