The biology of fracture healing: optimising outcome

Optimising the results of fracture treatment requires a holistic view of both patients and treatment. The nature of the patient determines the priority targets for outcome, which differ widely between the elderly and the young, and between the victims of high and low energy trauma. The efficacy of treatment depends on the overall process of care and rehabilitation as well as the strategy adopted to achieve bone healing. The rational basis for fracture treatment is the interaction between three elements: (i) the cell biology of bone regeneration; (ii) the revascularisation of devitalised bone and soft tissue adjacent to the fracture; and (iii) the mechanical environment of the fracture. The development of systems for early fracture stabilisation has been an advance. However, narrow thinking centred only on the restoration of mechanical integrity leads to poor strategy - the aim is to optimise the environment for bone healing. Future advances may come from the adjuvant use of molecular stimuli to bone regeneration.