Based on the diamond concept, application of platelet-rich plasma in the treatment of aseptic femoral shaft nonunion: A retrospective controlled study on 66 patients.

Background: Biologics, particularly platelet-rich plasma (PRP), have gained attention for promoting bone healing. This study assesses the efficacy of PRP-enhanced therapy in treating aseptic femoral shaft nonunion.

Methods: This retrospective study analyzed patients who underwent femoral fracture nonunion revision surgery at a high-level trauma center between January 2021 and April 2024. Patients were divided into two groups: Group 1 (PRP-enhanced) and Group 2 (non-PRP). Group 1 received internal fixation with auxiliary plate reinforcement, PRP-enriched grafts, and bioactive center creation. The primary endpoint was bone healing rate and time to healing; secondary endpoints included lower limb function, pain scores, complications, and risk factors for nonunion at final follow-up.

Results: Sixty-six patients were included (25 in Group 1, 41 in Group 2). At final follow-up, all patients in Group 1 healed, while 80.49 % of Group 2 healed (p = 0.049). The average healing time was shorter in Group 1 (7.61 months) compared to Group 2 (11.19 months) (p < 0.001). Group 1 had superior lower limb function and pain scores (p < 0.001). Long-term smoking (OR = 9.47, 95 % CI 1.39-64.51, P = 0.022) and inappropriate post-operative weight bearing (OR = 7.62, 95 % CI 1.12-51.57, P = 0.038) were identified as risk factors for nonunion.

Conclusion: In nonunion revision surgery, PRP-enhanced therapy significantly improves bone healing rates, reduces healing time, and carries fewer safety risks than traditional bone grafting. It offers an effective approach for nonunion treatment and provides a standardized clinical application for PRP in fracture nonunion surgeries.