Bone :: Biology

The epidemiology study in Royal Infirmary of Edinburgh, Scotland reported the incidence of fracture in 2000 which was 5,953 fractures in a population of 534,715 (11.3 in 1,000). (1) In general, the bone has a physiologic repairing process which consists of three basic steps; inflammation, proliferation and remodeling and the fracture can be healed spontaneously. (2) Failure of physiological regeneration of these steps which might cause the fracture nonunion. (3)This pathologic condition is one of the important complications after treatment fracture which occurs about 5-10% (Littenberg et al., 1998, Tzioupis and Giannoudis, 2007). It leads increase cost for further treatments and morbidity of the patients. (5) Moreover, the standard treatment, surgeon has to harvest the bone graft from the iliac crest and the patient also have a major second operation, for example decorticated bone, make the non union site bleeding and apply the bone graft. (6) There is a report that harvesting bone g raft from iliac crest can lead the painful scar and numbness around the harvest site and affect quality of life of the patient(Schwartz et al., 2009). Fortunately, nonunion can be prevented by many procedures, good surgical technique and proper implanted selection. (8) Minimally invasive (MIS) technique becomes more popular and there are many developed modern instruments which are friendly and easy usable. The advantage of the development is less tissue traumatized procedure which can preserve the biologic around the fracture site. (9) We can also prevent hypertrophic nonunion by providing an enough mechanic stability factor. (10) However, the high energy trauma as well as severe open fracture can make devastation of the soft tissue around the fracture site and might impair the biologic requirement for fracture healing .(11)And in this circumstance; the prevention by using MIS technique or even more strong stability implant cannot preventable because the soft tissue have loosen befo re treatment. Eventually, the atrophic nonunion might occur due to impair of the biologic component. (12) It is, thus, reasonable to augment with the biologic component for enhance and prevent bone healing in high risk case. The biologic part to support bone healing is consisted of the mediator part such as growth factors or cytokines and cellular part which are involved and orchestrated in fracture healing process. (13) Recently, promote and enhance healing process by difference kinds of mediator have been studied and reported. Interleukin, BMP, VEGF and bone stimulating mediator have positive effect for fracture healing and BMP2 and BMP7 have been accepted for treatment as the biologic stimulated in Human.