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The role of stem cells in fracture healing and nonunion

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Abstract

Nonunion and large bone defects present a therapeutic challenge to the surgeon and are often associated with significant morbidity. These defects are expensive to both the health care system and society. However, several surgical procedures have been developed to maximise patient satisfaction and minimise health-care-associated and socioeconomic costs. Integrating recent evidence into the diamond concept leads to one simple conclusion that not only provides us with answers to the “open questions” but also simplifies our entire understanding of bone healing. It has been shown that a combination of neo-osteogenesis and neovascularisation will restore tissue deficits, and that the optimal approach includes a biomaterial scaffold, cell biology techniques, a growth factor and optimisation of the mechanical environment. Further prospective, controlled, randomised clinical studies will determine the effectiveness and economic benefits of treatment with mesenchymal stem cells, not in comparison to other conventional surgical approaches but in direct conjunction with them.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    Hangama C. Fayaz

  2. Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    Peter V. Giannoudis

  3. Partners Orthopaedic Trauma Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    Mark S. Vrahas

  4. Trauma Service, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    Raymond Malcolm Smith

  5. Orthopaedic Trauma, University Hospital, Queen’s Medical Centre, GB-Nottingham, NG7 2UH, UK

    Christopher Moran

  6. Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany

    Hans Christoph Pape

  7. Department of Trauma Surgery, Hannover Medical School, Hannover, Germany

    Christian Krettek

  8. Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA

    Jesse B. Jupiter

Authors
  1. Hangama C. Fayaz
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  2. Peter V. Giannoudis
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  3. Mark S. Vrahas
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  4. Raymond Malcolm Smith
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  5. Christopher Moran
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  6. Hans Christoph Pape
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  7. Christian Krettek
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  8. Jesse B. Jupiter
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Corresponding author

Correspondence to Peter V. Giannoudis.

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Fayaz, H.C., Giannoudis, P.V., Vrahas, M.S. et al. The role of stem cells in fracture healing and nonunion. International Orthopaedics (SICOT) 35, 1587–1597 (2011). https://doi.org/10.1007/s00264-011-1338-z

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  • DOI: https://doi.org/10.1007/s00264-011-1338-z

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