Orthobiologics for Fracture Healing: Opportunities and Risks

Philipp Leucht, MD, and J. Tracy Watson, MD

Understanding of the biology of bone healing has increased dramatically, with a corresponding surge in the number of orthobiologics available for use in augmenting fracture healing and bone defect management. This often makes it problematic for surgeons to determine the correct biologic (osteogenic, osteoconductive, or osteoinductive) for a given clinical problem. Little formal guidance is available to help surgeons make educated decisions regarding the indicated use for a biologic or for the adjuvant that will have the most predictable and successful outcome for the specified indication.

Bone healing is a complex process involving many different cell types, tissues, and signaling pathways. As with a complex computer algorithm, the failure of one small component may crash the entire program. During fracture healing, the crucial interplay of biomechanics and biology may be affected by compromised blood supply, stripped periosteum, age-related decline in osteoprogenitor cells, systemic factors (immune suppression, malnutrition), mechanical instability, a critical sized bone defect, or a host of other conditions.

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