Das biologische Skalpell II – Frakturheilung und pharmakologische Einflussfaktoren

Zusammenfassung

Die Ursachen für eine gestörte oder ausbleibende Frakturheilung sind multifaktoriell. Neben mechanischen Ursachen kommt den biologischen Einflussfaktoren eine große Rolle zu. Da uns kaum Therapieansätze zur Stimulation der Frakturheilung zur Verfügung stehen, sollte die Optimierung der biologischen Grundvoraussetzungen essenzieller Bestandteil der Frakturbehandlung sein. Neben der Beachtung patientenbezogener Einflussfaktoren können auch verschiedene Medikamente die Frakturheilung positiv oder negativ beeinflussen. Bei jüngeren, ansonsten gesunden Patienten erfolgt im Rahmen der Frakturbehandlung regelhaft eine Medikation mit Arzneistoffen zur Schmerztherapie und zur Prophylaxe von Infektionen und Thrombosen. Bei vielen älteren Patienten liegt zusätzlich aufgrund bestehender Komorbiditäten häufig bereits zum Zeitpunkt der Fraktur eine Polymedikation mit unterschiedlichsten Arzneistoffen vor. Ziel der vorliegenden Arbeit ist es, eine Übersicht zu geben über pharmakologische Einflussfaktoren auf die Frakturheilung. Die Kenntnis dieser Einflussfaktoren ermöglicht es, durch Vermeidung bestimmter Arzneistoffe die Bedingungen für eine zeitgerechte Frakturheilung zu optimieren. Darüber hinaus soll ein Überblick gegeben werden, welche pharmakologischen Wirkstoffe aktuell oder in naher Zukunft zur Verfügung stehen, um die Frakturheilung zu stimulieren.

Abstract

The reasons for delayed fracture healing or non-union formation are multifactorial. Mechanical factors are well known to influence the process of fracture healing. However, there is a lack of knowledge about the biological conditions that have to be achieved for adequate bone healing. Treatment of non-unions is still demanding and we have only poor options to stimulate the bone healing process. Therefore, it is important to optimise the biological conditions to avoid non-union formation. Beside patient-related factors, pharmacological drugs are able to impede or stimulate fracture healing. Especially geriatric patients show a pre-existing drug medication due to different co-morbidities. However, also younger patients are frequently treated with different drugs for infection prophylaxis, analgesia or thrombosis prophylaxis. The aim of the current review article is to give an overview about the influence of different pharmacological agents on the process of fracture healing. A deeper understanding of a drug-related influence on fracture healing could help the medical practitioner to optimise the general conditions for adequate fracture healing, i.e., by avoiding specific pharmacological agents. Vice versa some drugs could be used to stimulate fracture healing in the future.

Schlüsselwörter

Frakturheilung - Biologie - Medikamente - Knochenheilung - Osteoporose

Key words

fracture healing - biology - drugs - bone healing - osteoporosis

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