title: Osteobiologics in foot and ankle surgery.
abstract: Osteobiological agents are a welcome addition to the surgeon’s armamentarium. These products should always be thought of as a complement to good surgical principles and construct. As history has shown, nothing outperforms the osteogenic properties of autograft bone. Even if allograft is procured for use, an attempt should be made to combine it with autograft if possible, given the primary indexprocedure in which it will be used. Structural support from corticocancellous autografts is also greater than allografts, which lose mechanical strength during the sterilization and preservation process. Bone fillers without structural support should be used only when there are other means of cortical contact. The ability of the human skeletal system to repair itself is amazing. Osseous healing relieson a complicated series of intrinsic and extrinsic factors. Some of these factors include a stable fixation construct, nutritional status, good surgical technique, and good decision making. Autogenous bone graft remains the gold standard, and the presence of native growth factors and osteogenic cells is mandatory to repair these deformities. When this microenvironment is disruptive, nonunion may result.Understanding the mechanisms of bony healing contributes to the available osteobiologics, which give the foot and ankle surgeon additional tools to enhance the reparative process of bony defects and the ability of the foot to restore itself.
authors.affiliation: Ankle & Foot Care Centers, 8175 Market Street, Youngstown, OH 44512, USA; St. Elizabeth Hospital, Youngstown, OH, USA; Heritage Valley Hospital, Beaver, PA, USA. Electronic address: ld5353@aol.com.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: DiDomenico
authors.affiliation: Heritage Valley Hospital, Beaver, PA, USA.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Thomas
mesh_terms: D001174:Arthrodesis; D001847:Bone Diseases / Q000601:surgery*; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D001861:Bone Regeneration / Q000502:physiology*; D016025:Bone Transplantation; D005529:Foot Bones / Q000293:injuries / Q000601:surgery*; D050723:Fractures, Bone / Q000601:surgery*; D015316:Genetic Therapy; D048091:Guided Tissue Regeneration; D006801:Humans; D010027:Osteotomy; D053657:Platelet-Rich Plasma
chemical_list: D019485:Bone Morphogenetic Proteins
keywords: Bone healing; Clinical application; Foot and ankle surgery; Osteobiologics