Outcomes of Percutaneous Administration of Platelet-Rich Plasma for Long Bone Nonunion in the Upper Extremities A Case Series

Abstract

Nonunion occurs when a fracture fails to heal within the anticipated time, which varies depending on the location and degree of related soft-tissue injury. Pain, poor quality of life, and psychological, social, and economic consequences greatly impact these orthopedic patients. Recent studies have proposed percutaneous injection of platelet-rich plasma (PRP) to treat nonunion. Platelets are present in the early inflammatory stages of fracture healing, in theory enhancing angiogenesis and the recruitment of mesenchymal cells. This study aimed to determine if percutaneous administration of a single 5 mL dose of platelet-rich plasma for long bone nonunion would result in bone union within a span of 3 months of follow-up. We present seven patients diagnosed with nonunion of long bones of the upper extremity. PRP was administered into the nonunion site percutaneously via imaging guidance. Improvements in pain scale and function were monitored using VAS and DASH scores. Radiographic union was assessed using the Modified Lane Radiographic Scoring System. The initial mean VAS score was 4.29 (SD = 2.56), decreasing to 2.71 (SD = 1.38) on the first follow-up, and 0.71 (SD = 0.76) on the third and last follow-up. Functional scores also improved, with a mean DASH score of 28.74 (SD = 4.06) on the last follow-up. The mean MLSRS score was 1.98 (MLSRS 1) and increased to 7.10 (SD = 1.59, MLSRS 3). Platelet-rich plasma (PRP) can be used to treat upper extremity long bone nonunion. The study showed improvements in pain, clinical, and radiographic union.