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Platelet-rich plasma enhances rib fracture strength and callus formation in vivo.

Publication ,  Journal Article
Camarena, A; Kang, L; Mirando, AJ; Augustine, E; McMillian, NS; Stinson, NC; Agarwal, SM; Becker, ML; Hilton, MJ; Fernandez-Moure, JS
Published in: J Trauma Acute Care Surg
September 6, 2024

BACKGROUND: Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor-rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fracture site would accelerate callus formation and improve callus strength. METHODS: Platelet-rich plasma was isolated from pooled Lewis rat blood and quantified. Thirty-two Lewis rats underwent fracture of the sixth rib and were treated with 100 μL PRP (1 × 106 platelets/μL) or saline. At 2 weeks, ribs were harvested and underwent a 3-point bend, x-ray, and microcomputed tomography, and callus sections were stained with 4',6-diamidino-2-phenylindole and Alcian blue and picrosirius red. At 6 weeks, ribs were harvested and underwent a 3-point bend test, x-ray, microcomputed tomography, and Alcian blue and picrosirius red staining. RESULTS: At 2 weeks, PRP increased callus diameter (9.3 mm vs. 4.3 mm, p = 0.0002), callus index (4.5 vs. 2.1, p = 0.0002), bone volume/total volume (0.0551 vs. 0.0361, p = 0.0024), cellularization (2,364 vs. 1,196, p < 0.0001), and cartilage (12.12% vs. 3.11%, p = 0.0001) and collagen (6.64% vs. 4.85%, p = 0.0087) content compared with controls. At 6 weeks, PRP increased fracture callus diameter (5.0 mm vs. 4.0 mm, 0.0466), callus index (2.5 vs. 2.0, p = 0.0466), BV/TV (0.0415 vs. 0.0308, p = 0.0358), and higher cartilage (8.21% vs. 3.26%, p < 0.0001) and collagen (37.61% vs. 28.00%, p = 0.0022) content compared with controls. At 6 weeks, PRP samples trended toward improved mechanical characteristics; however, these results did not reach significance (p > 0.05). CONCLUSION: Rib fractures are a common injury, and accelerated stabilization could improve clinical outcomes. Platelet-rich plasma significantly increased callus size, calcium deposition, and cartilage and collagen content at 2 and 6 weeks and trended toward improved strength and toughness on mechanical analysis at 6 weeks compared with controls, although this did not reach significance. These findings suggest that PRP may be a useful adjunct to accelerate and improve fracture healing in high-risk patients.

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Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

September 6, 2024

Location

United States
 

Citation

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Camarena, A., Kang, L., Mirando, A. J., Augustine, E., McMillian, N. S., Stinson, N. C., … Fernandez-Moure, J. S. (2024). Platelet-rich plasma enhances rib fracture strength and callus formation in vivo. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000004441
Camarena, Adrian, Lillian Kang, Anthony J. Mirando, Emily Augustine, Najerie S. McMillian, Natasha C. Stinson, Suresh M. Agarwal, Matthew L. Becker, Matthew J. Hilton, and Joseph S. Fernandez-Moure. “Platelet-rich plasma enhances rib fracture strength and callus formation in vivo.J Trauma Acute Care Surg, September 6, 2024. https://doi.org/10.1097/TA.0000000000004441.
Camarena A, Kang L, Mirando AJ, Augustine E, McMillian NS, Stinson NC, et al. Platelet-rich plasma enhances rib fracture strength and callus formation in vivo. J Trauma Acute Care Surg. 2024 Sep 6;
Camarena, Adrian, et al. “Platelet-rich plasma enhances rib fracture strength and callus formation in vivo.J Trauma Acute Care Surg, Sept. 2024. Pubmed, doi:10.1097/TA.0000000000004441.
Camarena A, Kang L, Mirando AJ, Augustine E, McMillian NS, Stinson NC, Agarwal SM, Becker ML, Hilton MJ, Fernandez-Moure JS. Platelet-rich plasma enhances rib fracture strength and callus formation in vivo. J Trauma Acute Care Surg. 2024 Sep 6;

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

September 6, 2024

Location

United States