Effect of platelet-rich plasma on fracture healing

•Approximately 10% of fractures do not heal uneventful, with nonunion being the most feared complication.•Platelets contain growth factors that play a role in fracture healing.•Platelet-rich plasma (PRP) has shown potential to induce fracture healing in animal studies, but studies in patients show c...

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Bibliographic Details
Published in:Injury 2021-06, Vol.52, p.S58-S66
Main Authors: Van Lieshout, Esther M.M., Den Hartog, Dennis
Format: Article
Language:English
Subjects:
Fracture healing
Platelet concentrate
Platelet-rich plasma, PRP
Platelets
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Summary:•Approximately 10% of fractures do not heal uneventful, with nonunion being the most feared complication.•Platelets contain growth factors that play a role in fracture healing.•Platelet-rich plasma (PRP) has shown potential to induce fracture healing in animal studies, but studies in patients show conflicting results.•Conflicts in the literature may be explained by heterogeneous study populations as well as by the absence of a consensus about the preparation of PRP, required platelet counts, and application technique.•Based on current literature, the routine use of PRP to improve fracture healing cannot be recommended. Bone has the ability to completely regenerate under normal healing conditions. Although fractures generally heal uneventfully, healing problems such as delayed union or nonunion still occur in approximately 10% of patients. Optimal healing potential involves an interplay of biomechanical and biological factors. Orthopedic implants are commonly used for providing the necessary biomechanical support. In situations where the biological factors that are needed for fracture healing are deemed inadequate, additional biological enhancement is needed. With platelets being packed with granules that contain growth factors and other proteins that have osteoinductive capacity, local application of platelet concentrates, also called platelet-rich plasma (PRP) seems an attractive biological to enhance fracture healing. This review shows an overview of the use PRP and its effect in enhancing fracture healing. PRP is extracted from the patient's own blood, supporting that its use is considered safe. Although PRP showed effective in some studies, other studies showed controversial results. Conflicts in the literature may be explained by the absence of consensus about the preparation of PRP, differences in platelet counts, low number of patients, and absence of a standard application technique. More studies addressing these issues are needed in order to determine the true effect of PRP on fracture healing.
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2020.12.005