title: The role of stem cells in fracture healing and nonunion.
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.
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. dr.hana.fayaz@hotmail.de
authors.forename: Hangama C
authors.initials: HC
authors.lastname: Fayaz
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
authors.forename: Mark S
authors.initials: MS
authors.lastname: Vrahas
authors.forename: Raymond Malcolm
authors.initials: RM
authors.lastname: Smith
authors.forename: Christopher
authors.initials: C
authors.lastname: Moran
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D001854:Bone Marrow Cells / Q000166:cytology / Q000502:physiology; D001861:Bone Regeneration / Q000502:physiology; D017690:Cell Transplantation; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000503:physiopathology*; D006801:Humans; D059630:Mesenchymal Stem Cells / Q000166:cytology / Q000502:physiology*; D018919:Neovascularization, Physiologic / Q000502:physiology; D010012:Osteogenesis / Q000502:physiology; D023822:Tissue Engineering / Q000379:methods; D054457:Tissue Scaffolds