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J Am Acad Orthop Surg, Vol 16, No 11, November 2008, 619-625.
© 2008 the American Academy of Orthopaedic Surgeons
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Recent Developments in the Biology of Fracture Repair

Francois N. K. Kwong, MD and Mitchel B. Harris, MD

Perspectives on Modern Orthopaedics articles provide an objective appraisal of new or controversial techniques or areas of investigation in orthopaedic surgery.

Dr. Kwong is Research Fellow, Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Dr. Harris is Associate Professor of Orthopaedic Surgery, Harvard Medical School, and Chief, Orthopaedic Trauma Service, Brigham and Women’s Hospital, Partners Orthopaedic Trauma Service, Boston, MA.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Kwong and Dr. Harris.

Reprint requests: Dr. Kwong, Center for Molecular Orthopaedics, Room BLI 044, 221 Longwood Avenue, Boston, MA 02115.

Fracture repair is dependent on local and systemic molecular and cellular processes. During fracture repair, mesenchymal stem cells are systemically recruited to the fracture site, and cytokines are released from the fracture site into the vascular system. In a significant minority of fractures, healing delays result from adverse clinical factors that interfere with these processes. Extrinsic factors, such as aging and smoking, adversely affect the molecular and cellular processes occurring locally in the fracture site. Fracture fixation affects healing through local changes in the biologic signaling within the fracture callus. Current biologic treatment of fractures includes the local application of osteoinductive bone morphogenetic proteins (ie, BMP-2, BMP-7) and cell-based therapies. Although clinical results with bone morphogenetic proteins have been satisfactory, they have not been as impressive as those reported in animal studies. Further understanding of the biology of fracture repair may lead to improved treatment modalities.






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.