Fracture healing: a harmony of optimal biology and optimal fixation?

Treatment of critical size bone defects is a clinical problem often encountered in young patients following severe open limb injuries. If bone growth fails then a variable degree of morbidity may prevail with the end point being amputation of the limb. In addition the demographic challenges of an increasingly aging population dictate the need for innovative approaches to skeletal reconstruction to augment and repair skeletal tissue lost as a result of implant loosening, trauma, degeneration or in situations involving revision surgery requiring bone stock. The increasing demand of bone tissue is supported by the fact that an excess of 500,000 bone grafting procedures take place annually in the United States and 2.2 million worldwide. In the United States, the estimated bone grafts and bone substitutes market totalled $543.1 million in revenues in 2001, whereas in Europe the allograft and synthetic bone graft substitutes market was estimated at $39.5 million in 2003. 5