Indian Journal of Orthopaedics Surgery 2020;6(1):35–40 Content available at: iponlinejournal.com Indian Journal of Orthopaedics Surgery Journal homepage: www.innovativepublication.com Original Research Article Role of PRP injection in delayed union and non union of long bone fractures Suresh Kumar Kaushik 1 , Apser Khan 1, *, Mrigank Mathur 1 , Milan Jaiswal 2 , Dushyant Jadon 1 1 Dept. of Orthopaedics, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India 2 Dept. of Pathology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India ARTICLE INFO Article history: Received 06-12-2019 Accepted 29-01-2020 Available online 21-04-2020 Keywords: Platelet rich plasma Non union Delayed unoin Adiposed derived stem cell Mesenchymal stem cells ABSTRACT Background: The evidence for PRP osteogenic potential has been suggested by several in vitro studies, i.e. PRP addition in culture medium promoted the proliferation and differentiation of human mesenchymal stem cells (MSCs) and the effect of PRP on osteogenic differentiation was also seen on human adipose derived stem cell (ADSC). We aim to study the role of PRP in accelerating bone healing potential at the fracture site in cases of delayed union or non union of long bones. Materials and Methods: The present study was conducted from JUNE 2018 to JUNE 2019 where 20 patients with delayed/non union of long bone fractures were treated with PRP injection. The patients were assessed for callus formation over radiological examination. Results: In our study 65 percent of the patients benefitted from PRP therapy and showed good callus formation and 35 percent did not benefit from the treatment and required further operative intervention. The pre procedure VAS score in patients with delayed union was 3.5 ± 1.3 and non union group was 2.8 ±1.4 which reduced to 1.2±0.3 and 1.1±0.3 respectively. Conclusion: The use of PRP in treatment of non union and delayed union of long bone fractures has shown good results with no complications, it is a promising new modality which needs prospective, randomised, placebo-controlled, multicentric-studies with a much larger sample size to clarify the results and better understanding of the effects of PRP in fracture healing. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Introduction Delayed fracture union is absence of callus formation 4 months after injury where as nonunion is considered after 6 months of injury without any progression towards union. Bone grafting is well accepted method of treatment of nonunion of long bone fractures. These grafts act as scaffolds which provides biomechanical strength, autologous and allogenic graft are commonly used. Nonunion of long bone fractures is still a serious complication after infection in compound fractures. It poses tremendous economic burden upon the society. Several methods & modalities of treatment have been devised to bring about early union including biodegradable implants, * Corresponding author. E-mail address: afserkhan@gmail.com (A. Khan). BMP-7 and PRP injection. PRP is autologous blood product containing very high concentration of platelets which provided PDGF- Platelet derived growth factor, VEGF- Vascular Endothelial growth factor, FGF- fibroblast growth factor. These factor are responsible for repair and granulation tissue formation. Substances released from activated platelets affect and induces intra cellular signaling pathways responsible for production of protein, required for fracture healing. Preparation of PRP concentrate requires two step procedure. In first step blood is divided into platelet rich and cell rich components. Second step involving centrifugation at high speed to reduce to desired volume of plasma containing > 10 lac platelets/ml of plasma. Platelet-rich plasma (PRP) is a concentration of blood platelets suspended in a small volume of plasma. The first https://doi.org/10.18231/j.ijos.2020.007 2395-1354/© 2020 Innovative Publication, All rights reserved. 35