Time to consider fracture nonunion an orphan disease? An update into pathophysiology, epidemiology and therapeutic solutions.

Abstract

Purpose: Fracture non-union (FNU) is a rare complication of bone fractures where healing does not occur without surgical intervention. This paper aims to summarize the current knowledge on FNUs from an orphan disease perspective, and to provide an overview of existing and some emerging treatment options.

Methods: Literature review.

Results: Epidemiological data on FNUs are limited and vary by population and methodology. While previously an overall estimate of 5-10% of nonunion of fractures has been reported, large epidemiological studies performed in Spain, Germany, Scotland and USA, reported that the prevalence of FNUs is less than 5 cases per 10.000 inhabitants justifying the criteria for an orphan designation. There are no approved pharmacological treatments for FNUs, highlighting the need for effective therapies. Current methods rely on mechanical stabilization of FNUs using various instrumentation with or without autologous bone grafting. Combining mechanical intervention and autologous bone grafting raises healing rates from 60-70% to more than 80%, but graft harvesting causes additional injury at the donor site. Lately, a novel drug, OSTEOGROW-C combining rhBMP6 with the patient's own blood coagulum as a carrier, augmented by synthetic ceramics for biomechanical support has been developed for the treatment of FNU. Results of preclinical studies suggested that OSTEOGROW-C is superior to other OSTEOGROW formulations and commercially available products.

Conclusion: Due to its low prevalence, FNU can be considered a rare disease. A novel drug, OSTEOGROW-C, represents a promising and safe therapeutic solution for inducing FNU healing.