Several papers and symposia were dedicated to reviewing the basic science of bone healing and the latest research on potential methods to augment bone formation. Miclau and colleagues from the University of California, San Francisco presented research that suggests that the mechanical environment of a fracture influences whether the differentiation of precursor cells results in either osteoblastic or chondrogenic phenotypes as early as 2 days after injury. The clinical implication is that delaying fracture fixation for more than 48 hours might result in more callus formation.
Previous research from the University of Toronto demonstrated that reaming of tibial fractures results in a large increase in extraosseous blood flow. Using a modification of their model, Koo and colleagues report that contusion of the tibia’s surrounding muscle decreases cortical blood flow and obviates the increase in muscle perfusion that occurs in normal soft tissue. These data have potential implications for the management of tibia fractures with significant soft tissue injuries.
Several investigators reported on new research on growth factors related to fracture healing. Schmidmaier and colleagues from Humboldt University in Berlin, Germany, demonstrated that fracture healing was accelerated in an animal model when intramedullary implants were coated with bone morphogenetic protein (BMP)-2. In another study from Germany, Kilian and colleagues demonstrated a significant increase in angiogenesis when autologous growth factors concentrated from platelets were combined with hydroxyapatite and placed in a pig femoral condyle defect. Hamish Simpson from Oxford University, Oxford, United Kingdom, presented data that characterized the expression of growth factors in an atrophic nonunion model at various time intervals. These researchers demonstrated that growth factor levels were similar between the healing and nonunion groups at less than 8 weeks, but at 16 weeks the growth factors were weakly expressed in the nonunion group. These data suggest that 16 weeks may be an ideal time to deliver exogenous growth factors to a fracture that is not healing. In a clinical study of patients with recalcitrant nonunions of the tibia, femur, clavicle, or humerus, McKee and colleagues from Toronto reported successful union in 13 of 15 cases using repeat internal fixation and application of recombinant human BMP-7.
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