Bone regeneration in limb lengthening

PURPOSE OF REVIEW: Impaired bone healing is a major source of complications in limb lengthening. This review presents our recent understanding of bone healing biology and basic research for modulating bone healing in limb lengthening. RECENT FINDINGS: Angiogenesis appears to play a major role in distraction osteogenesis with increased gene expression and upregulation of many angiogenic factors during the process. In-vivo and clinical studies have demonstrated the benefits of bone morphogenic protein, bisphosphonates, electromagnetic fields, and ultrasound to aid in bone healing during limb lengthening. SUMMARY: The mechanisms of distraction osteogenesis continue to be studied using in-vivo models. Beneficial effects of growth factors, bisphophonates, electromagnetic fields and ultrasound have been demonstrated to enhance bone healing in in-vivo limb-lengthening models. Further clinical studies are needed to demonstrate their efficacy.