Biological aspects to enhance fracture healing

Abstract

The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss. Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth. Autologous bone graft remains the gold standard, providing all of these qualities. Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft. Artificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties. Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus; however, their licencing is limited and larger studies are required to clarify their role. For recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.

Fracture healing on non-union fracture model promoted by non-thermal atmospheric-pressure plasma

“…Although PRP research holds promise, it currently lacks standardization. Furthermore, it remains unclear which specific PRP types can yield superior outcomes in terms of vital new bone formation [ 17 , 18 ]. BMPs stimulate osteoblasts, and bone tissue engineering techniques using suitable scaffolds combined with BMP become new options in reconstructive bone surgery.…”

A parathyroid hormone related supramolecular peptide for multi-functionalized osteoregeneration

“…Autologous bone transplantation is currently the gold standard to treat this troublesome disease, but it may cause various complications, such as bleeding, infection and chronic pain [ 3 ]. Allogenic or xenogeneic bone transplantation are also indispensable strategies in the clinic, but they are normally correlated with detrimental inflammation and pathogen transmission, ultimately causing graft failure [ 4 ]. As a thriving therapeutic measure, bone tissue engineering shows promising potential for surgical bone repair, which combines four pillars, including scaffold materials, bioactive factors, biophysical stimuli and repair cells [ 5 , 6 ].…”

Effectiveness of Socket Preservation in Maintaining Alveolar Bone Volume: A Systematic Review

“…Preservation of the postextraction alveoli plays a vital role in deciding on options for replacing missing teeth, helping to create healthy conditions so that the patient can obtain a better treatment. 6,16,17,20 In the past two decades, many treatment choices were mentioned, such as socket grafting with a biomaterial alone interposing a barrier element. However, there is no resolution regarding the best method for socket preservation: autogenous, allogenic, or alloplastic .…”