Abstract: Objective To retrospectively analyze the clinical efficacy of auxiliary steel plate combined with autologous platelet rich plasma (PRP) and replacement of intramedullary nails with steel plate fixation in the treatment of femoral shaft nonunion after intramedullary nail fixation. Methods A total of 30 patients with femoral fracture and bone nonunion after intramedullary nail fixation were selected from the Department of Orthopedics of our hospital from June 2019 to June 2022, including 26 males and 4 females. The average age was (36.8±7.1) years, ranging from 20 to 58 years. In the experimental group of 13 patients, intramedullary nails were retained and the fracture end was fixed with side plates. During the operation, autologous iliac bone mixed PRP was implanted in the bone defect site, and autologous PRP 10 mL/ (person) was injected into the bone non-union site 14 d and 28 d after surgery. In the control group, intramedullary nails were removed, and locking compression plates were fixed instead, followed by intraoperative autologous iliac bone grafting. Follow up observation and comparison of perioperative conditions and clinical fracture healing between the two groups of patients were conducted. Results All the 30 patients received complete follow-up for 2~33 months, with an average of (15.2±3.5) months. The operative time (min), intraoperative blood loss (mL) and postoperative drainage volume (mL) of the two groups were 95.7±47.2 vs. 167.6±71.5, 292.3±147.2 vs. 686.9±238.9, and 102.8±67.5 vs. 166.2±87.3, respectively, showing significant differences (P<0.05), and the length of hospitalization (d) was 10.3±5.2 vs. 12.5±6.8, with no significant difference (P>0.05). The clinical healing time of fractures (month) was 5.36±1.27 vs. 7.63±1.57 (P<0.05); the healing rates at 6 and 9 months after surgery were 92.3% (12/13) vs. 52.9% (9/17) (P<0.05), and 100% (13/13) vs. 82.4% (14/17) (P>0.05), respectively. Conclusion sIntraoperative and postoperative use of autologous PRP in the treatment of femoral fracture after intramedullary fixation is simple, short, less bleeding, and fast healing, which is an ideal treatment for clinical selection.

Key words: Platelet rich plasma, Femoral shaft fracture, Intramedullary fixation, Bone nonunion