Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures
Keywords:Closed distal radius fracture, L-PRP, P-PRP, RUSS
Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.
Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.
Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.
Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy.
Mulders MAM, Rikli D, Goslings JC, Schep NWL. Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents. Eur J Trauma Emerg Surg. 2017;43(2):239-48.
Lee JW, Hyun Kwon O, Kim TK, Cho YK, Choi KY, Chung HY, et al. Platelet-rich plasma: Quantitative assessment of growth factor levels and comparative analysis of activated and inactivated groups. Arch Plast Surg. 2013;40(5):530.
Greening DW, Simpson RJ, Sparrow RL. Preparation of platelet concentrates for research and transfusion purposes. In: Serum/Plasma Proteomics. Humana Press, New York: NY; 2017:31-42.
Kobayashi Y, Saita Y, Nishio H, Ikeda H, Takazawa Y, Nagao M, et al. Leukocyte concentration and composition in platelet-rich plasma (PRP) influences the growth factor and protease concentrations. J Orthop Sci. 2016;21(5):683-9.
Perut F, Filardo G, Mariani E, Cenacchi A, Pratelli L, Devescovi V, et al. Preparation method and growth factor content of platelet concentrate influence the osteogenic differentiation of bone marrow stromal cells. Cytotherapy. 2013;15(7):830-9.
Patel SP, Anthony SG, Zurakowski D, Didolkar MM, Kim PS, Wu JS, et al. Radiographic scoring system to evaluate union of distal radius fractures. J Hand Surg Am. 2014;39(8):1471-9.
McQueen M, Courtbrown JD, Heckman M. Rockwood and Green’s Fractures in Adults. 8th edn. Philadelphia: Wolters Kluwer Health; 2015:1057-1120.
Wolfe S, Hotchkiss R, Pederson W, Kozin S, Cohen M. Green’s Operative Hand Surgery. 7th ed. Philadephia, PA: Elsevier; 2017.
Devereaux J, Dargahi N, Fraser S, Nurgali K, Kiatos D, Apostolopoulos V. Leucocyte-rich platelet-rich plasma enhances fibroblast and extracellular matrix activity: Implications in wound healing. Int J Mol Sci. 2020;21(18):6519.
Kenmochi M. Clinical outcomes following injections of leukocyte-rich platelet-rich plasma in osteoarthritis patients. J Orthop. 2020;18:143-9.
Putra IG, Kawiyana IK, Dusak IW, Astawa P, Suyasa IK, Ridia KG, et al. Administration of platelet rich plasma results in better patient rated wrist examination (PRWE) and radius union scoring system (RUSS) in cases of distal radius fracture with conservative therapy. Multidiscipl J Sci Med Res. 2020.
Rathore DJ, V Joshi, Rathor N, Kajla D. Role of platelet rich plasma in close fracture distal end of radius healing- a comparative study. Indian J Appl Res. 2017;7(4).
Namazi H, Mehbudi A. Investigating the effect of intra-articular PRP injection on pain and function improvement in patients with distal radius fracture. Orthop Traumatol Surg Res. 2016;102(1):47-52.
Abd ElMaguid Mohammed SM. The usage of autologous platelet rich plasma in cases of mid-shaft tibial fracture fixed by interlocking nail tibia. Orthop Rheumatol Open Access J. 2019;14(5):1-11.
Dallari D, Tschon M, Sabbioni G, Giavaresi G. PRP and HA for hip osteoarthritis: Response. Am J Sports Med. 2016;44(9):NP44-6.
Cieslik-Bielecka A, Gazdzik TS, Bielecki TM, Cieslik T. Why the platelet-rich gel has antimicrobial activity? Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 2007;103(3):303-5.
M. Dohan Ehrenfest D, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, et al. In Search of a Consensus Terminology in the Field of Platelet Concentrates for Surgical Use: Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF), Fibrin Gel Polymerization and Leukocytes. Curr Pharm Biotechnol. 2012;13(7):1131-7.
Ziegler CG, Van Sloun R, Gonzalez S, Whitney KE, DePhillipo NN, Kennedy MI, et al. Characterization of Growth Factors, Cytokines, and Chemokines in Bone Marrow Concentrate and Platelet-Rich Plasma: A Prospective Analysis. Am J Sports Med. 2019;47(9):2174-87.
Davis VL, Abukabda AB, Radio NM, Witt-Enderby PA, Clafshenkel WP, Cairone JV, et al. Platelet-rich preparations to improve healing. Part II: Platelet activation and enrichment, leukocyte inclusion, and other selection criteria. J Oral Implantol. 2014;40(4):511-21.
Baht GS, Vi L, Alman BA. The role of the immune cells in fracture healing. Curr Osteoporos Rep. 2018;16(2):138-45.
Bastian OW, Koenderman L, Alblas J, Leenen LPH, Blokhuis TJ. Neutrophils contribute to fracture healing by synthesizing fibronectin + extracellular matrix rapidly after injury. Clin Immunol. 2016;164:78-84.
Lana JF, Macedo A, Ingrao ILG, Huber SC, Santos GS, Santana MHA. Leukocyte-rich PRP for knee osteoarthritis: Current concepts. J Clin Orthop Trauma. 2019;10:S179-82.