Hybrid fracture fixation systems developed for orthopaedic applications: A general review.

There are normally three phases in the fracture healing irrespective of differences in their fracture types, including reactive phase (haematoma and inflammatory stage), reparative phase (callus formation stage) and remodelling phase (remodelling stage) (Figure 1) [8], [9].

Nevertheless, these healing phases and healing mechanisms become quite different in patients with osteoporosis, where nearly all the reaction and healing phases are prolonged, and the healing abilities are limited in osteoporotic fractures [15]. Conventional orthopaedic implants made of permanent rigid metals with high stiffness are not favourable for osteoporotic fracture fixations because of deteriorated bone structure and poor mechanical stability. Too rigid fixation on the fracture site is unfavourable for fracture healing and its remodelling outcome due to limited cellular responses in periosteum and bone marrow [16]. Both clinical and experimental studies indicated that rigid internal fixators implanted over a longer period of time were unfavourable for fracture repair by increasing cortical resorption, which was even more obvious in osteoporotic fractures [17], [18]. Interfragmentary micromotion would be beneficial for callus stimulation and subsequent bone healing [19]. Therefore, bioactive materials with lower rigidity as orthopaedic implants would be preferred to improve the fracture healing for osteoporotic patients.

• 8. Szczesny G. Fracture healing and its disturbances. A literature review. Ortop Traumatol Rehabil. 2015 Oct;17(5):437–454.
• 9. Einhorn T.A., Gerstenfeld L.C. Fracture healing: mechanisms and interventions. Nat Rev Rheumatol. 2015 Jan;11(1):45–54.
• 15. Giannoudis P., Tzioupis C., Almalki T., Buckley R. Fracture healing in osteoporotic fractures: is it really different? A basic science perspective. Injury. 2007 Mar;38(Suppl. 1):S90–S99.
• 16. Zhang Y., Xu J., Ruan Y.C., Yu M.K., O’Laughlin M., Wise H. Implant-derived magnesium induces local neuronal production of CGRP to improve bone-fracture healing in rats. Nat Med. 2016 Aug 29.
• 17. Davidson C.W., Merrilees M.J., Wilkinson T.J., McKie J.S., Gilchrist N.L. Hip fracture mortality and morbidity–can we do better? N Z Med J. 2001 Jul 27;114(1136):329–332.
• 18. Sha M., Guo Z., Fu J., Li J., Yuan C.F., Shi L. The effects of nail rigidity on fracture healing in rats with osteoporosis. Acta Orthop. 2009 Feb;80(1):135–138.
• 19. Bagheri Z.S., Tavakkoli Avval P., Bougherara H., Aziz M.S., Schemitsch E.H., Zdero R. Biomechanical analysis of a new carbon fiber/flax/epoxy bone fracture plate shows less stress shielding compared to a standard clinical metal plate. J Biomech Eng. 2014 Sep;136(9):091002.

https://europepmc.org/article/pmc/pmc6350075

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