Failed fracture healing resulting in non-union remains a frequent and challenging clinical problem. Recent studies suggested an overall risk of 1.9% non-unions per fracture, ranging as high as 9% in certain high-risk groups. Considering the overall fracture incidence (4017 per 100.000 people/year in the US in 2010), affected patients are numerous. Treatment of non-unions remains challenging and costly due to the associated impaired local microbiology, osseous defects as well as high levels of infections. Furthermore, affected patients commonly need multiple and extensive surgical therapies as well as equipment and expertise that is reserved to highly specialized medical centres while failed non-union therapy may result in loss of function or even loss of the affected limb. Thus, non-unions not only severely affect patients’ quality of life but also the society on a socioeconomic level.
Studies investigating the factors contributing to the development of non-unions shed light on the complex and intricate nature of its pathogenesis and over the years led to the introduction of new treatment modalities to improve the outcome of non-union surgery ranging from novel surgical techniques to biologicals and non-invasive adjunct treatments. However, to date surgical treatment strategies used for non-union therapy are frequently based on the preference of the responsible surgeon rather than evidence as guidelines and high-quality studies remain scarce. In addition, the gold standard for diagnosing non-unions remains radiologic determination (x-ray and computed tomography) and is only possible after 6 months. Thus, highlighting the need for biomarkers or early diagnostic modalities. Due to the complex nature of non-union pathogenesis and a plethora of contributing factors interdisciplinary research is needed that involves basic scientists, clinicians, and radiologists. This special topic is intended to be a research platform for current advances in the field of non-union research as well as a compilation of high-quality studies that will facilitate evidence-based decision making in non-union therapy.
We are focusing on high-quality studies investigating the biology of non-union pathogenesis, surgical and non-surgical treatment modalities as well as their diagnosis. Basic research studies, as well as clinical studies, are of interest as long as they have a direct link to the three mentioned aspects of non-union research. Review articles will be considered if they present novel and relevant findings or provide a basis for evidence-based decision making.
• Advances in the understanding of non-union development. Specifically novel molecular and cellular findings including genomic findings (RNAseq) and findings addressing osteoimmunology.
• Advances in early detection of non-unions using conventional diagnostics, biomarkers or radiation-free diagnostic alternatives.
• Advances in the surgical and non-surgical treatment of non-unions including studies evaluating current treatment modalities as well as studies providing high-quality data for novel surgical techniques or adjunct non-surgical or biological therapeutics.
Failed fracture healing resulting in non-union remains a frequent and challenging clinical problem. Recent studies suggested an overall risk of 1.9% non-unions per fracture, ranging as high as 9% in certain high-risk groups. Considering the overall fracture incidence (4017 per 100.000 people/year in the US in 2010), affected patients are numerous. Treatment of non-unions remains challenging and costly due to the associated impaired local microbiology, osseous defects as well as high levels of infections. Furthermore, affected patients commonly need multiple and extensive surgical therapies as well as equipment and expertise that is reserved to highly specialized medical centres while failed non-union therapy may result in loss of function or even loss of the affected limb. Thus, non-unions not only severely affect patients’ quality of life but also the society on a socioeconomic level.
Studies investigating the factors contributing to the development of non-unions shed light on the complex and intricate nature of its pathogenesis and over the years led to the introduction of new treatment modalities to improve the outcome of non-union surgery ranging from novel surgical techniques to biologicals and non-invasive adjunct treatments. However, to date surgical treatment strategies used for non-union therapy are frequently based on the preference of the responsible surgeon rather than evidence as guidelines and high-quality studies remain scarce. In addition, the gold standard for diagnosing non-unions remains radiologic determination (x-ray and computed tomography) and is only possible after 6 months. Thus, highlighting the need for biomarkers or early diagnostic modalities. Due to the complex nature of non-union pathogenesis and a plethora of contributing factors interdisciplinary research is needed that involves basic scientists, clinicians, and radiologists. This special topic is intended to be a research platform for current advances in the field of non-union research as well as a compilation of high-quality studies that will facilitate evidence-based decision making in non-union therapy.
We are focusing on high-quality studies investigating the biology of non-union pathogenesis, surgical and non-surgical treatment modalities as well as their diagnosis. Basic research studies, as well as clinical studies, are of interest as long as they have a direct link to the three mentioned aspects of non-union research. Review articles will be considered if they present novel and relevant findings or provide a basis for evidence-based decision making.
• Advances in the understanding of non-union development. Specifically novel molecular and cellular findings including genomic findings (RNAseq) and findings addressing osteoimmunology.
• Advances in early detection of non-unions using conventional diagnostics, biomarkers or radiation-free diagnostic alternatives.
• Advances in the surgical and non-surgical treatment of non-unions including studies evaluating current treatment modalities as well as studies providing high-quality data for novel surgical techniques or adjunct non-surgical or biological therapeutics.
