Efficacy of Adjuvant Treatment for Fracture Nonunion/Delayed Union: A Network Meta-Analysis of Randomized Controlled Trials

Abstract

Abstract BackgroundFracture nonunion/delayed union seriously affects physical and mental health and quality of life. The aim of this study was to evaluate the relative efficacy of different adjuvant treatments for nonunion/delayed union by network meta-analysis.MethodsA comprehensive search was performed to identify randomized controlled trials (RCTs) evaluating adjuvant treatment in the management of nonunion/delayed union. A network meta-analysis reporting on healing rate, healing time, and adverse effect (AE) outcomes was conducted to assess and compare different interventions.ResultsThirty studies were included in analysis. For healing rate outcome, bone marrow aspirate (BMA) + autologous cancellous bone (ACB) was found to be significantly better than ACB alone (Odds ratio: 0.12; 95% confidence interval: 0.03, 0.59). In the ranking results, BMA+ platelet-rich plasma (PRP) (96%), BMA+ACB (90%), and BMA alone (82%) showed relative advantages in healing rate. Low-intensity pulsed ultrasonography (LIUS) intervention significantly shortened the healing time compared with ACB (Standardized mean difference: -8.93; 95% confidence interval: -14.37, -3.48). LIUS (99%), BMA+PRP (74%), and bone morphogenetic proteins (BMPs) (69%) have relative advantages.ConclusionsAmong the current intervention strategies, BMA and combination with PRP and ACB can improve the healing rate of nonunion/delayed union. LIUS can significantly shorten the healing time. However, large-scale, well-designed studies are still needed to confirm the results.Trial registration: retrospectively registered