The biology of fracture healing: optimising outcome

Optimising the results of fracture treatment requires a holistic view of bo th patients and treatment. The nature of the patient determines the priorit y targets for outcome, which differ widely between the elderly and the youn g, and between the victims of high and low energy trauma. The efficacy of t reatment 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 revascularisa tion 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 adv ance. However, narrow thinking centred only on the restoration of mechanica l integrity leads to poor strategy - the aim is to optimise the environment for bone healing. Future advances may come from the adjuvant use of molecu lar stimuli to bone regeneration.