Predicting fracture healing with blood biomarkers: the potential to assess patient risk of fracture nonunion

Abstract

Fracture non-union is a significant orthopaedic problem affecting a substantial number of patients yearly. Treatment of nonunions is devastating to patients and costly to the healthcare system. Unfortunately, the diagnosis of non-union is typically made in a reactionary fashion by an orthopaedic surgeon based on clinical assessment and radiographic features several months into treatment. For this reason, investigators have been trying to develop prediction algorithms; however, these have relied on population-based approaches and lack the predictive capability necessary to make individual treatment decisions. There is also a growing body of literature focussed on identifying blood biomarkers that are associated with non-union. This review describes the research that has been done in this area. Further studies of patient-centered, precision medicine approaches will likely improve fracture non-union diagnostic/prognostic capabilities.

Keywords:

• Fracture healing
• delayed union
• non-union
• biomarkers
• diagnosis
• prognosis

Acknowledgements

Elizabeth Whipple, medical librarian, for assistance searching for and acquiring articles reviewed. Gremah Adam for assistance reviewing abstracts for inclusion.

Disclosure statement

Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The authors report no conflict of interest.

Additional information

Funding

This project was supported by 1) the Indiana Clinical and Translational Sciences Institute, funded in part by UL1TR002529 from the National Institutes of Health; 2) Indiana Centre for Musculoskeletal Health Collaborative Pilot Project Grant; 3) Indiana Centre for Musculoskeletal Health Clinical Research Core P30AR072581; and 4) Indiana University Health Values Fund Grant VFR-478. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funding sources. RH and NC like to acknowledge Military Operational Medicine Research Program (MOMRP) for their support to conduct this study.