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Bilici Geçer R, Zengin ÖS, Karip BZ, Boran T, Çikler E, Özhan G, Dursun D. Effects of coenzyme Q 10 on orthodontic tooth movement and alveolar bone remodeling in rats. Clin Oral Investig 2024; 28:486. [PMID: 39145807 DOI: 10.1007/s00784-024-05881-2] [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: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVES To evaluate the effects of coenzyme Q10 (CoQ10) on alveolar bone remodeling and orthodontic tooth movement (OTM). MATERIALS AND METHODS An orthodontic appliance was placed in 42 female Sprague‒Dawley rats were divided into two groups: the orthodontic force (OF) group (n = 21) and the OF + CoQ10 (CoQ10) treatment group (n = 21). Each group was divided into 3 subgroups, and the rats were sacrificed on days 3, 7 and 14. The rats in CoQ10 and OF groups were administered 100 mg/kg b.w./day CoQ10 (in 1 mL/b.w. soybean oil) and 1 mL b.w./day soybean oil, respectively, by orogastric gavage. The OTM was measured at the end of the experiment. The osteoclast, osteoblast and capillary numbers; vascular endothelial growth factor (VEGF), receptor activator nuclear kappa B ligand (RANKL) and osteoprotegrin (OPG) levels in tissue; and total antioxidant status (TAS) and total oxidant status (TOS) in blood were determined. RESULTS Compared with the OF group, the CoQ10 treatment group exhibited decreased orthodontic tooth movement and osteoclast and capillary numbers. Indeed, the levels of VEGF and RANKL decreased, while the levels of OPG increased except on day 7. Additionally, the CoQ10 treatment group exhibited lower TOS and higher TAS on days 7 and 14 (p < 0.05). Histological findings showed that the morphology of osteoblasts changed in the CoQ10 group; however, there was no significant difference in the number of osteoblasts between the groups (p > 0.05). CONCLUSION Due to its effect on oxidative stress and inflammation, CoQ10 regulates bone remodeling by inhibiting osteoclast differentiation, promoting osteoblast differentiation and reducing the amount of OTM. CLINICAL RELEVANCE Considering that OTM may be slowed with the use of CoQ10, topics such as orthodontic treatment duration, orthodontic force activation and appointment frequency should be considered in treatment planning. It is predicted that the use of CoQ10 will support the effectiveness of treatment in clinical applications such as preventing relapse in orthodontic treatment by regulating bone modulation and anchorage methods that suppress/optimize unwanted tooth movement.
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Affiliation(s)
- Rumeysa Bilici Geçer
- Department of Orthodontics, Hamidiye Faculty of Dentistry, University of Health Sciences, Istanbul, Turkey
| | - Özge Sultan Zengin
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Betül Zehra Karip
- Department of Histology and Embryology, Hamidiye Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Tuğçe Boran
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Çikler
- Department of Histology and Embryology, Hamidiye Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Gül Özhan
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Derya Dursun
- Department of Orthodontics, Hamidiye Faculty of Dentistry, University of Health Sciences, Istanbul, Turkey.
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Seth I, Bulloch G, Seth N, Siu A, Clayton S, Lower K, Roshan S, Nara N. Effect of Perioperative Vitamin C on the Incidence of Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 61:748-754. [PMID: 34961681 DOI: 10.1053/j.jfas.2021.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
Complex regional pain syndrome type 1 (CRPS-I) is a complex complication that occurs after limb extremity surgeries. Controversy exists regarding the effectiveness of vitamin C in reducing that condition. Therefore, we conducted this systematic review and meta-analysis to assess the role of vitamin C on CRPS-I and functional outcomes after distal radius, wrist, foot, and ankle surgeries. We searched Medline (via PubMed), Embase, the Cochrane Library, Clinicaltrial.gov, and Google Scholar for relevant studies comparing perioperative vitamin C versus placebo after distal radius, wrist, foot, and ankle surgeries from infinity to May 2021. Continuous data such as functional outcomes and pain scores were pooled as mean differences, while dichotomous variables such as the incidence of complex regional pain syndrome and complications were pooled as odds ratios, with 95% confidence interval, using R software (meta package, version 4.9-0) for Windows. Eight studies were included. The timeframe for vitamin C administration in each study ranged from 42 to 50 days postinjury and/or surgical fixation. The effect size showed that vitamin C was associated with a decreased rate of CRPS-1 than placebo (odds ratio 0.33, 95% confidence interval [0.17, 0.63]). No significant difference was found between vitamin C and placebo in terms of complications (odds ratio 1.90, 95% confidence interval [0.99, 3.65]), functional outcomes (mean difference 6.37, 95% confidence interval [-1.40, 14.15]), and pain scores (mean difference -0.14, 95% confidence interval [-1.07, 0.79]). Overall, vitamin C was associated with a decreased rate of CRPS-I than placebo, while no significant difference was found regarding complications, functional outcomes, and pain scores. These results hold true when stratifying fracture type (distal radius, ankle, and foot surgeries) and vitamin C dose (500 mg or 1 g).
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Affiliation(s)
- Ishith Seth
- Bendigo Base Hospital, Bendigo, Victoria, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nimish Seth
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adrian Siu
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Stephanie Clayton
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kirk Lower
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sasha Roshan
- Department of Orthopaedic Surgery, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Naveen Nara
- Department of Orthopaedic Surgery, Ballarat Base Hospital, Ballarat, Victoria, Australia
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Sheppard AJ, Barfield AM, Barton S, Dong Y. Understanding Reactive Oxygen Species in Bone Regeneration: A Glance at Potential Therapeutics and Bioengineering Applications. Front Bioeng Biotechnol 2022; 10:836764. [PMID: 35198545 PMCID: PMC8859442 DOI: 10.3389/fbioe.2022.836764] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 01/24/2023] Open
Abstract
Although the complex mechanism by which skeletal tissue heals has been well described, the role of reactive oxygen species (ROS) in skeletal tissue regeneration is less understood. It has been widely recognized that a high level of ROS is cytotoxic and inhibits normal cellular processes. However, with more recent discoveries, it is evident that ROS also play an important, positive role in skeletal tissue repair, specifically fracture healing. Thus, dampening ROS levels can potentially inhibit normal healing. On the same note, pathologically high levels of ROS cause a sharp decline in osteogenesis and promote nonunion in fracture repair. This delicate balance complicates the efforts of therapeutic and engineering approaches that aim to modulate ROS for improved tissue healing. The physiologic role of ROS is dependent on a multitude of factors, and it is important for future efforts to consider these complexities. This review first discusses how ROS influences vital signaling pathways involved in the fracture healing response, including how they affect angiogenesis and osteogenic differentiation. The latter half glances at the current approaches to control ROS for improved skeletal tissue healing, including medicinal approaches, cellular engineering, and enhanced tissue scaffolds. This review aims to provide a nuanced view of the effects of ROS on bone fracture healing which will inspire novel techniques to optimize the redox environment for skeletal tissue regeneration.
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Affiliation(s)
- Aaron J. Sheppard
- Department of Orthopaedic Surgery, Louisiana State University Health Shreveport, Shreveport, LA, United States
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Ann Marie Barfield
- Department of Orthopaedic Surgery, Louisiana State University Health Shreveport, Shreveport, LA, United States
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Yufeng Dong
- Department of Orthopaedic Surgery, Louisiana State University Health Shreveport, Shreveport, LA, United States
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Dutton LK, Rhee PC. Complex Regional Pain Syndrome and Distal Radius Fracture: Etiology, Diagnosis, and Treatment. Hand Clin 2021; 37:315-322. [PMID: 33892884 DOI: 10.1016/j.hcl.2021.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by a constellation of signs and symptoms including pain out of proportion to the injury or insult, autonomic dysfunction, trophic changes, and impaired function. CRPS may occur following either conservative or surgical management of distal radius fractures and can significantly complicate the trajectory of a patient's recovery. Although the incidence, diagnosis, prevention, and treatment of this condition have been extensively studied, optimal methods to identify, prevent, and treat this condition remain controversial. This article reviews the available literature on the diagnosis and treatment of CRPS in distal radius fractures.
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Affiliation(s)
- Lauren Kate Dutton
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Peter Charles Rhee
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Kressin C, Pandya K, Woodward BM, Donaldson C, Flannery AH. Ascorbic Acid in the Acute Care Setting. JPEN J Parenter Enteral Nutr 2021; 45:874-881. [PMID: 33675075 DOI: 10.1002/jpen.2102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Ascorbic acid (AA) is an essential nutrient with many physiologic roles not limited to the prevention of scurvy. Beyond its role as a supplement, it has gained popularity in the acute care setting as an inexpensive medication for a variety of conditions. Because of limitations with absorption of oral formulations and reduced serum concentrations observed in acute illness, intravenous (IV) administration, and higher doses, may be needed to produce the desired serum concentrations for a particular indication. Following a PubMed search, we reviewed published studies relevant to AA in the acute care setting and summarized the results in a narrative review. In the acute care setting, AA may be used for improved wound healing, improved organ function in sepsis and acute respiratory distress syndrome, faster resolution of vasoplegic shock after cardiac surgery, reduction of resuscitative fluids in severe burn injury, and as an adjunctive analgesic, among other uses. Each indication differs in its level of evidence supporting exogenous administration of AA, but overall, AA was not commonly associated with adverse effects in the identified studies. Use of AA remains an active area of clinical investigation for various indications in the acute care patient population.
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Affiliation(s)
- Christian Kressin
- Acute Care Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Komal Pandya
- Acute Care Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | | | - Chris Donaldson
- Acute Care Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Alexander H Flannery
- Acute Care Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
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Pleiotropic actions of Vitamin D in composite musculoskeletal trauma. Injury 2020; 51:2099-2109. [PMID: 32624209 DOI: 10.1016/j.injury.2020.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/21/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
Composite tissue injuries are the result of high energy impacts caused by motor vehicle accidents, gunshot wounds or blasts. These are highly traumatic injuries characterized by wide-spread, penetrating wounds affecting the entire musculoskeletal system, and are generally defined by frank volumetric muscle loss with concomitant segmental bone defects. At the tissue level, the breadth of damage to multiple tissue systems, and potential for infection from penetration, have been shown to lead to an exaggerated, often chronic inflammatory response with subsequent dysregulation of normal musculoskeletal healing mechanisms. Aside from the direct effects of inflammation on myogenesis and osteogenesis, frank muscle loss has been shown to directly impair fracture union and ultimately contribute to failed wound regeneration. Care for these injuries requires extensive surgical intervention and acute care strategies. However, often these interventions do not adequately mitigate inflammation or promote proper musculoskeletal injury repair and force amputation of the limb. Therefore, identification of factors that can promote tissue regeneration and mitigate inflammation could be key to restoring wound healing after composite tissue injury. One such factor that may directly affect both inflammation and tissue regeneration in response to these multi-tissue injuries may be Vitamin D. Beyond traditional roles, the pleiotropic and localized actions of Vitamin D are increasingly being recognized in most aspects of wound healing in complex tissue injuries - e.g., regulation of inflammation, myogenesis, fracture callus mineralization and remodeling. Conversely, pre-existing Vitamin D deficiency leads to musculoskeletal dysfunction, increased fracture risk or fracture non-unions, decreased strength/function and reduced capacity to heal wounds through increased inflammation. This Vitamin D deficient state requires acute supplementation in order to quickly restore circulating levels to an optimal level, thereby facilitating a robust wound healing response. Herein, the purpose of this review is to address the roles and critical functions of Vitamin D throughout the wound healing process. Findings from this review suggest that careful monitoring and/or supplementation of Vitamin D may be critical for wound regeneration in composite tissue injuries.
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Bolat E, Esenlik E, Öncü M, Özgöçmen M, Avunduk MC, Yüksel Ö. Evaluation of the effects of vitamins C and E on experimental orthodontic tooth movement. J Dent Res Dent Clin Dent Prospects 2020; 14:131-137. [PMID: 32908655 PMCID: PMC7464231 DOI: 10.34172/joddd.2020.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 11/09/2022] Open
Abstract
Background. This experimental study aimed to assess the effects of Vitamins C and E on orthodontic tooth movement. Methods. Fifty-one male Wistar albino rats were divided into six groups: five appliance groups and one control group. The appliance groups had an orthodontic appliance consisting of a closed-coil spring ligated between the maxillary incisor and maxillary first molar (50 g). Vitamin E and C (150 mg/kg) were injected intraperitoneally per day in the first and second groups, respectively. Vitamins E and C (20 μL) were locally injected into the periodontal gap of the moving teeth in the third and fourth groups, respectively, once every three days. No vitamin was injected in the last (fifth) appliance group.The experimental period was 18 days. Histological and biochemical (alkaline phosphatase, osteocalcin, and NTx levels) evaluations of the samples were performed, and maxillary incisor‒molar distance was measured before and after the experiment. Results. The amount of tooth movement was similar in the appliance groups. All the vitamin groups showed significantly increased osteoblastic activity, while those treated with systemic vitamins exhibited significantly increased numbers of collagen fibers on the tension side compared to the appliance control group (P<0.05). Conclusion. Vitamin C and E supplements positively affected bone formation on the tension side of the teeth during experimental orthodontic tooth movement.
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Affiliation(s)
- Esra Bolat
- Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Elçin Esenlik
- Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Meral Öncü
- Department of Histology Embriyology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Meltem Özgöçmen
- Department of Histology Embriyology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Mustafa Cihat Avunduk
- Department of Pathology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
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Roberts JL, Drissi H. Advances and Promises of Nutritional Influences on Natural Bone Repair. J Orthop Res 2020; 38:695-707. [PMID: 31729041 DOI: 10.1002/jor.24527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 02/04/2023]
Abstract
Impaired fracture healing continues to be a significant public health issue. This is more frequently observed in aging populations and patients with co-morbidities that can directly influence bone repair. Tremendous progress has been made in the development of biologics to enhance and accelerate the healing process; however, side-effects persist that can cause significant discomfort and tissue damage. This has been the impetus for the development of safe and natural strategies to hasten natural bone healing. Of the many possible approaches, nutrition represents a safe, affordable, and non-invasive strategy to positively influence each phase of fracture repair. However, our understanding of how healing can be hindered by malnutrition or enhanced with nutritional supplementation has lagged behind the advancements in both surgical management and the knowledge of molecular and cellular drivers of skeletal fracture repair. This review serves to bridge this knowledge gap as well as define the importance of nutrition during fracture healing. The extant literature clearly indicates that pre-existing nutritional deficiencies should be corrected, and nutritional status should be carefully monitored to prevent the development of malnutrition for the best possible healing outcome. It remains unclear, however, whether the provision of nutrients beyond sufficiency has any benefit on fracture repair and patient outcomes. The combined body of pre-clinical studies using a variety of animal models suggests a promising role of nutrition as an adjuvant therapy to facilitate fracture repair, but extensive research is needed, specifically at the clinical level, to clarify the utility of nutritional interventions in orthopedics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:695-707, 2020.
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Affiliation(s)
- Joseph L Roberts
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia.,Nutrition and Health Sciences Program, Emory University, Atlanta, Georgia
| | - Hicham Drissi
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia.,Nutrition and Health Sciences Program, Emory University, Atlanta, Georgia
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Hill-Mündel K, Schlegl J, Biesalski HK, Ehnert S, Schröter S, Bahrs C, Nohr D, Nüssler AK, Ihle C. Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome. J Clin Med 2019; 9:jcm9010066. [PMID: 31888071 PMCID: PMC7019571 DOI: 10.3390/jcm9010066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022] Open
Abstract
Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.
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Affiliation(s)
- Katharina Hill-Mündel
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Johannes Schlegl
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Hans Konrad Biesalski
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Steffen Schröter
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Christian Bahrs
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Donatus Nohr
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Andreas K. Nüssler
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Christoph Ihle
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
- Correspondence: ; Tel.: +49-7071-606-1065
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Akça EK, Atalay B, Öner B. Histopathologic and Immunohistochemical Investigation of the Effects of Vitamin C on Bone Healing in Rats Exposed to Nicotine. J Oral Maxillofac Surg 2019; 78:194.e1-194.e14. [PMID: 31605679 DOI: 10.1016/j.joms.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/12/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of the present study was to perform a histopathologic and immunohistochemical investigation of the effects of vitamin C on bone healing in rats exposed to nicotine. MATERIALS AND METHODS A total of 52 male Sprague-Dawley rats were assigned to 4 main groups: control, vitamin C, nicotine, and nicotine plus vitamin C. The rats in the nicotine groups were injected with nicotine at 12-hour intervals for 4 weeks. At the end of 4 weeks, a tibial defect was created in all the rats. Subcutaneous injections were administered at the same intervals postoperatively, and the vitamin C groups received intraperitoneal vitamin C injections every day for the first 3 days and then every other day postoperatively. The rats were sacrificed on postoperative days 7 and 21. The blood samples collected during sacrifice were tested to determine the blood cotinine levels, and histopathological and immunohistochemical analyses were performed on tibia samples. RESULTS The histopathologic evaluation revealed that nicotine significantly increased the amount of necrosis and significantly decreased new bone formation and the bone healing score. The presence of necrosis in the nicotine plus vitamin C group was significantly lower on day 21 (P = .005). A statistically significant difference was observed among the new bone formation of the control, nicotine, vitamin C, and nicotine plus vitamin C groups on day 21 (P = .001). The new bone healing score of the nicotine group was significantly lower than that of the control, vitamin C, and nicotine plus vitamin C groups (P = .003, P = .001, and P = .001). The immunohistochemical evaluation showed that nicotine increased the hypoxia-inducible factor-1α and vascular endothelial growth factor levels and decreased the bone morphogenetic protein-2 levels, especially in the groups sacrificed on day 21. CONCLUSIONS Vitamin C did not have a significant effect on bone healing. However, vitamin C administered with nicotine decreased the metabolism of nicotine and, thus, increased nicotine excretion.
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Affiliation(s)
- Eda Kaya Akça
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Berkem Atalay
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Bilgin Öner
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Influence of vitamin C on the incidence of CRPS-I after subacromial shoulder surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:221-226. [PMID: 31541301 DOI: 10.1007/s00590-019-02542-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/29/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The primary aim of this study was to determine whether postoperative administration of vitamin C (VC) is associated with reduced risk of complex regional pain syndrome type I (CRPS-I) after subacromial shoulder surgery (SaSS). The secondary objective of the study was to identify risk factor for the development of CRPS-I after SaSS. MATERIALS AND METHODS A retrospective cohort study was performed to evaluate 542 patients undergoing SaSS from January 2015 to December 2016. The cohort was divided into two groups based on VC administration [Group I (no VC) and Group II (500 mg/day oral VC for 50 days postoperatively)]. The relationship between VC administration and development of CRPS-I was assessed. Demographics, preoperative clinical parameters, and operative variables were evaluated to determine their effect on the incidence of CRPS-I. RESULTS A total of 267 patients (Group II) undergoing SaSS received VC, and 266 patients (Group I) did not. The incidence of CRPS-I was significantly different between two groups (36(13%) vs 18(7%), p = 0.009). Multivariable regression, however, demonstrated that VC reduced the risk of CRPS-I after SaSS by > 50% (aOR = 0.49; 95% CI 0.27-0.91). Patients undergoing open surgery (aOR = 2.19; 95% CI 1.2-4.0) were more likely to develop CRPS-I postoperatively. Higher preoperative Constant score (aOR = 0.94; 95% CI 0.91-0.98) was associated with lower risk for CRPS-I development. CONCLUSIONS The present study found that VC administered prophylactically for 50 days postoperatively is effective in preventing CRPS-I development after SaSS. CRPS-I is a common complication following SaSS, especially in the setting of an open approach. The authors recommend preventive management with VC and arthroscopic approaches when possible for SaSS. LEVEL OF EVIDENCE III Retrospective comparative study.
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DePhillipo NN, Aman ZS, Kennedy MI, Begley JP, Moatshe G, LaPrade RF. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. Orthop J Sports Med 2018; 6:2325967118804544. [PMID: 30386805 PMCID: PMC6204628 DOI: 10.1177/2325967118804544] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Recent investigations on the biochemical pathways after a musculoskeletal injury have suggested that vitamin C (ascorbic acid) may be a viable supplement to enhance collagen synthesis and soft tissue healing. Purpose To (1) summarize vitamin C treatment protocols; (2) report on the efficacy of vitamin C in accelerating healing after bone, tendon, and ligament injuries in vivo and in vitro; and (3) report on the efficacy of vitamin C as an antioxidant protecting against fibrosis and promoting collagen synthesis. Study Design Systematic review; Level of evidence, 2. Methods A systematic review was performed, with the inclusion criteria of animal and human studies on vitamin C supplementation after a musculoskeletal injury specific to collagen cross-linking, collagen synthesis, and biologic healing of the bone, ligament, and tendon. Results The initial search yielded 286 articles. After applying the inclusion and exclusion criteria, 10 articles were included in the final analysis. Of the preclinical studies evaluating fracture healing, 2 studies reported significantly accelerated bone healing in the vitamin C supplementation group compared with control groups. The 2 preclinical studies evaluating tendon healing reported significant increases in type I collagen fibers and scar tissue formation with vitamin C compared with control groups. The 1 preclinical study after anterior cruciate ligament (ACL) reconstruction reported significant short-term (1-6 weeks) improvements in ACL graft incorporation in the vitamin C group compared with control groups; however, there was no long-term (42 weeks) difference. Of the clinical studies evaluating fracture healing, 1 study reported no significant differences in the rate of fracture healing at 50 days or functional outcomes at 1 year. Vitamin C supplementation was shown to decrease oxidative stress parameters by neutralizing reactive oxygen species through redox modulation in animal models. No animal or human studies reported any adverse effects of vitamin C supplementation. Conclusion Preclinical studies demonstrated that vitamin C has the potential to accelerate bone healing after a fracture, increase type I collagen synthesis, and reduce oxidative stress parameters. No adverse effects were reported with vitamin C supplementation in either animal models or human participants; thus, oral vitamin C appears to be a safe supplement but lacks clinical evidence compared with controls. Because of the limited number of human studies, further clinical investigations are needed before the implementation of vitamin C as a postinjury supplement.
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Affiliation(s)
- Nicholas N DePhillipo
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - J P Begley
- The Steadman Clinic, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Oslo University Hospital, Oslo, Norway.,OSTRC, Norwegian School of Sports Science, Oslo, Norway
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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Aïm F, Klouche S, Frison A, Bauer T, Hardy P. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2017; 103:465-470. [PMID: 28274883 DOI: 10.1016/j.otsr.2016.12.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complex regional pain syndrome type I (CRPS-I), previously known as reflex sympathetic dystrophy, is common after conservatively or surgically treated wrist fractures. Several studies support the efficacy of vitamin C in preventing CRPS-I, although the data are somewhat conflicting. The primary objective of this systematic literature review and meta-analysis was to assess the efficacy of vitamin C therapy in preventing CRPS-I after a wrist fracture. METHODS Randomised, placebo-controlled trials of vitamin C to prevent CRPS-I after wrist fractures were sought in the three main databases: PubMed (1980 to December 2015), CENTRAL (Central 2015, number 12), and Embase (1980 to December 2015). Two authors worked independently to select articles. Data from selected articles were collected independently. RESULTS Three randomised placebo-controlled trials in a total of 875 patients were included. Treatment was non-operative in 758/890 (85.1%) fractures and operative in 132 (14.9%) fractures. Vitamin C supplementation was started on the day of the injury and continued for 50 days. In the group given 500mg of vitamin C daily, the risk ratio for CRPS-I was 0.54 (95%CI, 0.33-0.91; P=0.02). Thus, the risk of developing CRPS-I was significantly decreased by prophylactic treatment with 500mg of vitamin C per day. The heterogeneity rate was 65% (non-significant). CONCLUSION Daily supplementation with 500mg of vitamin C per day for 50 days decreases the 1-year risk of CRPS-I after wrist fracture. LEVEL OF EVIDENCE II, systematic review of level I and II studies.
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Affiliation(s)
- F Aïm
- Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France.
| | - S Klouche
- Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - A Frison
- Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - T Bauer
- Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - P Hardy
- Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France
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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.
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Affiliation(s)
- Umut Hatay Gölge
- Department of Orthopaedics and Traumatology, School of Medicine, Çanakkale Onsekiz Mart University, 17000, Çanakkale, Turkey,
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16
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Malay S, Chung KC. Testing the validity of preventing chronic regional pain syndrome with vitamin C after distal radius fracture. [Corrected]. J Hand Surg Am 2014; 39:2251-7. [PMID: 25239047 PMCID: PMC4785877 DOI: 10.1016/j.jhsa.2014.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The American Academy of Orthopaedic Surgeons recommends the use of vitamin C to prevent complex regional pain syndrome (CRPS) for patients with distal radius fractures (DRFs). We hypothesized that the evidence for supporting this recommendation is weak, based on epidemiological principles of association and causality. The specific aim of this project was to test the validity of this recommendation. METHODS We conducted a literature review to retrieve articles reporting on the use of vitamin C to prevent CRPS. Data collected included sample size, study design type, dose of vitamin C used, and outcome measures of association expressed as relative risk (RR) and odds ratio. We then applied Hill criteria to evaluate the relationship between vitamin C and CRPS. RESULTS We obtained 225 articles from the database search. After the exclusion of duplicates, unrelated articles, editorial letters, and commentaries, we found 4 articles and 1 systematic review relevant to our topic. Six of the 9 Hill criteria were met, and an earlier meta-analysis showed a quantified reduction in CRPS risk. However, criteria like biological plausibility, specificity, and coherence were not met. CONCLUSIONS The number of causal/association criteria met was adequate to support the scientific premise of the effect of vitamin C in preventing CRPS after DRF. Furthermore, vitamin C administration is of relatively low cost and has few complications unless administered in large doses. Owing to sufficient epidemiological evidence availability, the American Academy of Orthopaedic Surgeons recommendation of vitamin C to prevent CRPS has practical merit. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Sunitha Malay
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
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Ekrol I, Duckworth AD, Ralston SH, Court-Brown CM, McQueen MM. The influence of vitamin C on the outcome of distal radial fractures: a double-blind, randomized controlled trial. J Bone Joint Surg Am 2014; 96:1451-9. [PMID: 25187584 DOI: 10.2106/jbjs.m.00268] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture. METHODS A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score. RESULTS There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing. CONCLUSIONS This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ingri Ekrol
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Stuart H Ralston
- Rheumatic Disease Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
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Giordano V, Albuquerque RPE, Amaral NPD, Chame CC, Souza FD, Apfel MÍR. Supplementary vitamin C does not accelerate bone healing in a rat tibia fracture model. ACTA ORTOPEDICA BRASILEIRA 2014; 20:10-2. [PMID: 24453572 PMCID: PMC3718416 DOI: 10.1590/s1413-78522012000100001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/12/2011] [Indexed: 11/21/2022]
Abstract
Objective To investigate the role of ascorbic acid supplementation on bone healing after rat
tibia fracture. Methods Thirty male Wistar rats were randomly divided into Vitamin C (Group A) and sham (Group
B) groups (15 rats each). Group A received 200 mg intraperitoneally per kg per day of
ascorbic acid and Group B was given saline 5 ml per kg per day intraperitoneally once a
day. The animals were caged in pairs and allowed free access to tap water and a standard
rodent chow ad libitum. Fractures were produced manually, they were not stabilized, and
unprotected weight-bearing was allowed. At two, four, and six weeks post-fracture, the
rats in both groups were anesthetized and sacrificed by cervical dislocation. Callus
tissue was dissected, prepared, and analyzed histologically. Histomorphological analysis
was performed at six weeks post-fracture and the extent of fracture healing was
determined using a five-point scale. Results There were no histological and histomorphological differences between drug-treated
animals and the sham in the three different stages studied. By six weeks post-fracture,
the five animals of each group had a complete bone union. Conclusion Under the studied conditions, intraperitoneal Vitamin C supplementation does not
accelerate the fracture healing process after experimental tibia fracture in rats.
Level of evidence: Level 2, individual study with experimental
design.
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Kumar MD, John KMM, Karthik S. The Bone Fracture–Healing Potential ofOrmocarpum cochinchinense, Methanolic Extract on Albino Wistar Rats. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10496475.2012.726954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maria John K, Venkatesan D, Sandhiya S, Karthik S, Natarajan S. In vitro Synthesis of Calcite Crystals from Ormocarpum cochinchinense (L.) a Traditional Bone Healing Aid of Southern India. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/ajpp.2011.312.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Uysal T, Amasyali M, Olmez H, Enhos S, Karslioglu Y, Gunhan O. Effect of vitamin C on bone formation in the expanded inter-premaxillary suture. Early bone changes. J Orofac Orthop 2011; 72:290-300. [DOI: 10.1007/s00056-011-0034-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Kurklu M, Yildiz C, Kose O, Yurttas Y, Karacalioglu O, Serdar M, Deveci S. Effect of alpha-tocopherol on bone formation during distraction osteogenesis: a rabbit model. J Orthop Traumatol 2011; 12:153-8. [PMID: 21761226 PMCID: PMC3163787 DOI: 10.1007/s10195-011-0145-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/17/2011] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the effects of alpha-tocopherol on distraction osteogenesis. Materials and methods Right tibias of 30 New Zealand white rabbits were distracted at a rate of 0.5 mm/day for 20 days with a circular external fixator. Experimental group rabbits (n = 15) were administered i.m. 20 mg/kg/day alpha-tocopherol for 30 days. Radiographic examinations were performed at the 20th, 30th and 40th days. Bone scintigraphy was performed at the 5th and 20th days. Serum total antioxidant capacity (TAC) was measured at the 5th and 30th days. All animals were sacrificed and the right tibias of all animals were harvested for histopathologic examination at the 40th day. Results Radiologic scores were statistically similar at the 20th day. However, the experimental group demonstrated higher radiologic scores at the 30th and 40th days. A scintigraphic baseline study at the 5th day of the study showed statistically similar osteoblastic activities in both groups. However, at the 20th day, osteoblastic activity was significantly higher in the experimental group. Serum TAC values were also significantly higher in the experimental group at the 30th day. At necropsy, histopathologic examination revealed statistically significantly higher scores in the experimental group. Conclusion The results of this study show that alpha-tocopherol has beneficial effects on new bone formation during distraction osteogenesis.
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Affiliation(s)
- Mustafa Kurklu
- Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Cemil Yildiz
- Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ozkan Kose
- Antalya Education and Research Hospital, Orthopaedics and Traumatology Clinic, Pinarbaşi mh. 758.sk. Nazlibahce Evleri A Blok D8, Konyaalti, Antalya, Turkey
| | - Yuksel Yurttas
- Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ozgur Karacalioglu
- Department of Nuclear Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Muhittin Serdar
- Deparment of Clinical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - Salih Deveci
- Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey
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Sandukji A, Al-Sawaf H, Mohamadin A, Alrashidi Y, Sheweita SA. Oxidative stress and bone markers in plasma of patients with long-bone fixative surgery: role of antioxidants. Hum Exp Toxicol 2011; 30:435-442. [PMID: 20534639 DOI: 10.1177/0960327110374203] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
It is well known that bone markers (e.g. osteocalcin and alkaline phosphatase) play a significant role in healing of bone fractures, whereas oxidative stress delay such healing. The present study aimed to investigate the effect of a mixture of antioxidants (vitamins A, C, E, and selenium) on oxidative stress parameters, and the levels of bone healing markers in the plasma of male patients following fixative surgery of long bones. Antioxidant tablets (300 µg vitamin A, 10 mg vitamin E, 60 mg vitamin C, and 75 µg selenium) were administered to groups 3 and 4 (10 patients in each) for 1 and 2 weeks, respectively, in addition to the regular postoperative treatment. Groups 1 (25 patients) and 2 (10 patients) received the regular post-operative treatment consisting of intravenous (I.V.) second generation of cephalosporin 1000 mg/day for 3 days, oral diclofenac 50 mg, and paracetamol 500 mg twice daily for 15 days. Osteocalcin level and alkaline phosphatase activity as well as antioxidant enzymes superoxide dismutase (SOD), glutathione reductase (GR), as well as glutathione (GSH), and thiobarbituric acid reactive substances (TBARS) as indices of oxidative stress, were determined in the plasma of all patients after 1 or 2 weeks of long-bone fixative surgery. The results revealed that osteocalcin level and the activity of alkaline phosphatase were markedly increased in the plasma of patients who received antioxidants for 2 weeks. In addition, after 1 and/or 2 weeks, the levels of TBARS were significantly lower in the antioxidant-treated patients compared with those who did not receive antioxidants. On the other hand, the activities of SOD and GR were markedly elevated in plasma of patients who received antioxidants after 1 or 2 weeks compared with patients who received regular therapy. Moreover, the level of plasma GSH was markedly increased only after 2 weeks in patients who received antioxidants. It is concluded that administration of antioxidant vitamins A, E, and C in addition to selenium could accelerate bone healing after long-bone fixative surgery. Therefore, antioxidants should be considered in designing therapeutic protocols in post-operative bone surgery.
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Affiliation(s)
- A Sandukji
- Department of Orthopedic Surgery, Taibah University, KSA
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Uysal T, Gorgulu S, Yagci A, Karslioglu Y, Gunhan O, Sagdic D. Effect of resveratrol on bone formation in the expanded inter-premaxillary suture: early bone changes. Orthod Craniofac Res 2011; 14:80-7. [DOI: 10.1111/j.1601-6343.2011.01511.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah AS, Verma MK, Jebson PJL. Use of oral vitamin C after fractures of the distal radius. J Hand Surg Am 2009; 34:1736-8. [PMID: 19896015 DOI: 10.1016/j.jhsa.2009.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 08/20/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Apurva S Shah
- Department of Orthopaedic Surgery, University of Michigan Hospitals, Ann Arbor, MI, USA.
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Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL. Protective effect of total and supplemental vitamin C intake on the risk of hip fracture--a 17-year follow-up from the Framingham Osteoporosis Study. Osteoporos Int 2009; 20:1853-61. [PMID: 19347239 PMCID: PMC2766028 DOI: 10.1007/s00198-009-0897-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Vitamin C may play a role in bone health. In the Framingham Study, subjects with higher total or supplemental vitamin C intake had fewer hip fractures and non-vertebral fractures as compared to subjects with lower intakes. Therefore, vitamin C may have a protective effect on bone health in older adults. INTRODUCTION Dietary antioxidants such as vitamin C may play a role in bone health. We evaluated associations of vitamin C intake (total, dietary, and supplemental) with incident hip fracture and non-vertebral osteoporotic fracture, over a 15- to 17-year follow-up, in the Framingham Osteoporosis Study. METHODS Three hundred and sixty-six men and 592 women (mean age 75 +/- 5 years) completed a food frequency questionnaire (FFQ) in 1988-1989 and were followed for non-vertebral fracture until 2003 and hip fracture until 2005. Tertiles of vitamin C intake were created from estimates obtained using the Willett FFQ, after adjusting for total energy (residual method). Hazard ratios were estimated using Cox-proportional hazards regression, adjusting for covariates. RESULTS Over follow-up 100 hip fractures occurred. Subjects in the highest tertile of total vitamin C intake had significantly fewer hip fractures (P trend = 0.04) and non-vertebral fractures (P trend = 0.05) compared to subjects in the lowest tertile of intake. Subjects in the highest category of supplemental vitamin C intake had significantly fewer hip fractures (P trend = 0.02) and non-vertebral fractures (P trend = 0.07) compared to non-supplement users. Dietary vitamin C intake was not associated with fracture risk (all P > 0.22). CONCLUSION These results suggest a possible protective effect of vitamin C on bone health in older adults.
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Affiliation(s)
- Shivani Sahni
- Dietary Assessment and Epidemiology Research Program, Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) and Friedman School of Nutrition Science and Policy (FSNSP), Tufts University
| | - Marian T. Hannan
- Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School
| | - David Gagnon
- Department of Biostatistics, Boston University School of Public Health
| | - Jeffrey Blumberg
- Antioxidants Research Laboratory, HNRCA and FSNSP, Tufts University
| | | | - Douglas P. Kiel
- Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School
| | - Katherine L. Tucker
- Dietary Assessment and Epidemiology Research Program, Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) and Friedman School of Nutrition Science and Policy (FSNSP), Tufts University
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Uysal T, Amasyali M, Olmez H, Karslioglu Y, Gunhan O. Stimulation of bone formation in the expanding inter-premaxillary suture by vitamin E, in rat. ACTA ACUST UNITED AC 2009. [DOI: 10.4041/kjod.2009.39.5.337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tancan Uysal
- Associate Professor and Chair, Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Mihri Amasyali
- Research Assistant, Department of Orthodontics, Centre of Dental Sciences, Gülhane Military Medical Academy, Ankara, Turkey
| | - Huseyin Olmez
- Associate Professor, Department of Orthodontics, Centre of Dental Sciences, Gülhane Military Medical Academy, Ankara, Turkey
| | - Yildirim Karslioglu
- Assistant Professor, Department of Pathology, Faculty of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
| | - Omer Gunhan
- Professor, Department of Pathology, Faculty of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
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Alcantara-Martos T, Delgado-Martinez AD, Vega MV, Carrascal MT, Munuera-Martinez L. Effect of vitamin C on fracture healing in elderly Osteogenic Disorder Shionogi rats. ACTA ACUST UNITED AC 2007; 89:402-7. [PMID: 17356161 DOI: 10.1302/0301-620x.89b3.18007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the effect of vitamin C on fracture healing in the elderly. A total of 80 elderly Osteogenic Disorder Shionogi rats were divided into four groups with different rates of vitamin C intake. A closed bilateral fracture was made in the middle third of the femur of each rat. Five weeks after fracture the femora were analysed by mechanical and histological testing. The groups with the lower vitamin C intake demonstrated a lower mechanical resistance of the healing callus and a lower histological grade. The vitamin C levels in blood during healing correlated with the torque resistance of the callus formed (r = 0.525). Therefore, the supplementary vitamin C improved the mechanical resistance of the fracture callus in elderly rats. If these results are similar in humans, vitamin C supplementation should be recommended during fracture healing in the elderly.
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Affiliation(s)
- T Alcantara-Martos
- Hospital San Agustin, Avda de San Cristobal S/N, 23700 Linares, Jaén, Spain.
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Duygulu F, Yakan B, Karaoglu S, Kutlubay R, Karahan OI, Ozturk A. The effect of zymosan and the protective effect of various antioxidants on fracture healing in rats. Arch Orthop Trauma Surg 2007; 127:493-501. [PMID: 17639432 DOI: 10.1007/s00402-007-0395-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2005] [Indexed: 02/09/2023]
Abstract
AIM To investigate the effects of free oxygen radicals and various antioxidants on bone healing after experimental formation of fracture. MATERIALS AND METHODS Fifty male rats were used and divided into five groups (ten rats in each). The right forelimbs of the rats were broken by bimanual compression method. One hour before this procedure, 5 ml/kg of intraperitoneal (i.p.) physiologic saline were given to the control Group 1. All 40 rats in the experimental Groups 2, 3, 4 and 5 were treated with i.p. zymosan at a dosage of 100 mg/kg to induce the production of free radicals by stimulating NADPH oxidase in polymorphonuclear leukocytes. Zymosan induction was stopped on the fifth post-fracture day. In addition to the zymosan, i.p. 1 g/kg/day of dimethyl sulfoxide were given to the animals in Group 3, 50 mg/kg/d of Ginko biloba Extract (EGb 761) in Group 4 and 500 mg/kg/day of vitamin C in Group 5. Radiographs of the fractures of all animals were obtained to assess callus formation, remodeling and bridging bone formation under ether anesthetics on postfracture day 7, 14 and 21. All rats were euthanized on day 22, and sections of the radius and ulna were examined both histologically with light and electron microscopy and ultrastructurally. Statistical analysis was made with Kruskal-Wallis variance analyze test and comparison between groups was performed by Dunn's multiple comparison test. RESULTS An impairment of bone healing was observed in Group 2 inducted with purely zymosan. Variable results were obtained for bone healing in the groups treated with various antioxidants. There was very significant difference of fracture healing between Groups 1 and 2 both histologically and radiologically (P < 0.001). There was significant difference between Groups 2 and 5 radiologically (P < 0.05). CONCLUSION Free oxygen radicals demonstrate a negative effect on fracture healing and vitamin C (an antioxidant) partially prevents the negative effect of zymosan on fracture healing.
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Affiliation(s)
- Fuat Duygulu
- Department of Orthopedics, Erciyes University Medical Faculty, Kayseri, Turkey.
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Abstract
PURPOSE OF REVIEW The impact of vitamin C on oxidative stress-related diseases is moderate because of its limited oral bioavailability and rapid clearance. Parenteral administration can increase the benefit of vitamin C supplementation as is evident in critically ill patients. The aim here is to assess recent evidence of the clinical benefit and underlying effects of parenteral vitamin C in conditions of oxidative stress. RECENT FINDINGS In critically ill patients and after severe burns, the rapid restoration of depleted ascorbate levels with high-dose parenteral vitamin C may reduce circulatory shock, fluid requirements and oedema. SUMMARY Oxidative stress is associated with reduced ascorbate levels. Ascorbate is particularly effective in protecting the vascular endothelium, which is especially vulnerable to oxidative stress. The restoration of ascorbate levels may have therapeutic effects in diseases involving oxidative stress. The rapid replenishment of ascorbate is of special clinical significance in critically ill patients who experience drastic reductions in ascorbate levels, which may be a causal factor in the development of circulatory shock. Supraphysiological levels of ascorbate, which can only be achieved by the parenteral and not by the oral administration of vitamin C, may facilitate the restoration of vascular function in the critically ill patient.
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Affiliation(s)
- Gerard P McGregor
- Institute of Physiology, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
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Mendelssohn S. Why choice is more important for longevity than genetics, environment and circumstance. J Altern Complement Med 2005; 10:913-5. [PMID: 15673983 DOI: 10.1089/acm.2004.10.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Oztuna V, Ersöz G, Ayan I, Eskandari MM, Uğuz K, Kuyurtar F. Head injury-associated bone fractures induce bacterial translocation: an experimental study. J Orthop Trauma 2004; 18:92-5. [PMID: 14743028 DOI: 10.1097/00005131-200402000-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether long bone fractures cause bacterial translocation and to investigate the effect of concomitant head trauma on this process. DESIGN An in vivo animal model. SETTING Animal Laboratory, University of Mersin School of Medicine, Mersin, Turkey. SUBJECTS Male Sprague-Dawley rats (n = 60). INTERVENTION Sixty male Sprague-Dawley rats were divided into five groups: (1). anesthesia only (control group, n = 12); (2). anesthesia and tibia fracture (n = 12); (3). anesthesia, tibia fracture, and femur fracture (n = 12); (4). anesthesia, tibia fracture, femur fracture, and moderate head trauma (n = 12); and (5). moderate head trauma only (n = 12). After 24 hours, mesenteric lymph nodes, liver, spleen, ileum, and systemic blood samples were quantitatively cultured for aerobic organisms. MAIN OUTCOME MEASUREMENTS Colony-forming unit per gram for bacteria count. RESULTS The incidence of bacterial translocation was higher in groups that had fractures (4/12 in group 2; 5/12 in group 3) than in the control group (2/12); however, this did not reach statistical significance. There was a significant increase in the number of subjects with bacterial translocation in group 4 (9/12) compared with the control group and group 5 (3/12) (P = 0.0123, P = 0.0391). CONCLUSIONS Multiple fractures of long bones associated with head injury promote bacterial translocation.
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Affiliation(s)
- Volkan Oztuna
- Departments of Orthopaedics, Mersin University School of Medicine, Mersin, Turkey.
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Durak K, Sonmez G, Sarisozen B, Ozkan S, Kaya M, Ozturk C. Histological assessment of the effect of alpha-tocopherol on fracture healing in rabbits. J Int Med Res 2003; 31:26-30. [PMID: 12635530 DOI: 10.1177/147323000303100104] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
To investigate the effect of alpha-tocopherol (vitamin E) on fracture healing in rabbits, two groups of 10 rabbits were either injected with alpha-tocopherol (treated) or untreated (controls). The right femurs of both groups were fractured, and the treated group were injected intramuscularly with 20 mg/kg alpha-tocopherol daily for 5 days starting on the day of fracture. After 21 days, histological sections of the fractured region were examined and scored. Fracture healing had progressed further in the alpha-tocopherol group than in the control group. A statistically significant difference between the histological grading of fracture healing in the two groups was found. This difference may result from an antioxidant (alpha-tocopherol) effect on free oxygen radicals in the fracture area. We conclude that alpha-tocopherol may affect fracture healing favourably and might be useful as a therapeutic agent in clinical fracture management.
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Affiliation(s)
- K Durak
- Department of Orthopaedics and Traumatology, Uludag University Faculty of Medicine, Bursa, Turkey.
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