Can we accelerate fracture healing? A critical analysis of the literature.

The characterization of the molecular mediators regulating the fracture healing response over the past decade has vastly expanded our knowledge in this area at the molecular level. It is clear today that the physiological mechanisms governing the biology of bone repair and turnover are complex and far from being well understood. Several of the molecules implicated in the healing process have become available for use in the clinical setting thanks to advances made in recombinant technology. Current evidence of their effect in accelerating fracture healing in both experimental and clinical studies is promising. However, despite these findings, several factors require further investigation, including the ideal timing to administer these molecules, which is the most effective dose, and the factors affecting the lack of consistency in the experimental designs and animal models that have been used. In addition, the available evidence lacks phase III, level I studies. Until such studies become available, the results should be interpreted with caution.