Effects of trkB and trkC neurotrophin receptor agonists on thermal nociception: a behavioral and electrophysiological study

Nerve-growth factor (NGF), a member of the neurotrophin family, plays an important role in nociceptor function. Prompted by a previous uinexpected finding that NT-4/5, as well as NGF sensitizes single nociceptors to noxious heat, we have explored the relative potency of all neurotrophins in eliciting thermal hyperalgesia. NGF, brain-derived neurotrophic factor (BDNF), NT-4/5 and NT-3 were injected locally into the hind paw of rats, and the behavioral response to noxious heat was compared with that from the other paw that received an identical injection of vehicle. Like NGF, agonists of tyrosine kinaseB (trkB) receptors (NT-4/5 and BDN F) induced thermal hyperalgesia in the first 5 h after treatment (NT-4/5 > BDNF) but the effect had worn off by 24 h. In contrast, the trkC agonist NT-3 had no effect on the response to noxious heat. Electrophysiological recordings from single C-fibres in the in vitro skin-saphenous nerve preparation revealed sensitization to noxious heat stimuli after direct application of BDNF to the receptive field, as previously noted for NT-4/5, and in parallel with the behavioral findings. NT-3 was ineffective as in the behavioral studies. These results suggest that trkB agonists BDNF and NT-4/5 as well as the trkA agonist NGF can regulate nociceptive responses to noxious heat.

Effect of loading and fracture motions on diaphyseal tibial fractures

A computerized motion sensor was used to record the three-dimensional components of interfragmentary motion during healing in three patients with closed, low-energy fractures of the tibial diaphysis treated with functional braces. At the first measurement session 2 weeks after fracture, the patients applied approximately 15 kg to the injured limb. Although this produced 1-4 mm of translation of the fragments, this was recovered when the load was removed. The maximum rotational and angulatory displacements often occurred as the patients rose from the chair with no weight applied to the limb and frequently were reduced as the 15 kg of load was applied. Under load, the maximum axial rotation was 3 degrees and the maximum angular displacement was 1 degree. As with the translations, the initial rotational and angulatory positions of the fragments were recovered when the load was removed and the patient returned to the seated position. At 8 weeks, the patient applied full body weight, producing a maximum interfragmentary translation of 0.5 mm and maximum axial rotation or angulation of 0.5 degrees. Abundant peripheral callus formed in all three fractures, and they healed by 15 weeks through typical gradual consolidation and mineralization of the callus, accompanied by a corresponding reduction in interfragmentary motions.

Technique for producing controlled closed fractures in a rabbit model

We describe a new technique to produce a closed fracture of the rabbit tibia with reproducible location and shape of the fracture. The hindlimb of a New Zealand White rabbit was enclosed in a bivalved cast, a 1.5 mm diameter hole was drilled through the lateral tibial cortex, and the tibia was fractured by loading in three-point bending in an arbor press. The cast protected the soft tissues from being crushed while it concentrated the bending moment at the intended fracture site. The cortical hole functioned as a stress riser and fracture initiation site, such that the influence of the loading rate on the fracture characteristics was minimized. Transverse fractures or oblique fractures at any desired angle could be produced by variations of the position of the cortical drill hole relative to the central loading point. Thirty-four tibial fractures (18 transverse and 16 oblique) were produced. The rabbits were killed immediately, and the fracture angle and the extent of tissue damage were evaluated radiographically, as well as macroscopically. This method produced a consistent location of the fracture, with 88% reproducibility of the fracture angle and only minor damage to the adjacent soft tissues.

The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results

The correlation between the thickness of the cement mantle, the medullary canal fill, and the orientation of the stem and the long-term radiographic outcome of 836 cemented femoral components in patients who had a primary total hip replacement was assessed with use of survival analysis over a twenty-one-year follow-up period. The femoral stems of hips that had a two to five-millimeter-thick cement mantle in the proximal medial region had a better outcome than stems implanted with a thicker or thinner cement mantle. Stems in femora with less than two millimeters of proximal medial cancellous bone had a better outcome than stems in femora with thicker cancellous bone. Stems that filled more than half of the medullary canal had better radiographic results than those that filled half or less. Progressive loosening, fracture of the cement, and radiolucent lines at the stem-cement or bone-cement interfaces were more likely to develop in stems that were oriented in more than 5 degrees of varus than in those in neutral or valgus. The noted correlations were true whether the stem was made of titanium alloy or of stainless steel. The results of this study emphasize the importance of careful preoperative planning in total hip arthroplasty done with cement and provide guidelines for the selection of the shape, size, and position of the stem.

Healing and remodeling of articular incongruities in a rabbit fracture model

Healing of 0.5 or 1.0-millimeter step-off defects associated with displaced intra-articular fractures of the medial femoral condyle was examined in fifty-four adult New Zealand White rabbits. The rabbits were treated with either immobilization for three weeks, intermittent active motion, or continuous passive motion for seven days. At twelve weeks, the healing and remodeling of the step-off defects were examined with use of contact-pressure maps on pressure-sensitive film, light microscopy (with hematoxylin and eosin or safranin-O staining), and scanning electron microscopy. Macroscopically, the sharp profile that had been present initially with both sizes of step-off defect had rounded off; however, there was less residual incongruity with the 0.5-millimeter step-offs than with the 1.0-millimeter step-offs. Among step-off defects of the same size, the method of treatment had no discernible effect on the macroscopic appearance of the surface of the joint. With fresh step-offs (the control group), the contact pressure of the cartilage on the elevated side was approximately three times greater than that at a distance from the step-off. On the depressed side, an unloaded zone extended approximately three times the height of the step-off, with an average width of 3.4 millimeters for the 1.0-millimeter step-offs and 1.6 millimeters for the 0.5-millimeter step-offs. After healing and remodeling, the unloaded zone still averaged 2.5 millimeters in width for the 1.0-millimeter step-offs but had decreased to only 0.35 millimeter in width for the 0.5-millimeter step-offs. For seven of the nine 0.5-millimeter step-offs, the contact pressure in the previously unloaded zone ranged from 0.5 to 1.5 megapascals, with a mean of 0.8 megapascal (40 per cent of the normal mean contact pressure at this location). Under light microscopy, the cartilage on the elevated side of the healed step-offs had decreased in thickness, was displaced toward the defect and tapered toward the depressed side, and ended in a hypocellular tissue flap. In contrast, the cartilage on the depressed side had thickened as a result of hyperplasia of the chondrocytes and hypertrophy of the cartilage and had failed to establish continuity between the sides of the defect. There was a marked increase in the subchondral vascular bed and re-establishment of the subchondral plate. With the exception of the aforementioned hypocellular tissue flap, safranin O stained the cartilage on both levels of the step-off uniformly, which indicated the absence of glycosaminoglycan depletion.(ABSTRACT TRUNCATED AT 400 WORDS)

Total hip replacement after failed hemiarthroplasty or mould arthroplasty. Comparison of results with those of primary replacements

We compared the radiographic results of secondary total hip replacements, 99 following failed uncemented hemiarthroplasties and 21 following failed mould arthroplasties, with those of 825 primary cemented total hip replacements. The probability of occurrence of a number of radiological changes over time was calculated using survival analysis. The mean follow-up was 7.6 years (range one month to 20 years). The performance of the secondary total hip replacements varied with the preceding implant and was different for acetabular and femoral components. The incidence of radiological loosening was higher for femoral components implanted after failed hemiarthroplasties and for acetabular components after failed mould arthroplasties. However, the incidence of continuous radiolucent lines was lower for the acetabular components of converted hemiarthroplasties than for the primary replacements.