eMedicine Specialties > Orthopedic Surgery > Trauma

General Principles of Fracture Care: Follow-up

Author: Richard Buckley, MD, FRCS(C), Head of Orthopedic Trauma Surgery, Clinical Associate Professor, Department of Surgery, Division of Orthopedics, University of Calgary
Coauthor(s): Carlo D A Panaro, MD, Resident, Department of Orthopedic Surgery, University of Alberta
Contributor Information and Disclosures

Updated: Mar 5, 2009

Future and Controversies

Two subjects that will be prominent in upcoming years are the use of minimally invasive fracture-fixation techniques and the use of biologic agents to aid in fracture healing.

Minimally invasive orthopedic techniques, from arthroscopic surgery to the use of intramedullary nails, have dramatically decreased the morbidity rate associated with orthopedic surgical intervention. Krettek et al were prominent in developing the concept of minimally invasive percutaneous plate osteosynthesis (MIPPO) with indirect reduction.45 This technique involves the use of anatomically preshaped plates and instrumentation to safely and effectively insert the plate percutaneously or through limited incisions. Various plates, clamps, and other devices aid in the reduction of the affected bones.

Certain advantages of MIPPO may include faster bone healing, reduced infection rate, decreased need for bone grafting, less postoperative pain, faster rehabilitation, and more aesthetic results. Some disadvantages may include difficulty with indirect reduction, increased C-arm exposure, malunion, pseudoarthrosis through diastases, and delayed union with flexible fixation in simple fractures.37

The use of biologic agents that aid in fracture healing will be commonly used in fracture management. Currently, autologous and cadaveric bone grafts are used in fracture management. Autologous cancellous bone grafts are used to fill defects and to provide stimulus for growth. Cadaveric cortical bone grafting is commonly used to provide diaphyseal structural support and to aid in filling large diaphyseal deficits.

A number of organic and synthetic materials have been used to promote fracture healing. These include hydroxyapatite, tricalcium phosphate, and calcium sulfate. Other biologic agents that have been recognized as stimulators of fracture healing include peptide-signaling molecules (eg, bone morphogenic protein, β-transforming growth factor, gene family fibroblast growth factor, and platelet-derived growth factor) and immunomodulatory cytokines (interleukins 1 and 6). These biologic agents are not commonly used, but with further research, they may become important in fracture healing.

 


More on General Principles of Fracture Care

Overview: General Principles of Fracture Care
Workup: General Principles of Fracture Care
Treatment: General Principles of Fracture Care
Follow-up: General Principles of Fracture Care
Multimedia: General Principles of Fracture Care
References
Further Reading
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References

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Contributor Information and Disclosures

Author

Richard Buckley, MD, FRCS(C), Head of Orthopedic Trauma Surgery, Clinical Associate Professor, Department of Surgery, Division of Orthopedics, University of Calgary
Richard Buckley, MD, FRCS(C) is a member of the following medical societies: Canadian Orthopaedic Association and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Coauthor(s)

Carlo D A Panaro, MD, Resident, Department of Orthopedic Surgery, University of Alberta
Carlo D A Panaro, MD is a member of the following medical societies: Alberta Medical Association, Canadian Medical Association, and Canadian Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

James F Kellam, MD, Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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