Orthobiologics in Trauma: Current Trends, Future Directions, and Regenerative Strategies

There is a paradigm shift in the field of regenerative medicine in trauma toward the application of orthobiologics, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), mesenchymal stem cells (MSCs), and bone morphogenetic proteins (BMPs). This review critically examines the clinical evidence, mechanisms of action, and potential of orthobiologics in the treatment of delayed unions, non-unions, acute fractures, and soft-tissue injuries. The literature indicates that BMPs are effective in bone repair, particularly in open fractures. In non-unions, PRP and BMAC/MSCs have demonstrated encouraging outcomes in bone healing and decreased revision surgeries. Although the evidence is encouraging, the use of these treatments is limited by the differences in clinical trials, preparation procedures, and standardization. Over the next few years, the development of precision medicine will lead to clinical successes, with biomarker-based treatments and next-generation cell-free therapies, including exosomes, potentially complementing existing therapies. The review also highlights the need for rigorous randomized controlled trials, protocols and longitudinal research to integrate these promising therapies into trauma treatment algorithms.