Orthobiologics in Fracture Healing: Current Clinical Evidence for PRP, BMAC, and Growth Factor Therapies
Keywords:
orthobiologics; fracture healing; platelet-rich plasma; bone marrow aspirate concentrate; bone morphogenetic proteins; mesenchymal stem cells; nonunionAbstract
Orthobiologics represent a transformative approach in trauma surgery, offering biologically active agents to augment impaired fracture healing. Delayed union and nonunion affect approximately 5-10% of all fractures, imposing substantial clinical and socioeconomic burdens. This narrative review evaluates current clinical evidence for four major orthobiologic categories: platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), bone morphogenetic proteins (BMPs), and mesenchymal stem cells (MSCs). Each agent possesses a distinct mechanism of action, preparation technique, and efficacy profile. PRP provides concentrated growth factors including PDGF, TGF-beta, and VEGF; BMAC delivers multipotent progenitor cells from the iliac crest; BMPs function as potent osteoinductive cytokines; and MSCs modulate the immune microenvironment while differentiating into osteoblasts. Clinical data indicate MSC therapy achieves union rates exceeding 90% in nonunion cases, while PRP and BMAC demonstrate variable but generally favorable outcomes. Standardization of preparation protocols and robust randomized controlled trials remain essential for integrating these therapies into routine orthopedic practice.
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