Is There an Impact of Concomitant Injuries and Timing of Fixation of Major Fractures on Fracture Healing? A Focused Review of Clinical and Experimental Evidence

Frank Hildebrand*, Martijn van Griensven, Markus Huber-Lang, Stefanie B Flohe, Hagen Andruszkow, Ingo Marzi, Hans-Christoph Pape, Trauma Research Network of the German Society of Trauma, DGU

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

OBJECTIVE: This review aims to summarize current knowledge regarding the underlying patho-mechanisms of delayed fracture healing in polytraumatized patients.

DATA SOURCES AND STUDY SELECTION: The following search terms were used: "fracture", "hemorrhage," "chest trauma," "inflammation," "inflammatory response," "fracture healing," "delayed healing," "nonunion," "fracture stabilisation," "intramedullary nailing," "external fixation," "early total care," and "damage control." Medline, Embase, and Cochrane Library were searched for studies published between January 1, 1990 through March 30, 2014. Of 1322 publications, 68 were included in the current summary.

CONCLUSION: Concomitant injuries and the strategy for fracture stabilization seem to affect bone metabolism and fracture healing. Among the relevant patho-mechanisms, interactions between the local and systemic inflammatory response seem to play a role. However, the consequences of fracture fixation strategies in case of severe concomitant injuries on local inflammation and bone healing remain unknown.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)104-112
Number of pages9
JournalJournal of Orthopaedic Trauma
Volume30
Issue number3
DOIs
Publication statusPublished - Mar 2016
Externally publishedYes

Keywords

  • Animals
  • Evidence-Based Medicine
  • Fracture Fixation, Internal/statistics & numerical data
  • Fracture Healing
  • Fractures, Bone/epidemiology
  • Humans
  • Multiple Trauma/epidemiology
  • Prevalence
  • Risk Assessment
  • Time-to-Treatment/statistics & numerical data
  • Treatment Outcome
  • THORACIC TRAUMA
  • SOFT-TISSUE TRAUMA
  • EXTERNAL FIXATION
  • POLYTRAUMA PATIENTS
  • primary fracture stabilization
  • DAMAGE CONTROL
  • TIBIAL SHAFT FRACTURES
  • fracture healing
  • CONTROL ORTHOPEDIC-SURGERY
  • HEMORRHAGIC-SHOCK
  • BONE-FORMATION
  • multiple trauma
  • INFLAMMATORY RESPONSE

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