Impaired Bone Healing: Current Understanding and Future Perspectives

Dear Colleagues,

Bone healing is a complex but well-orchestrated physiological process which recapitulates aspects of the embryonic skeletal development in combination with the normal response to acute tissue injury. It encompasses multiple biological phenomena and is margined by the combination of osteoconduction (extracellular matrix formation); osteoinduction (timed cellular recruitment, proliferation and differentiation of mesenchymal stem cells (MSCs) into osteoblasts and chondroblasts, controlled by multiple signaling molecules); and osteogenesis (new bone formation). In contrast to scar formation, which occurs in the majority of other tissue types in adults, bone has the innate capability to repair and regenerate, regaining its former biomechanical and biochemical properties.

Despite advances in the understanding of the pathophysiological mechanisms of fracture healing, the incidence of non-union remains largely unchanged over the years and has been estimated at between 5% and 10%, representing a major social and financial burden in every healthcare system. It is generally accepted that the progression to a non-union in most cases represents a multifactorial process. Various risk factors have been implicated in compromised fracture healing, generally divided into two main categories: patient-dependent and patient-independent factors. In the majority of cases no obvious cause can be found, while an important factor that is often underestimated is the body’s ability to heal a fracture. This may involve insufficiency/dysfunction of the cellular components (osteoprogenitor cells), molecular elements (osteoinductive molecules and other mediators), angiogenesis, extracellular matrix, and local immunoregulation.

A large number of different strategies have been proposed in the literature for managing non-unions. These commonly aim to enhance the local and/or systemic biological environments, along with optimization of the mechanical stability and local vascularity.

In this Special Issue we invite studies focusing on the etiology and management of non-unions, both in the clinical and laboratory context. We particularly invite manuscripts identifying specific risk factors contributing to the development of non-unions and treatment strategies for their prevention/treatment.

Dr. Michalis Panteli
Prof. Dr. Peter V. Giannoudis
Guest Editors

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• non-union
• fracture related infection
• avascular necrosis
• tissue engineering
• 3D bioprinting