This paper reviews the current literature concerning the main clinical factors which can impair the healing of fractures and makes recommendations on avoiding or minimising these in order to optimise the outcome for patients. The clinical implications are described.

A significant number of lower extremity fractures result in mal-union necessitating effective treatments to restore ambulation. Prior research in diabetic animal fracture models demonstrated improved healing following local insulin application to the fracture site and indicated that local insulin therapy can aid bone regeneration, at least within an insulin-dependent diabetic animal model. This...

Smad3 is an intracellular signaling molecule in the transforming growth factor β (TGF-β) pathway that serves as a regulator of chondrogenesis and osteogenesis. To investigate the role of the TGF-β/Smad3 signaling in the process of fracture healing, an open fracture was introduced in mouse tibiae, and the histology of the healing process was compared between wild-type (WT) and Smad3-null (KO) mi...

background: several systemic factors and hormones are thought to regulate the fracture healing process. vitamin d has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism. objectives: the aim of this study is to determine the serum changes in the level of vitamin d during the acute healing period of tibial and femoral shaft fra...

Fracture repair is influenced by the mechanical environment, particularly when cyclic loads are applied across the fracture site. However, the specific mechanical loading parameters that accelerate fracture healing are unknown. Intact bone adaptation studies show enhanced bone formation with pauses inserted between loading cycles. We hypothesized pause-inserted noninvasive external loading to m...

Evidence • Adults—2 RCTs (N = 140) of predominantly middle-aged women with Colles fractures randomized to flurbiprofen (14 days)1 or piroxicam (20 mg/d for 8 weeks)2 versus placebo: -No difference in recovery time, physiotherapy needs, malunion or nonunion,1 functional recovery, or healing.2 -Superior pain relief with NSAIDs (both trial arms allowed acetaminophen if required). -Limitations: abo...