Nonunion of Femoral Fractures: Treatment Options and PRP Efficacy

Nonunion of femoral fracture

Since the surgery in May 2021, the fracture has not healed properly.
The X-ray showing the entire bone screw placement can be viewed here: https://i.imgur.com/IWr30qa.jpg.
More than a year has passed, and it still hasn't healed: https://i.imgur.com/YmvbymU.jpg.
Currently, my doctor has provided three options: 1.
Administer PRP (Platelet-Rich Plasma) to stimulate bone growth without surgery; if that doesn't work, then consider option 2.
The doctor has been encouraging me to try this, but I feel that its effectiveness may be limited, especially since both sides of the fracture have turned white and seem to be forming independently.
My doctor mentioned there is a 30-40% chance of healing with this method.
2.
Perform surgery to graft bone into the gap with minimal debridement.
3.
Conduct surgery to remove the entire bone screw and plate and replace them.
I would like to ask the physician, is PRP really effective for bone healing? Or do you have any other suggestions? Thank you!

Mo, 40~49 year old female. Ask Date: 2022/09/05

Dr. Shi Guozheng reply Orthopedics

The location of your fracture is just below the intertrochanteric region of the femur, where the bone is particularly dense and has a slower healing rate.
It typically takes about one and a half to two years for this type of fracture to heal.
If you are currently not experiencing any pain, there is no need for immediate intervention; you can continue to monitor it for up to two years.
There is usually a good chance of healing.

Reply Date: 2022/09/05

More Info

Understanding the nonunion of femoral fractures is crucial for determining the most effective treatment options. Nonunion occurs when a fractured bone fails to heal properly, which can lead to persistent pain, functional impairment, and the need for further interventions. In your case, it appears that you have been dealing with a nonunion femoral fracture for over a year, and your physician has proposed several treatment options, including the use of Platelet-Rich Plasma (PRP) therapy.

PRP therapy has gained popularity in recent years as a potential treatment for various musculoskeletal injuries and conditions, including nonunion fractures. The rationale behind PRP therapy is that it utilizes the patient's own blood, which is rich in growth factors and cytokines, to promote healing and tissue regeneration. The idea is that by injecting PRP into the nonunion site, it may stimulate the bone healing process and enhance the chances of successful union.

However, the efficacy of PRP in treating nonunion fractures remains a topic of debate within the medical community. While some studies suggest that PRP can be beneficial in promoting bone healing, others indicate that the evidence is not robust enough to recommend it as a standalone treatment. The effectiveness of PRP may also depend on various factors, including the type of fracture, the patient's overall health, and the presence of any underlying conditions that may affect healing.

In your specific situation, where the fracture has not healed for over a year, it is essential to consider the following points:
1. Assessment of the Nonunion: Your physician should conduct a thorough evaluation of the nonunion site, including imaging studies, to determine the quality of the bone and the surrounding tissue. This assessment can help guide the treatment decision.

2. PRP Therapy: While PRP may offer some benefits, it is generally considered more effective when used in conjunction with other treatments rather than as a standalone option. If you choose to proceed with PRP, it may be wise to combine it with other interventions, such as bone grafting or surgical stabilization, to enhance the likelihood of healing.

3. Surgical Options: The surgical options presented by your physician, including bone grafting and the removal of hardware, are well-established approaches for addressing nonunion fractures. Bone grafting can provide the necessary biological material to stimulate healing, while removing any hardware that may be causing irritation or preventing healing can also be beneficial.

4. Consultation with a Specialist: If you have concerns about the proposed treatments or the effectiveness of PRP, consider seeking a second opinion from an orthopedic specialist who has experience in treating nonunion fractures. They may provide additional insights or alternative treatment options.

5. Rehabilitation: Regardless of the treatment chosen, a comprehensive rehabilitation program is crucial for optimizing recovery. Physical therapy can help restore function, strength, and mobility to the affected limb.

In conclusion, while PRP therapy may have potential benefits for promoting bone healing, its effectiveness in treating nonunion fractures is not universally accepted. It is essential to weigh the options carefully, considering both the potential benefits and limitations of PRP in your specific case. Collaborating closely with your healthcare provider to develop a tailored treatment plan that addresses your unique needs and circumstances will be key to achieving a successful outcome.

Similar Q&A

Understanding Non-Displaced Closed Fractures of the Toes: Treatment Options

Hello, Doctor. I slipped and hit an object, resulting in pain and bruising in the last three toes of my left foot. Four days after the injury, I visited an orthopedic specialist, and X-rays revealed fractures in both the fourth and fifth toes. The doctor diagnosed them as non-dis...

Dr. Shi Guozheng reply Orthopedics
Toe fractures typically heal on their own, and there is no evidence to suggest that platelet-rich plasma (PRP) treatment is effective.

Managing Nonunion of Right Femur Fracture: Expert Opinions and Options

Because the area of my right thigh has had a comminuted fracture that hasn't healed for 6 to 7 years, a physician at one hospital suggested removing the steel nail at the knee to allow compression on the non-healed area to promote growth. However, another physician at a diff...

Dr. Shi Guozheng reply Orthopedics
The choice of surgical method depends on whether there is any bone defect. If the bone has not healed properly over the years, the best option may be bone grafting combined with fixation using screws or plates.

Understanding Nonunion in Ankle Fractures: Recovery and Treatment Options

I apologize for the questions, but I would like to ask Dr. Wang about the healing process after a fracture of the left ankle. It has been about five months since the fracture, and I experience pain whenever I put any weight on the injured area of the ankle. Additionally, I feel p...

Dr. Wang Shouji reply Orthopedics
Hello: Generally speaking, nonunion of fractures should consider two points: 1. Poor environmental contact at the fracture site, and 2. Insufficient stability at the fracture site. However, healing should occur within six months, after which rehabilitation can gradually restore f...

Understanding Avascular Necrosis of the Femoral Condyle: Treatment Options and Recovery

Hello Dr. Chen, My mother suddenly fell on the street due to knee pain while walking six months ago. At that time, she had an X-ray examination at a nearby orthopedic clinic, but the doctor did not find any abnormalities. Due to the pandemic, she delayed visiting a rehabilitatio...

Dr. Chen Bochen reply Orthopedics
Hello: If the MRI shows early-stage osteonecrosis of the medial condyle, conservative treatment can be employed, which includes non-weight bearing with crutches, along with regenerative treatments such as platelet-rich plasma (PRP) therapy and hyperbaric oxygen therapy. Arthrosco...