Nonunions treated with autologous preparation rich in growth factors

J Orthop Trauma. 2009 Jan;23(1):52-9. doi: 10.1097/BOT.0b013e31818faded.


Objectives: 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.

Design: The design of the study was a retrospective case series.

Setting: The private practice was in 2 centers.

Patients: 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).

Intervention: 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.

Main outcome measurements: 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.

Conclusion: This study, although uncontrolled, shows that PRGF technology is clinically safe and can enhance the healing of nonhypertrophic nonunions.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bone Nails
  • Bone Transplantation
  • Combined Modality Therapy
  • Female
  • Fracture Fixation, Intramedullary / methods*
  • Fracture Healing
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / therapy*
  • Fractures, Ununited / diagnostic imaging
  • Fractures, Ununited / therapy*
  • Humans
  • Intercellular Signaling Peptides and Proteins / administration & dosage*
  • Male
  • Middle Aged
  • Radiography
  • Range of Motion, Articular
  • Retrospective Studies
  • Young Adult


  • Intercellular Signaling Peptides and Proteins