Effect of intramedullary platelet-rich plasma on fracture healing in elderly intertrochanteric fractures: A randomized controlled trial.

Background: Intertrochanteric fractures in the elderly present challenges due to poor bone healing and high complication rates. Platelet-rich plasma (PRP) may promote early bone regeneration, but clinical evidence, especially for osteoporotic fractures, is limited. Unlike extramedullary injections, intramedullary PRP specifically targets the vascular marrow at the fracture site. This randomized controlled trial aimed to evaluate the effect of intramedullary PRP application on fracture healing and clinical outcomes in elderly patients undergoing surgical fixation for intertrochanteric fractures.

Hypothesis: We hypothesized that intramedullary PRP would accelerate early bone healing and improve postoperative functional recovery compared to placebo.

Patients and methods: This single-center, double-blind, parallel-group trial was conducted from November 2020 to December 2024. Patients aged ≥60 years with isolated low-energy intertrochanteric femoral fractures were randomized to receive either 5 mL of autologous PRP or 5 mL of normal saline intraoperatively. All patients underwent fixation with a short cephalomedullary nail. Follow-up assessments were performed at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively.

Results: Eighty-four patients were randomized (40 to the PRP group, 44 to the control group), with no significant differences in baseline characteristics. At 2 weeks, the PRP group showed a significantly higher Radiographic Union Score for Hip (RUSH) than the control group (12.0 vs. 10.5; P <  0.001); however, no significant differences were observed at 6 weeks, 3 months, or 6 months. Postoperative bone turnover markers (P1NP, osteocalcin, ALP, Beta-Crosslaps, and bone-specific ALP) were comparable between groups. Functional outcomes, assessed by the Harris Hip Score, Barthel Index, and De Morton Mobility Index at 6 weeks and 6 months, did not differ significantly.

Discussion: Intramedullary PRP did not improve mid- to long-term fracture healing or functional outcomes in elderly patients with intertrochanteric fractures. Although early radiographic healing was enhanced at 2 weeks, this benefit was not sustained over time. Functional recovery also showed no significant difference. PRP may offer limited clinical benefit in this population, and further research is needed to assess its role in selected subgroups or with modified protocols.

Level of evidence: I.