Both PRP and bone marrow injection gives results in fracture nonunion. Which one is better for the old age with nonunited fracture??
In my opinion conservative treatment with miniinvasive application of biological stimulants is not the treatment modality of first choice in long bone nonunited fractures. Osteosynthesis with osteoplasty (autografts) should be considered first.
Dear Mahmoud
Its important to know the treatment type for the fracture: Conservative or surgical ?
Before answer the question, we need to know if the nonunion is caused by mechanical, biological, or both causes.
Most of cases with nonunion we have biological cause as there is stable internal fixation. like ILN or locked plate. I have a long experience with bone marrow which had success rate over 86 % in my cases.
but some patients ask me about PRP as it is easy to prepare and injection of PRP can happened with local aneasthesia. most reports nowdays regrets its results on PRP uses either in tendons or bone healing. So, I was asking about more personal experiencewith PRP.
Osteoporotic conditions increase for sure the problem, but the basic situation remains exactly the same as it is for non-osteoporotic ones... Need for stable osteosynthesis with compression of the fracture site, if possible in suitable functional conditions... (I don't like ILIZAROV method except for certain conditions where distraction may be helpful). I fully agree (once more) with Prof. TANCHEV for this, local adjuvants may help, a little bit, but only in cases where nice biomechanics conditions can be restored.
To my knowledge there is no a systematic face to face study comparing both.
And fully agree with Prof. Tenchev
I think PRP has a very small indication in this situation, like stable fixation in a very small gap. If there is a moderate to large gap I would think about to use cancellous autograft.
Dear Mahmoud
Bone tissue has an exceptional quality to regenerate to native tissue in response to injury. However, the fracture repair process requires mechanical stability or a viable biological microenvironment or both to ensure successful healing to native tissue.
I have not experience with PRP but the gold standard is cancellous autograft
i think that the first problem in osteoporotic bone fracture is difficulty to obtain stable and secure fixation so the problem is mainly mechanical and not biological so in nonunion we must achieve stable fixation plus cancellous autograft
I am totally agree with all comments about the gold standard cancellous bone autograft. for several years I have more than one research about the use of Autogenous bone marrow Injections with very satisfied results. I will try to submit my work with its detailed results.
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