Chin J Traumatol. 2026 Jul 31:S1008-1275(26)00146-X. doi: 10.1016/j.cjtee.2026.06.001. Online ahead of print.
ABSTRACT
PURPOSE: Non-union fractures of the lower extremity remain a major clinical challenge due to high mechanical loading, compromised vascularity, and limited soft-tissue coverage. Platelet-rich plasma (PRP) has emerged as a biological adjunct to enhance bone healing; however, its efficacy in non-union fractures is still debated. This review aimed to synthesize available evidence on reported outcomes of adjunctive PRP use in non-union lower extremity fractures.
METHODS: A comprehensive literature search up to 31st October 2025 was performed in PubMed, ScienceDirect, ProQuest, Cochrane, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews guidelines. Eligible studies included adult patients with non-union tibial or femoral fractures treated with PRP as platelet gel, platelet concentrate, or composite graft, compared with standard treatment or without PRP. The primary outcome was time to radiographic union, while radiographic non-union and complications were evaluated as secondary outcomes. Random-effects models with the DerSimonian-Laird method were used to calculate pooled effect sizes, and heterogeneity was assessed using I2 statistics.
RESULTS: Seven studies involving 230 patients were included. Heterogeneous PRP-augmented surgical strategies significantly reduced time to radiographic union by 2.59 weeks compared with control (95% confidence intervals: -4.14 to -1.05; p < 0.001, I2 = 0%). Subgroup analysis showed a consistent direction of effect across randomized and observational studies. The pooled analysis of radiographic non-union showed a non-significant trend favoring PRP (odds ratio: 0.35; 95% confidence intervals: 0.11 – 1.08; p = 0.07; I2 = 0%). Complication outcomes were inconsistently reported, and available data did not identify a clear signal of serious PRP-related harm.
CONCLUSION: Heterogeneous PRP-augmented surgical strategies, including PRP gel, platelet concentrate, and composite graft, were associated with a modest reduction in time to radiographic union in lower extremity non-union fractures. Adequately powered trials using standardized PRP protocols and clinically meaningful outcomes are required.
PMID:42562721 | DOI:10.1016/j.cjtee.2026.06.001
