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Background <p>Although successful outcomes of platelet-rich plasma (PRP) in treating nonunion fractures have been reported, there are widespread confounding factors and biases in the studies. This study aims to assess the biological benefits of PRP-enhanced therapy while controlling for the two core factors of nonunion fractures—biomechanics and biology.</p> Methods <p>Retrospective analysis of medical records of patients with aseptic atrophic tibial diaphyseal fracture nonunion treated with a single locking plate in a tertiary trauma center. Patients were divided into the PRP group and the non-PRP group based on the use of PRP. The surgical procedure for the non-PRP group was a single locked plate fixation combined with autologous iliac bone grafting. For the PRP group, PRP-enhanced autologous iliac bone grafting and the creation of a bioactive chamber were added. The outcome measures included the union rate, average healing time, visual analog scale pain score, lower limb function score, and complications.</p> Results <p>A total of 90 patients were included, with 39 patients in the PRP group and 51 patients in the non-PRP group. The average follow-up was 16.15 ± 3.14&#xa0;months in the PRP group and 15.86 ± 3.26&#xa0;months in the non-PRP group. No significant differences were observed between the two groups in terms of demographic characteristics and disease parameters (<i>P</i> &gt; 0.05). At 9&#xa0;months post-revision surgery, the healing rate in the PRP group was higher than that in the non-PRP group (58.97% vs 33.33%, <i>p</i> = 0.015,χ<sup>2</sup> = 5.885), but the final union rate did not differ significantly (92.31% vs 78.43%, <i>p</i> = 0.072,χ<sup>2</sup> = 3.240). After excluding cases of persistent nonunion, the PRP group had a significantly shorter average healing time compared to the non-PRP group (8.88 ± 2.03&#xa0;months vs 10.54 ± 2.59&#xa0;months, <i>p</i> = 0.002, t =  −3.103,95%CI: [ −2.74,  −0.60]) and a higher lower limb function score (67.72 ± 4.18 vs 64.55 ± 5.98, <i>p</i> = 0.003, t = 2.700, 95%CI: [0.83, 5.52]). The PRP group had 4 (10.26%) complications, while the non-PRP group had 8 (15.69%) complications.</p> Conclusion <p>In the treatment of atrophic fracture nonunion, PRP enhanced autologous iliac bone grafting can shorten bone healing time and accelerate the healing process, thereby improving limb function more rapidly. This finding provides a superior treatment option clinically for patients in need of accelerated nonunion healing and early recovery of lower limb function.</p>

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Platelet-rich plasma enhanced therapy for aseptic atrophic tibial diaphyseal nonunion: a single-center retrospective controlled study of 90 cases

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  • 发表日期：

    2025年11月11日

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  • Guoqing Niu,
  • Shiheng Wang,
  • Jianrong Chen,
  • Zhiliang Ma,
  • Ke Jie,
  • Jiuxu Yao,
  • Zhiling Liao

摘要

Background

Although successful outcomes of platelet-rich plasma (PRP) in treating nonunion fractures have been reported, there are widespread confounding factors and biases in the studies. This study aims to assess the biological benefits of PRP-enhanced therapy while controlling for the two core factors of nonunion fractures—biomechanics and biology.

Methods

Retrospective analysis of medical records of patients with aseptic atrophic tibial diaphyseal fracture nonunion treated with a single locking plate in a tertiary trauma center. Patients were divided into the PRP group and the non-PRP group based on the use of PRP. The surgical procedure for the non-PRP group was a single locked plate fixation combined with autologous iliac bone grafting. For the PRP group, PRP-enhanced autologous iliac bone grafting and the creation of a bioactive chamber were added. The outcome measures included the union rate, average healing time, visual analog scale pain score, lower limb function score, and complications.

Results

A total of 90 patients were included, with 39 patients in the PRP group and 51 patients in the non-PRP group. The average follow-up was 16.15 ± 3.14 months in the PRP group and 15.86 ± 3.26 months in the non-PRP group. No significant differences were observed between the two groups in terms of demographic characteristics and disease parameters (P > 0.05). At 9 months post-revision surgery, the healing rate in the PRP group was higher than that in the non-PRP group (58.97% vs 33.33%, p = 0.015,χ2 = 5.885), but the final union rate did not differ significantly (92.31% vs 78.43%, p = 0.072,χ2 = 3.240). After excluding cases of persistent nonunion, the PRP group had a significantly shorter average healing time compared to the non-PRP group (8.88 ± 2.03 months vs 10.54 ± 2.59 months, p = 0.002, t =  −3.103,95%CI: [ −2.74,  −0.60]) and a higher lower limb function score (67.72 ± 4.18 vs 64.55 ± 5.98, p = 0.003, t = 2.700, 95%CI: [0.83, 5.52]). The PRP group had 4 (10.26%) complications, while the non-PRP group had 8 (15.69%) complications.

Conclusion

In the treatment of atrophic fracture nonunion, PRP enhanced autologous iliac bone grafting can shorten bone healing time and accelerate the healing process, thereby improving limb function more rapidly. This finding provides a superior treatment option clinically for patients in need of accelerated nonunion healing and early recovery of lower limb function.