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. 2015 Jun;8(2):193-9.
doi: 10.1007/s12178-015-9265-z.

Biologic adjuvants and bone: current use in orthopedic surgery

Benjamin Smith  1 , Todd Goldstein, Charles Ekstein
Affiliations

Biologic adjuvants and bone: current use in orthopedic surgery

Benjamin Smith et al. Curr Rev Musculoskelet Med. 2015 Jun.

Abstract

Normal bone healing is a complex process that eventually restores original structure and function to the site of trauma. However, clinical circumstances such as nonunion, critical-sized defects, systemic bone disease, and fusion procedures have stimulated a search for ways to enhance this normal healing process. Biologics are an important part of this search and many, including bone marrow aspirate concentrate, demineralized bone matrix, platelet-rich plasma, bone morphogenic proteins, and platelet-derived growth factor, are currently in clinical use. Many others, including mesenchymal stem cells, parathyroid hormone, and Nel-like molecule-1 (NELL-1) will likely be in use in the future depending on the results of preclinical and clinical trials.

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Figures

Fig. 1
Fig. 1
Graphical representation of the three overlapping phases of bone healing. Cytokines direct inflammatory and stem cell migration to the injured area. A fibrous callous is formed during the repair phase that is ultimately remodeled in the final phase to more closely resemble the original structure. Figure 5a from Claes L, Recknagel S, Ignatius A. Fracture healing under healthy and inflammatory conditions. Nat Rev Rheumatol. 2012;8(3):133–43
Fig. 2
Fig. 2
ClinicalTrials.gov was searched for relevant trials using biologic adjuvants in orthopedic surgery for bone. The number of trials investigating each category of biologic is displayed above. MSC mesenchymal stem cell, BMP bone morphogenetic protein, BMAC bone marrow aspirate concentrate, DBM demineralized bone matrix, PTH parathyroid hormone, PDGF platelet-derived growth factor
See this image and copyright information in PMC

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