Clinical and Research Approaches to Treat Non-union Fracture

Abstract

The gold standard to treat delayed or non-healing bone injuries is still the use of autologous bone grafts to foster regeneration. Besides its successful treatment outcome, it also has disadvantages: a second surgery is needed in order to harvest the bone material and the material is highly limited. Looking into the recent literature, a multitude of different research approaches were already conducted to identify new possible strategies to treat impaired bone regeneration: application of mesenchymal stromal cells, platelet lysates, growth factors, interference in the immune system, or bone formation stimulation by ultrasound. This review gives an overview of the treatment approaches actually performed in the clinic as well as at the bench in the context of compromised bone healing. It clearly highlights the complexity of the nature of non-healing bone fractures as well as patient-dependent factors influencing the healing process.

Evaluation of effectiveness of 45S5 bioglass doped with niobium for repairing critical‐sized bone defect in in vitro and in vivo models

“…care systems (Schlundt et al, 2018). In fact, it has been reported that the treatment of an established non-union of a bone costs over $10,000 on average (Schlundt et al, 2018).…”

“…care systems (Schlundt et al, 2018). In fact, it has been reported that the treatment of an established non-union of a bone costs over $10,000 on average (Schlundt et al, 2018). The estimated number of fractures for the year 2000 was 9.0 million worldwide, but, as some fractures cause disability for a period longer than 1 year this number was estimated at approximately 50 million (Johnell & Kanis, 2006).…”

Mechano-Biological Computer Model of Scaffold-Supported Bone Regeneration: Effect of Bone Graft and Scaffold Structure on Large Bone Defect Tissue Patterning

“…Based on experimental observations of limited bone formation in untreated large bone defects (Mehta et al, 2012), an activity latency period (15 days) for progenitor cells was implemented in the baseline model to simulate a hypothetical case of non-stimulated bone regeneration. Simulation results led to non-union with bone marrow cavity capping, as observed in experimental studies on non-unions (Mehta et al, 2011;Schlundt et al, 2018). This approach has been already used to model impaired healing in silico (Borgiani, 2020).…”

Mammalian legumain – A lysosomal cysteine protease with extracellular functions?

“…However, a major disadvantage of this approach is poor engraftment of hBMSC in damaged bone tissue thus providing only transitory effects [256]. Around 15% of fractures never heal, due to compromised functions of endogenous hBMSC followed by loss of OB efficacy [257,258]. Non-healing fractures lead to additional surgical procedures and system [257].…”

“…Around 15% of fractures never heal, due to compromised functions of endogenous hBMSC followed by loss of OB efficacy [257,258]. Non-healing fractures lead to additional surgical procedures and system [257]. Usually, non-healing fractures are treated by bone graft implantation thus providing hBMSC and growth factors necessary to enhance bone regeneration [259].…”