Application of Platelet-rich Plasma or Bone Marrow Aspirate for Stable Nonunion

Abstract

Despite current advances in orthopedic technology, nonunion of long bone fractures remains a common complication. The current “gold-standard” treatment for atrophic nonunions uses autologous iliac crest bone graft to augment healing, which has its own array of morbidities. Recent literature shows that percutaneously obtaining mesenchymal stem cells from the iliac crest offers similar success rates of union without the morbidity of graft harvesting. An additional option in treating atrophic nonunion is the use of platelet-rich plasma (PRP) to facilitate healing. PRP functions as an osteoinductive agent, containing several fundamental growth factors and chemoattractants, which may be deficient in the compromised host. This study reviews the technique of obtaining bone marrow aspirate and PRP for percutaneous introduction into tibial nonunions.