title: Nonunions treated with autologous preparation rich in growth factors.
abstract: OBJECTIVE
  To evaluate the clinical safety and efficacy of using a biologic technology known as preparation rich in growth factors (PRGF) for the treatment of nonhypertrophic nonunion.
  
  
  METHODS
  The design of the study was a retrospective case series.
  
  
  METHODS
  The private practice was in 2 centers.
  
  
  METHODS
  There were 15 patients with a total of 16 aseptic nonunions, 12 diaphyseal and 4 supracondylar, diagnosed as nonhypertrophic. The mean time since prior surgical treatment was 21 months (9-46 months).
  
  
  METHODS
  Supracondylar and diaphyseal nonunions followed surgical fixation with condylar plating or intramedullary nailing, whereas a composite biomaterial created by mixing PRGF with bone allograft was applied. The area was then covered with autologous fibrin membranes. Stable nonunions were treated with repeated percutaneous injections of PRGF; this minimally invasive procedure was also applied if delayed healing was suspected after surgical treatment.
  
  
  METHODS
  Radiographic union using radiographic views was taken in 2 planes. Clinical outcome evaluated pain, motion at the fracture site upon manual stress testing, and recovery of range of motion.
  
  
  RESULTS
  All nonunions treated operatively healed after a single procedure, even though additional PRGF had to be injected in 2 patients. Two of 3 stable nonunions achieved healing only after repeated percutaneous PRGF injections. The mean time from surgery and/or PRGF application to union was 4.9 months (2-8 months). Complications associated with the described procedure were not observed.
  
  
  CONCLUSIONS
  This study, although uncontrolled, shows that PRGF technology is clinically safe and can enhance the healing of nonhypertrophic nonunions.
authors.affiliation: Unidad de Cirugia Artroscópica UCA, Clínica USP-La Esperanza, Vitoria, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Sanchez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Anitua
authors.forename: Ramon
authors.initials: R
authors.lastname: Cugat
authors.forename: Juan
authors.initials: J
authors.lastname: Azofra
authors.forename: Jorge
authors.initials: J
authors.lastname: Guadilla
authors.forename: Roberto
authors.initials: R
authors.lastname: Seijas
authors.forename: Isabel
authors.initials: I
authors.lastname: Andia
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D036341:Intercellular Signaling Peptides and Proteins