Clinical Aspects of Fracture Healing: An Overview

Abstract

The assessment, diagnosis, and management of fractures, particularly fractures that exhibit delayed healing, present considerable unique challenges to both patients and physicians. Fracture healing results from a complex series of biochemical events that may produce complete restoration of the anatomic and biochemical properties of the original osseous tissue. Fracture healing requires appropriate reduction, mechanical stability, and adequate vascularity to the fracture site; compromise of one of these elements may lead to delayed healing or nonunion. The patient's history, physical examination, and findings based on radiographs or other imaging modalities allow for assessment and characterization of the progression of healing. If nonunion is recognized, it is important for the clinician to understand the current treatment options that are available to optimize healing. Physical stimulation therapies include electromagnetic stimulation and low-intensity pulsed ultrasonography. Osteogenic factors used locally to promote fracture healing include autologous bone marrow and peptide signaling molecules such as platelet-derived growth factors, fibroblast growth factors, and bone morphogenetic proteins. Systemic biological protein such as parathyroid hormone and factors that target the Wnt family of signaling molecules offers promising data regarding its abilities to promote healing. Large segmental defects must be managed depending on the type and severity of the injury and may require treatment with bone grafts, induced membrane techniques, acute shortening, or distraction osteogenesis. A systematic approach in evaluating fracture union and an understanding of the modern methods to promote fracture healing will allow clinicians to significantly improve the treatment of patients with these injuries.

Micropore-induced capillarity enhances bone distribution in vivo in biphasic calcium phosphate scaffolds

“…It reduces the occurrence of large empty spaces that compromise the mechanical properties of the implanted scaffold [51]. In addition, effective vascularization is a prerequisite for sustainable bone growth in the scaffold [9,14] to ensure nutrient and waste transport. A homogeneous bone distribution therefore implies that extensive vasculature has developed throughout the scaffold.…”

“…Synthetic grafts made of metals, polymers and ceramics have been investigated [2,8–10]. However, the extensive research efforts to determine an optimal design for bone graft substitutes have not led to a well-defined solution [10,11], and the treatment of large, load-bearing bone defects remains a challenge [5,9,10,12–14].…”

“…The chemical and structural similarity of BCP with bone mineral confers biocompatibility, bioactivity and osteoconductivity [9,15,17]. Loading scaffolds with exogenous cells and/or growth factors confers osteoinductivity [6,7,14,16,18,19]. However, harvesting cells and controlling their fate in vivo is challenging [6,7,14,16,18], and the use of growth factors has been linked to serious side effects ranging from ectopic bone formation to cancers, due to the difficulty in controlling release kinetics in vivo [5,7,16,20,21].…”

Effect of thymoquinone: the extract of nigella sativa in accelerating soft callus formation in fracture

“…Several methods can be done to shorten healing time of fractures, both invasive procedures, such as mechanical and biophysical approaches, and biological interventions, for example bone grafting method, growth factors, and also natural substances from surrounding environment. 15,16 When traumatic fractures occur, reactive oxygen species (ROS) will increase in amount , causing an inclining number of osteoclast and stimulating bone resorption, which results in decreasing differentiation of osteoblasts. Increase of ROS will create disturbance in regeneration of fractures.…”

Multiscale Porosity Directs Bone Regeneration in Biphasic Calcium Phosphate Scaffolds

“…The shortcomings associated with biological grafts like allografts and autografts have encouraged the development of artificial bone scaffolds. However, despite substantial research efforts over the past 25 years, ,− the repair of large and load-bearing bone defects remains a major challenge. The difficulty resides partially in the range of length scales that need to be considered when designing a bone scaffold …”