{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:05:34Z","timestamp":1792389934182,"version":"4.4.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis included 52 femoral nonunion patients treated at a tertiary trauma center (2020\u20132024). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cohort demographics: 35 males, 17 females; mean age 41.38\u202fyears, BMI 24.79\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Nonunion subtypes: hypertrophic (36.5%,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f19), atrophic (50%,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f26), oligotrophic (13.5%,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f7); locations: femoral shaft (63.5%,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f33), supracondylar (36.5%,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f19). All achieved union (mean follow-up: 19.01\u202fmonths) with mean union time 6.56\u202f\u00b1\u202f1.04\u202fmonths. Postoperative outcomes: pain score 0.63\u202f\u00b1\u202f0.97, LEFS 63.92\u202f\u00b1\u202f5.92, incision healing 12.13\u202f\u00b1\u202f1.36\u202fdays. The incidence rate of serious complications was 3.85% (2\/52).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The protocol demonstrated efficacy and safety, achieving rapid union (6.56\u202fmonths), 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1615628","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T01:20:50Z","timestamp":1749691250000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Dual locking plate fixation, PRP-augmented autologous bone grafting, and bioactive core construction for femoral fracture nonunion: a retrospective study of 52 cases"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhihao","family":"Peng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Jie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahua","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/s41572-021-00289-8","article-title":"Non-union bone fractures","volume":"7","author":"Wildemann","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"111779","DOI":"10.1016\/j.injury.2024.111779","article-title":"Long-term patient reported outcomes after revision surgery for lower extremity nonunion: a retrospective cohort study","volume":"55","author":"Wagner","year":"2024","journal-title":"Injury"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.injury.2020.11.029","article-title":"Fracture nonunion in long bones: a literature review of risk factors and surgical management","volume":"52","author":"Nicholson","year":"2020","journal-title":"Injury"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1080\/14712598.2024.2391491","article-title":"Clinical management and innovation in fracture non-union","volume":"24","author":"Siverino","year":"2024","journal-title":"Expert Opin Biol Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2385","DOI":"10.1007\/s00264-022-05519-6","article-title":"The technique of \u201cautologous bone grafting through channels\u201d combined with double-plate fixation is effective treatment of femoral nonunion","volume":"46","author":"Wang","year":"2022","journal-title":"Int Orthop"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1111\/os.12017","article-title":"Nonunion of distal femoral fractures: a systematic review","volume":"5","author":"Ebraheim","year":"2013","journal-title":"Orthop Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.1016\/j.injury.2015.09.027","article-title":"Exchange nailing for femoral diaphyseal fracture non-unions: risk factors for failure","volume":"46","author":"Tsang","year":"2015","journal-title":"Injury"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"28988","DOI":"10.1038\/s41598-024-79513-w","article-title":"Double plating and iliac crest bone graft can safely fix femoral shaft nonunion","volume":"14","author":"Taheriazam","year":"2024","journal-title":"Sci Rep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"103896","DOI":"10.1016\/j.otsr.2024.103896","article-title":"A systematic scoping review of the latest data on orthobiologics in the surgical treatment of non-union","volume":"110","author":"Gagnon","year":"2024","journal-title":"Orthop Traumatol Surg Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11914-020-00643-x","article-title":"The use of platelet-rich plasma (PRP) for the management of non-union fractures","volume":"19","author":"Andersen","year":"2021","journal-title":"Curr Osteoporos Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1111\/j.1537-2995.2008.02033.x","article-title":"Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells","volume":"49","author":"Giusti","year":"2008","journal-title":"Transfusion"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"S58","DOI":"10.1016\/j.injury.2020.12.005","article-title":"Effect of platelet-rich plasma on fracture healing","volume":"52","author":"Van Lieshout","year":"2020","journal-title":"Injury"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00264-016-3342-9","article-title":"Platelet-rich plasma for the treatment of bone defects: from pre-clinical rational to evidence in the clinical practice. A systematic review","volume":"41","author":"Roffi","year":"2016","journal-title":"Int Orthop"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"9905067","DOI":"10.1155\/2021\/9905067","article-title":"Revision with locking compression plate by compression technique for Diaphyseal nonunions of the femur and the tibia: a retrospective study of 54 cases","volume":"2021","author":"Ding","year":"2021","journal-title":"Biomed Res Int"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1016\/j.injury.2011.04.016","article-title":"Enhancement of fracture healing with the diamond concept: the role of the biological chamber","volume":"42","author":"Calori","year":"2011","journal-title":"Injury"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1186\/s12891-021-04840-2","article-title":"Preliminary outcomes of the combination of demineralized bone matrix and platelet rich plasma in the treatment of long bone non-unions","volume":"22","author":"Nie","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00068-018-0905-z","article-title":"Diagnosis and management of long-bone nonunions: a nationwide survey","volume":"45","author":"\u00d6zkan","year":"2018","journal-title":"Eur J Trauma Emerg Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"177","DOI":"10.2106\/JBJS.F.00742","article-title":"Exchange nailing of ununited fractures","volume":"89","author":"Brinker","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1007\/s00402-023-05183-4","article-title":"Comparing outcomes of plate augmentation, nail exchange, and nail exchange with plate augmentation in the treatment of atrophic femoral shaft nonunion after intramedullary nailing: a multicenter retrospective study","volume":"144","author":"Kook","year":"2024","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1007\/s00264-010-0983-y","article-title":"Comparison of mechani-cal rigidity between plate augmentation leaving the nail in situand interlocking nail using cadaveric fracture model of thefemur","volume":"35","author":"Park","year":"2011","journal-title":"Int Orthop"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"650","DOI":"10.3390\/jpm13040650","article-title":"Augmentative plating versus exchange intramedullary nailing for the treatment of aseptic non-unions of the femoral shaft-a biomechanical study in a SawboneTM model","volume":"13","author":"Walcher","year":"2023","journal-title":"J Pers Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"111412","DOI":"10.1016\/j.injury.2024.111412","article-title":"Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients","volume":"55","author":"Devendra","year":"2024","journal-title":"Injury"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1302\/0301-620X.98B4.34870","article-title":"Exchange nailing for nonunion of diaphyseal fractures of the tibia: our results and an analysis of the risk factors for failure","author":"Tsang","year":"2016","journal-title":"Bone Joint J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1186\/s12891-022-05781-0","article-title":"Does nail size or difference between canal and nail diameter influence likelihood of union or time to union of femoral shaft fractures treated with intramedullary nailing? A retrospective cohort study","volume":"23","author":"Shih","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1007\/s00068-020-01333-0","article-title":"Augmentation plating leaving the nail in situ is an excellent option for treating femoral shaft nonunion after IM nailing: a multicentre study","volume":"47","author":"Uliana","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.injury.2013.10.015","article-title":"Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail","volume":"45","author":"Lin","year":"2013","journal-title":"Injury"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/os.13581","article-title":"Augmented stability in leaving original internal fixation with multidimensional cross locking plate through mini-open femoral anterior approach for aseptic femoral shaft nonunion: a retrospective cohort study","volume":"15","author":"Wu","year":"2022","journal-title":"Orthop Surg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1097\/TA.0b013e31817c9905","article-title":"Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience","volume":"65","author":"Nadkarni","year":"2008","journal-title":"J Trauma"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1007\/s00264-022-05379-0","article-title":"Bridge plating with decortication, autologous bone graft, and tight closure: a \u201cstepwise surgical diamond concept\u201d for treatment of nonunion in a series of fifty five patients","volume":"46","author":"Chamseddine","year":"2022","journal-title":"Int Orthop"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"237","DOI":"10.5435\/JAAOS-D-23-00453","article-title":"Approach to tibial shaft nonunions: diagnosis and management","volume":"32","author":"Wellings","year":"2024","journal-title":"J Am Acad Orthop Surg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1097\/CORR.0000000000002809","article-title":"What is the likelihood of union and frequency of complications after parallel plating and supplemental bone grafting for resistant distal femoral nonunions?","volume":"482","author":"Gavaskar","year":"2023","journal-title":"Clin Orthop Relat Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1186\/s12891-023-06675-5","article-title":"Medial augmentation plating of aseptic distal femoral nonunions","volume":"24","author":"Lotzien","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"S18","DOI":"10.1016\/j.injury.2021.01.043","article-title":"Autologous bone graft: is it still the gold standard?","volume":"52","author":"Schmidt","year":"2021","journal-title":"Injury"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"111711","DOI":"10.1016\/j.injury.2024.111711","article-title":"Efficacy and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with autologous bone for the treatment of long bone nonunion: a report of a prospective case series","volume":"55","author":"Choi","year":"2024","journal-title":"Injury"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.spinee.2011.04.023","article-title":"A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned","volume":"11","author":"Carragee","year":"2011","journal-title":"Spine J"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"4597","DOI":"10.3390\/jcm10194597","article-title":"Effect of bone morphogenetic protein-2 in the treatment of long bone non-unions","volume":"10","author":"Fuchs","year":"2021","journal-title":"J Clin Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1089\/ten.TEB.2015.0357","article-title":"A review of the clinical side effects of bone morphogenetic protein-2","volume":"22","author":"James","year":"2016","journal-title":"Tissue Eng Part B Rev"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/j.injury.2008.08.011","article-title":"Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions: a prospective randomised clinical study on 120 patients","volume":"39","author":"Calori","year":"2008","journal-title":"Injury"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1002\/jor.25123","article-title":"A prospective randomized double-blind clinical trial to assess the effects of leukocyte-reduced platelet-rich plasma on pro-inflammatory, degradative, and anabolic biomarkers after closed pilon fractures","volume":"40","author":"Zitsch","year":"2021","journal-title":"J Orthop Res"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s13770-024-00665-x","article-title":"The effect of platelet fibrin plasma (PFP) on postoperative refractory wounds: physiologically concentrated platelet plasma in wound repair","volume":"21","author":"Fan","year":"2024","journal-title":"Tissue Eng Regen Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1186\/s12917-024-04358-4","article-title":"Autologous platelet-rich fibrin enhances skin wound healing in a feline trauma model","volume":"20","author":"Zhang","year":"2024","journal-title":"BMC Vet Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e173","DOI":"10.1016\/j.surge.2022.11.004","article-title":"Recombinant human bone morphogenetic protein is a valid alternative to autologous bone graft for long bone non-unions: a systematic review and meta-analysis","volume":"21","author":"Xie","year":"2023","journal-title":"Surgeon"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1615628\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T01:20:51Z","timestamp":1749691251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1615628\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":42,"alternative-id":["10.3389\/fmed.2025.1615628"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1615628","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,12]]},"article-number":"1615628"}}