1. KOA CONFERENCE Eldoret 2016

2. USE OF PLASMA PLATELET CONCENTRATE IN MANAGEMENT OF NON-UNION OF LONG BONE FRACTURES: A REVIEW OF THE LITERATURE AND CASE REPORT Mutiso VM, Anzala O, Khainga S, Nur AM

3. What is it? ■Platelet Rich Plasma (PRP) is prepared by centrifuging whole blood ■It is the platelet enriched Fluid portion of whole blood separated from the red blood cells by spinning

4. Whats in it? ■This contains numerous growth factors and cytokines which include - Platelet Derived Growth Factor (PDGF) - Transforming Growth Factor (TGF) - Insulin like Growth Factors ( IGF) - Vascular Endothelial Growth Factor ( VEGF) - Interleukin8 (IL-8)

5. Theory of use ■Must be autologous ■Added toautologous bone graft enhancing its activity

6. Case ■Middle aged lady ■Suffered fracture of the tibia ■Had Multiple surgeries over time ■Subsequent inability to bear weight for about two years

7. surgery ■Excision of triangular piece of sequestrum ■Sub- periosteal excision of small portion of fibula ■Autologous bone grafting ■Application of autologous Platelet Rich Plasma ■Fixation with Proximal Tibial Locking Plate

8. outcome ■Follow up at 9 months ■Union proceeding, at least 50% of circumference united. ■Patient allowed to bear weight as comfortable.

10. AP View: note missing triangular piece medially

11. Lateral view: more medial callus than lateral. Note missing piece of fibula

12. Lateral view. Note osteoarthritis of the knee joint

13. Discussion ■Use of PRP ongoing for the last decade or so ■Mixed results. ■No clear cut evidence of its efficacy

14. conclusion ■Be your own judge

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