Consolidation des fractures

Abstract

Fracture healing is a complex cascade of cellular recruitment and differentiation directed by a series of growth factors and cytokines. Over the past three decades significant advances have been made in the knowledge of this process and in the ways surgeons treat fractures. Several biologic and biophysical approaches have been developped to promote healing in difficult to heal fractures. The idea that micromotion, during 5 or 6 weeks, may lead to an enhancement of healing has been scientifically validated. Electric and electromagnetic devices have been shown to affect the healing process positively in delayed unions, non unions and osteotomies. Low intensity ultrasound is approved by the Food and Drug Administration to accelerate and to augment the healing of fresh fractures. The potential uses of bone morphogenetic proteins to enhance fracture healing are encouraging. This potential has yet to be determined. Advances in regional gene therapy should provide orthopaedists with an additional treatment option for conditions requiring the formation of new bone. There is clearly a need for much more research into the basic biology of fracture and directed toward the enhancement of fracture healing.