Open Fracture Reduction

The patient was a 74-year-old woman who presented to the office with chronic, worsening, right hip pain. Her past medical history included myasthenia gravis and dyslipidemia.

The answer to the question is “yes and no.” Orthobiologics are adjuvants that are thought to improve the endogenous healing potential of the injured skeletal element. Although orthopedic implants and surgical techniques have improved significantly over the last few decades, we still encounter fractures that, despite all efforts, fail to unite. These are the situations where orthobiologics will make a difference. Unfortunately, at this stage, we are unable to predict at the time of the index surgery who will unite and who will end up with a nonunion. In addition, we can often only guess whether a growth factor is needed, a fracture site is lacking skeletal stem cells or the stem cells are less osteogenic due to an underlying medical condition. Once we are able to identify the fracture that will require augmentation with a biologic, such as bone marrow aspirate concentrate, platelet-rich plasma or others, then we will be able to recommend meaningful use of orthobiologics for primary trauma cases. Until then, the use will be limited to patients in which the past medical history or clinical appearance of the injured limb suggest suboptimal healing potential. While this is not a wrong approach per se, it will lead to overuse of these costly products.