Substances that enhance fracture-healing and bone regeneration have
valuable clinical application and merit future research. Advances in these
technologies will enhance our ability to heal fractures in a more effective
and expedient manner. This review provides a brief description of the
different techniques and technologies and their respective clinical utility.
This paper also reviews the available literature on gene therapy, tissue
engineering, growth factors, osteoconductive agents, and physical forces and
assesses the evidence regarding the current status of these techniques of
healing and regenerating bone.
Only twenty-seven articles met our guidelines for studies containing
Level-I evidence. We were able to determine that atrophic nonunions and
pseudarthrosis led to poorer outcomes, and the results were uniformly poor
irrespective of the technique used.
Although the literature contains a large number of studies on the effects
of different agents and modalities on bone repair and healing, it still is not
clear how these agents work or in what circumstances they should be used. Many
of the treatment modalities of interest are still at an experimental stage, so
good evidence to support clinical practice is lacking. Additional multicenter,
prospective randomized studies are needed to define the indications,
specifications, dosage, limitations, and contraindications in the treatment of
nonunions. Studies are also needed to address the full clinical feasibility of
the role of each modality in fracture-healing and repair.