Evaluation of the Role of PRP in Acute Tibial Shaft Fractures Fixation With IM Nail: A Double-Blinded Randomized Controlled Trial

Abstract

Introduction: Tibial shaft fractures, particularly those classified as AO 42-C3, represent a significant orthopedic challenge due to their high risk of delayed union or nonunion. Intramedullary nailing is a widely used treatment, though optimizing biological healing remains essential. Platelet-rich plasma (PRP), containing abundant growth factors, has been suggested as a therapeutic aid to enhance fracture healing. Methods: A randomized controlled trial was conducted, including 32 patients diagnosed with acute AO 42-C3 pure diaphyseal tibial fractures. Patients were randomized into two groups: 16 received PRP injections, while 16 received normal saline solution (NSS) injections as a control. The primary outcome, cortex-to-callus ratio, was assessed via radiographs over a 6-month follow-up. Secondary outcomes included patient-reported measures such as the SF-36 and EQ-5D-3L questionnaires and time to union. Results: The PRP group exhibited a significantly higher cortex-to-callus ratio during the third and fourth months of follow-up (p < 0.05), indicating accelerated callus formation. Moreover, the PRP group exhibited a statistically significant reduction in time to union compared with the NSS group (p < 0.05). Although other patient-reported outcomes did not show significant differences, the PRP group displayed an upward trend in SF-36 scores (p < 0.05). Discussion: PRP significantly enhances midstage fracture healing in tibial shaft fractures, as evidenced by improved callus formation and reduced time to union. These results indicate that PRP holds promise as a therapeutic adjunct for managing tibial fractures. Additional studies with larger sample sizes and diverse fixation techniques are needed to validate these findings and further assess the broader potential of PRP in orthopedic practice.