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Orthopedics16685 papers

Disorder of fracture healing

Last edited: 4/23/2026

Overview

Disorder of fracture healing refers to complications that impede the normal process of bone repair, leading to delayed union, non-union, or malunion. These issues can arise due to factors such as infection, inadequate blood supply, or impaired cellular processes.

Diagnosis

  • Clinical Presentation: Persistent pain, swelling, limited mobility, and radiographic evidence of delayed healing 3337.
  • Radiographic Imaging: X-rays to assess bone healing progression; CT or MRI for detailed assessment of soft tissue involvement 3337.
  • Biomechanical Testing: Stress tests or bone density scans to evaluate healing integrity 3337.
  • Laboratory Tests: Blood tests to rule out systemic issues like infection or metabolic disorders 3337.
  • Management

  • First-Line Treatments:
  • - Biological Agents: Use of platelet-rich plasma (PRP) to enhance growth factor delivery 933. - Extracellular Matrices: Application of small intestinal submucosa extracellular matrix (SIS-ECM) to provide a scaffold for healing 2326.
  • Adjunctive Therapies:
  • - Electrical Stimulation: Intermittent pneumatic compression (IPC) and electrical stimulation to promote angiogenesis and tissue regeneration 6067. - Nutritional Support: Ensuring adequate vitamin D and calcium levels to support bone healing 2749. - Infection Control: Antibiotics if infection is present, guided by culture and sensitivity tests 118.

    Special Populations

  • Elderly: Increased risk of delayed healing due to comorbidities and reduced healing capacity; consider PRP and nutritional support 2733.
  • Diabetes: Higher incidence of infection and impaired healing; emphasize strict glycemic control and advanced wound care modalities like PRP 327.
  • Comorbidities: Presence of conditions like osteoporosis or vascular disease may necessitate tailored approaches, including biomechanical support and enhanced biological interventions 3349.
  • Key Recommendations

  • Use Platelet-Rich Plasma (PRP) for Enhanced Healing: Apply PRP to stimulate growth factor release and promote bone healing (Evidence: Moderate) 933.
  • Implement Electrical Stimulation for Chronic Cases: Incorporate intermittent pneumatic compression or electrical stimulation to accelerate healing in non-healing fractures (Evidence: Moderate) 6067.
  • Ensure Adequate Nutritional Support: Maintain optimal levels of vitamin D and calcium to support bone healing processes (Evidence: Moderate) 2749.
  • Monitor and Treat Infections Promptly: Utilize appropriate antibiotics based on culture and sensitivity results to prevent infection-related healing delays (Evidence: Strong) 118.
  • Consider Extracellular Matrix Products: Employ small intestinal submucosa extracellular matrix as a scaffold to facilitate bone regeneration (Evidence: Moderate) 2326.
  • References

    Showing 100 most recent of 193 indexed papers.

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What's New in Wound Healing: Treatment Advances and Microbial Insights. American journal of clinical dermatology 2025. link 6 Sekar D, Nagarajan P, Ekambaram G, Port Louis LR, Bazeer AB. From slime to sublime: the impact of snail mucin on scar therapy and wound healing in dermatology. Cutaneous and ocular toxicology 2025. link 7 Ranire-Maguire M, Caprioli R, Taylor C, Rodger R, Thomas A, Oropallo A. Use of a next-generation multilayered foam dressing in hard-to-heal wounds: a prospective, multicentre study. Journal of wound care 2025. link 8 Hodge NE, Dahl CB, Liljenquist BB, Thomas EJ. Clinical experience depicting wound regression trends with carePATCH: a case series. Journal of wound care 2025. link 9 Perussolo J, Calciolari E, Dereka X, Donos N. Platelet-rich plasma and plasma rich in growth factors in extra-oral wound care. Periodontology 2000 2025. link 10 Janowska A, Fidanzi C, Romanelli M, Iannone M, Oranges T, Montaquila F et al.. Fractional Epidermal Skin Grafts in Hard-to-Heal Wounds: Case Series. The international journal of lower extremity wounds 2025. link 11 Mendivil J, McMahon AE, Ojelade OT, Hobson K, Marballie M, Alvarez S et al.. Clinical use of DermaBind TL/FM as a wound covering for hard-to-heal wounds of various aetiologies: a case series. Journal of wound care 2025. link 12 Abdel Azim S, Whiting C, Friedman AJ. Applications of nitric oxide-releasing nanomaterials in dermatology: Skin infections and wound healing. Nitric oxide : biology and chemistry 2024. link 13 Neyens J, Heusden WV, Veenendaal DV, Schols J. Effects of concurrent optical and magnetic stimulation in hard-to-heal wounds: a real-world evidence case series. Journal of wound care 2024. link 14 Swain D, Cole W, Barrett C, Black G, Hudson C, Lacqua M et al.. The use of a multimodal wound matrix to treat a variety of hard-to-heal wounds: a case series surveillance. Journal of wound care 2024. link 15 Cole W. Treatment of bacterially contaminated lower extremity ulcers with a fatty acid-containing wound matrix: a case series. Journal of wound care 2024. link 16 Townsend EC, Cheong JZA, Radzietza M, Fritz B, Malone M, Bjarnsholt T et al.. What is slough? Defining the proteomic and microbial composition of slough and its implications for wound healing. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2024. link 17 Bozkurt AS, Yılmaz ŞG. Effect of Bovine Lactoferrin Treatment on Iron Homeostasis and Gene Expression Changes in Multiple Organ Dysfunctions During Wound Healing Process in Rats. Current gene therapy 2024. link 18 Tang TY, Mak MYQ, Yap CJQ, Boey JEC, Chan SL, Soon SXY et al.. An Observational Clinical Trial Examining the Effect of Topical Oxygen Therapy (Natrox. The international journal of lower extremity wounds 2024. link 19 Xu C, Hu L, Zeng J, Wu A, Deng S, Zhao Z et al.. Gynura divaricata (L.) DC. promotes diabetic wound healing by activating Nrf2 signaling in diabetic rats. Journal of ethnopharmacology 2024. link 20 Meng X, Xiao X, Jeon S, Kim D, Park BJ, Kim YJ et al.. An Ultrasound-Driven Bioadhesive Triboelectric Nanogenerator for Instant Wound Sealing and Electrically Accelerated Healing in Emergencies. Advanced materials (Deerfield Beach, Fla.) 2023. link 21 Davies OG, Williams S, Goldie K. The therapeutic and commercial landscape of stem cell vesicles in regenerative dermatology. Journal of controlled release : official journal of the Controlled Release Society 2023. link 22 Suhandi C, Mohammed AFA, Wilar G, El-Rayyes A, Wathoni N. Effectiveness of Mesenchymal Stem Cell Secretome on Wound Healing: A Systematic Review and Meta-analysis. Tissue engineering and regenerative medicine 2023. link 23 Jeffery S. Clinical benefits of small intestinal submucosa extracellular matrix and review of the evidence. Journal of wound care 2023. link 24 Kurz P, Danner G, Lembelembe JP, Nair HKR, Martin R. Activation of healing and reduction of pain by single-use automated microcurrent electrical stimulation therapy in patients with hard-to-heal wounds. International wound journal 2023. link 25 Dissemond J, Aare K, Ozer K, Gandhi D, Ryan JL, DeKoven M. Aquacel Ag Advantage/Ag+ Extra and Cutimed Sorbact in the management of hard-to-heal wounds: a cohort study. Journal of wound care 2023. link 26 Jeffery S. Clinical benefits of small intestinal submucosa extracellular matrix and review of the evidence. Journal of wound care 2023. link 27 Bikle DD. Role of vitamin D and calcium signaling in epidermal wound healing. Journal of endocrinological investigation 2023. link 28 Cogo A, Bignozzi AC, Hermans MH, Quint BJ, Snels JP, Schultz G. A desiccation compound as a biofilm- and necrosis-removing agent: a case series. Journal of wound care 2022. link 29 Herron K. Impact of a novel synthetic nanofibre matrix to treat hard-to-heal wounds. Journal of wound care 2022. link 30 Senkowsky J, Li S, Nair A, Pal S, Hu W, Tang L. A wound alkalinity measurement to predict non-healing wound outcomes. Journal of wound care 2022. link 31 Janowska A, Romanelli M, Oranges T, Davini G, Iannone M, Dini V. Prognostic Indicators of Wound Healing in Atypical Wounds: A Case Series. The international journal of lower extremity wounds 2022. link 32 Grada A, Phillips TJ. Nutrition and cutaneous wound healing. Clinics in dermatology 2022. link 33 Popescu MN, Iliescu MG, Beiu C, Popa LG, Mihai MM, Berteanu M et al.. Autologous Platelet-Rich Plasma Efficacy in the Field of Regenerative Medicine: Product and Quality Control. BioMed research international 2021. link 34 Milne J, Swift A, Smith J, Martin R. Electrical stimulation for pain reduction in hard-to-heal wound healing. Journal of wound care 2021. link 35 Dini V, Romanelli M, Oranges T, Davini G, Janowska A. Blue light emission in the management of hard-to-heal wounds. Italian journal of dermatology and venereology 2021. link 36 Bolton L. Platelet-Rich Plasma: Optimal Use in Surgical Wounds. Wounds : a compendium of clinical research and practice 2021. link 37 Bachar-Wikstrom E, Manchanda M, Bansal R, Karlsson M, Kelly-Pettersson P, Sköldenberg O et al.. Endoplasmic reticulum stress in human chronic wound healing: Rescue by 4-phenylbutyrate. International wound journal 2021. link 38 Wilmink JM, Ladefoged S, Jongbloets A, Vernooij JCM. The evaluation of the effect of probiotics on the healing of equine distal limb wounds. PloS one 2020. link 39 Poljšak N, Kreft S, Kočevar Glavač N. Vegetable butters and oils in skin wound healing: Scientific evidence for new opportunities in dermatology. Phytotherapy research : PTR 2020. link 40 Nguyen JK, Huang A, Siegel DM, Jagdeo J. Variability in Wound Care Recommendations Following Dermatologic Procedures. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2020. link 41 Landsman A. Visualization of Wound Healing Progression With Near Infrared Spectroscopy: A Retrospective Study. Wounds : a compendium of clinical research and practice 2020. link 42 González-de la Torre H, Verdú-Soriano J, Quintana-Lorenzo ML, Berenguer-Pérez M, Lavín RS, Soldevilla-Ágreda J. Specialised wound care clinics in Spain: distribution and characteristics. Journal of wound care 2020. link 43 Calcei JG, Rodeo SA. Orthobiologics for Bone Healing. Clinics in sports medicine 2019. link 44 Schneider HP, Landsman A. Preclinical and Clinical Studies of Hyaluronic Acid in Wound Care: A Case Series and Literature Review. Wounds : a compendium of clinical research and practice 2019. link 45 Mosca RC, Ong AA, Albasha O, Bass K, Arany P. Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach. Advances in skin & wound care 2019. link 46 Hirotsu K, Kannan S, Brian Jiang SI. Treatment of Hypertrophic Granulation Tissue: A Literature Review. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2019. link 47 Givol O, Kornhaber R, Visentin D, Cleary M, Haik J, Harats M. A systematic review of Calendula officinalis extract for wound healing. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2019. link 48 Zeleníková R, Vyhlídalová D. Applying honey dressings to non-healing wounds in elderly persons receiving home care. Journal of tissue viability 2019. link 49 Zinder R, Cooley R, Vlad LG, Molnar JA. Vitamin A and Wound Healing. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2019. link 50 Pavlovčič U, Jezeršek M. Handheld 3-dimensional wound measuring system. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 2018. link 51 Grada A, Mervis J, Falanga V. Research Techniques Made Simple: Animal Models of Wound Healing. The Journal of investigative dermatology 2018. link 52 Chernoff G, Bryan N, Park AM. Mesothelial Stem Cells and Stromal Vascular Fraction: Use in Functional Disorders, Wound Healing, Fat Transfer, and Other Conditions. Facial plastic surgery clinics of North America 2018. link 53 Kogan S, Sood A, Granick MS. Amniotic Membrane Adjuncts and Clinical Applications in Wound Healing: A Review of the Literature. Wounds : a compendium of clinical research and practice 2018. link 54 Mayer D, Armstrong D, Schultz G, Percival S, Malone M, Romanelli M et al.. Cell salvage in acute and chronic wounds: a potential treatment strategy. Experimental data and early clinical results. Journal of wound care 2018. link 55 Rembe JD, Fromm-Dornieden C, Stuermer EK. Effects of Vitamin B Complex and Vitamin C on Human Skin Cells: Is the Perceived Effect Measurable?. Advances in skin & wound care 2018. link 56 Pérez-Recalde M, Ruiz Arias IE, Hermida ÉB. Could essential oils enhance biopolymers performance for wound healing? A systematic review. Phytomedicine : international journal of phytotherapy and phytopharmacology 2018. link 57 Kahn S. Highlights from the advanced wound healing stream at the LINK Congress. British journal of nursing (Mark Allen Publishing) 2017. link 58 Keen MA. Hyaluronic Acid in Dermatology. Skinmed 2017. link 59 Kimmel H, Gittleman H. Retrospective observational analysis of the use of an architecturally unique dermal regeneration template (Derma Pure®) for the treatment of hard-to-heal wounds. International wound journal 2017. link 60 Arvesen K, Nielsen CB, Fogh K. Accelerated wound healing with combined NPWT and IPC: a case series. British journal of community nursing 2017. link 61 Ferrer-Sola M, Sureda-Vidal H, Altimiras-Roset J, Fontsere-Candell E, Gonzalez-Martinez V, Espaulella-Panicot J et al.. Hydrosurgery as a safe and efficient debridement method in a clinical wound unit. Journal of wound care 2017. link 62 Sridharan K, Sivaramakrishnan G. Efficacy of topical insulin in wound healing: A preliminary systematic review and meta-analysis of randomized controlled trials. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2017. link 63 Zhou X, Patel D, Sen S, Shanmugam V, Sidawy A, Mishra L et al.. Poly-ADP-ribose polymerase inhibition enhances ischemic and diabetic wound healing by promoting angiogenesis. Journal of vascular surgery 2017. link 64 Müller CS, Burgard B, Zimmerman M, Vogt T, Pföhler C. 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    Original source

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