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Crutcher WL, Magnusson EA, Griffith KM, Alford CA, Nielsen ED, Elkins JM, Lujan TJ, Kleweno CP, Lack WD. Bridge Plate Fixation of Distal Femur Fractures: Defining Deficient Radiographic Callus Formation and Its Associations. J Orthop Trauma 2023; 37:475-479. [PMID: 37127901 DOI: 10.1097/bot.0000000000002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To determine whether deficient early callus formation can be defined objectively based on the association with an eventual nonunion and specific patient, injury, and treatment factors. METHODS Final healing outcomes were documented for 160 distal femur fractures treated with locked bridge plate fixation. Radiographic callus was measured on postoperative radiographs until union or nonunion had been declared by the treating surgeon. Deficient callus was defined at 6 and 12 weeks based on associations with eventual nonunion through receiver-operator characteristic analysis. A previously described computational model estimated fracture site motion based on the construct used. Univariable and multivariable analyses then examined the association of patient, injury, and treatment factors with deficient callus formation. RESULTS There were 26 nonunions. The medial callus area at 6 weeks <24.8 mm 2 was associated with nonunion (12 of 39, 30.8%) versus (12 of 109, 11.0%), P = 0.010. This association strengthened at 12 weeks with medial callus area <44.2 mm 2 more closely associated with nonunion (13 of 28, 46.4%) versus (11 of 120, 9.2%), P <0.001. Multivariable logistic regression analysis found limited initial longitudinal motion (OR 2.713 (1.12-6.60), P = 0.028)) and Charlson Comorbidity Index (1.362 (1.11-1.67), P = 0.003) were independently associated with deficient callus at 12 weeks. Open fracture, mechanism of injury, smoking, diabetes, plate material, bridge span, and shear were not significantly associated with deficient callus. CONCLUSION Deficient callus at 6 and 12 weeks is associated with eventual nonunion, and such assessments may aid future research into distal femur fracture healing. Deficient callus formation was independently associated with limited initial longitudinal fracture site motion derived through computational modeling of the surgical construct but not more routinely discussed parameters such as plate material and bridge span. Given this, improved methods of in vivo assessment of fracture site motion are necessary to further our ability to optimize the mechanical environment for healing. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William L Crutcher
- University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA
| | | | | | - Cory A Alford
- University of Washington School of Medicine, Seattle, WA
| | - Ena D Nielsen
- University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA
| | - Jacob M Elkins
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, IA; and
| | - Trevor J Lujan
- Boise State University, Department of Mechanical and Biomedical Engineering, Boise, ID
| | - Conor P Kleweno
- University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA
| | - William D Lack
- University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA
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2
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Kang D. Evaluating the Accuracy and Reliability of Blowout Fracture Area Measurement Methods: A Review and the Potential Role of Artificial Intelligence. J Craniofac Surg 2023; 34:1834-1836. [PMID: 37322582 DOI: 10.1097/scs.0000000000009486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Blowout fractures are a common type of facial injury that requires accurate measurement of the fracture area for proper treatment planning. This systematic review aimed to summarize and evaluate the current methods for measuring blowout fracture areas and explore the potential role of artificial intelligence (AI) in enhancing accuracy and reliability. A comprehensive search of the PubMed database was conducted, focusing on studies published since 2000 that investigated methods for measuring blowout fracture area using computed tomography scans. The review included 20 studies, and the results showed that automatic methods, such as computer-aided measurements and computed tomography-based volumetric analysis, provide higher accuracy and reliability compared with manual and semiautomatic techniques. Standardizing the method for measuring blowout fracture areas can improve clinical decision-making and facilitate outcome comparison across studies. Future research should focus on developing AI models that can account for multiple factors, including fracture area and herniated tissue volume, to enhance their accuracy and reliability. Integration of AI models has the potential to improve clinical decision-making and patient outcomes in the assessment and management of blowout fractures.
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Affiliation(s)
- Daihun Kang
- Department of Plastic and Reconstructive Surgery, Catholic Kwandong University International Saint Mary's Hospital, Seo-gu, Incheon, Republic of Korea
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3
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Shariyate MJ, Kheir N, Caro D, Abbasian M, Rodriguez EK, Snyder BD, Nazarian A. Assessment of Bone Healing: Opportunities to Improve the Standard of Care. J Bone Joint Surg Am 2023; 105:1193-1202. [PMID: 37339171 DOI: 10.2106/jbjs.22.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.
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Affiliation(s)
- Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University Yerevan, Armenia
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4
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Hopkinson M, Jones G, Evans L, Gohin S, Magnusdottir R, Salmon P, Chenu C, Meeson R, Javaheri B, Pitsillides AA. A new method for segmentation and analysis of bone callus in rodent fracture models using micro-CT. J Orthop Res 2023; 41:1717-1728. [PMID: 36582023 PMCID: PMC10947128 DOI: 10.1002/jor.25507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/18/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Fracture burden has created a need to better understand bone repair processes under different pathophysiological states. Evaluation of structural and material properties of the mineralized callus, which is integral to restoring biomechanical stability is, therefore, vital. Microcomputed tomography (micro-CT) can facilitate noninvasive imaging of fracture repair, however, current methods for callus segmentation are only semiautomated, restricted to defined regions, time/labor intensive, and prone to user variation. Herein, we share a new automatic method for segmenting callus in micro-CT tomograms that will allow for objective, quantitative analysis of the bone fracture microarchitecture. Fractured and nonfractured mouse femurs were scanned and processed by both manual and automated segmentation of fracture callus from cortical bone after which microarchitectural parameters were analyzed. All segmentation and analysis steps were performed using CTAn (Bruker) with automatic segmentation performed using the software's image-processing plugins. Results showed automatic segmentation reliably and consistently segmented callus from cortical bone, demonstrating good agreement with manual methods with low bias: tissue volume (TV): -0.320 mm3 , bone volume (BV): 0.0358 mm3 , and bone volume/tissue volume (BV/TV): -3.52%, and was faster and eliminated user-bias and variation. Method scalability and translatability across rodent models were verified in scans of fractured rat femora showing good agreement with manual methods with low bias: TV: -3.654 mm3 , BV: 0.830 mm3 , and BV/TV: 7.81%. Together, these data validate a new automated method for segmentation of callus and cortical bone in micro-CT tomograms that we share as a fast, reliable, and less user-dependent tool for application to study bone callus in fracture, and potentially elsewhere.
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Affiliation(s)
- Mark Hopkinson
- Comparative Biological SciencesRoyal Veterinary CollegeLondonUK
| | - Gareth Jones
- Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Lucinda Evans
- Comparative Biological SciencesRoyal Veterinary CollegeLondonUK
| | - Stephanie Gohin
- Comparative Biological SciencesRoyal Veterinary CollegeLondonUK
| | | | | | - Chantal Chenu
- Comparative Biological SciencesRoyal Veterinary CollegeLondonUK
| | - Richard Meeson
- Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
- Division of SurgeryUniversity College LondonLondonUK
| | - Behzad Javaheri
- Comparative Biological SciencesRoyal Veterinary CollegeLondonUK
- Present address:
School of Mathematics, Computer Science and EngineeringCity University of LondonLondonUK
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5
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Bowers K, Weinhandl JT, Anderson DE. A review of equine tibial fractures. Equine Vet J 2023; 55:171-181. [PMID: 35569040 PMCID: PMC10084381 DOI: 10.1111/evj.13599] [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: 02/15/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
Equine tibial fractures are relatively infrequent in racing and non-racing sport horses, but limitations in successful treatment of tibial fractures in adult horses result in relatively high mortality compared with other musculoskeletal injuries. The aetiology of tibial fracture can be classified into two general categories: traumatic impact or fatigue failure. Tibial stress fractures, also known as fatigue fractures, are often rated as the second most common stress fracture in racing Thoroughbreds; young age, early stage in race training, and initiation of training after a period of rest are the reported risk factors. Both impact and fatigue fracture propagation are dependent on the magnitude of force applied and on the local composition/alignment of mineralised collagen in the tibial lamella. Extensive research has characterised the pattern of strain distribution and stress remodelling within the equine tibia, but in vivo measurement of load and angular moments are currently not feasible. Further research is warranted to correlate biomechanical theory of tibia fatigue fracture propagation with current histopathological data. Preventative measures for fatigue fractures aim to optimise diagnostic efficiency, reduce the interval between injury and diagnosis and modify racing and training conditions to reduce non-specific fracture risk. Treatment options for complete tibial fractures in adult horses are limited, but with careful case selection, successful outcomes have been reported after open reduction and internal fixation. On the other hand, tibial stress fractures and minimally displaced incomplete fractures are typically treated conservatively and have good prognosis for athletic recovery. This review aims to describe the current literature regarding tibial fracture aetiology, prevalence, risk factors, fracture biomechanics, treatment, prognosis and prevention.
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Affiliation(s)
- Kristin Bowers
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, Tennessee, USA
| | - David E Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
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Giraudo C, Nistri F, Ferrigno P, Dolci G, Stramare R, Guglielmi G, Mammana M, Quaia E, Giunta D, Dell'Amore A, Rea F. Sternal transplant using cadaveric allograft: quantitative and qualitative assessment of bone healing by computed tomography. Quant Imaging Med Surg 2021; 11:502-509. [PMID: 33532251 DOI: 10.21037/qims-20-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternal transplant using cadaveric allograft (STCA) is a complex and rarely performed surgical procedure usually applied for massive bone tissue loss, sternotomy complications, or neoplastic resections. Although radiological imaging and especially computed tomography (CT) is routinely applied for the post-surgical assessment, up to now, a standardized approach evaluating the outcome of STCAs is missing. Therefore, aim of this study was to qualitatively and quantitatively evaluate, by CT, bone healing after STCA. Methods The first and the last available postsurgical CT of patients who underwent STCA in two tertiary centers between 2009 and 2017 were collected. Standardized regions of interest were applied on the cancellous bone along the transplanted sternum, and, as reference, on the fourth thoracic vertebra, at both time points, collecting the density values. The areas nearby the fixation devices were assessed by a four-points qualitative score. To evaluate the mineralization, the analysis of the variance (ANOVA) with post-hoc Bonferroni correction was applied for the quantitative measurements while the Wilcoxon test was used for the qualitative score (P<0.05). To evaluate the intra-rater reliability of the qualitative and the quantitative analyses, the same rater repeated the measurements after two months and the Cohen's kappa (k) and the intraclass correlation coefficient (ICC) were computed. Results Fourteen patients (11 females, 61±12.8 years) were examined. The first control CTs were performed 32±40.26 days after the STCA and the last CT were acquired after 729±745 days. The quantitative and the qualitative score significantly increased between the two intervals (P<0.05, each). The density of the transplanted sternum was lower than that of the vertebral reference at the first CT (P=0.006) while no differences occurred at the last control (P=0.361). The assessments showed high intra-rater reliability and agreement (ICC ≥0.890, k≥0.906). Conclusions The hereby-proposed qualitative and quantitative methods demonstrated to be good tools for assessing bone healing after STCA.
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Affiliation(s)
- Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Francesca Nistri
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Pia Ferrigno
- Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy
| | - Giampiero Dolci
- Department of Cardiothoracic Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - Roberto Stramare
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy
| | - Emilio Quaia
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Domenica Giunta
- Department of Cardiothoracic Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy
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7
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Schwab A, Levato R, D’Este M, Piluso S, Eglin D, Malda J. Printability and Shape Fidelity of Bioinks in 3D Bioprinting. Chem Rev 2020; 120:11028-11055. [PMID: 32856892 PMCID: PMC7564085 DOI: 10.1021/acs.chemrev.0c00084] [Citation(s) in RCA: 378] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/23/2022]
Abstract
Three-dimensional bioprinting uses additive manufacturing techniques for the automated fabrication of hierarchically organized living constructs. The building blocks are often hydrogel-based bioinks, which need to be printed into structures with high shape fidelity to the intended computer-aided design. For optimal cell performance, relatively soft and printable inks are preferred, although these undergo significant deformation during the printing process, which may impair shape fidelity. While the concept of good or poor printability seems rather intuitive, its quantitative definition lacks consensus and depends on multiple rheological and chemical parameters of the ink. This review discusses qualitative and quantitative methodologies to evaluate printability of bioinks for extrusion- and lithography-based bioprinting. The physicochemical parameters influencing shape fidelity are discussed, together with their importance in establishing new models, predictive tools and printing methods that are deemed instrumental for the design of next-generation bioinks, and for reproducible comparison of their structural performance.
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Affiliation(s)
- Andrea Schwab
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Riccardo Levato
- Department
of Orthopaedics, University Medical Center
Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department
of Clinical Sciences, Faculty of Veterinary
Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - Matteo D’Este
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Susanna Piluso
- Department
of Orthopaedics, University Medical Center
Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department
of Developmental BioEngineering, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - David Eglin
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Jos Malda
- Department
of Orthopaedics, University Medical Center
Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department
of Clinical Sciences, Faculty of Veterinary
Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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9
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Virtual structural analysis of tibial fracture healing from low-dose clinical CT scans. J Biomech 2019; 83:49-56. [DOI: 10.1016/j.jbiomech.2018.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/22/2022]
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10
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McKenzie JA, Buettmann E, Abraham AC, Gardner MJ, Silva MJ, Killian ML. Loss of scleraxis in mice leads to geometric and structural changes in cortical bone, as well as asymmetry in fracture healing. FASEB J 2016; 31:882-892. [PMID: 27864378 DOI: 10.1096/fj.201600969r] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023]
Abstract
Scleraxis (Scx) is a known regulator of tendon development, and recent work has identified the role of Scx in bone modeling. However, the role of Scx in fracture healing has not yet been explored. This study was conducted to identify the role of Scx in cortical bone development and fracture healing. Scx green fluorescent protein-labeled (ScxGFP) reporter and Scx-knockout (Scx-mutant) mice were used to assess bone morphometry and the effects of fracture healing on Scx localization and gene expression, as well as callus healing response. Botulinum toxin (BTX) was used to investigate muscle unloading effects on callus shape. Scx-mutant long bones had structural and mechanical defects. Scx gene expression was elevated and bmp4 was decreased at 24 h after fracture. ScxGFP+ cells were localized throughout the healing callus after fracture. Scx-mutant mice demonstrated disrupted callus healing and asymmetry. Asymmetry of Scx-mutant callus was not due to muscle unloading. Wild-type littermates (age matched) served as controls. This is the first study to explore the role of Scx in cortical bone mechanics and fracture healing. Deletion of Scx during development led to altered long bone properties and callus healing. This study also demonstrated that Scx may play a role in the periosteal response during fracture healing.-McKenzie, J. A., Buettmann, E., Abraham, A. C., Gardner, M. J., Silva, M. J., Killian, M. L. Loss of scleraxis in mice leads to geometric and structural changes in cortical bone, as well as asymmetry in fracture healing.
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Affiliation(s)
- Jennifer A McKenzie
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Evan Buettmann
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adam C Abraham
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J Gardner
- Department of Orthopedic Surgery, Stanford University, Redwood City, California, USA; and
| | - Matthew J Silva
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan L Killian
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; .,Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
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