The biomechanical and histological effects of platelet-rich plasma on fracture healing
Guzel Y, Karalezli N, Doral M, et al. Knee Surg Sports Traumatol, Arthrosc. 2013 Oct 30 [Epub ahead of print].
Take Home Message: The administration of platelet-rich plasma (PRP) using a standard preparation technique may accelerate long bone fracture healing.
Platelets, which are naturally occurring in blood tissue, secrete growth factors and cytokines that may enhance regenerative processes in the body. Platelet-rich plasma (PRP) may be beneficial as an adjunct therapy with spinal fusion surgery, prosthetic and periodontal therapy, and the treatment of non-unions. However, there is still little known about the biomechanical effects of PRP on the healing of fractures. The aim of this prospective, randomized animal study was to determine the effect of PRP on the fracture healing of long bones. The authors divided 70 female rats into one of three groups: no PRP group, PRP-added group, and control group (no fracture, no PRP). Rats from the no PRP (n=30) and PRP-added (n=30) groups underwent mid-diaphysis transverse femur fractures and had their fractures fixed with 1-mm K-wires. Only the PRP-added group then received an autologous PRP injection in the fracture line prepared as per a standardized protocol (Anitua technique. The authors performed histological assessments at four weeks and nine weeks post-surgery to determine the extent of bone recovery. Some rats also underwent biomechanical testing in the ninth week post-surgery to assess the structural integrity of the bone (No-PRP group: 8 rats, PRP-added group: 8 rats, and control group: 10 rats). The authors found that rats in the PRP-added group demonstrated earlier weight-bearing, accelerated fracture healing (e.g. osteochondral bone formation, reorganization of the cancellous bone), and were able to withstand more force when maximum loading was applied to the bone, compared with rats that did not receive PRP. Interesting to note, the femurs of the PRP-added group were as strong as the control group’s femurs that were never fractured.
The results of this study suggest that injection of PRP into a fracture site of a long bone may speed recovery and increase the bone’s ability to withstand stress. Although PRP injections have yet to be standardized into a most effective technique and concentration, the Anitua technique used in this study shows promising effects in the healing of fractures in long bones. However, clinicians should keep in mind that this study was conducted on rats and not on human models. Furthermore, this study did not look at the treatment of nonunions, a serious complication in fracture healing, and so the effect of PRP on nonunions has yet to be determined. Despite these limitations, these findings are intriguing and may eventually prompt clinical trials to determine if PRP can accelerate fracture healing or avoid nonunions in humans.
Questions for Discussion: What is your experience as a clinician with PRP? Aside from PRP, what other therapeutic interventions have you used to promote the healing of long bone fractures? Have you found one intervention to be superior in terms of return-to-play/functionality or incidence of re-fracture?
Written by: Tiffany Kobordo
Reviewed by: Lisa Chinn and Jeffrey Driban
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