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Highly Accessed Review

Biologic adjuvants for fracture healing

Mandeep S Virk and Jay R Lieberman*

Author Affiliations

Department of Orthopaedic Surgery, Keck School of Medicine and University of Southern California, 1520 San Pablo Street, Suite 200, Los Angeles, CA 90033, USA

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Arthritis Research & Therapy 2012, 14:225  doi:10.1186/ar4053

Published: 30 November 2012

Abstract

Bone tissue has an exceptional quality to regenerate to native tissue in response to injury. However, the fracture repair process requires mechanical stability or a viable biological microenvironment or both to ensure successful healing to native tissue. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. Preclinical and clinical studies using biologic agents like recombinant bone morphogenetic proteins have demonstrated an efficacy similar or better than that of autologous bone graft in acute fracture healing. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.