Objective  To detect the clinical effects of platelet rich plasma (PRP) combined with bone graft and internal fixation for bone nonunion by conducting Meta-analysis.

Methods  PubMed, Ovid Embase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM were electronically searched to collect randomized controlled trials (RCTs) of PRP for bone nonunion from inception to October 9, 2023. The data of included studies was extracted and the risk of bias was assessed, and a Meta-analysis was performed by using RevMan 5.3 and R 4.3.1 software.

Results  Ten moderate-quality RCTs involving 522 bone nonunion patients (260 in PRP combined group, and 262 in bone graft and internal fixation group) were included. The results of Meta-analysis showed that compared with the bone graft and internal fixation group, PRP combined with bone graft and internal fixation could significantly increase the nonunion healing rate [OR=3.73, 95%CI (2.04, 6.85), P<0.001], decrease the fracture clinical healing time [SMD= -2.38, 95%CI (-2.79, -1.98), P<0.001] and bone healing time [SMD=-1.76, 95%CI (-2.35, -1.16), P<0.001], improve the scores of X-ray [MD=0.86, 95%CI (0.47, 1.25), P<0.001], decrease the incidence of complications [OR=0.32, 95%CI (0.18, 0.55), P<0.001], while there were no significant difference in hospital stays [MD=-3.08, 95%CI (-6.99, 0.83), P=0.12] and the limb function [OR=1.91, 95%CI (0.90, 4.05), P=0.09].

Conclusion  PRP combined with bone graft and internal fixation may be an effective and safe therapeutic method for nonunion, which could increase the nonunion healing rate, decrease the healing time and the incidence of complications. Due to sample-size of the study, more high-quality RCTs are need to verify the above conclusion.

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