1
|
Quantitative Assessment of the Restoration of Original Anatomy after 3D Virtual Reduction of Long Bone Fractures. Diagnostics (Basel) 2022; 12:diagnostics12061372. [PMID: 35741182 PMCID: PMC9222009 DOI: 10.3390/diagnostics12061372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The purpose of this study was to demonstrate the usefulness of 3D image-based virtual reduction by validating the evaluation criteria according to guidelines suggested by the AO Surgery Reference. Methods: For this experiment, 19 intact radial ORTHObones (ORTHObones radius, 3B Scientific, Germany, Hamburg) without any fractures were prepared. All ORTHObones with six cortical marking holes (three points on the distal part and three points on the proximal part) were scanned using a CT scanner twice (before/after intentional fracture of the ORTHObone). After the virtual reduction of all 19 ORTHObones, accuracy evaluations using the four criteria (length variation, apposition variation, alignment variation, Rotation Variation) suggested in the AO Surgery Reference were performed. Results: The mean (M) length variation was 0.42 mm, with 0.01 mm standard deviation (SD). The M apposition variation was 0.48 mm, with 0.40 mm SD. The M AP angulation variation (for alignment variation) was 3.24°, with 2.95° SD. The M lateral angulation variation (for alignment variation) was 0.09°, with 0.13° SD. The M angle of axial rotation was 1.27° with SD: 1.19°. Conclusions: The method of accuracy evaluation used in this study can be helpful in establishing a reliable plan.
Collapse
|
2
|
Abstract
Objectives: Methods: Results: Conclusions:
Collapse
|
3
|
Chaudhary DS, Solanki JJ, Verma T, Chavali VH. Monitoring the Progress of Treatment in Fracture Non-Union: The Role of Alkaline Phosphatase and Ultrasonography. Rev Bras Ortop 2021; 56:796-803. [PMID: 34900110 PMCID: PMC8651451 DOI: 10.1055/s-0041-1724072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/02/2020] [Indexed: 10/31/2022] Open
Abstract
Objective To evaluate the role of serum alkaline phosphatase (ALP) and ultrasonography (USG) in monitoring the progress of treatment in diaphyseal non-unions. Methods This prospective observational cohort study included adult patients with diaphyseal fractures of major long bones previously treated with internal fixation and eventually resulting in non-union. Following the definitive treatment for non-union, the patients were followed-up periodically for six months, and serial monitoring of the levels of ALP and USG were performed along with radiographs (X-rays) to ascertain the status of the union. Results After an initial rise at seven weeks, ALP levels declined to normal values in fractures which united, whereas they remained high in cases of persistent non-union. Similarly, after an elevation of the vascular resistive index (RI) at around 12 weeks in all the patients, it decreased in cases progressing to union, while it remained persistently high even at 24 weeks in fractures failing to unite. Cases of persistent non-union continued to show hypoechogenic callus at 24 weeks instead of converting into hyperechogenic callus, as observed in cases which progressed to union. Conclusion Significant changes suggestive of union appeared simultaneously on the X-rays, USG and ALP levels during the follow-up. However, a serial examination of the ALP levels and USG during the follow-up gave a hint of the direction of progress in the healing process of fracture non-union. Their role in monitoring the outcome of non-union is more complimentary than supplementary to the X-rays.
Collapse
Affiliation(s)
- Dhanji S Chaudhary
- Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
| | - Jayur J Solanki
- Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
| | - Tarun Verma
- Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
| | - Viswanath H Chavali
- Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
| |
Collapse
|
4
|
Nicholson JA, Yapp LZ, Keating JF, Simpson AHRW. Monitoring of fracture healing. Update on current and future imaging modalities to predict union. Injury 2021; 52 Suppl 2:S29-S34. [PMID: 32826052 DOI: 10.1016/j.injury.2020.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
Fracture nonunion causes considerable patient morbidity and an associated burden to society. Traditional reliance on radiographs to monitor union has limitations as bridging callus of long bone fractures can take three or more months to occur. Computed Tomographic (CT) scanning is becoming increasingly popular and can evaluate bridging callus in the late stages of healing to confirm union. The use of dynamic contrast enhanced Magnetic Resonance Imaging (MRI) and advances in nuclear imaging may yield benefits in the assessment of the infected nonunion. Emerging evidence supports the use of ultrasound to detect bridging callus prior to radiographic confirmation and it may be of use to predict patients at high risk of nonunion. This paper is part of a Supplement supported by The Osteosynthesis and Trauma Care Foundation (OTCF).
Collapse
Affiliation(s)
- J A Nicholson
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom.
| | - L Z Yapp
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
| | - J F Keating
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
| | - A H R W Simpson
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
| |
Collapse
|
5
|
Nauta SP, Poeze M, Heeren RMA, Porta Siegel T. Clinical use of mass spectrometry (imaging) for hard tissue analysis in abnormal fracture healing. Clin Chem Lab Med 2021; 58:897-913. [PMID: 32049645 DOI: 10.1515/cclm-2019-0857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/16/2019] [Indexed: 12/23/2022]
Abstract
Common traumas to the skeletal system are bone fractures and injury-related articular cartilage damage. The healing process can be impaired resulting in non-unions in 5-10% of the bone fractures and in post-traumatic osteoarthritis (PTOA) in up to 75% of the cases of cartilage damage. Despite the amount of research performed in the areas of fracture healing and cartilage repair as well as non-unions and PTOA, still, the outcome of a bone fracture or articular cartilage damage cannot be predicted. Here, we discuss known risk factors and key molecules involved in the repair process, together with the main challenges associated with the prediction of outcome of these injuries. Furthermore, we review and discuss the opportunities for mass spectrometry (MS) - an analytical tool capable of detecting a wide variety of molecules in tissues - to contribute to extending molecular understanding of impaired healing and the discovery of predictive biomarkers. Therefore, the current knowledge and challenges concerning MS imaging of bone and cartilage tissue as well as in vivo MS are discussed. Finally, we explore the possibilities of in situ, real-time MS for the prediction of outcome during surgery of bone fractures and injury-related articular cartilage damage.
Collapse
Affiliation(s)
- Sylvia P Nauta
- The Maastricht MultiModal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, The Netherlands.,Department of Orthopedic Surgery and Traumasurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Division of Traumasurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Ron M A Heeren
- The Maastricht MultiModal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University, Universiteitssingel 50, 6229ER Maastricht, The Netherlands
| | - Tiffany Porta Siegel
- The Maastricht MultiModal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Rodrigues KEM, Lucas KDA, Cordeiro ALL, Silva RPM, Santos FGDA, de Carvalho YK. 3D models of nonunion fractures in long bones as education tools. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2021; 43:e114820. [PMID: 35749084 PMCID: PMC9179198 DOI: 10.29374/2527-2179.bjvm114820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022] Open
Abstract
The appearance of fracture complications can present itself as a difficult scenario in a veterinarian's practice, and it can be difficult to diagnose and have a poor prognosis. The recognition of the different types of nonunion fractures can enable quick guidance on the best way to act, thus reducing the cost of treatment and the patient's suffering. The objective of this study was to create 3D models of nonunion fractures in long bones (3D NUFs). The study was carried out in three stages: 1) creating biscuit models from representations of nonunion fractures; 2) scanning the biscuit models of nonunion fractures and 3D modeling; and 3) printing and finishing the 3D models of nonunion fractures (hereafter, 3D NUFs). The creation of biscuit prototypes and the respective digitalization were decisive in producing 3D NUFs, which reproduced the main characteristics of each type of nonunion fracture classification described in the literature. It took 31.1 hours to create and print all 3D NUFs using 95.66 grams of filament (ABS) for a total cost of $3.73. The creation of 3D NUFs from the biscuit dough presented a new way of obtaining didactic models for the teaching of veterinary medicine. The 3D NUFs represent the different forms of low-cost manifestations that characterize this disease, which can be used as a possible teaching-learning tool for veterinary education.
Collapse
Affiliation(s)
- Katriny Elifelina Monteiro Rodrigues
- Undergraduate in Veterinary Medicine, Centro de Ciência Biológicas e da Natureza (CCBN), Universidade Federal do Acre (UFAC), Rio Branco, AC, Brasil
| | - Kleber dos Anjos Lucas
- Undergraduate in Veterinary Medicine, Centro de Ciência Biológicas e da Natureza (CCBN), Universidade Federal do Acre (UFAC), Rio Branco, AC, Brasil
| | - Andrey Luiz Lopes Cordeiro
- Veterinarian, MSc. Programa de Pós-Graduação Sanidade e Produção Animal Sustentável na Amazônia Ocidental (PPGESPA), CCBN, UFAC, Rio Branco, AC, Brasil
| | - Romeu Paulo Martins Silva
- Physical educator, DSc., Departamento de Biotecnologia, Universidade Federal do Catalão (UFCAT), Catalão, GO, Brasil
| | | | - Yuri Karaccas de Carvalho
- Veterinarian, DSc., CCBN, UFAC, Rio Branco, AC, Brasil
- Correspondence Yuri Karaccas de Carvalho Centro de Ciências Biológicas e da Natureza, Universidade Federal do Acre - UFAC Rodovia BR 364, Km 04, Distrito Industrial CEP 69920-900 - Rio Branco (AC), Brasil E-mail:
| |
Collapse
|
7
|
Dallari D, Rani N, Sabbioni G, Mazzotta A, Cenacchi A, Savarino L. Radiological assessment of the PRF/BMSC efficacy in the treatment of aseptic nonunions: A retrospective study on 90 subjects. Injury 2016; 47:2544-2550. [PMID: 27659848 DOI: 10.1016/j.injury.2016.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/24/2016] [Accepted: 09/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nonunion is a major orthopaedic concern because of treatment difficulty, high costs and devastating effects on the patients' life quality. Therefore, there is interest in the use of bone substitutes and cell-based strategies to augment fracture repair. We aimed to verify if Platelet Rich Fibrin (PRF) added with bone marrow stromal cells (BMSC) was able to improve the reparative process in the aseptic nonunion, and to establish whether it was worthwhile with atrophic nonunion. The primary outcome was radiological union. As secondary endpoint, the healing time was assessed, and the radiological consolidation grade at each follow-up. METHODS We identified 113 subjects with tibia or femur nonunion and retrospectively created two groups. Group A was constituted by 56 subjects who underwent the standard procedure, i.e. Judet decortication with/out internal fixation devices, and opposite cortical homoplastic stick. In 57 patients, the standard procedure was modified by adding PRF and BMSC carried by homologous lyophilised bone chips (group B). The same surgeon performed all the operations. To our knowledge, no data are reported in the literature about such application. Since a "gold standard" for healing quantification does not exist, a new scoring radiological system was applied, at 1.5, 3, 6, 12 and 24 months after treatment. RESULTS At the final 24-month follow-up, the radiological union percentage was 94,12 in group B and 95,12% in group A. A decreased healing time was demonstrated in the presence of PRF/BMSC in comparison with the standard procedure. When we compared the radiological scores at each follow-up, we found that the PRF/BMSC combination significantly improved the consolidation grade at 1.5-, 3- and 6-month follow-up in femurs and at 1.5-month follow-up in tibiae. Furthermore, an improved consolidation grade was demonstrated in the atrophic subjects treated with adjuvants compared to atrophic patients treated with the standard procedure at 1.5-month follow-up. CONCLUSIONS This study supports the concept that the use of PRF/BMSC, during the standard procedure, is effective in shortening nonunion healing time. It could allow an early mobilization of patients, minimizing suffering, and could be an effective tool to reduce the health-care costs resulting from this issue. LEVEL OF EVIDENCE Therapeutic level III.
Collapse
Affiliation(s)
- D Dallari
- Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - N Rani
- Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - G Sabbioni
- Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - A Mazzotta
- Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - A Cenacchi
- Service of Immunohematology and Transfusional medicine, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - L Savarino
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Department of Complex Orthopaedic-Trauma Pathology Rizzoli Orthopaedic Institute, Bologna, Italy
| |
Collapse
|
8
|
Breer S, Auerswald M, Fuchs S, Jürgens C, Faschingbauer M, Dannenberg O. Versorgung von Pseudarthrosen der langen Röhrenknochen. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s10039-015-0100-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
9
|
Abstract
Infected non-union is a devastating complication post fracture fixation. While its incidence is small, its management is lengthy, challenging and costly. Complex reconstruction surgery is often required with unpredictable outcomes despite the significant advances that have been made in diagnostics, surgical techniques and antibiotic protocols. In this article we present recent approaches to the surgical treatment of this condition.
Collapse
|
10
|
|
11
|
Abstract
Fracture non-union remains a clinical problem despite advances in the understanding of basic science and technology. Each fracture has a unique personality as does the patient suffering the injury. Thus, each case must be treated on an individual basis. This article defines the problem of fracture non-union and reports recent epidemiological studies. We discuss relevant risk factors and methods for assessing patients who have a tendency toward fracture non-union. There are many treatment options for patients with non-union, where a number of these modalities are still under review. We discuss current evidence with the use of bone morphogenic protein, platelet-rich plasma and low-intensity pulsed ultrasound to augment the treatment of fracture non-union.
Collapse
|
12
|
Sousa CP, Dias IR, Lopez-Peña M, Camassa JA, Lourenço PJ, Judas FM, Gomes ME, Reis RL. Bone turnover markers for early detection of fracture healing disturbances: A review of the scientific literature. AN ACAD BRAS CIENC 2015; 87:1049-61. [PMID: 25993365 DOI: 10.1590/0001-3765201520150008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/30/2015] [Indexed: 01/18/2023] Open
Abstract
Imaging techniques are the standard method for assessment of fracture healing processes. However, these methods are perhaps not entirely reliable for early detection of complications, the most frequent of these being delayed union and non-union. A prompt diagnosis of such disorders could prevent prolonged patient distress and disability. Efforts should be directed towards the development of new technologies for improving accuracy in diagnosing complications following bone fractures. The variation in the levels of bone turnover markers (BTMs) have been assessed with regard to there ability to predict impaired fracture healing at an early stage, nevertheless the conclusions of some studies are not consensual. In this article the authors have revised the potential of BTMs as early predictors of prognosis in adult patients presenting traumatic bone fractures but who did not suffer from osteopenia or postmenopausal osteoporosis. The available information from the different studies performed in this field was systematized in order to highlight the most promising BTMs for the assessment of fracture healing outcome.
Collapse
Affiliation(s)
- Cristina P Sousa
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Isabel R Dias
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Mónica Lopez-Peña
- Department of Veterinary Clinics Sciences, Faculty of Veterinary Medicine, Universidad de Santiago de Compostela, Lugo, Spain
| | - José A Camassa
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | | | - Manuela E Gomes
- Departamento de Engenharia de Polímeros, Universidade do Minho, Barco GMR, Portugal
| | - Rui L Reis
- Departamento de Engenharia de Polímeros, Universidade do Minho, Barco GMR, Portugal
| |
Collapse
|
13
|
Abstract
Fracture healing is a complex biological process that requires interaction among a series of different cell types. Maintaining the appropriate temporal progression and spatial pattern is essential to achieve robust healing. We can temporally assess the biological phases via gene expression, protein analysis, histologically, or non-invasively using biomarkers as well as imaging techniques. However, determining what leads to normal versus abnormal healing is more challenging. Since the ultimate outcome of fracture healing is to restore the original functions of bone, assessment of fracture healing should include not only monitoring the restoration of structure and mechanical function, but also an evaluation of the restoration of normal bone biology. Currently few non-invasive measures of biological factors of healing exist; however, recent studies that have correlated non-invasive measures with fracture healing outcome in humans have shown that serum TGFbeta1 levels appear to be an indicator of healing versus non-healing. In the future, developing additional measures to assess biological healing will improve the reliability and permit us to assess stages of fracture healing. Additionally, new functional imaging technologies could prove useful for better understanding both normal fracture healing and predicting dysfunctional healing in human patients.
Collapse
Affiliation(s)
- KD Hankenson
- Department of Clinical Studies New Bolton Center, School of Veterinary Medicine and Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania
| | - G Zmmerman
- Department of Orthopedic and Trauma Surgery, University of Heidelberg, Theresienkrankenhaus Mannheim, Germany
| | | |
Collapse
|
14
|
Characterization and in vivo biological performance of biosilicate. BIOMED RESEARCH INTERNATIONAL 2013; 2013:141427. [PMID: 24205501 PMCID: PMC3800615 DOI: 10.1155/2013/141427] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
After an introduction showing the growing interest in glasses and glass-ceramics as biomaterials used for bone healing, we describe a new biomaterial named Biosilicate. Biosilicate is the designation of a group of fully crystallized glass-ceramics of the Na2O-CaO-SiO2-P2O5 system. Several in vitro tests have shown that Biosilicate is a very active biomaterial and that the HCA layer is formed in less than 24 hours of exposure to “simulated body fluid” (SBF) solution. Also, in vitro studies with osteoblastic cells have shown that Biosilicate disks supported significantly larger areas of calcified matrix compared to 45S5 Bioglass, indicating that this bioactive glass-ceramic may promote enhancement of in vitro bone-like tissue formation in osteogenic cell cultures. Finally, due to its special characteristics, Biosilicate has also been successfully tested in several in vivo studies. These studies revealed that the material is biocompatible, presents excellent bioactive properties, and is effective to stimulate the deposition of newly formed bone in animal models. All these data highlight the huge potential of Biosilicate to be used in bone regeneration applications.
Collapse
|
15
|
Kido HW, Oliveira P, Parizotto NA, Crovace MC, Zanotto ED, Peitl-Filho O, Fernandes KPS, Mesquita-Ferrari RA, Ribeiro DA, M. Renno AC. Histopathological, cytotoxicity and genotoxicity evaluation of Biosilicate® glass-ceramic scaffolds. J Biomed Mater Res A 2012; 101:667-73. [DOI: 10.1002/jbm.a.34360] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/19/2012] [Accepted: 06/26/2012] [Indexed: 11/10/2022]
|
16
|
Moghaddam A, Müller U, Roth HJ, Wentzensen A, Grützner PA, Zimmermann G. TRACP 5b and CTX as osteological markers of delayed fracture healing. Injury 2011; 42:758-64. [PMID: 21168135 DOI: 10.1016/j.injury.2010.11.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/17/2010] [Accepted: 11/10/2010] [Indexed: 02/02/2023]
Abstract
Radiological studies are the standard method to monitor fracture healing but they do not allow a timely assessment of bone healing. Biochemical markers react rapidly to changes in bone metabolism during fracture healing and could be an additional tool to monitor this process. The goal of this study was to observe changes in serum biomarkers and evaluate the possible differences in the serum levels of tartrate-resistant acid phosphatase 5b (TRACP 5b), total N-terminal propeptide of type I collagen (PINP), bone-specific alkaline phosphatase (BAP), and C-terminal cross-linking telopeptide of type I collagen (CTX) in patients with normal and delayed fracture healing. Several serum samples were collected for one year after the surgical treatment of long bone fractures in 248 patients. From this large pool, 15 patients with atrophic nonunion were matched to 15 patients with normal bone healing. Post-operative changes in osteological markers were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd weeks. The patients were followed both clinically and radiologically for the entire one-year duration of the study. In the first week, the absolute values of CTX decreased significantly (p=0.0164) in cases of delayed fracture healing. The relative values of TRACP 5b were significantly decreased at weeks 4 (p=0.0066) and 8 (p=0.0043). BAP and PINP levels decreased in the first week followed by an increase, but there were no significant differences in the absolute or relative values during the healing process in both patient groups. For the first time, we have demonstrated changes in serum concentrations of TRACP 5b, PINP, BAP, and CTX during normal and delayed fracture healing. Characteristic changes in systemic TRACP 5b and CTX levels could reflect the initial process of successful fracture healing and may be used in clinical practice to monitor the healing process. Furthermore, it could be very important for determining the beneficial effects of additional treatments such as ultrasound or BMPs in clinical trials.
Collapse
Affiliation(s)
- A Moghaddam
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfallchirurgie und Orthopädie, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany.
| | | | | | | | | | | |
Collapse
|
17
|
Blum ALL, BongioVanni JC, Morgan SJ, Flierl MA, dos Reis FB. Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. ACTA ACUST UNITED AC 2010; 92:565-70. [PMID: 20357336 DOI: 10.1302/0301-620x.92b4.23475] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistent pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications.
Collapse
Affiliation(s)
- A L L Blum
- Department of Orthopaedics and Traumatology, Federal University, Rua Borges Lagoa, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
18
|
|
19
|
Tosounidis T, Kontakis G, Nikolaou V, Papathanassopoulos A, Giannoudis PV. Fracture healing and bone repair: an update. TRAUMA-ENGLAND 2009. [DOI: 10.1177/1460408609335922] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bone healing represents a physiological process of repair and restoration of function. Recent advances in a variety of medical disciplines have enabled scientists and clinicians to characterise this phenomenon at the molecular level. A number of molecular mediators and cells interact utilising different pathways. Despite the involvement of many local and systemic factors failure of the naturally occurring mechanisms can occur leading to either delayed union or non-union. This review article is focused on the recent understanding of the mechanisms governing the bone repair process.
Collapse
Affiliation(s)
| | - George Kontakis
- Department of Orthopaedics and Traumatology, University of Crete, Greece
| | - Vassilis Nikolaou
- Academic Department of Trauma and Orthopaedics, University of Leeds, UK
| | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, University of Leeds, UK,
| |
Collapse
|
20
|
Kwong FN, Hoyland JA, Freemont AJ, Evans CH. Altered relative expression of BMPs and BMP inhibitors in cartilaginous areas of human fractures progressing towards nonunion. J Orthop Res 2009; 27:752-7. [PMID: 19058174 PMCID: PMC4382003 DOI: 10.1002/jor.20794] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present study was conducted to evaluate the hypothesis that an imbalance in the local production of bone morphogenetic proteins (BMPs) and BMP inhibitors exists within the cartilaginous intermediate of nonhealing fractures. Biopsies were recovered intraoperatively from human fractures that, upon follow-up, were found to heal normally or become nonunions. The samples were examined by immunohistochemistry to determine the expression of BMP-2, BMP-14, and the BMP inhibitors noggin and chordin. Expression was determined semiquantitatively based on the area of positive staining per area of cartilage and by determining the number of positively staining cells and the intensity of staining. There was a significant reduction in BMP-2 and BMP-14 expression in cartilaginous areas of nonhealing fractures compared to healing fractures. However, there was no difference in the expression of the BMP inhibitors between the two groups of fractures. This imbalance in the expression of BMPs and BMP inhibitors within cartilaginous areas of developing nonunions may account for their reduced bone forming ability. These data suggest strategies for preventing the development of nonunions by altering levels of BMPs and their inhibitors within fracture sites.
Collapse
Affiliation(s)
- Francois N.K. Kwong
- Center for Molecular Orthopaedics, Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115,Tissue Injury and Repair Group, School of Clinical and Laboratory Sciences, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT United Kingdom
| | - Judith A. Hoyland
- Tissue Injury and Repair Group, School of Clinical and Laboratory Sciences, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT United Kingdom
| | - Anthony J. Freemont
- Tissue Injury and Repair Group, School of Clinical and Laboratory Sciences, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT United Kingdom
| | - Christopher H. Evans
- Center for Molecular Orthopaedics, Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115
| |
Collapse
|