The bone union process: pathophysiology and clinical issues. Factors conditioning the occurrence of bone union on the molecular level.
The discovery of protein substances that fulfill transmission functions (cytokines) and regulatory functions (growth factors) has made it possible to study the processes taking place on the molecular level during bone union. The present article will discuss the impact of prostoglandis (pGE, pGF), growth factors (TGF-B, BMP, PDGF, IGF and FGF) and cytokines (IL-6, IL-11) on bone union processes. Contemporary views on the physiology of bone fracture healing are presented, and some of the factors accelerating healing are discussed. Familiarity with the physiology of the bone union process, and in particular the role played in its proper course by growth factors and tissue hormones (cytokines), makes it possible to exercise direct control on the molecular level over the various phases. The results obtained in the course of numerous clinical and laboratory trials give grounds for considerable hope that it will prove possible to exert a direct impact on bone union processes by using these agents. This pertains especially union processes by using these agents. This pertains especially to cases of disturbances in bone union (delayed union, non-union). Greater knowledge of the role these substances play in the various processes involved in proper bone union after fracture, and the development of technology for their manufacture on an industrial scale, will doubtless bring about widespread clinical application of these substances.
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Zakład Chirurgii Transplantacyjnej, Instytut Centrum Medycyny Doświadczalnej i Klinicznej, Polska Akademia Nauk, Warszawa; Oddział Ortopedyczno-Urazowy, Szpital Czerniakowski, Warszawa.
Deszczyński
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