Platelet-rich plasma enhances rib fracture strength and callus formation in vivo

Adrian Camarena; Lillian Kang; Anthony J Mirando; Emily Augustine; Najerie S McMillian; Natasha C Stinson; Suresh M Agarwal; Matthew L Becker; Matthew J Hilton; Joseph S Fernandez-Moure

doi:10.1097/TA.0000000000004441

Platelet-rich plasma enhances rib fracture strength and callus formation in vivo

J Trauma Acute Care Surg. 2024 Sep 6. doi: 10.1097/TA.0000000000004441. Online ahead of print.

Authors

Adrian Camarena¹, Lillian Kang, Anthony J Mirando, Emily Augustine, Najerie S McMillian, Natasha C Stinson, Suresh M Agarwal, Matthew L Becker, Matthew J Hilton, Joseph S Fernandez-Moure

Affiliation

¹ From the Department of Surgery (A.C., L.K., S.M.A., J.S.F.-M.), Duke University Medical Center; Department of Orthopedic Surgery (A.J.M., M.J.H.), Duke University School of Medicine; Division of Trauma, Acute, and Critical Care Surgery (N.S.M., S.M.A., J.S.F.-M.), Duke University Medical Center; and Department of Chemistry (E.A., N.C.S., M.L.B.), Department of Mechanical Engineering and Materials Science (E.A., N.C.S., M.L.B.), Department of Biomedical Engineering (E.A., N.C.S., M.L.B.), Department of Orthopedic Surgery (E.A., N.C.S., M.L.B.), and Department of Cell Biology (M.J.H.), Duke University, Durham, North Carolina.

PMID: 39238099
DOI: 10.1097/TA.0000000000004441

Abstract

Background: Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor-rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fracture site would accelerate callus formation and improve callus strength.

Methods: Platelet-rich plasma was isolated from pooled Lewis rat blood and quantified. Thirty-two Lewis rats underwent fracture of the sixth rib and were treated with 100 μL PRP (1 × 106 platelets/μL) or saline. At 2 weeks, ribs were harvested and underwent a 3-point bend, x-ray, and microcomputed tomography, and callus sections were stained with 4',6-diamidino-2-phenylindole and Alcian blue and picrosirius red. At 6 weeks, ribs were harvested and underwent a 3-point bend test, x-ray, microcomputed tomography, and Alcian blue and picrosirius red staining.

Results: At 2 weeks, PRP increased callus diameter (9.3 mm vs. 4.3 mm, p = 0.0002), callus index (4.5 vs. 2.1, p = 0.0002), bone volume/total volume (0.0551 vs. 0.0361, p = 0.0024), cellularization (2,364 vs. 1,196, p < 0.0001), and cartilage (12.12% vs. 3.11%, p = 0.0001) and collagen (6.64% vs. 4.85%, p = 0.0087) content compared with controls. At 6 weeks, PRP increased fracture callus diameter (5.0 mm vs. 4.0 mm, 0.0466), callus index (2.5 vs. 2.0, p = 0.0466), BV/TV (0.0415 vs. 0.0308, p = 0.0358), and higher cartilage (8.21% vs. 3.26%, p < 0.0001) and collagen (37.61% vs. 28.00%, p = 0.0022) content compared with controls. At 6 weeks, PRP samples trended toward improved mechanical characteristics; however, these results did not reach significance (p > 0.05).

Conclusion: Rib fractures are a common injury, and accelerated stabilization could improve clinical outcomes. Platelet-rich plasma significantly increased callus size, calcium deposition, and cartilage and collagen content at 2 and 6 weeks and trended toward improved strength and toughness on mechanical analysis at 6 weeks compared with controls, although this did not reach significance. These findings suggest that PRP may be a useful adjunct to accelerate and improve fracture healing in high-risk patients.