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Foot FAQ

Question:

What are orthobiolgics? I saw this word in an article on bone fractures but I can't remember what they are for exactly. Now that I have a broken ankle myself, I want to go back and reread about them.

Answer:

Orthobiologics refers to growth factors and proteins used to help bone and soft tissues heal. It's a fairly new area of study and development. These biologic agents are applied during surgery with the goal of boosting the body's natural healing process. Right now, there are three major orthobiologic products available for use during surgery. These include: 1) platelet-rich plasma (PRP), 2) bone morphogenetic proteins (BMPs), and 3) platelet-derived growth factor (PDGF). With platelet-rich plasma, the patient donates his or her own blood for this procedure. The blood is separated in order to collect the platelets. Platelets travel around the body in the blood at all times. They are always ready to be available. When a cut or bleeding injury occurs, the platelets act like superglue and quickly form blood clots to stop the bleeding. Platelets are full of various growth factors. Growth factors are important in wound healing because they are like the Maitre d' (the man in charge at a restaurant). They signal to the waiters (other cells needed for inflammation, healing, and tissue recovery) when and where to go (the site in need of attention). Each stage of soft-tissue and bone healing requires different kinds of cells to complete the process. Surgeons have found more and more uses for platelet-rich plasma. It started with mouth and jaw surgery and now extends to include bone healing in spine fusions, fracture repair, surgery to lengthen an uneven leg or arm, and tendon healing. It makes sense that this same product could be used with ankle fusions. And especially when the patient is at high-risk for infection, delayed wound healing, or other complications after surgery. Studies show that platelet-rich plasma also works well for ankle fractures that aren't healing well, for ankle joint replacements, surgery to correct foot deformities, and repair of Achilles tendon ruptures. The platelet product can be painted on bone, sprayed on the surface of ankle implants used in joint replacements, or injected into healing tendons. The results are all the same: faster fusion or healing time. In the case of tendon repair, joint range of motion, function, and return to full activities improve much faster as well. The next orthobiologic product reviewed is bone morphogenetic proteins (BMPs). These proteins specifically target bone growth. BMPs persuade the bone to create new bone cells in order to heal fracture sites or fill in bone defects. The third group of orthobiologics includes platelet-derived growth factor (PDGF). You may be wondering how is this different from the first group we talked about: platelet-rich plasma? Platelet-derived growth factor is actually one of the specific platelet growth factors that make up part of the platelet-rich plasma. It just happens that researchers have been able to take this one specific platelet growth factor and study it more closely for use in bone fractures. The clinical application of platelet-derived growth factor has been mostly with rats. But the findings so far suggest that it could be used to enhance bone healing in patients with poor bone healing of the foot and ankle. Not every surgeon uses these products and not every patient is a candidate for their use. But it's always good to be up on the latest treatment techniques for a problem you have. Don't hesitate to ask your orthopedic surgeon what he or she thinks of these products and whether you might be able to take advantage of them yourself. Siddhant K. Mehta, et al. The Role of Growth Factors in Foot and Ankle Surgery. In Current Orthopaedic Practice. May/June 2010. Vol. 21. No. 3. Pp. 245-250.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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