Current Concepts of Fracture Healing, Delayed Unions, and Nonunions

F. C. den Boer; P. Patka; F. C. Bakker; H. J. Th M. Haarman

doi:10.1055/s-2002-30627

Osteosynthesis and Trauma Care, Table of Contents

Osteosynthesis and Trauma Care 2002; 10(1): 1-7
DOI: 10.1055/s-2002-30627

Original Articles

Current Concepts of Fracture Healing, Delayed Unions, and Nonunions

F. C. den Boer, P. Patka, F. C. Bakker, H. J. Th. M. Haarman

Department of Surgery/Traumatology, VU University Medical Centre, Amsterdam, The Netherlands

Abstract

Zusammenfassung

Im Gegensatz zu vielen anderen Geweben und Organen im Körper hat das Skelett eine auffallende Potenz zur Regeneration. Die Heilung einer Knochenfraktur umfasst eine komplizierte Cascade von Vorgängen auf zellulärem und biochemischen Niveau, welche in einer kompletten strukturellen und funktionellen Wiederherstellung des betreffenden Knochens endet. Gestörte Heilung tritt in 5 bis 10 % aller Frakturen auf, was erkennbar ist als ein delayed union oder ein nonunion. Nonunions können klassifiziert werden als hypertroph oder atroph, jedes mit spezifischen ursächlichen Faktoren. Diese Faktoren sind wichtig, weil die ursächlichen Mechanismen die notwendige Behandlung diktieren. Behandlungsmethoden, die die Frakturheilung stimulieren, können angewendet werden bei delayed unions und nonunions. Zusätzlich können diese Methoden verwendet werden bei der Behandlung von frischen Frakturen mit dem Ziel, die Heilungszeit zu verkürzen und gestörte Heilung zu verhindern. Behandlungen, die die Knochenheilung stimulieren, können eingeteilt werden in biologische, mechanische und biophysische Methoden.
In diesem Artikel werden der Frakturheilungsprozess, die ursächlichen Mechanismen der gestörten Knochenheilung und Behandlung mit dem Ziel, die Frakturheilung zu stimulieren, beschrieben. Die präsentierten Daten basieren auf der heutigen Literatur, und die neuesten Entwicklungen im Bereich von stimulierter Knochenheilung sind berücksichtigt.

Abstract

In contrast to many other tissues and organs in the body, the skeleton has a striking potential for regeneration. The healing of a bone fracture involves a complicated cascade of events on a cellular and biochemical level, that ends in a complete structural and functional restoration of the involved bone. Impaired healing occurs in 5 to 10 % of all fractures, which becomes evident as a delayed union or a nonunion. Nonunions can be classified as hypertrophic or atrophic, each with specific causative factors. These factors are important, because the mechanisms underlying impaired fracture healing dictate the necessary treatment. Treatment methods, that enhance fracture healing, can be applicated in delayed unions and nonunions. Furthermore, these methods can be used in the treatment of fresh fractures in order to shorten the healing time and to prevent impaired healing. Treatments that promote bone healing can be divided into biological, mechanical, and biophysical methods.
In this paper, the fracture healing process, mechanisms underlying impaired bone healing, and treatments aimed at enhancement of fracture healing are described. The presented data are based on the current literature and include the newest developments in the field of enhanced bone repair.

Schlüsselwörter

Frakturheilung - Verzögerte Knochenbruchheilung - Pseudoarthrose - Gesteigerte Knochenbruchheilung

Key words

Fracture healing - Delayed union - Nonunion - Enhanced bone repair

Full Text

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Dr. Frank C. den Boer

Department of Surgery

VU University Medical Centre

P.O. Box 70 57

1007 MB Amsterdam

The Netherlands

Phone: +31-20-44 402 68

Fax: +31-20-44 402 74

Email: frankdenboer@hotmail.com