Dual locking plate fixation, PRP-augmented autologous bone grafting, and bioactive core construction for femoral fracture nonunion: a retrospective study of 52 cases

Zhihao Peng; Shiheng Wang; Ke Jie; Yonghong Dai; Kunyu Wang; Jiahua Wu; Feng Wu; Jianrong Chen

doi:10.3389/fmed.2025.1615628

Dual locking plate fixation, PRP-augmented autologous bone grafting, and bioactive core construction for femoral fracture nonunion: a retrospective study of 52 cases

Front Med (Lausanne). 2025 Jun 12:12:1615628. doi: 10.3389/fmed.2025.1615628. eCollection 2025.

Authors

Zhihao Peng^#^{1

2}, Shiheng Wang^#^{1

3}, Ke Jie^{1

2

3}, Yonghong Dai^{1

3}, Kunyu Wang⁴, Jiahua Wu^{1

3}, Feng Wu^{1

2}, Jianrong Chen^{1

2

3}

Affiliations

¹ The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, China.
² Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
³ Guangzhou University of Chinese Medicine, Guangzhou, China.
⁴ Henan University of Chinese Medicine, Zhengzhou, China.

^# Contributed equally.

Abstract

Background: Femoral nonunion remains a challenging orthopedic condition. This study evaluates a combined protocol integrating biomechanical stabilization (dual locking plate fixation) and maximal biological stimulation (PRP-augmented autologous bone grafting with bioactive core construction) to optimize bone healing.

Methods: A retrospective analysis included 52 femoral nonunion patients treated at a tertiary trauma center (2020-2024). Outcomes assessed radiographic union (9-month and final follow-up), clinical union time, thigh incision healing, pain scores (VAS), lower extremity function (LEFS), and complications.

Results: Cohort demographics: 35 males, 17 females; mean age 41.38 years, BMI 24.79 kg/m². Nonunion subtypes: hypertrophic (36.5%, n = 19), atrophic (50%, n = 26), oligotrophic (13.5%, n = 7); locations: femoral shaft (63.5%, n = 33), supracondylar (36.5%, n = 19). All achieved union (mean follow-up: 19.01 months) with mean union time 6.56 ± 1.04 months. Postoperative outcomes: pain score 0.63 ± 0.97, LEFS 63.92 ± 5.92, incision healing 12.13 ± 1.36 days. The incidence rate of serious complications was 3.85% (2/52).

Conclusion: The protocol demonstrated efficacy and safety, achieving rapid union (6.56 months), robust functional recovery (LEFS 63.92), and a low incidence of serious complications (3.85%). Biomechanical-biological integration represents a viable strategy for femoral nonunion management.

Keywords: autologous iliac bone grafting; dual plate fixation; femoral fracture nonunion; fracture nonunion; platelet-rich plasma.