1
|
Menger MM, Tobias AL, Bauer D, Bleimehl M, Scheuer C, Menger MD, Histing T, Laschke MW. Parathyroid hormone stimulates bone regeneration in an atrophic non-union model in aged mice. J Transl Med 2023; 21:844. [PMID: 37996876 PMCID: PMC10668449 DOI: 10.1186/s12967-023-04661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Non-union formation still represents a major burden in trauma and orthopedic surgery. Moreover, aged patients are at an increased risk for bone healing failure. Parathyroid hormone (PTH) has been shown to accelerate fracture healing in young adult animals. However, there is no information whether PTH also stimulates bone regeneration in atrophic non-unions in the aged. Therefore, the aim of the present study was to analyze the effect of PTH on bone regeneration in an atrophic non-union model in aged CD-1 mice. METHODS After creation of a 1.8 mm segmental defect, mice femora were stabilized by pin-clip fixation. The animals were treated daily with either 200 mg/kg body weight PTH 1-34 (n = 17) or saline (control; n = 17) subcutaneously. Bone regeneration was analyzed by means of X-ray, biomechanics, micro-computed tomography (µCT) imaging as well as histological, immunohistochemical and Western blot analyses. RESULTS In PTH-treated animals bone formation was markedly improved when compared to controls. This was associated with an increased bending stiffness as well as a higher number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts and CD31-positive microvessels within the callus tissue. Furthermore, PTH-treated aged animals showed a decreased inflammatory response, characterized by a lower number of MPO-positive granulocytes and CD68-positive macrophages within the bone defects when compared to controls. Additional Western blot analyses demonstrated a significantly higher expression of cyclooxygenase (COX)-2 and phosphoinositide 3-kinase (PI3K) in PTH-treated mice. CONCLUSION Taken together, these findings indicate that PTH is an effective pharmacological compound for the treatment of non-union formation in aged animals.
Collapse
Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany.
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany.
| | - Anne L Tobias
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - David Bauer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Michelle Bleimehl
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| |
Collapse
|
2
|
Menger MM, Bauer D, Bleimehl M, Scheuer C, Braun BJ, Herath SC, Rollmann MF, Menger MD, Laschke MW, Histing T. Sildenafil, a phosphodiesterase-5 inhibitor, stimulates angiogenesis and bone regeneration in an atrophic non-union model in mice. J Transl Med 2023; 21:607. [PMID: 37684656 PMCID: PMC10486066 DOI: 10.1186/s12967-023-04441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Non-union formation represents a major complication in trauma and orthopedic surgery. The phosphodiesterase-5 (PDE-5) inhibitor sildenafil has been shown to exert pro-angiogenic and pro-osteogenic effects in vitro and in vivo. Therefore, the aim of the present study was to analyze the impact of sildenafil in an atrophic non-union model in mice. After creation of a 1.8 mm segmental defect, mice femora were stabilized by pin-clip fixation. Bone regeneration was analyzed by means of X-ray, biomechanics, photoacoustic and micro-computed tomography (µCT) imaging as well as histological, immunohistochemical and Western blot analyses at 2, 5 and 10 weeks after surgery. The animals were treated daily with either 5 mg/kg body weight sildenafil (n = 35) or saline (control; n = 35) per os. Bone formation was markedly improved in defects of sildenafil-treated mice when compared to controls. This was associated with a higher bending stiffness as well as an increased number of CD31-positive microvessels and a higher oxygen saturation within the callus tissue. Moreover, the bone defects of sildenafil-treated animals contained more tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts and CD68-positive macrophages and exhibited a higher expression of the pro-angiogenic and pro-osteogenic markers cysteine rich protein (CYR)61 and vascular endothelial growth factor (VEGF) when compared to controls. These findings demonstrate that sildenafil acts as a potent stimulator of angiogenesis and bone regeneration in atrophic non-unions.
Collapse
Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany.
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany.
| | - David Bauer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Michelle Bleimehl
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076, Tuebingen, Germany
| |
Collapse
|
3
|
Menger MM, Stief M, Scheuer C, Rollmann MF, Herath SC, Braun BJ, Ehnert S, Nussler AK, Menger MD, Laschke MW, Histing T. Diclofenac, a NSAID, delays fracture healing in aged mice. Exp Gerontol 2023; 178:112201. [PMID: 37169100 DOI: 10.1016/j.exger.2023.112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, belong to the most prescribed analgesic medication after traumatic injuries. However, there is accumulating evidence that NSAIDs impair fracture healing. Because bone regeneration in aged patients is subject to significant changes in cell differentiation and proliferation as well as a markedly altered pharmacological action of drugs, we herein analyzed the effects of diclofenac on bone healing in aged mice using a stable closed femoral facture model. Thirty-three mice (male n = 14, female n = 19) received a daily intraperitoneal injection of diclofenac (5 mg/kg body weight). Vehicle-treated mice (n = 29; male n = 13, female n = 16) served as controls. Fractured mice femora were analyzed by means of X-ray, biomechanics, micro computed tomography (μCT), histology and Western blotting. Biomechanical analyses revealed a significantly reduced bending stiffness in diclofenac-treated animals at 5 weeks after fracture when compared to vehicle-treated controls. Moreover, the callus tissue in diclofenac-treated aged animals exhibited a significantly reduced amount of bone tissue and higher amounts of fibrous tissue. Further histological analyses demonstrated less lamellar bone after diclofenac treatment, indicating a delay in callus remodeling. This was associated with a decreased number of osteoclasts and an increased expression of osteoprotegerin (OPG) during the early phase of fracture healing. These findings indicate that diclofenac delays fracture healing in aged mice by affecting osteogenic growth factor expression and bone formation as well as osteoclast activity and callus remodeling.
Collapse
Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany.
| | - Maximilian Stief
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
| | - Sabrina Ehnert
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Andreas K Nussler
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
| |
Collapse
|
4
|
Menger MM, Körbel C, Bauer D, Bleimehl M, Tobias AL, Braun BJ, Herath SC, Rollmann MF, Laschke MW, Menger MD, Histing T. Photoacoustic imaging for the study of oxygen saturation and total hemoglobin in bone healing and non-union formation. PHOTOACOUSTICS 2022; 28:100409. [PMID: 36213763 PMCID: PMC9535319 DOI: 10.1016/j.pacs.2022.100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Non-union formation represents a major complication in trauma surgery. Adequate vascularization has been recognized as vital for bone healing. However, the role of vascularization in the pathophysiology of non-union formation remains elusive. This is due to difficulties in studying bone microcirculation in vivo. Therefore, we herein studied in a murine osteotomy model whether photoacoustic imaging may be used to analyze vascularization in bone healing and non-union formation. We found that oxygen saturation within the callus tissue is significantly lower in non-unions compared to unions and further declines over time. Moreover, the amount of total hemoglobin (HbT) within the callus tissue was markedly reduced in non-unions. Correlation analyses showed a strong positive correlation between microvessel density and HbT, indicating that photoacoustically determined HbT is a valid parameter to assess vascularization during bone healing. In summary, photoacoustic imaging is a promising approach to study vascular function and tissue oxygenation in bone regeneration.
Collapse
Affiliation(s)
- Maximilian M. Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, 72076 Tübingen, Germany
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Christina Körbel
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - David Bauer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Michelle Bleimehl
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Anne L. Tobias
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Benedikt J. Braun
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, 72076 Tübingen, Germany
| | - Steven C. Herath
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, 72076 Tübingen, Germany
| | - Mika F. Rollmann
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, 72076 Tübingen, Germany
| | - Matthias W. Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Michael D. Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saar, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, 72076 Tübingen, Germany
| |
Collapse
|
5
|
Schagemann JC, Neumann H, Schäfers J, Paech A, Wendlandt R, Oheim R, Schulz AP. Similar Clinical Outcome in Locking and Conventional Plate Osteosynthesis for the Treatment of AO 44-B2 Ankle Fractures. Foot Ankle Spec 2022:19386400221136757. [PMID: 36418935 DOI: 10.1177/19386400221136757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Biomechanical studies have proved that locking plates have better primary stability besides versatility regarding fracture pattern while reducing bone contact and bridging the gap, whereas conventional nonlocking plates (plus lag screw) depend on bone-plate compression. The clinical benefit of locking plates over nonlocking plates remains unanswered, however. Therefore, this retrospective cohort study was set up to test the hypothesis that the use of locking plates for unstable ankle fractures will result in fewer re-displacements, superior bony healing, and functional and clinical outcomes better than observed in the nonlocking cohort. METHODS Bimalleolar ankle fractures (AO 44-B2) without syndesmotic injury treated with either a locking or a nonlocking plate were included. Groups were compared for complications, bone healing, secondary dislocation, progressions of osteoarthritis, and clinical outcome using patient-reported outcome measures. RESULTS Data revealed no clinical outcome differences (Olerud-Molander Ankle Score: nonlocking 88.2 ± 14.4, locking 88.8 ± 12.3, P = .69, robust two 1-sided test for equality (RTOST): P = .03; American Orthopaedic Foot and Ankle Score: nonlocking 91.2 ± 12.9, locking 91.8 ± 11.3, P = .96, RTOST: P = .04). Nevertheless, a significant postoperative progression of osteoarthritis was detected in both groups (P = .04). This was independent of implant (P = .16). Although difference was not significant, locking plates were preferred in older (P = .78) and sicker patients (P = .63) and in cases with severer osteoarthritis (P = .16), and were associated with a higher complication rate (P = .42) and secondary dislocation (nonlocking 9.4%, locking 18.2%; P = .42). Re-displacement, however, was not a compelling reason for revision. CONCLUSIONS The present study shows statistically significant equality of both types of implants. Contrary to our expectation, locking plates seemed to be associated with a higher risk for re-displacement. Overall, the use of either locking or nonlocking plates for unstable AO 44-B2 fractures is safe and successful despite significant progression of osteoarthritis. LEVEL OF EVIDENCE III, Retrospective observational cohort study.
Collapse
Affiliation(s)
- Jan C Schagemann
- Christophorus Kliniken Coesfeld, Coesfeld, Germany
- Universität zu Lübeck, Lübeck, Germany
| | | | | | | | | | - Ralf Oheim
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Arndt Peter Schulz
- Universität zu Lübeck, Lübeck, Germany
- BG Klinikum Hamburg, Hamburg, Germany
| |
Collapse
|
6
|
Menger MM, Bauer D, Bleimehl M, Scheuer C, Ehnert S, Menger MD, Histing T, Laschke MW. Comparison of two non-union models with damaged periosteum in mice: Segmental defect and pin-clip fixation versus transverse fracture and K-wire stabilization. Bone 2022; 162:116475. [PMID: 35752408 DOI: 10.1016/j.bone.2022.116475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 11/02/2022]
Abstract
Despite growing knowledge about the mechanisms of fracture healing, non-union formation still represents a major complication in trauma and orthopedic surgery. Non-union models in mice gain increasing interest, because they allow investigating the molecular and cellular mechanisms of failed fracture healing. These models often use segmental defects to achieve non-union formation. Alternatively, failed fracture healing can be induced by transverse fractures with additional periosteal injury. The present study systematically compared the reliability of these two approaches to serve as non-union model. A 0.6 mm K-wire was inserted into the femora of CD-1 mice in a retrograde fashion and a closed transverse femoral fracture was created. Subsequently, the fracture site was exposed and the periosteum was cauterized. This approach was compared with a well-established non-union model involving the pin-clip fixation of a 1.8 mm segmental defect. The callus tissue was analyzed by means of radiography, biomechanics, histology and Western blotting. At 10 weeks after surgery 10 out of 12 femora (83.3 %) of the K-wire group showed a non-union formation. The pin-clip model resulted in 100 % non-union formation. The K-wire group showed increased bone formation, osteoclast activity and bending stiffness when compared to the group with pin-clip fixation. This was associated with a higher expression of bone formation markers. However, the number of CD31-positive microvessels was reduced in the K-wire group, indicating an impaired angiogenic capacity after periosteal cauterization. These findings suggest that the pin-clip model is more reliable for the study of non-union formation in mice. The K-wire model including periosteal injury by cauterization however, may be particularly applied in preclinical studies which explore the effects of damaged periosteum and reduced angiogenic capacity to trauma-induced fractures.
Collapse
Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany.
| | - David Bauer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Michelle Bleimehl
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Sabrina Ehnert
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| |
Collapse
|
7
|
Peters J, Singh G, Hakobyan H. Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite. Ther Clin Risk Manag 2022; 18:551-560. [PMID: 35586156 PMCID: PMC9109884 DOI: 10.2147/tcrm.s361006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT). Patients and Methods Patients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed. Results A total of 26 clavicles in 25 patients with a mean age of 50.7 (16–85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6–31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32–35) points and 0.6±1.6 (0–5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1–58.9) points, and no patient experienced any pain at the last follow-up. Conclusion Our initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.
Collapse
Affiliation(s)
- Jens Peters
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
- Correspondence: Jens Peters, Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Schmelingstrasse 47, Sulingen, Lower Saxony, 27232, Germany, Tel +49 4271 82 33210, Fax +49 4271 82 33212, Email
| | - Gurdeep Singh
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
| | - Hrayr Hakobyan
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
| |
Collapse
|
8
|
MENGER MM, STUTZ J, EHNERT S, NUSSLER AK, ROLLMANN MF, HERATH SC, BRAUN BJ, POHLEMANN T, MENGER MD, HISTING T. Development of an ischemic fracture healing model in mice. Acta Orthop 2022; 93:466-471. [PMID: 35478260 PMCID: PMC9047454 DOI: 10.2340/17453674.2022.2529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE In fracture healing, ischemia caused by vascular injuries, chronic vascular diseases, and metabolic comorbidities is one of the major risk factors for delayed union and non-union formation. To gain novel insights into the molecular and cellular pathology of ischemic fracture healing, appropriate animal models are needed. Murine models are of particular interest, as they allow to study the molecular aspects of fracture healing due to the availability of both a large number of murine antibodies and gene-targeted animals. Thus, we present the development of an ischemic fracture healing model in mice. MATERIAL AND METHODS After inducing a mild ischemia by double ligature of the deep femoral artery in CD-1 mice, the ipsilateral femur was fractured by a 3-point bending device and stabilized by screw osteosynthesis. In control animals, the femur was fractured and stabilized without the induction of ischemia. The femora were analyzed at 2 and 5 weeks after fracture healing by means of radiology, biomechanics, histology, and histomorphometry. RESULTS The surgically induced ischemia delayed and impaired the process of fracture healing. This was indicated by a lower Goldberg score, decreased bending stiffness, and reduced bone callus formation in the ischemic animals when compared with the controls. INTERPRETATION We introduce a novel ischemic femoral fracture healing model in mice, which is characterized by delayed bone healing. In future, the use of this model may allow both the elucidation of the molecular aspects of ischemic fracture healing and the study of novel treatment strategies.
Collapse
Affiliation(s)
- Maximilian M MENGER
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar,Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen
| | - Janine STUTZ
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar,Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg/Saar
| | - Sabrina EHNERT
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Andreas K NUSSLER
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mika F ROLLMANN
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen
| | - Steven C HERATH
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen
| | - Benedikt J BRAUN
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen
| | - Tim POHLEMANN
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg/Saar
| | - Michael D MENGER
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar
| | - Tina HISTING
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen
| |
Collapse
|
9
|
Study on TiO2 Nanofilm That Reduces the Heat Production of Titanium Alloy Implant in Microwave Irradiation and Does Not Affect Fracture Healing. DISEASE MARKERS 2022; 2022:4910731. [PMID: 35465264 PMCID: PMC9020966 DOI: 10.1155/2022/4910731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
Background Metal implants can produce heat and damage adjacent tissues under microwave irradiation, which makes local metal implants in the body a contraindication for microwave therapy. However, with the wide application of titanium alloy implants which have low permeability and low conductivity, this concept has been challenged. Our team members have confirmed through previous research that continuous low-power microwave irradiation does not cause thermal damage to the surrounding tissues of the titanium alloy. Is there any other way to further increase the dose of microwave irradiation while reducing the heat production of titanium alloy implants? In this study, the effect of TiO2 nanofilm on reducing the heat production of titanium alloy implants in microwave field was verified by animal experiments, and the effect of TiO2 nanofilm on fracture healing was observed. Methods 30 rabbits were selected. In the experiment of temperature measurement, 10 rabbits were randomly divided into experimental group (n = 5) and control group (n = 5), and the contralateral lower limb of the rabbits in experimental group was set as the sham operation group. The right femurs in the experimental group were implanted with Ti6Al4V plates coated with TiO2 nanofilm, and the right femurs in the control group were implanted with common titanium alloy plates without TiO2 nanofilm. The same surgical procedure was used in the sham operation group, but no plate was implanted. The temperature of the deep tissue above the metal implant was measured with an anti-interference thermocouple thermometer during 20 minutes of microwave irradiation. The other 20 rabbits were randomly divided into two groups, experimental group (n = 10) and control group (n = 10). The femoral shaft fracture models were established again. Ti6Al4V plates coated with TiO2 nanofilm and common titanium alloy plates were implanted in the two groups, respectively, and both groups were exposed to continuous microwave irradiation with a power of 40 W or 60 W for 30 days after operation. The fracture healing was evaluated by X-ray at 0 day, 14 days, and 30 days after microwave irradiation, respectively. The animals were sacrificed at 30 days after operation for histopathological assessment. Results The temperature in the experimental group, control group, and sham operation group increased significantly after 40 W and 60 W microwave irradiation (2.18 ± 0.15°C~6.02 ± 0.38°C). When exposed to 40 W microwave, the temperature rise of the control group was 4.0 ± 0.34°C, which was significantly higher than that of the experimental group 2.82 ± 0.15°C (P < 0.01) and the sham operation group 2.18 ± 0.33°C (P < 0.01). There was no significant difference in temperature rise between the experimental group and the sham operation group (P = 0.21). When exposed to 60 W microwave, the temperature rise of the control group was 6.02 ± 0.38°C, which was significantly higher than that of the experimental group 3.66 ± 0.14°C (P < 0.01) and sham operation group 2.96 ± 0.22°C (P < 0.01), and there was no significant difference between the experimental group and the sham operation group (P = 0.32). X-ray evaluation showed that there was no significant difference in callus maturity between the experimental group and the control group at 14 days (P = 0.554), but there was significant difference in callus maturity between the two groups at 30 days (P = 0.041). The analysis of bone histologic and histomorphometric data at 30 days was also consistent with this. Conclusion Under the animal experimental condition, compared with the common titanium alloy implant, the TiO2 nanofilm can reduce the heat production of the titanium alloy implant in the 2450 MHz microwave field and has no adverse effect on fracture healing. This study opens up a promising new idea for the application of microwave therapy to metal implants in human body.
Collapse
|
10
|
Hixon KR, Miller AN. Animal models of impaired long bone healing and tissue engineering- and cell-based in vivo interventions. J Orthop Res 2022; 40:767-778. [PMID: 35072292 DOI: 10.1002/jor.25277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
Bone healing after injury typically follows a systematic process and occurs spontaneously under appropriate physiological conditions. However, impaired long bone healing is still quite common and may require surgical intervention. Various complications can result in different forms of impaired bone healing including nonunion, critical-size defects, or stress fractures. While a nonunion may occur due to impaired biological signaling and/or mechanical instability, a critical-size defect exhibits extensive bone loss that will not spontaneously heal. Comparatively, a stress fracture occurs from repetitive forces and results in a non-healing crack or break in the bone. Clinical standards of treatment vary between these bone defects due to their pathological differences. The use of appropriate animal models for modeling healing defects is critical to improve current treatment methods and develop novel rescue therapies. This review provides an overview of these clinical bone healing impairments and current animal models available to study the defects in vivo. The techniques used to create these models are compared, along with the outcomes, to clarify limitations and future objectives. Finally, rescue techniques focused on tissue engineering and cell-based therapies currently applied in animal models are specifically discussed to analyze their ability to initiate healing at the defect site, providing information regarding potential future therapies. In summary, this review focuses on the current animal models of nonunion, critical-size defects, and stress fractures, as well as interventions that have been tested in vivo to provide an overview of the clinical potential and future directions for improving bone healing.
Collapse
Affiliation(s)
- Katherine R Hixon
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA.,Thayer School of Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA
| |
Collapse
|
11
|
Choi Y, Yang YH, Kwon YH. Reliability of Goldberg Scoring System in the Radiographic Evaluation of Bony Union after Bone Grafting. Clin Orthop Surg 2021; 13:549-557. [PMID: 34868505 PMCID: PMC8609213 DOI: 10.4055/cios19152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/22/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Evaluation of bony union after bone grafting is very important in orthopedic surgery. The aim of this study was to verify inter- and intraobserver reliability of the Goldberg scoring system for radiographic evaluation of bony union after bone grafting in various situations of animal models. Methods Twenty-seven male C57/BL6 mice, which lack the ability to synthesize galactose-alpha-1,3-galactose (GalT KO mice), and 9 C57/BL6 mice carrying a wild-type gene were used as animal models. We divided the mice into four groups. In group 1, syngenic bone grafting and intramedullary fixation were performed (9 wild type C57BL/6 mice). In group 2, allogenic bone grafting was performed (9 GalT KO mice). In group 3, an alpha-galactosidase-treated porcine xenograft was transplanted into the femur to reduce the antigenicity (9 GalT KO mice). In group 4, a non-treated porcine xenobone grafting was performed (9 GalT KO mice). The level of radiographic bony union (Goldberg method) was assessed by three orthopedic surgeons. Intra- and interobserver reliability for radiographic evaluation was assessed. Results In the Goldberg scoring system, most of the radiographic measurements showed substantial to almost perfect intraobserver reliability. The total score showed substantial intraobserver reliability. The kappa coefficient (κ) of the first examiner was 0.603, the κ of the second examiner was 0.790, and the κ of the third examiner was 0.758. The scoring system showed substantial interobserver reliability. The κ of the first session was 0.641 and the κ of the second session was 0.649. Conclusions The Goldberg scoring system is a reliable tool for radiographic evaluation of bony union after bone grafting.
Collapse
Affiliation(s)
- Young Choi
- Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea
| | - Young Hoon Yang
- Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea
| | - Young-Ho Kwon
- Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
12
|
Lai CC, Wang TM, Chang CH, Pao JL, Fang HW, Chang CC, Lin SM, Lan TY. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021; 22:977. [PMID: 34814872 PMCID: PMC8609868 DOI: 10.1186/s12891-021-04855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
Collapse
Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Shang-Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
| |
Collapse
|
13
|
Hixon KR, McKenzie JA, Sykes DAW, Yoneda S, Hensley A, Buettmann EG, Zheng H, Skouteris D, McAlinden A, Miller AN, Silva MJ. Ablation of Proliferating Osteoblast Lineage Cells After Fracture Leads to Atrophic Nonunion in a Mouse Model. J Bone Miner Res 2021; 36:2243-2257. [PMID: 34405443 PMCID: PMC8719642 DOI: 10.1002/jbmr.4424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 01/19/2023]
Abstract
Nonunion is defined as the permanent failure of a fractured bone to heal, often necessitating surgical intervention. Atrophic nonunions are a subtype that are particularly difficult to treat. Animal models of atrophic nonunion are available; however, these require surgical or radiation-induced trauma to disrupt periosteal healing. These methods are invasive and not representative of many clinical nonunions where osseous regeneration has been arrested by a "failure of biology". We hypothesized that arresting osteoblast cell proliferation after fracture would lead to atrophic nonunion in mice. Using mice that express a thymidine kinase (tk) "suicide gene" driven by the 3.6Col1a1 promoter (Col1-tk), proliferating osteoblast lineage cells can be ablated upon exposure to the nucleoside analog ganciclovir (GCV). Wild-type (WT; control) and Col1-tk littermates were subjected to a full femur fracture and intramedullary fixation at 12 weeks age. We confirmed abundant tk+ cells in fracture callus of Col-tk mice dosed with water or GCV, specifically many osteoblasts, osteocytes, and chondrocytes at the cartilage-bone interface. Histologically, we observed altered callus composition in Col1-tk mice at 2 and 3 weeks postfracture, with significantly less bone and more fibrous tissue. Col1-tk mice, monitored for 12 weeks with in vivo radiographs and micro-computed tomography (μCT) scans, had delayed bone bridging and reduced callus size. After euthanasia, ex vivo μCT and histology showed failed union with residual bone fragments and fibrous tissue in Col1-tk mice. Biomechanical testing showed a failure to recover torsional strength in Col1-tk mice, in contrast to WT. Our data indicates that suppression of proliferating osteoblast-lineage cells for at least 2 weeks after fracture blunts the formation and remodeling of a mineralized callus leading to a functional nonunion. We propose this as a new murine model of atrophic nonunion. © 2021 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Katherine R Hixon
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer A McKenzie
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - David A W Sykes
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - Susumu Yoneda
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Austin Hensley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Evan G Buettmann
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Hongjun Zheng
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Dimitrios Skouteris
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Audrey McAlinden
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.,Department of Cell Biology & Physiology, Washington University in St. Louis, St. Louis, MO, USA.,St. Louis Shriners Hospital Research Center, Shriners Hospital for Children, St. Louis, MO, USA
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew J Silva
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
14
|
Menger MM, Laschke MW, Scheuer C, Bauer D, Bleimehl M, Später T, Rollmann MF, Braun BJ, Herath SC, Raza A, Menger MD, Histing T. Establishment of a reliable model to study the failure of fracture healing in aged mice. J Gerontol A Biol Sci Med Sci 2021; 77:909-917. [PMID: 34626193 DOI: 10.1093/gerona/glab304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
The failure of fracture healing represents a substantial clinical problem. Moreover, aged patients demonstrate an elevated risk for failed bone healing. However, murine models to study the failure of fracture healing are established only in young adult animals. Therefore, the aim of this study was to develop a reliable model to study failed fracture healing in aged mice. After creation of a 1.8 mm segmental defect and periosteal resection, femora of aged mice (18-20 months) and young adult control mice (3-4 months) were stabilized by pin-clip fixation. Segmental defects were analyzed by means of biomechanics, X-ray and micro-computed tomography (µCT), as well as histomorphometric, immunohistochemical and Western blot analysis. After 10 weeks all animals showed a complete lack of osseous bridging, resulting in fracture healing failure. Segmental defects in aged mice revealed a reduced bone formation and vascularization when compared to young adult mice. This was associated with a decreased expression of bone formation markers. In addition, we detected a reduced number of tartrate-resistance acid phosphatase (TRAP)-positive osteoclasts and an elevated osteoprotegerin (OPG)/receptor activator of NF-ĸB ligand (RANKL)-ratio in aged animals, indicating a reduced osteoclast activity. Moreover, aged animals showed also an enhanced inflammatory response, characterized by an increased infiltration of macrophages within the callus tissue. Taken together, we herein report for the first time a reliable model to study fracture healing failure in aged mice. In the future, the use of this model enables to study novel therapeutic strategies and molecular mechanics of failed fracture healing during aging.
Collapse
Affiliation(s)
- Maximilian M Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany.,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - David Bauer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Michelle Bleimehl
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Thomas Später
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Ahsan Raza
- Department of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421 Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Tina Histing
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany.,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| |
Collapse
|
15
|
Hu P, McKenzie JA, Buettmann EG, Migotsky N, Gardner MJ, Silva MJ. Type 1 diabetic Akita mice have low bone mass and impaired fracture healing. Bone 2021; 147:115906. [PMID: 33662611 PMCID: PMC8546917 DOI: 10.1016/j.bone.2021.115906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes (T1DM) impairs bone formation and fracture healing in humans. Akita mice carry a mutation in one allele of the insulin-2 (Ins2) gene, which leads to pancreatic beta cell dysfunction and hyperglycemia by 5-6 weeks age. We hypothesized that T1DM in Akita mice is associated with decreased bone mass, weaker bones, and impaired fracture healing. Ins2 ± (Akita) and wildtype (WT) males were subjected to femur fracture at 18-weeks age and healing assessed 3-21 days post-fracture. Non-fractured left femurs were assessed for morphology (microCT) and strength (bending or torsion) at 19-21 weeks age. Fractured right femurs were assessed for callus mechanics (torsion), morphology and composition (microCT and histology) and gene expression (qPCR). Both Akita and WT mice gained weight from 3 to 18 weeks age, but Akita mice weighed less starting at 5 weeks (-5.2%, p < 0.05). At 18-20 weeks age Akita mice had reduced serum osteocalcin (-30%), cortical bone area (-16%), and thickness (-17%) compared to WT, as well as reduced cancellous BV/TV (-39%), trabecular thickness (-23%) and vBMD (-31%). Mechanical testing of non-fractured femurs showed decreased structural (stiffness, ultimate load) and material (ultimate stress) properties of Akita bones. At 14 and 21 days post fracture Akita mice had a significantly smaller callus than WT mice (~30%), with less cartilage and bone area. Assessment of torsional strength showed a weaker callus in Akita mice with lower stiffness (-42%), maximum torque (-44%) and work to fracture (-44%). In summary, cortical and cancellous bone mass were reduced in Akita mice, with lower bone mechanical properties. Fracture healing in Akita mice was impaired by T1DM, with a smaller, weaker fracture callus due to decreased cartilage and bone formation. In conclusion, the Akita mouse mimics some of the skeletal features of T1DM in humans, including osteopenia and impaired fracture healing, and may be useful to test interventions.
Collapse
Affiliation(s)
- Pei Hu
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jennifer A McKenzie
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States
| | - Evan G Buettmann
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States; Department of Biomedical Engineering, Washington University, Saint Louis, MO, United States
| | - Nicole Migotsky
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States; Department of Biomedical Engineering, Washington University, Saint Louis, MO, United States
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew J Silva
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States; Department of Biomedical Engineering, Washington University, Saint Louis, MO, United States.
| |
Collapse
|
16
|
Fenelon M, Etchebarne M, Siadous R, Grémare A, Durand M, Sentilhes L, Catros S, Gindraux F, L'Heureux N, Fricain JC. Comparison of amniotic membrane versus the induced membrane for bone regeneration in long bone segmental defects using calcium phosphate cement loaded with BMP-2. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 124:112032. [PMID: 33947534 DOI: 10.1016/j.msec.2021.112032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
Thanks to its biological properties, the human amniotic membrane (HAM) combined with a bone substitute could be a single-step surgical alternative to the two-step Masquelet induced membrane (IM) technique for regeneration of critical bone defects. However, no study has directly compared these two membranes. We first designed a 3D-printed scaffold using calcium phosphate cement (CPC). We assessed its suitability in vitro to support human bone marrow mesenchymal stromal cells (hBMSCs) attachment and osteodifferentiation. We then performed a rat femoral critical size defect to compare the two-step IM technique with a single-step approach using the HAM. Five conditions were compared. Group 1 was left empty. Group 2 received the CPC scaffold loaded with rh-BMP2 (CPC/BMP2). Group 3 and 4 received the CPC/BMP2 scaffold covered with lyophilized or decellularized/lyophilized HAM. Group 5 underwent a two- step induced membrane procedure with insertion of a polymethylmethacrylate (PMMA) spacer followed by, after 4 weeks, its replacement with the CPC/BMP2 scaffold wrapped in the IM. Micro-CT and histomorphometric analysis were performed after six weeks. Results showed that the CPC scaffold supported the proliferation and osteodifferentiation of hBMSCs in vitro. In vivo, the CPC/BMP2 scaffold very efficiently induced bone formation and led to satisfactory healing of the femoral defect, in a single-step, without autograft or the need for any membrane covering. In this study, there was no difference between the two-step induced membrane procedure and a single step approach. However, the results indicated that none of the tested membranes further enhanced bone healing compared to the CPC/BMP2 group.
Collapse
Affiliation(s)
- Mathilde Fenelon
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France.
| | - Marion Etchebarne
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Department of maxillofacial surgery, F-33076 Bordeaux, France
| | - Robin Siadous
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France
| | - Agathe Grémare
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Odontology and Oral Health Department, F-33076 Bordeaux, France
| | - Marlène Durand
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, CIC 1401, 33000, Bordeaux, France; INSERM, CIC 1401, 33000 Bordeaux, France
| | - Loic Sentilhes
- CHU Bordeaux, Department of Obstetrics and Gynecology, F-33076, Bordeaux, France
| | - Sylvain Catros
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France
| | - Florelle Gindraux
- Service de Chirurgie Orthopédique, Traumatologique et Plastique, CHU Besançon, F-25000 Besançon, France; Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | | | - Jean-Christophe Fricain
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France
| |
Collapse
|
17
|
Morizane K, Goto K, Kawai T, Fujibayashi S, Otsuki B, Shimizu T, Matsuda S. Bone Coverage around Hydroxyapatite/Poly( L-Lactide) Composite Is Determined According to Depth from Cortical Bone Surface in Rabbits. MATERIALS 2021; 14:ma14061458. [PMID: 33802655 PMCID: PMC8002476 DOI: 10.3390/ma14061458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Composites of unsintered hydroxyapatite (HA) and poly(L-lactide) (PLLA) reinforced by compression forging are biodegradable, bioactive, and have ultrahigh strength. However, foreign body reactions to PLLA and physical irritation can occur when not covered by bone. We aimed to confirm the relationships between the depth of the implanted HA-PLLA threaded pins and the new bone formation. We inserted HA-PLLA composite threaded pins (diameter: 2.0 or 4.5 mm) into the femoral and tibial bones of 32 mature male Japanese white rabbits (weight 3.0–3.5 kg) with the pin head 1 or 0 mm below or protruding 1 or 2 mm above surrounding cortical bone. Eight euthanized rabbits were radiologically and histologically assessed at various intervals after implantation. Bone bridging was complete over pins of both diameters at ~12 weeks, when inserted 1 mm below the surface, but the coverage of the pins inserted at 0 mm varied. Bone was not formed when the pins protruded >1 mm from the bone surface. No inflammation developed around the pins by 25 weeks. However, foreign body reactions might develop if composites are fixed above the bone surface, and intraosseous fixation would be desirable using double-threaded screws or a countersink to avoid screw head protrusion.
Collapse
Affiliation(s)
| | - Koji Goto
- Correspondence: ; Tel./Fax: +81-5-751-3366
| | | | | | | | | | | |
Collapse
|
18
|
Menger MM, Bremer P, Scheuer C, Rollmann MF, Braun BJ, Herath SC, Orth M, Später T, Pohlemann T, Menger MD, Histing T. Pantoprazole impairs fracture healing in aged mice. Sci Rep 2020; 10:22376. [PMID: 33361800 PMCID: PMC7758334 DOI: 10.1038/s41598-020-79605-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
Proton pump inhibitors (PPIs) belong to the most common medication in geriatric medicine. They are known to reduce osteoclast activity and to delay fracture healing in young adult mice. Because differentiation and proliferation in fracture healing as well as pharmacologic actions of drugs markedly differ in the elderly compared to the young, we herein studied the effect of the PPI pantoprazole on bone healing in aged mice using a murine fracture model. Bone healing was analyzed by biomechanical, histomorphometric, radiological and protein biochemical analyses. The biomechanical analysis revealed a significantly reduced bending stiffness in pantoprazole-treated animals when compared to controls. This was associated with a decreased amount of bone tissue within the callus, a reduced trabecular thickness and a higher amount of fibrous tissue. Furthermore, the number of osteoclasts in pantoprazole-treated animals was significantly increased at 2 weeks and decreased at 5 weeks after fracture, indicating an acceleration of bone turnover. Western blot analysis showed a lower expression of the bone morphogenetic protein-4 (BMP-4), whereas the expression of the pro-angiogenic parameters was higher when compared to controls. Thus, pantoprazole impairs fracture healing in aged mice by affecting angiogenic and osteogenic growth factor expression, osteoclast activity and bone formation.
Collapse
Affiliation(s)
- Maximilian M Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany. .,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany.
| | - Philipp Bremer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Thomas Später
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Tina Histing
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany.,Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| |
Collapse
|
19
|
Stiel N, Moritz M, Babin K, Suling A, Rupprecht M, Beil FT, Stuecker R, Spiro AS. The Use of Bovine Xenogeneic Bone Graft for Dega Pelvic Osteotomy in Children with Hip Dysplasia: A Retrospective Study of 147 Treated Hips. J Clin Med 2020; 9:jcm9072241. [PMID: 32679727 PMCID: PMC7408747 DOI: 10.3390/jcm9072241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Backgrounds: Dega pelvic osteotomy is commonly used to correct acetabular dysplasia in children with open triradiate cartilage. The use of bovine xenogeneic bone graft (Tutobone®) for Dega osteotomy has not been reported so far. This study aimed to determine the clinical and radiological outcome in a large series of children with hip dysplasia who were treated by Dega osteotomy using a bovine xenogeneic block for stabilisation. Methods: A retrospective, single-centre study was conducted including 101 patients (147 hips) with different underlying diseases. The acetabular angle of Hilgenreiner (AA) and the lateral center-edge angle (LCA) were analysed to quantify the correction of acetabular indices. Graft incorporation was assessed using the Goldberg scoring system. Results: the mean preoperative AA improved from 28.1 (SD: 6.7) to 14.7 (SD: 5.1) after surgery (p < 0.001). The mean preoperative LCA improved from 9.9 (SD: 6.7) to 21.8 (SD: 6.8) postoperatively (p < 0.001). Both indices remained stable at the one-year follow-up examination. Graft incorporation was excellent with a mean Goldberg score of 6.6. Heterotopic ossification occurred in one hip without clinical relevance. Graft-related complications were not noted. Conclusions: Dega osteotomy using Tutobone® is safe and effective in the treatment of acetabular dysplasia in children independent of the underlying disease.
Collapse
Affiliation(s)
- Norbert Stiel
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Menard Moritz
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Kornelia Babin
- Department of Pediatric Orthopaedics, Schoen Clinic Hamburg Eilbek, 22081 Hamburg, Germany;
| | - Anna Suling
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Martin Rupprecht
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Frank T. Beil
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Ralf Stuecker
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
| | - Alexander S. Spiro
- Department of Pediatric Orthopaedics, Altonaer Children’s Hospital, 22763 Hamburg, Germany; (N.S.); (M.M.); (M.R.); (R.S.)
- Correspondence: ; Tel.: +49-40-88908-382
| |
Collapse
|
20
|
Yalçınozan M, Türker M, Çırpar M. Effects of a novel biodegredable implant system on a rat tibia fracture model. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:453-460. [PMID: 32812878 DOI: 10.5152/j.aott.2020.18331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the effects of a novel biodegradable implant releasing platelet-derived growth factor (PDGF) at the fracture site on fracture healing in a rat tibia fracture model. METHODS In this study, 35 male Sprague-Dawley rats weighing between 300 and 350 g were used. The rats were divided into four groups: Group A (control group without any treatment, n=10), Group B (spacer without PDGF Group, n=10), Group C (spacer with PDGF group, n=10), and Group D (healthy rat Group, n=5). Standardized fractures were created in the right tibias of rats, and then biodegradable implants made of poly-β-hydroxybutyrate-co-3-hydroxy valerate were implanted at the fracture sites in Groups B and C. In Group C, implants were loaded with 600 ng of PDGF. Animals were sacrificed 30 days after the operation, and fracture healing in each group was assessed radiologically based on the Goldberg score. Furthermore, the anteroposterior (AP) and mediolateral (ML) callus diameters were measured macroscopically, and fracture sites were mechanically tested. RESULTS In the radiological assessment, Group C showed higher fracture healing rate than Groups A and B (p=0.001), whereas no significant difference was found between group C and Group D (p>0.05). In the macroscopic assessment, while Group C exhibited the thickest AP callus diameter (p=0.02), no significant differences in ML callus diameters existed among the groups (p>0.05). Mechanical testing revealed that Group C had higher torsional strength (p=0.001) and stiffness than Groups A and B (p=0.001) while there was no significant difference between Groups C and D (p>0.05). CONCLUSION Biodegradable implant releasing PDGF may have positive effects on fracture healing.
Collapse
Affiliation(s)
- Mehmet Yalçınozan
- Department of Orthopaedics and Traumatology, Near East University Hospital, Mersin, Turkey
| | - Mehmet Türker
- Department of Orthopaedics and Traumatology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Meriç Çırpar
- Department of Orthopaedics and Traumatology, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| |
Collapse
|
21
|
Dincel YM, Alagoz E, Arikan Y, Caglar AK, Dogru SC, Ortes F, Arslan YZ. Biomechanical, histological, and radiological effects of different phosphodiesterase inhibitors on femoral fracture healing in rats. J Orthop Surg (Hong Kong) 2019; 26:2309499018777885. [PMID: 29848169 DOI: 10.1177/2309499018777885] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the biomechanical, histological, and radiological effects of sildenafil and pentoxifylline on femoral fracture healing in rats. METHODS Forty-eight Sprague-Dawley rats were divided into three groups equally according to the pharmacological agents to be investigated. Femoral shaft fractures were formed in the left side. Group 1 (control group), group 2, and group 3 were administered with saline, sildenafil, and pentoxifylline during the fracture healing process, respectively. Eight rats from each group were euthanized on days 15 and 30. X-ray images of the rats were taken after euthanasia for radiographical examination. Femur samples were subjected to histopathological and biomechanical (three-point bending) examinations. RESULTS Radiologically, no difference between the Goldberg scores of the groups was found for day 15 ( p > 0.05), while higher Goldberg scores were obtained from group 2 than that of group 1 ( p > 0.05) and group 3 ( p < 0.05) for day 30. In the biomechanical analysis, higher mean breaking forces were found both for day 15 and day 30 from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p > 0.05) and group 3 (for day 15 p < 0.05 and day 30 p < 0.01). Higher mean absorbed energy values were obtained from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p < 0.05) and group 3 (for day 15 p < 0.01 and day 30 p < 0.01). A significant difference was not found between the histological scores of all groups ( p > 0.05) for day 15, while the histological score of group 1 on day 30 was found to be significantly lower than that of sildenafil and pentoxifylline groups ( p < 0.05). CONCLUSION Sildenafil had a positive effect on fracture healing, while pentoxifylline did not provide consistent positive effect.
Collapse
Affiliation(s)
- Yasar Mahsut Dincel
- 1 Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ender Alagoz
- 2 Department of Orthopaedics and Traumatology, İstanbul Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Arikan
- 1 Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Aysel Kara Caglar
- 3 Department of Pathology, İstanbul Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Suzan Cansel Dogru
- 4 Department of Mechanical Engineering, Faculty of Engineering, Istanbul University, Avcilar, Istanbul, Turkey
| | - Faruk Ortes
- 4 Department of Mechanical Engineering, Faculty of Engineering, Istanbul University, Avcilar, Istanbul, Turkey
| | - Yunus Ziya Arslan
- 4 Department of Mechanical Engineering, Faculty of Engineering, Istanbul University, Avcilar, Istanbul, Turkey
| |
Collapse
|
22
|
McKenzie JA, Maschhoff C, Liu X, Migotsky N, Silva MJ, Gardner MJ. Activation of hedgehog signaling by systemic agonist improves fracture healing in aged mice. J Orthop Res 2019; 37:51-59. [PMID: 29663560 PMCID: PMC6226344 DOI: 10.1002/jor.24017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
Fracture healing is a complex process of many coordinated biological pathways. This system can go awry resulting in nonunion, which leads to significant patient morbidity. The Hedgehog (Hh) signaling pathway is upregulated in fracture healing. We hypothesized that the Hh signaling pathway can be pharmacologically modulated to positively affect fracture healing. Diaphyseal femur fractures were created in elderly mice (18 months, C57BL/6 females), which have a blunted and delayed healing response compared to younger mice, and were stabilized with intramedullary pins. To activate the Hh pathway we targeted the receptor Smoothened using an agonist (Hh-Ag1.5 [Hh-Ag]) and compared this to a vehicle control. Expression of Hh target genes were significantly increased in the fracture callus of the agonist group compared to controls, indicating pathway activation. Expression of osteogenic and chondrogenic-related genes was greatly upregulated in fracture callus versus intact femora, although Hh agonist treatment did not consistently enhance this response. Blindly graded, radiographic callus healing scores were significantly higher in the Hh-Ag groups at post operative day (POD) 14, indicating earlier callus bridging. On microCT, Hh-Ag treatment led to greater callus volume (+40%) and bone volume (+25%) at POD21. By day 14, callus vascularity, as assessed by 3D microCT angiography vessel volume, was 85% greater in the Hh-Ag group. Finally, mechanical strength of the calluses in the Hh-Ag groups was significantly greater than in the control groups at POD21. In conclusion, systemic administration of a Hh agonist appears to improve the osseous and vascular healing responses in a mouse fracture healing-impaired model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Collapse
Affiliation(s)
| | | | - Xiaochen Liu
- Washington University Orthopedics, St. Louis, MO
| | | | | | - Michael J. Gardner
- Washington University Orthopedics, St. Louis, MO,Stanford University Orthopedics, Stanford, CA
| |
Collapse
|
23
|
DeBaun MR, Stahl AM, Daoud AI, Pan CC, Bishop JA, Gardner MJ, Yang YP. Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft. J Orthop Res 2019; 37:60-68. [PMID: 30273977 DOI: 10.1002/jor.24153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023]
Abstract
Critical bone defects pose a formidable orthopaedic problem in patients with bone loss. We developed a preclinical model based on the induced membrane technique using a synthetic graft to replace autograft for healing critical bone defects. Additionally, we used a novel osteoconductive scaffold coupled with a synthetic membrane to evaluate the potential for single-stage bone regeneration. Three experimental conditions were investigated in critical femoral defects in rats. Group A underwent a two-stage procedure with insertion of a polymethylmethacrylate (PMMA) spacer followed by replacement with a 3D printed polycaprolactone(PCL)/β-tricalcium phosphate (β-TCP) osteoconductive scaffold after 4 weeks. Group B received a single-stage PCL/β-TCP scaffold wrapped in a PCL-based microporous polymer film creating a synthetic membrane. Group C received a single-stage bare PCL/β-TCP scaffold. All groups were examined by serial radiographs for callus formation. After 12 weeks, the femurs were explanted and analyzed with micro-CT and histology. Mean callus scores tended to be higher in Group A. Group A showed statistically significant greater bone formation on micro-CT compared with other groups, although bone volume fraction was similar between groups. Histology results suggested extensive bone ingrowth and new bone formation within the macroporous scaffolds in all groups and cell infiltration into the microporous synthetic membrane. This study supports the use of a critical size femoral defect in rats as a suitable model for investigating modifications to the induced membrane technique without autograft harvest. Future investigations should focus on bioactive synthetic membranes coupled with growth factors for single-stage bone healing. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Collapse
Affiliation(s)
- Malcolm R DeBaun
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Alexander M Stahl
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Departiment of Chemistry, Stanford University, Stanford, California
| | - Adam I Daoud
- School of Medicine, Stanford University, Stanford, California
| | - Chi-Chun Pan
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Departiment of Mechanical Engineering, Stanford University, Stanford, California
| | - Julius A Bishop
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Michael J Gardner
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Yunzhi P Yang
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Material Science and Engineering, Stanford University, Stanford, California.,Departiment of Bioengineering, Stanford University, Stanford, California
| |
Collapse
|
24
|
Sung KH, Kwon SS, Chung CY, Lee KM, Kim J, Park MS. Use of iliac crest allograft for Dega pelvic osteotomy in patients with cerebral palsy. BMC Musculoskelet Disord 2018; 19:375. [PMID: 30326877 PMCID: PMC6192369 DOI: 10.1186/s12891-018-2293-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background Dega pelvic osteotomy is commonly performed procedure in patients with cerebral palsy (CP) undergoing hip reconstructive surgery for hip displacement. However, there has been no study investigating the outcomes after Dega pelvic osteotomy using allograft in patients with CP. This study investigated the outcomes of Dega pelvic osteotomy using iliac crest allograft in CP with hip displacement and the factors affecting allograft incorporation. Methods This study included 110 patients (150 hips; mean age 8y7mo; 68 males, 42 females) who underwent hip reconstructive surgeries including Dega pelvic osteotomy using iliac crest allograft. To evaluate the time of allograft incorporation, Goldberg score was evaluated according to the follow-up period on all postoperative hip radiographs. The acetabular index, migration percentage, and neck-shaft angle were also measured on the preoperative and postoperative follow-up radiographs. Results The mean estimated time for allograft incorporation (Goldberg score ≥ 6) was 1.1 years postoperatively. All hips showed radiographic union at the final follow-up and there was no case of graft-related complications. Patients with Gross Motor Function Classification System (GMFCS) level V had 6.9 times higher risk of radiographic delayed union than those with GMFCS level III and IV. Acetabular index did not increase during the follow-up period (p = 0.316). Conclusions Dega pelvic osteotomy using iliac crest allograft was effective in correcting acetabular dysplasia, without graft-related complications in patients with CP. Furthermore, the correction of acetabular dysplasia remained stable during the follow-up period.
Collapse
Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Suwon, Gyeonggi, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Jaeyoung Kim
- Department of Orthopaedic Surgery, H Plus Yangji Hospital, Seoul, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea.
| |
Collapse
|
25
|
Peterburs B, Mittelstaedt A, Haas P, Petri M, Westphal R, Dullin C, Sehmisch S, Neunaber C. Biomechanical and histological analyses of the fracture healing process after direct or prolonged reduction. Eur J Med Res 2018; 23:39. [PMID: 30180907 PMCID: PMC6122772 DOI: 10.1186/s40001-018-0337-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background Reduction of femoral shaft fractures remains a challenging problem in orthopaedic surgery. Robot-assisted reduction might ease reduction and fracture treatment. However, the influence of different reduction pathways on patients’ physiology is not fully known yet. Therefore, the aim of this study was to examine the biomechanics and histology of fracture healing after direct and prolonged robot-assisted reduction in an in vivo rat model. Methods 144 male CD® rats were randomly assigned to 12 groups. Each animal received an external fixator and an osteotomy on the left femoral shaft. On the fourth postoperative day, the 1× reduction groups received a single reduction maneuver, whereas the 10× reduction groups received the same reduction pathway with ten repetitions. The control groups did not undergo any reduction maneuvers. Animals were killed after 1, 2, 3 and 4 weeks, respectively, and the composition of the fracture gap was analyzed by µCT and non-decalcified histology. Biomechanical properties were investigated by a three-point bending test, and the bone turnover markers PINP, bCTx, OPG, sRANKL, TRACP-5b, BALP, and OT/BGP were measured. Results One week after the reduction maneuver, µCT analysis showed a higher cortical bone volume in the 1× reduction group compared to the 10× reduction group. Biomechanically, the control group showed higher maximum force values measured by three-point bending test compared to both reduction groups. Furthermore, less collagen I formation was examined in the 10× reduction group compared to the control group after 1 week of fracture healing. PINP concentration was decreased in 10× reduction group after 1 week compared to control group. The same trend was seen after 3 weeks. Conclusion A single reduction maneuver has a beneficial effect in the early phase of the fracture healing process compared to repeated reduction maneuvers. In the later phase of fracture healing, no differences were found between the groups.
Collapse
Affiliation(s)
- Benedikt Peterburs
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Anke Mittelstaedt
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Philipp Haas
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Petri
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf Westphal
- Institute for Robotics and Process Control, Technical University Braunschweig, Mühlenpfordtstraße 23, 38106, Brunswick, Germany
| | - Christian Dullin
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,Italian Synchrotron Light Source 'Elettra', SYRMEP Beamline, Trieste, Italy
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedic and Reconstructive Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, Goettingen, 37075, Germany
| | - Claudia Neunaber
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
26
|
Severe Hemorrhagic Shock Leads to a Delayed Fracture Healing and Decreased Bone Callus Strength in a Mouse Model. Clin Orthop Relat Res 2017; 475:2783-2794. [PMID: 28795328 PMCID: PMC5638746 DOI: 10.1007/s11999-017-5473-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple trauma is frequently associated with hemorrhagic shock and fractures of the extremities. Clinically, the rate of impaired fracture healing (delayed healing and nonunion) seems to be increased in patients with multiple injuries compared with patients with isolated fractures. As the underlying pathogenesis remains poorly understood, we aimed to analyze the biomechanical properties during fracture healing in a murine model. QUESTIONS The aim of this study was to determine whether fracture healing after severe hemorrhagic shock results in (1) delayed bridging as determined by macroscopic and radiographic assessment, (2) altered conditions of callus components as determined by µCT, and (3) decreased maximum bending moment measured by a three-point-bending test compared with ordinary fracture healing. METHODS Male C57BL/6NCrl mice were randomly assigned to five groups and four different times (five to 10 mice per group and time). Only the right femur from each mouse was used for analysis: the trauma hemorrhage (TH) group received a pressure-controlled hemorrhagic shock via catheter; the osteotomy (Fx) group underwent osteotomy and implantation of an external fixator on the right femur; the combined trauma (THFx) group received hemorrhagic shock and an external fixator with osteotomy; the sham group underwent implantation of a catheter and external fixator but had no blood loss or osteotomy, and the control group underwent no interventions. After 2, 3, 4, or 6 weeks, five to 10 animals of each group were sacrificed. Bones were analyzed macroscopically and via radiographs, µCT, and three-point-bending test. Statistical significance was set at a probability less than 0.05. Comparisons were performed using the Mann-Whitney U or the Kruskal-Wallis test. RESULTS In the Fx group, the osteotomy gap was stable and bridged after 2 weeks in contrast to some bones in the THFx group where stable bridging did not occur. No difference was observed between the groups. µCT analysis showed reduced density of bone including callus (THFx: 1.17 g/cm3; interquartile range [IQR], 0.04 g/cm3; Fx: 1.22 g/cm3; IQR, 0.04 g/cm3; p = 0.002; difference of medians [DM], -0.048; 95% CI, -0.073 to -0.029) and increased share of callus per volume of bone mass (%) after 2 weeks in the THFx group compared with the Fx group (THFx: 44.16%; IQR, 8.66%; Fx: 36.73%; IQR, 4.39%; p = 0.015; DM, 7.634; 95% CI, 2.018-10.577). The three-point-bending test established a decreased maximum bending moment in the THFx group compared with the Fx group 2 weeks after surgery (THFx: 7.10 Nmm; IQR, 11.25 Nmm; Fx: 11.25 Nmm; IQR, 5.70 Nmm; p = 0.026; DM, -5.043; 95% CI, -10.867 to -0.74). No differences were observed between the THFx and Fx groups after more than 2 weeks. CONCLUSION In this in vivo mouse fracture model, we conclude that hemorrhagic shock retards fracture healing during the early phase of the facture healing process. CLINICAL RELEVANCE A severe hemorrhagic shock in patients could result in initial delayed fracture healing and needs special attention. We plan to conduct a prospective, observational clinical research study to analyze if delayed fracture healing occurs in patients after severe blood loss.
Collapse
|
27
|
Liu X, McKenzie JA, Maschhoff CW, Gardner MJ, Silva MJ. Exogenous hedgehog antagonist delays but does not prevent fracture healing in young mice. Bone 2017; 103:241-251. [PMID: 28734986 PMCID: PMC5568453 DOI: 10.1016/j.bone.2017.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/29/2017] [Accepted: 07/14/2017] [Indexed: 01/15/2023]
Abstract
Fracture healing recapitulates many aspects of developmental osteogenesis. The hedgehog (Hh) signaling pathway, essential to skeletal development, is upregulated during fracture healing, although its importance is unclear. Our goal was to assess the functional importance of Hh signaling in endochondral fracture healing. We created closed, transverse diaphyseal femur fractures in mice, stabilized with an intramedullary pin, and administered a systemic Hh inhibitor or vehicle. Because Hh pathway activation is mediated by the receptor Smoothened (Smo), we used the Smo antagonist GDC-0449 (GDC, 50mg/kg, twice daily) to target the pathway. First, in vehicle-treated 10-wk. female C57BL/6 mice we confirmed that Hh signaling was increased in fracture callus compared to intact bone, with >5-fold upregulation of target genes Ptch1 and Gli1. Additionally, using 10-wk. male and female Gli1 reporter mice, we saw a strong activation of the reporter in the osseous regions of the fracture callus 7-10days after fracture. GDC treatment significantly blunted these responses, indicating effective inhibition of fracture-induced Hh signaling in bone. Moreover, microCT analysis revealed that GDC treatment significantly reduced cancellous and cortical bone volume at non-fracture sites (tibial metaphysis and diaphysis), suggesting that the drug inhibited normal bone formation. GDC treatment had a modest effect on fracture healing, with evidence of delayed callus mineralization radiographically (significantly lower Goldberg score at day 14) and by microCT (reduced callus vBMD at 14days), and a delay in the recovery of torsional rotation to normal (elevated rotation-at-peak torque at 21days). On the other hand, GDC treatment did not inhibit qPCR or morphological measures of chondrogenesis or angiogenesis, and did not impair the recovery of failure torque (at day 14 or 21), a measure of biomechanical competence. In summary, GDC treatment inhibited Hh signaling, which delayed but did not prevent fracture healing in young mice. We conclude that Hh signaling is strongly induced after fracture and may play a role in early callus mineralization, although it does not appear to be required for eventual healing.
Collapse
Affiliation(s)
- Xiaochen Liu
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jennifer A McKenzie
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Clayton W Maschhoff
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States
| | - Michael J Gardner
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, United States
| | - Matthew J Silva
- Department of Orthopaedic Surgery and Musculoskeletal Research Center, Washington University School of Medicine, Saint Louis, MO, United States
| |
Collapse
|
28
|
Dülgeroglu TC, Metineren H. Evaluation of the Effect of Platelet-Rich Fibrin on Long Bone Healing: An Experimental Rat Model. Orthopedics 2017; 40:e479-e484. [PMID: 28295124 DOI: 10.3928/01477447-20170308-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/30/2017] [Indexed: 02/03/2023]
Abstract
Pseudoarthrosis, or nonunion, of the long bones is a challenging medical condition for orthopedic surgeons to treat. Therefore, healing enhancer materials are commonly used. The authors investigated whether platelet-rich fibrin accelerates long bone healing by comparing radiological and histological findings in a rat model of open femoral fracture. Platelet-rich fibrin is a current biomaterial that contains many growth factors and platelets. There are no studies in the literature investigating the effects of platelet-rich fibrin on fracture healing. Sixteen mature male rats were divided into 2 groups. In both groups, an open femoral fracture was created. The platelet-rich fibrin was obtained by centrifuging blood collected from the rats. Rats in the study group were treated with sterile platelet-rich fibrin, and those in the control group were administered saline. The rats were killed at the end of 4 weeks and examined histologically and radiologically. The radiographic and histological scores of the 2 groups differed significantly (P<.05). These results indicate that platelet-rich fibrin is an efficient biomaterial in fracture healing and that it increases the amount of osseous tissue formation. Platelet-rich fibrin does not cause an allergic reaction, is cost-effective, and is easy to obtain. Additional studies are necessary to determine whether platelet-rich fibrin accelerates the fracture healing process or induces a better quality of fracture healing. [Orthopedics. 2017; 40(3):e479-e484.].
Collapse
|
29
|
Tsai TT, Tai CL, Ho NYJ, Lai PL, Fu TS, Niu CC, Chen LH, Chen WJ. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model. PLoS One 2017; 12:e0167296. [PMID: 28052066 PMCID: PMC5214709 DOI: 10.1371/journal.pone.0167296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/11/2016] [Indexed: 11/24/2022] Open
Abstract
Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients.
Collapse
Affiliation(s)
- Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Lung Tai
- Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Natalie Yi-Ju Ho
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
30
|
Endogenous Production of n-3 Polyunsaturated Fatty Acids Promotes Fracture Healing in Mice. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:3571267. [PMID: 29065587 PMCID: PMC5488487 DOI: 10.1155/2017/3571267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/16/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022]
Abstract
Bone fracture is a global healthcare issue for high rates of delayed healing and nonunions. Although n-3 polyunsaturated fatty acid (PUFA) is considered as a beneficial factor for bone metabolism, only few studies till date focused on the effects of n-3 PUFAs on fracture healing. In this study, we investigated the effect of endogenous n-3 PUFAs on fracture healing by measuring femur fracture repair in both fat-1 transgenic mice and WT mice. Proximal femoral fracture model was established in fat-1 transgenic mice and WT mice, respectively, and then the fracture was analyzed by using X-ray, micro-computed tomography (micro-CT), and histological assessment at 7, 14, 21, 28, and 35 days after fixation. The results showed that compared with WT mice, fat-1 mice exhibited acceleration in fracture healing through radiographic and histological analysis (18–21 days versus 21–28 days postfracture). Meanwhile, X-ray and micro-CT analysis that showed better remodeling callus formation were in the fat-1 group compared to WT group. Furthermore, histological analysis revealed that endogenous n-3 PUFAs promoted local endochondral ossification and accelerated the remodeling of calcified calluses after fracture. In conclusion, the present study indicated that endogenously produced n-3 PUFAs promote fracture healing process and accelerate bone remodeling in mice, and supplementation of n-3 PUFAs was positively associated with fracture healing.
Collapse
|
31
|
Diehl R, Ferrara F, Müller C, Dreyer AY, McLeod DD, Fricke S, Boltze J. Immunosuppression for in vivo research: state-of-the-art protocols and experimental approaches. Cell Mol Immunol 2016; 14:146-179. [PMID: 27721455 PMCID: PMC5301156 DOI: 10.1038/cmi.2016.39] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023] Open
Abstract
Almost every experimental treatment strategy using non-autologous cell, tissue or organ transplantation is tested in small and large animal models before clinical translation. Because these strategies require immunosuppression in most cases, immunosuppressive protocols are a key element in transplantation experiments. However, standard immunosuppressive protocols are often applied without detailed knowledge regarding their efficacy within the particular experimental setting and in the chosen model species. Optimization of such protocols is pertinent to the translation of experimental results to human patients and thus warrants further investigation. This review summarizes current knowledge regarding immunosuppressive drug classes as well as their dosages and application regimens with consideration of species-specific drug metabolization and side effects. It also summarizes contemporary knowledge of novel immunomodulatory strategies, such as the use of mesenchymal stem cells or antibodies. Thus, this review is intended to serve as a state-of-the-art compendium for researchers to refine applied experimental immunosuppression and immunomodulation strategies to enhance the predictive value of preclinical transplantation studies.
Collapse
Affiliation(s)
- Rita Diehl
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany
| | - Fabienne Ferrara
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany.,Institute of Vegetative Physiology, Charite University Medicine and Center for Cardiovascular Research, Berlin 10115, Germany
| | - Claudia Müller
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany
| | - Antje Y Dreyer
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany
| | | | - Stephan Fricke
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany
| | - Johannes Boltze
- Fraunhofer-Institute for Cell Therapy and Immunology, Leipzig 04103, Germany.,Fraunhofer Research Institution for Marine Biotechnology and Institute for Medical and Marine Biotechnology, University of Lübeck, Lübeck 23562, Germany
| |
Collapse
|
32
|
Histing T, Heerschop K, Klein M, Scheuer C, Stenger D, Holstein JH, Pohlemann T, Menger MD. Characterization of the healing process in non-stabilized and stabilized femur fractures in mice. Arch Orthop Trauma Surg 2016; 136:203-11. [PMID: 26602903 DOI: 10.1007/s00402-015-2367-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although a variety of suitable fracture models for mice exist, in many studies bone healing was still analyzed without fracture stabilization. Because there is little information whether the healing of non-stabilized fractures differs from that of stabilized fractures, we herein studied the healing process of non-stabilized compared to stabilized femur fractures. MATERIALS AND METHODS Twenty-one CD-1 mice were stabilized after midshaft fracture of the femur with an intramedullary screw allowing micromovements and endochondral healing. In another 22 mice the femur fractures were left unstabilized. Bone healing was studied by radiological, biomechanical, histomorphometric and protein expression analyses. RESULTS Non-stabilized femur fractures revealed a significantly lower biomechanical stiffness compared to stabilized fractures. During the early phase of fracture healing non-stabilized fractures demonstrated a significantly lower amount of osseous tissue and a higher amount of cartilage tissue. During the late phase of fracture healing both non-stabilized and stabilized fractures showed almost 100 % osseous callus tissue. However, in stabilized fractures remodeling was almost completed with lamellar bone while non-stabilized fractures still showed large callus with great amounts of woven bone, indicating a delay in bone remodeling. Of interest, western blot analyses of callus tissue demonstrated in non-stabilized fractures a significantly reduced expression of vascular endothelial growth factor and a slightly lowered expression of bone morphogenetic protein-2 and collagen-10. CONCLUSION Non-stabilized femur fractures in mice show a marked delay in bone healing compared to stabilized fractures. Therefore, non-stabilized fracture models may not be used to analyze the mechanisms of normal bone healing.
Collapse
Affiliation(s)
- T Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany.
| | - K Heerschop
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - M Klein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - C Scheuer
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - D Stenger
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - J H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - M D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| |
Collapse
|
33
|
The effect of vitamin D and bisphosphonate on fracture healing: An experimental study. J Clin Orthop Trauma 2016; 7:90-4. [PMID: 27182145 PMCID: PMC4857164 DOI: 10.1016/j.jcot.2016.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the effects of the using bisphosphonate, vitamin D, and a combination of bisphosphonate and vitamin D on fracture healing, by comparison of radiological and histological findings of the study groups and a control group. METHODS A total of 24 rats were randomly divided into 4 groups. A mid-third fracture was created in the femur of all rats. Saline was administered to Group A, bisphosphonate (Alendronate) to Group B, bisphosphonate (Alendronate) + vitamin D (Calcitriol) to Group C and vitamin D (Calcitriol) to Group D. All preparations were administered orally for 28 days. RESULTS No statistically significant difference was determined between the groups in respect of the effect on fracture healing according to radiological findings. The histological findings of fracture healing showed Groups B and C to be significantly more advanced than Group A (p = 0.017, p = 0.009). However no significant difference was found in Group D comparison with Group A (p = 0.224). CONCLUSION According to the histological findings, advanced fracture healing was seen in the groups administered with bisphosphonate or combined bisphosphonate and vitamin D compared to the use of vitamin D alone and the control group. It was concluded that bisphosphonate treatment combined with vitamin D can be used safely without any negative effect on fracture healing.
Collapse
|
34
|
Herath SC, Lion T, Klein M, Stenger D, Scheuer C, Holstein JH, Mörsdorf P, Rollmann MFR, Pohlemann T, Menger MD, Histing T. Stimulation of angiogenesis by cilostazol accelerates fracture healing in mice. J Orthop Res 2015; 33:1880-7. [PMID: 26134894 DOI: 10.1002/jor.22967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023]
Abstract
Cilostazol, a selective phosphodiesterase-3 inhibitor, is known to control cyclic adenosine monophosphate (c-AMP) and to stimulate angiogenesis through upregulation of pro-angiogenic factors. There is no information, however, whether cilostazol affects fracture healing. We, therefore, studied the effect of cilostazol on callus formation and biomechanics during fracture repair. Bone healing was analyzed in a murine femur fracture stabilized with an intramedullary screw. Radiological, biomechanical, histomorphometric, histochemical, and protein biochemical analyses were performed at 2 and 5 weeks after fracture. Twenty-five mice received 30 mg/kg body weight cilostazol p.o. daily. Controls (n=24) received equivalent amounts of vehicle. In cilostazol-treated animals radiological analysis at 2 weeks showed an improved healing with an accelerated osseous bridging compared to controls. This was associated with a significantly higher amount of bony tissue and a smaller amount of cartilage tissue within the callus. Western blot analysis showed a higher expression of cysteine-rich protein 61 (CYR61), bone morphogenetic protein (BMP)-4, and receptor activator of NF-kappaB ligand (RANKL). At 5 weeks, improved fracture healing after cilostazol treatment was indicated by biomechanical analyses, demonstrating a significant higher bending stiffness compared to controls. Thus, cilostazol improves fracture healing by accelerating both bone formation and callus remodeling.
Collapse
Affiliation(s)
- Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Thorsten Lion
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Moritz Klein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - David Stenger
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Claudia Scheuer
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Saarland, Germany
| | - Jörg H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Philipp Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Mika F R Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Saarland, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saarland, Germany
| |
Collapse
|
35
|
Gölge UH, Kaymaz B, Arpaci R, Kömürcü E, Göksel F, Güven M, Güzel Y, Cevizci S. Effects of Boric Acid on Fracture Healing: An Experimental Study. Biol Trace Elem Res 2015; 167:264-71. [PMID: 25846213 DOI: 10.1007/s12011-015-0326-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Boric acid (BA) has positive effects on bone tissue. In this study, the effects of BA on fracture healing were evaluated in an animal model. Standard closed femoral shaft fractures were created in 40 male Sprague-Dawley rats under general anesthesia. The rats were allocated into five groups (n = 8 each): group 1, control with no BA; groups 2 and 3, oral BA at doses of 4 and 8 mg/kg/day, respectively; group 4, local BA (8 mg/kg); and group 5, both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally). After closed fracture creation, the fracture line was opened with a mini-incision, and BA was locally administered to the fracture area in groups 4 and 5. In groups 2, 3, and 5, BA was administered by gastric gavage daily until sacrifice. The rats were evaluated by clinical, radiological, and histological examinations. The control group (group 1) significantly differed from the local BA-exposed groups (groups 4 and 5) in the clinical evaluation. Front-rear and lateral radiographs revealed significant differences between the local BA-exposed groups and the control and other groups (p < 0.05). Clinical and radiological evaluations demonstrated adequate agreement between observers. The average histological scores significantly differed across groups (p = 0.007) and were significantly higher in groups 4 and 5 which were the local BA (8 mg/kg) and both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally), respectively, compared to the controls. This study suggests that BA may be useful in fracture healing. Further research is required to demonstrate the most effective local dosage and possible use of BA-coated implants.
Collapse
Affiliation(s)
- Umut Hatay Gölge
- Department of Orthopaedics and Traumatology, School of Medicine, Çanakkale Onsekiz Mart University, 17000, Çanakkale, Turkey,
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVES To develop and validate a translatable and reproducible rodent critical-sized defect (CSD) model and to determine the optimal dose of recombinant human bone morphogenetic protein (BMP)-7 required to consistently heal the CSD in the new model. METHODS Rats with 6-mm CSDs stabilized with a commercial radiolucent plate and screws with angular stability were randomly assigned to 4 treatment groups with varied doses of recombinant human BMP-7 (25, 50, 75, and 100 μg) on absorbable collagen sponge and a single control group (absorbable collagen sponge alone). Bone formation was evaluated by radiographs, micro-computed tomography, histology, and biomechanics. RESULTS All the rats treated with 100 μg of BMP-7 with CSDs were united by 4 weeks and all 75- and 50-μg-group rats united by 6 weeks. None of the animals in the 25-μg BMP-7 group or the control group were healed at the time of killing. Bone volume, bone mineral density, the ratio of bone volume to total volume, stiffness, and ultimate load to failure were maximal in the 50-μg group. Total callus volume progressively increased with increasing BMP dose. Histologic analysis demonstrated increased callus width with increasing BMP-7 doses above 50 μg, but the bone seemed structurally abnormal. CONCLUSIONS There was a 100% union rate in the 50-, 75-, and 100-μg BMP-7-treated groups. None of the control or 25-μg-dose rats united. The biomechanical data demonstrated that 50 μg of BMP-7 produced the highest mechanical strength in the bone regenerate. These data also suggest that administration of BMP-7 above 50 μg does not improve bone regeneration and actually seems to produce lower quality bone with diminished biomechanical properties.
Collapse
|
37
|
Incidence and risk factors of allograft bone failure after calcaneal lengthening. Clin Orthop Relat Res 2015; 473:1765-74. [PMID: 25394963 PMCID: PMC4385336 DOI: 10.1007/s11999-014-4052-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 11/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Calcaneal lengthening with allograft is frequently used for the treatment of patients with symptomatic planovalgus deformity; however, the behavior of allograft bone after calcaneal lengthening and the risk factors for graft failure are not well documented. QUESTIONS/PURPOSES (1) What proportion of the patients treated with allograft bone had radiographic evidence of graft failure and what further procedures were performed? (2) What are the risk factors for radiographic graft failure after calcaneal lengthening? (3) What patient factors are associated with the magnitude of correction achieved after calcaneal lengthening? METHODS Between May 2003 and January 2014, we performed 341 calcaneal lengthenings on 202 patients for planovalgus deformity, the etiology of which included idiopathic, cerebral palsy, and other neuromuscular disease. Of these, 176 patients (87%) had adequate followup for graft evaluation, defined as lateral radiographs taken before and at least 6 months after the index procedure (mean, 18 months; range, 6-100 months) and 117 patients (58%) had adequate followup for the assessment of the extent of correction, defined as weightbearing anteroposterior and lateral radiographs taken before and at least 1 year after the index procedure (mean, 24 months; range, 12-96 months). These patients' results were evaluated retrospectively. The Goldberg scoring system was chosen for demonstration of allograft behavior. A score lower than 6 at 6 months after surgery was defined as radiographic graft failure; the highest possible score was 7 points, and this represented graft incorporation with excellent reorganization of the graft and no loss of height. The patient age, sex, diagnosis, graft material, ambulatory status, and use of antiseizure medication were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. Additionally, six radiographic indices were analyzed for their effects on the extent of correction. RESULTS The mean estimated Goldberg score was 6 (SD, 1.14) at 6 months after calcaneal lengthening with 11 feet (4%) classified as radiographic graft failure (Goldberg score < 6). Of these, four feet (1%) underwent reoperation using an iliac autograft bone resulting from pain and loss of correction. Multivariate analysis showed that the tricortical iliac crest allograft was superior to the patellar allograft (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.1-9.8; p = 0.038) and the possibility of radiographic graft failure was found to increase along with age (OR, 1.2; 95% CI, 1.0-1.3; p = 0.006). Radiographically, the extent of correction was found to decrease with patient age, as observed at the anteroposterior talus-first metatarsal angle (p < 0.001), lateral talocalcaneal angle (p < 0.001), lateral talus-first metatarsal angle (p < 0.001), and relative calcaneal length (p = 0.041). CONCLUSIONS Graft failure can occur after calcaneal lengthening using allograft. Our study showed that the tricortical iliac allograft was superior to the patellar allograft, and further studies are warranted to further elucidate the effects of age on radiographic graft failure. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
|
38
|
Sato K, Watanabe Y, Harada N, Abe S, Matsushita T, Yamanaka K, Kaneko T, Sakai Y. Establishment of Reproducible, Critical-Sized, Femoral Segmental Bone Defects in Rats. Tissue Eng Part C Methods 2014; 20:1037-41. [DOI: 10.1089/ten.tec.2013.0612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Kenji Sato
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Noriko Harada
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoshi Abe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Matsushita
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Katsuyuki Yamanaka
- Research and Development Department, GC Corporation, Itabashi, Tokyo, Japan
| | - Tadashi Kaneko
- Research and Development Department, GC Corporation, Itabashi, Tokyo, Japan
| | - Yuhiro Sakai
- Research and Development Department, GC Corporation, Itabashi, Tokyo, Japan
| |
Collapse
|
39
|
Fretwurst T, Spanou A, Nelson K, Wein M, Steinberg T, Stricker A. Comparison of four different allogeneic bone grafts for alveolar ridge reconstruction: a preliminary histologic and biochemical analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:424-31. [PMID: 25183228 DOI: 10.1016/j.oooo.2014.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/14/2014] [Accepted: 05/16/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Allograft material for alveolar ridge reconstruction is quite promising and appears to be as equally successful as bone autograft material. The aim of the present study was to compare four different allogeneic bone grafts in terms of their histologic structure and DNA content before grafting. STUDY DESIGN Four allograft specimens from different suppliers were analyzed histologically, and the DNA content was analyzed before clinical use of the allografts. RESULTS Organic tissue remnants were detected in all of the evaluated samples. In the present samples adipocytes, fibroblasts, osteocytes, and chondrocytes were identified and DNA isolation and purification was possible. CONCLUSION Demineralized freeze-dried allogeneic bone transplants can stimulate new bone formation and are a viable alternative to bone autograft material. However, the well-tolerated use of allograft material in regard to our findings should be further investigated.
Collapse
Affiliation(s)
- Tobias Fretwurst
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany.
| | | | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Martin Wein
- Department of Oral Biotechnology, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Thorsten Steinberg
- Department of Oral Biotechnology, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Andres Stricker
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| |
Collapse
|
40
|
Yañez Arauz JM, del Vecchio JJ, Amor RT, Piazza DA. Non-irradiated frozen structural allograft in reconstructive surgeries of the hindfoot and midfoot. Foot Ankle Surg 2014; 20:120-4. [PMID: 24796831 DOI: 10.1016/j.fas.2014.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. METHODS We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications. RESULTS We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen. CONCLUSION This treatment is a good option to treat severe defects or fill sequelae deformities.
Collapse
Affiliation(s)
| | | | - Ricardo Tito Amor
- Department of Orthopaedic Surgery, Austral University Hospital, Buenos Aires, Argentina
| | - Diego Amadeo Piazza
- Department of Orthopaedic Surgery, Austral University Hospital, Buenos Aires, Argentina
| |
Collapse
|
41
|
Park MS, Kim TG, Lee KM, Chung CY, Kwon SS, Yoon IH, Park CG. Effects of reduction in the alpha-gal antigen on bony union: a model of xenobone graft using GalT knockout mouse. Xenotransplantation 2014; 21:267-73. [PMID: 24635119 DOI: 10.1111/xen.12092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among the bone graft sources used currently, the availability of autografts is limited and allografts are expensive. Therefore, xenobone grafts have drawn attention as a new source of bone grafts, although immunologic rejection issues are unresolved. This study used a GalT knockout mouse model to investigate the effects of reducing the alpha-gal epitope using alpha-galactosidase on the union of porcine xenobone grafts. METHODS Sixty-eight alpha-gal knockout C57/BL6 mice and eight wild-type mice were used. The mice were divided into five groups: In group 1 (26 alpha-gal knockout mice), an alpha-galactosidase-treated porcine xenograft was transplanted into the mouse femur to reduce antigenicity, and intramedullary fixation was performed. In group 2 (26 alpha-gal knockout mice), a non-treated porcine xenobone graft was performed. In group 3 (eight alpha-gal knockout C57/BL6 mice), syngenic bone grafts were performed. In group 4 (eight wild-type C57/BL6 mice), syngenic bone grafts were performed. In group 5 (eight C57/BL6 alpha-gal knockout mice), a bone defect model was obtained by maintaining the gap of the osteotomy site. Groups 3, 4, and 5 were used for positive and negative control groups. Qualitative immunohistochemical analysis of the porcine bone was performed to detect the presence of the alpha-gal epitope in groups 1 and 2. The concentration of the anti-alpha-gal antibody was evaluated using a quantitative enzyme-linked immunosorbent assay (ELISA) at the time of sacrifice (3, 4, and 5 weeks after the operation). Histologic and radiologic results (Goldberg method) for the bone union were compared. RESULTS The qualitative immunohistochemical analysis showed that the alpha-gal epitope was reduced when xenobone grafts were treated with alpha-galactosidase. Compared with group 2, group 1 showed a low anti-alpha-gal antibody concentration in the ELISA results. In group 2, the anti-alpha-gal antibody concentration increased with time. Group 1 showed significantly better histologic union than group 2, but the amount of radiologic union was similar in the two groups. CONCLUSIONS Alpha-galactosidase treatment of a porcine xenobone graft can reduce the alpha-gal epitope. This reduction in the antigen could significantly reduce the humoral immune response to the alpha-gal antigen in C57/BL6 alpha-gal knockout mice, leading to significant improvements in histologic union. This study provides a relevant GalT knockout mouse model for detecting the effects of alpha-gal epitope reduction by alpha-galactosidase on the union of porcine xenobone grafts.
Collapse
Affiliation(s)
- Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | | | | | | | | | | | | |
Collapse
|
42
|
Delawi D, Kruyt MC, Huipin Y, Vincken KL, de Bruijn JD, Oner FC, Dhert WJ. Comparing Autograft, Allograft, and Tricalcium Phosphate Ceramic in a Goat Instrumented Posterolateral Fusion Model. Tissue Eng Part C Methods 2013; 19:821-8. [DOI: 10.1089/ten.tec.2012.0576] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Diyar Delawi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moyo C. Kruyt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuan Huipin
- MIRA Institute, Twente University, Enschede, The Netherlands
| | - Koen L. Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost D. de Bruijn
- MIRA Institute, Twente University, Enschede, The Netherlands
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - F. Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter J.A. Dhert
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
43
|
Harris JS, Bemenderfer TB, Wessel AR, Kacena MA. A review of mouse critical size defect models in weight bearing bones. Bone 2013; 55:241-7. [PMID: 23416847 PMCID: PMC3650094 DOI: 10.1016/j.bone.2013.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/21/2012] [Accepted: 02/06/2013] [Indexed: 01/15/2023]
Abstract
Current and future advances in orthopedic treatment are aimed at altering biological interactions to enhance bone healing. Currently, several clinical scenarios exist for which there is no definitive treatment, specifically segmental bone loss from high-energy trauma or surgical resection - and it is here that many are aiming to find effective solutions. To test experimental interventions and better understand bone healing, researchers employ critical size defect (CSD) models in animal studies. Here, an overview of CSDs is given that includes the specifications of varying models, a discussion of current scaffold and bone graft designs, and current outcome measures used to determine the extent of bone healing. Many promising graft designs have been discovered along with promising adjunctive treatments, yet a graft that offers biomechanical support while allowing for neovascularization with eventual complete resorption and remodeling remains to be developed. An overview of this important topic is needed to highlight current advances and provide a clear understanding of the ultimate goal in CSD research--develop a graft for clinical use that effectively treats the orthopedic conundrum of segmental bone loss.
Collapse
Affiliation(s)
| | | | | | - Melissa A. Kacena
- Corresponding Author: Melissa A. Kacena, Ph.D., Department of Orthopaedic Surgery, Indiana University School of Medicine, 1120 South Drive, FH115, Indianapolis, IN 46202, Tel.: 317-278-3482, Fax: 317-278-9568,
| |
Collapse
|
44
|
Hautz T, Zelger BG, Weißenbacher A, Zelger B, Brandacher G, Landin L, Morelon E, Kanitakis J, Jablecki J, Lee WA, Pratschke J, Schneeberger S. Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation. Clin Transplant 2013; 27:E81-90. [DOI: 10.1111/ctr.12086] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Theresa Hautz
- Department of Visceral, Transplant and Thoracic Surgery; Center for Operative Medicine; Innsbruck Medical University; Innsbruck; Austria
| | - Bettina G. Zelger
- Department of Pathology; Innsbruck Medical University; Innsbruck; Austria
| | - Annemarie Weißenbacher
- Department of Visceral, Transplant and Thoracic Surgery; Center for Operative Medicine; Innsbruck Medical University; Innsbruck; Austria
| | - Bernhard Zelger
- Department of Dermatology; Innsbruck Medical University; Innsbruck; Austria
| | | | - Luis Landin
- Division of Plastic and Reconstructive Surgery; “La Paz” University Hospital; Madrid; Spain
| | - Emmanuel Morelon
- Department of Transplantation; Edouard Herriot Hospital; Hospices Civils de Lyon; Université de Lyon; Lyon; France
| | - Jean Kanitakis
- Department of Dermatology; Edouard Herriot Hospital; Hospices Civils de Lyon; Lyon; France
| | - Jerzy Jablecki
- Subdepartment of Replantation of Limbs; St Jadwiga Hospital; Trzebnica; Poland
| | - W.P. Andrew Lee
- Department of Plastic and Reconstructive Surgery; Johns Hopkins University School of Medicine; Baltimore; MD; USA
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery; Center for Operative Medicine; Innsbruck Medical University; Innsbruck; Austria
| | | |
Collapse
|
45
|
The Effect of Various Types Low Molecular Weight Heparins on Fracture Healing. Thromb Res 2013; 131:e114-9. [DOI: 10.1016/j.thromres.2013.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 06/07/2012] [Accepted: 01/02/2013] [Indexed: 11/19/2022]
|
46
|
Histing T, Klein M, Stieger A, Stenger D, Steck R, Matthys R, Holstein JH, Garcia P, Pohlemann T, Menger MD. A new model to analyze metaphyseal bone healing in mice. J Surg Res 2012; 178:715-21. [DOI: 10.1016/j.jss.2012.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 11/25/2022]
|
47
|
Histing T, Stenger D, Scheuer C, Metzger W, Garcia P, Holstein JH, Klein M, Pohlemann T, Menger MD. Pantoprazole, a proton pump inhibitor, delays fracture healing in mice. Calcif Tissue Int 2012; 90:507-14. [PMID: 22527206 DOI: 10.1007/s00223-012-9601-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/01/2012] [Indexed: 01/22/2023]
Abstract
Proton pump inhibitors (PPIs), which are widely used in the treatment of dyspeptic problems, have been shown to reduce osteoclast activity. There is no information, however, on whether PPIs affect fracture healing. We therefore studied the effect of the PPI pantoprazole on callus formation and biomechanics during fracture repair. Bone healing was analyzed in a murine fracture model using radiological, biomechanical, histomorphometric, and protein biochemical analyses at 2 and 5 weeks after fracture. Twenty-one mice received 100 mg/kg body weight pantoprazole i.p. daily. Controls (n = 21) received equivalent amounts of vehicle. In pantoprazole-treated animals biomechanical analysis revealed a significantly reduced bending stiffness at 5 weeks after fracture compared to controls. This was associated with a significantly lower amount of bony tissue within the callus and higher amounts of cartilaginous and fibrous tissue. Western blot analysis showed reduced expression of the bone formation markers bone morphogenetic protein (BMP)-2, BMP-4, and cysteine-rich protein (CYR61). In addition, significantly lower expression of proliferating cell nuclear antigen indicated reduced cell proliferation after pantoprazole treatment. Of interest, the reduced expression of bone formation markers was associated with a significantly diminished expression of RANKL, indicating osteoclast inhibition. Pantoprazole delays fracture healing by affecting both bone formation and bone remodeling.
Collapse
Affiliation(s)
- T Histing
- Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, 66421, Homburg/Saar, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Melatonin Impairs Fracture Healing by Suppressing RANKL-Mediated Bone Remodeling. J Surg Res 2012; 173:83-90. [DOI: 10.1016/j.jss.2010.08.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 08/09/2010] [Accepted: 08/19/2010] [Indexed: 11/23/2022]
|
49
|
Vascularized Fibular Flaps Enhance Histological Repair in Pasteurized Autogenous Bone Graft. Ann Plast Surg 2011; 67:416-20. [DOI: 10.1097/sap.0b013e318201fe0a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Histing T, Marciniak K, Scheuer C, Garcia P, Holstein JH, Klein M, Matthys R, Pohlemann T, Menger MD. Sildenafil accelerates fracture healing in mice. J Orthop Res 2011; 29:867-73. [PMID: 21246617 DOI: 10.1002/jor.21324] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/08/2010] [Indexed: 02/04/2023]
Abstract
Sildenafil, a cyclic guanosine monophosphate (cGMP)-dependent phospodiesterase-5 inhibitor, has been shown to be a potent stimulator of angiogenesis through upregulation of pro-angiogenic factors and control of cGMP concentration. Herein, we determined whether sildenafil also influences angiogenic growth factor expression and bone formation during the process of fracture healing. Bone healing was studied in a murine closed femur fracture model using radiological, biomechanical, histomorphometric, and protein biochemical analysis at 2 and 5 weeks after fracture. Thirty mice received 5 mg/kg body weight sildenafil p.o. daily. Controls (n = 30) received equivalent amounts of vehicle. After 2 weeks of fracture healing sildenafil significantly increased osseous fracture bridging, as determined radiologically and histologically. This resulted in an increased biomechanical stiffness compared to controls. A smaller callus area with a slightly reduced amount of cartilaginous tissue indicated an accelerated healing process. After 5 weeks the differences were found blunted, demonstrating successful healing in both groups. Western blot analysis showed a significantly higher expression of the pro-angiogenic and osteogenic cysteine-rich protein (CYR) 61, confirming the increase of bone formation. We show for the first time that sildenafil treatment accelerates fracture healing by enhancing bone formation, most probably by a CYR61-associated pathway.
Collapse
Affiliation(s)
- Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg/Saar, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|