Abstract
Background: Recently, there is an increasing interest in the therapeutic potential of platelet-rich plasma (PRP) for bone fracture treatment. Nevertheless, the effect of PRP for bone fracture treatment remains controversial and is still a matter of discussion. Therefore, we performed a systematic review to evaluate the efficacy and safety of PRP injection for treatment of bone fracture.Methods: The main bibliographic databases, including Medline, PubMed, Embase, Web of Science, and the Cochrane library, were comprehensively searched for studies focusing on the application of platelet-rich plasma (PRP) on bone fracture treatment. All relevant articles were screened for eligibility and subdivided into the preclinical and clinical studies. Data were extracted and presented systematically.Results: Finally, twenty-six in vitro preclinical studies (basic studies), nine in vivo preclinical studies (animal studies), and nine clinical studies, met the selection criteria, and were included in the present systematic review. Preclinical studies showed an overall positive effect of PRP on osteoblast-like cells in vitro and bone healing in animal models. The most used treatment for bone fracture in animal and clinical studies is fixation surgery combined with PRP injection. The clinical studies reported PRP shortened bony healing duration, and had no positive effect on improving the healing rate of closed fractures. However, the results of functional outcomes are controversial. Additionally, compared with control group, PRP would not increase the rate of postoperative wound infection.Conclusion: The present systematic review confirmed the continuing interests of PRP as an additional treatment for bone fracture. Preclinical studies highlighted the potential value of PRP as promising therapy for bone fracture. However, the preclinical evidence did not translate into a similar result in the clinical studies. In addition, types of fractures and procedures of PRP preparation are heterogeneous in enrolled studies, which might result in controversial results. Meanwhile, characteristics of PRP, such as platelet concentration, the numbers of leukocytes, still need to be determined and further research is required.
Highlights
Bone tissue is a major part of the musculoskeletal system and provides the framework which supports the body and maintains its shape [1,2,3]
Bone tissue has the potential for spontaneous healing after injuries, the regenerative capacity of bone tissue is limited by many factors, such as age, type of fracture, genetic bone disorder [4,5,6]
Details of all enrolled studies are summarized in the present systematic review, and the main results will be discussed separately for preclinical and clinical studies in this systematic review
Summary
Bone tissue is a major part of the musculoskeletal system and provides the framework which supports the body and maintains its shape [1,2,3]. The principle of clinical treatment for a fracture is reduction and fixation. Many clinical approaches, such as administration of bone morphogenetic proteins [12, 13], cell-based therapies [14, 15], platelet-rich plasma [16], or implantation of graft biomaterials [17], have been used either alone or in combination to enhance bone regeneration. There is an increasing interest in the therapeutic potential of platelet-rich plasma (PRP) for bone fracture treatment. The effect of PRP for bone fracture treatment remains controversial and is still a matter of discussion. We performed a systematic review to evaluate the efficacy and safety of PRP injection for treatment of bone fracture
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