Platelet-rich plasma in the treatment of delayed union and nonunion fractures: An umbrella meta-analysis.

Abstract

Long bone fractures may exhibit nonunion/delayed union and the precise mechanism underlying this devastating condition remain unknown. More recently, a series of meta-analyses have examined the effect of local administration of platelet-rich plasma (PRP) in patients suffering from nonunion/delayed union fractures; however, the conclusions of available meta-analyses have remained debatable. This umbrella meta-analysis was performed to synthesize and recalculate available evidence to assess the certainty of the effect of PRP on nonunion/delayed union fractures. Relevant meta-analyses and individual studies investigating the effect of PRP therapy on nonunion/delayed union fractures were obtained through a systematic search in PubMed, Web of Knowledge, and Scopus up to November 2023. Meta-analyses were re-conducted for healing rate and healing time using a random effects model. The methodology quality of the included meta-analyses and the quality of evidence was assessed using the AMSTAR2 and GRADE criteria, respectively. A total of 5 meta-analyses with 13 individual studies, comprising 1362 patients, were included. The analysis revealed a significant improvement in both healing rate (relative risk (RR) = 1.30, 95%CI: 1.06 to 1.60) and healing time (mean difference (MD): -1.25, 95 % CI: -2.09 to -0.42) of nonunion/delayed union fractures. However, when individual studies were pooled, PRP was not effective in increasing the healing rate, while it was effective in reducing healing time (MD = -2.15, 95 % CI = -3.17 to -1.13). PRP therapy had no significant effect on pain improvement and the Excellent/Good Posttreatment Limb Function. The risk of the adverse side effects was not significant. This umbrella meta-analysis revealed that PRP may reduce healing time in patients with nonunion/delayed union fractures, with no potential side effects. This finding is needed to be confirmed by further studies.