Introduction Nonunion of long bones is a condition burdened by a high frequency of therapeutic failures. The aim of the present study was to evaluate the use of platelet gel supplementation to accelerate the healing of long bone nonunions treated by external fixation. Materials and methods Twenty consecutive patients with atrophic tibial, humeral, ulnar, or radial nonunion treated with percutaneous stabilization with unilateral external fixator and injection of autologous platelet gel were followed prospectively. The healing time was compared to the results observed in a historical control group in which the external fixation was not supplemented with platelet gel. The rate of consolidation and time to healing in the two groups was evaluated in a blinded fashion by independent observers. The nonunion was judged to be healed when bridging callus formation on both radiographic views was observed on at least three of four cortices. Results The cure rate of nonunions was 90 % in the patients treated with platelet gel (18/20) and 85 % in the controls (17/20) (p = 0.633). The mean time to radiographic healing in the group treated with platelet gel was 147 ± 63 days and no significant differences with the controls (153 ± 61 days) were appreciated (p = 0.784). Analyzing the mean healing time for separate segments, no differences were noted between study and control group (tibia: 112 ± 43 and 130 ± 5 days, respectively, p = 0.382; humerus: 225 ± 36 and 202 ± 70 days, respectively, p = 0.530). Discussion There is a lack of literature data on the effectiveness of platelet gel and growth factors in the treatment of nonunions of long bones. The present study shows that the percutaneous injection platelet gel is not effective in promoting the healing of nonunions of long bones treated with external fixators. Conclusions The present study failed to show the clinical usefulness of isolated percutaneous platelet gel supplementation in long bone nonunions treated by external fixation.

External fixation and platelet-rich plasma for the treatment of nonunions of long bones

MARICONDA, MASSIMO;A. Cozzolino;CERBASI, SIMONE;RECANO, PASQUALE;COSTA, GIOVAN GIUSEPPE
2013

Abstract

Introduction Nonunion of long bones is a condition burdened by a high frequency of therapeutic failures. The aim of the present study was to evaluate the use of platelet gel supplementation to accelerate the healing of long bone nonunions treated by external fixation. Materials and methods Twenty consecutive patients with atrophic tibial, humeral, ulnar, or radial nonunion treated with percutaneous stabilization with unilateral external fixator and injection of autologous platelet gel were followed prospectively. The healing time was compared to the results observed in a historical control group in which the external fixation was not supplemented with platelet gel. The rate of consolidation and time to healing in the two groups was evaluated in a blinded fashion by independent observers. The nonunion was judged to be healed when bridging callus formation on both radiographic views was observed on at least three of four cortices. Results The cure rate of nonunions was 90 % in the patients treated with platelet gel (18/20) and 85 % in the controls (17/20) (p = 0.633). The mean time to radiographic healing in the group treated with platelet gel was 147 ± 63 days and no significant differences with the controls (153 ± 61 days) were appreciated (p = 0.784). Analyzing the mean healing time for separate segments, no differences were noted between study and control group (tibia: 112 ± 43 and 130 ± 5 days, respectively, p = 0.382; humerus: 225 ± 36 and 202 ± 70 days, respectively, p = 0.530). Discussion There is a lack of literature data on the effectiveness of platelet gel and growth factors in the treatment of nonunions of long bones. The present study shows that the percutaneous injection platelet gel is not effective in promoting the healing of nonunions of long bones treated with external fixators. Conclusions The present study failed to show the clinical usefulness of isolated percutaneous platelet gel supplementation in long bone nonunions treated by external fixation.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11588/571866
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