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Clinical Orthobiologic Approach to Failure or Delay in Bone Healing

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Bio-orthopaedics

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Abstract

Great part of the fractures heal spontaneously in the expected timing, if correctly treated, but approximately 5–10% don’t, with an incidence of 19 per 100,000. [1] Delayed unions and non-unions of long bone fractures, the latter defined by the Food and Drug Administration as fractures for which a minimum of 9 months has elapsed since the injury and for which there have been no signs of healing for 3 months, represent an important therapeutic challenge for the orthopaedic surgeons, but also an important social economic burden due to the morbidity, the costs and the disability to work that these conditions cause. Already in 1995, Einhorn and co-workers reported that, in the United States, of about 5.6 millions fractures treated, up to 10% do not heal completely [2] and this requires several complex and long-lasting type of treatments. Looking to what this means in terms of costs, in the UK, Dahabreh, Dimitriou and Giannoudis, in 2011 [3], reported that the treatment of one single case of non-union requires 13.844,68 pounds that is well related to what reported some years before in 2005 [4] for the costs sustained in Canada to treat a tibial shaft fracture, equal to 18.712 Canadian dollars. This pattern was ulteriorly emphasised in the epidemiological study conducted on 5,169,140 Scottish population, published in 2013, where the cost to the National Health Service of United Kingdom of treating a non-union has been reported to range between £7000 and £79,000 [5]. The authors reported that 4895 non-unions were treated as inpatients in Scotland between 2005 and 2010, averaging 979 per year, with an overall incidence of 18.94 per 100,000 population per year, with the gender distribution of 57% incidence in male and 43% in female and an overall age peak incidence in the fourth decade of life. Extrapolating from Scottish figures of 1000 cases of non-union per annum, the incidence of non-union in the United Kingdom is around 11,700 cases per annum. This would suggest that non-union costs the health services in the United Kingdom alone several hundreds of millions of pounds per year [6].

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  1. Clinica Nostra Signora Della Mercede, Rome, Italy

    Fabio Valerio Sciarretta

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  1. O.A.S.I. Bioresearch Foundation NPO, Milan, Italy

    Alberto Gobbi

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  3. Musculoskeletal and Joint Research Foundation, San Diego, California, USA

    John G. Lane

  4. Department of Orthopedics, Acibadem University, Istanbul, Turkey

    Mustafa Karahan

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Sciarretta, F.V. (2017). Clinical Orthobiologic Approach to Failure or Delay in Bone Healing. In: Gobbi, A., Espregueira-Mendes, J., Lane, J., Karahan, M. (eds) Bio-orthopaedics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54181-4_35

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