101
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Liu YZ, Akhter MP, Gao X, Wang XY, Wang XB, Zhao G, Wei X, Wu HJ, Chen H, Wang D, Cui L. Glucocorticoid-induced delayed fracture healing and impaired bone biomechanical properties in mice. Clin Interv Aging 2018; 13:1465-1474. [PMID: 30197508 PMCID: PMC6112798 DOI: 10.2147/cia.s167431] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The objective of the study was to investigate the effects of glucocorticoid (GC) on the fracture healing process in a closed femur fracture mice model. Materials and methods Forty 12-week-old female CD-1 mice were randomly allocated into four groups: healthy control and mice with prednisone exposure (oral gavage), 6 mg/kg/day (GC-L), 9 mg/kg/day (GC-M) and 12 mg/kg/day (GC-H). Three weeks after the initiation of prednisone dosing, closed femur fractures were created on prednisone-exposed mice and the healthy control. Prednisone administration was continued for 9 weeks post-fracture, and X-ray imaging was performed weekly to monitor the fracture healing process until the mice were euthanized. Necropsy was performed after 9 weeks and the fractured femurs were isolated and processed at necropsy for micro-CT and biomechanical property analysis. Another 20 mice (control and GC-H, 10 mice/group) were used for histology and micro-CT analysis at early time point (2-week post fracture) with continued prednisone exposure. Results The results showed that oral administration of prednisone for 3 months in this strain of mice could inhibit endochondral ossification and delay the healing process, especially hard callus formation (woven bone) and bone remodeling during healing. It also could significantly decrease bone biomechanical properties. Conclusion Long-term GC administration leads to significantly delayed fracture healing and impaired bone biomechanical properties. This mouse model may be used to systematically study the cellular and molecular mechanisms underlying fracture healing with GC treatment background and may also be used to study the influence of different therapeutic interventions for bone fracture healing.
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Affiliation(s)
- Yan-Zhi Liu
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, People's Republic of China, .,Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Mohammed P Akhter
- Osteoporosis Research Center, Department of Medicine, Creighton University, Omaha, NE, USA
| | - Xiang Gao
- Stem Cell Research and Cellular Therapy Center, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Xiao-Yan Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Xiao-Bei Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Gang Zhao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Xin Wei
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Hao-Jun Wu
- Stem Cell Research and Cellular Therapy Center, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Hang Chen
- Stem Cell Research and Cellular Therapy Center, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Dong Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA,
| | - Liao Cui
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, People's Republic of China,
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102
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A Novel In Vivo Model to Study Impaired Tissue Regeneration Mediated by Cigarette Smoke. Sci Rep 2018; 8:10926. [PMID: 30026555 PMCID: PMC6053433 DOI: 10.1038/s41598-018-28687-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/13/2018] [Indexed: 12/27/2022] Open
Abstract
Cigarette smoke is associated with several pathologies including chronic respiratory diseases and cancer. In addition, exposure to cigarette smoke is correlated with impaired wound healing, where a significant decrease in the regenerative capacity of smokers is well documented and broadly considered a negative risk factor after trauma or surgery. So far, some in vitro and in vivo models have been described to study how exposure to cigarette smoke diminishes the regenerative potential in different organisms. However, although useful, many of these models are difficult and expensive to implement and do not allow high-throughput screening approaches. In order to establish a reliable and accessible model, we have evaluated the effects of cigarette smoke extract (CSE) on zebrafish development and regeneration. In this work, zebrafish embryos and larvae were exposed to low doses of aqueous CSE showing severe developmental abnormalities in a dose-dependent manner. Furthermore, when adult zebrafish were subjected to caudal fin amputation, we observed a significant decrease in the regenerative capacity of animals exposed to CSE. The effect was exacerbated in male and aged fish compared to female or young organisms. The establishment of a zebrafish model to assess the consequences of cigarette smoke and its effects on animal physiology could provide a new tool to study the underlying mechanisms involved in impaired tissue regeneration, and aid the development of novel approaches to treat complications associated with cigarette smoke toxicity.
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103
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Cheng A, Krishnan L, Tran L, Stevens HY, Xia B, Lee N, Williams JK, Gibson G, Guldberg RE. The Effects of Age and Dose on Gene Expression and Segmental Bone Defect Repair After BMP-2 Delivery. JBMR Plus 2018; 3:e10068. [PMID: 30828685 PMCID: PMC6383700 DOI: 10.1002/jbm4.10068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 11/25/2022] Open
Abstract
Age is a well‐known influential factor in bone healing, with younger patients generally healing bone fractures more rapidly and suffering fewer complications compared with older patients. Yet the impact age has on the response to current bone healing treatments, such as delivery of bone morphogenetic protein 2 (BMP‐2), remains poorly characterized. It remains unclear how or if therapeutic dosing of BMP‐2 should be modified to account for age‐related differences in order to minimize potential adverse effects and consequently improve patient bone‐healing outcomes. For this study, we sought to address this issue by using a preclinical critically sized segmental bone defect model in rats to investigate age‐related differences in bone repair after delivery of BMP‐2 in a collagen sponge, the current clinical standard. Femoral defects were created in young (7‐week‐old) and adult (8‐month‐old) rats, and healing was assessed using gene expression analyses, longitudinal radiography, ex vivo micro‐computed tomography (µCT), as well as torsional testing. We found that young rats demonstrated elevated expression of genes related to osteogenesis, chondrogenesis, and matrix remodeling at the early 1‐week time point compared with adult rats. These early gene expression differences may have impacted long‐term healing as the regenerated bones of young rats exhibited higher bone mineral densities compared with those of adult rats after 12 weeks. Furthermore, the young rats demonstrated significantly more bone formation and increased mechanical strength when BMP‐2 dose was increased from 1 µg to 10 µg, a finding not observed in adult rats. Overall, these results indicate there are age‐related differences in BMP‐2‐mediated bone regeneration, including relative dose sensitivity, suggesting that age is an important consideration when implementing a BMP‐2 treatment strategy. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Albert Cheng
- George W. Woodruff School of Mechanical Engineering Georgia Institute of Technology Atlanta GA USA.,Parker H. Petit Institute for Bioengineering and Bioscience Georgia Institute of Technology Atlanta GA USA
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering and Bioscience Georgia Institute of Technology Atlanta GA USA
| | - Lisa Tran
- Emory University School of Medicine Atlanta GA USA
| | - Hazel Y Stevens
- George W. Woodruff School of Mechanical Engineering Georgia Institute of Technology Atlanta GA USA
| | - Boao Xia
- George W. Woodruff School of Mechanical Engineering Georgia Institute of Technology Atlanta GA USA
| | - Nari Lee
- Emory University Pediatric Engineering Research Summer Experience Atlanta GA USA
| | | | - Greg Gibson
- Center for Integrative Genomics School of Biological Sciences Georgia Institute of Technology Atlanta GA USA
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering Georgia Institute of Technology Atlanta GA USA.,Parker H. Petit Institute for Bioengineering and Bioscience Georgia Institute of Technology Atlanta GA USA
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104
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Ledet EH, Sanders GP, DiRisio DJ, Glennon JC. Load-sharing through elastic micro-motion accelerates bone formation and interbody fusion. Spine J 2018; 18:1222-1230. [PMID: 29452282 PMCID: PMC6008179 DOI: 10.1016/j.spinee.2018.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/06/2018] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Achieving a successful spinal fusion requires the proper biological and biomechanical environment. Optimizing load-sharing in the interbody space can enhance bone formation. For anterior cervical discectomy and fusion (ACDF), loading and motion are largely dictated by the stiffness of the plate, which can facilitate a balance between stability and load-sharing. The advantages of load-sharing may be substantial for patients with comorbidities and in multilevel procedures where pseudarthrosis rates are significant. PURPOSE We aimed to evaluate the efficacy of a novel elastically deformable, continuously load-sharing anterior cervical spinal plate for promotion of bone formation and interbody fusion relative to a translationally dynamic plate. STUDY DESIGN/SETTING An in vivo animal model was used to evaluate the effects of an elastically deformable spinal plate on bone formation and spine fusion. METHODS Fourteen goats underwent an ACDF and received either a translationally dynamic or elastically deformable plate. Animals were followed up until 18 weeks and were evaluated by plain x-ray, computed tomography scan, and undecalcified histology to evaluate the rate and quality of bone formation and interbody fusion. RESULTS Animals treated with the elastically deformable plate demonstrated statistically significantly superior early bone formation relative to the translationally dynamic plate. Trends in the data from 8 to 18 weeks postoperatively suggest that the elastically deformable implant enhanced bony bridging and fusion, but these enhancements were not statistically significant. CONCLUSIONS Load-sharing through elastic micro-motion accelerates bone formation in the challenging goat ACDF model. The elastically deformable implant used in this study may promote early bony bridging and increased rates of fusion, but future studies will be necessary to comprehensively characterize the advantages of load-sharing through micro-motion.
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Affiliation(s)
- Eric H. Ledet
- ReVivo Medical, 33 Old Niskayuna Road, Loudonville, NY 12211,Rensselaer Polytechnic Institute, Department of Biomedical Engineering, 110 8 Street, Troy, NY 12180,Stratton VA Medical Center, R&D Service, 113 Holland Avenue, Albany, NY, 12208
| | | | - Darryl J. DiRisio
- ReVivo Medical, 33 Old Niskayuna Road, Loudonville, NY 12211,Albany Medical College, Department of Neurosurgery, 47 New Scotland Avenue, Albany, NY 12208
| | - Joseph C. Glennon
- Veterinary Specialties Referral Center, 1641 Main Street, Pattersonville, NY 12137
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105
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Lisowska B, Kosson D, Domaracka K. Positives and negatives of nonsteroidal anti-inflammatory drugs in bone healing: the effects of these drugs on bone repair. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1809-1814. [PMID: 29950815 PMCID: PMC6016595 DOI: 10.2147/dddt.s164565] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Tissue damage following injury triggers the processes of coagulation, inflammation and healing. In tissues surrounding the bone, the result of the healing process is a scar, while bone tissue has a unique ability to achieve shape, strength and pre-injury function. Bone healing is a process of regeneration rather than classic recovery. The result of this process is the formation of new, healthy bone tissue instead of a scar. Many factors can inhibit or impair the bone healing process, and their influence is critical during the stages of inflammation and angiogenesis and finally on the clinical outcome. Nonsteroidal anti-inflammatory drugs (NSAIDs) play an essential role associated with their analgesic potency and anti-inflammatory effects. NSAIDs are also the most often used drugs in patients who require pain control and inflammation reduction due to musculoskeletal diseases or injures. Although their analgesic effect is well documented, NSAIDs also interfere with bone healing; therefore, the relative benefits and disadvantages connected with their administration should be taken into consideration. Despite the negative effect, NSAIDs have beneficial properties, but their clinical benefits in relation to dose and time of use are still unclear. Therefore, in this review, we focus on bone healing with relation to the impact of NSAIDs.
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Affiliation(s)
- Barbara Lisowska
- Department of Anesthesiology and Intensive Care, John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Division of Teaching Warsaw, Warsaw, Poland
| | - Karolina Domaracka
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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106
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MacLeod AR, Pankaj P. Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations. Injury 2018; 49 Suppl 1:S12-S18. [PMID: 29929685 DOI: 10.1016/s0020-1383(18)30296-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most locked plating failures are due to inappropriate device configuration for the fracture pattern. Several studies cite screw positioning variables such as the number and spacing of screws as responsible for occurrences of locking plate breakage, screw loosening, and peri-prosthetic re-fracture. It is also widely accepted that inappropriate device stiffness can inhibit or delay healing. Careful preoperative planning is therefore critical if these failures are to be prevented. This study examines several variables which need to be considered when optimising a locking plate fixation device for fracture treatment including: material selection; screw placement; the effect of the fracture pattern; and the bone-plate offset. We demonstrate that device selection is not straight-forward as many of the variables influence one-another and an identically configured device can perform very differently depending upon the fracture pattern. Finally, we summarise the influence of some of the key parameters and the influence this can have on the fracture healing environment and the stresses within the plate in a flowchart.
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Affiliation(s)
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, UK.
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107
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Abstract
Approximately a third of patients presenting with long-bone non-union have undergone plate fixation as their primary procedure. In the assessment of a potential fracture non-union it is critical to understand the plating technique that the surgeon was intending to achieve at the primary procedure, i.e. whether it was direct or indirect fracture repair. The distinction between delayed union and non-union is a diagnostic dilemma especially in plated fractures, healing by primary bone repair. The distinction is important as nonunions are not necessarily part of the same spectrum as delayed unions. The etiology of a fracture non-union is usually multifactorial and the factors can be broadly categorized into mechanical factors, biological (local and systemic) factors, and infection. Infection is present in ~40% of fracture non-unions, often after open fractures or impaired wound healing, but in 5% of all non-unions infection is present without any clinical or serological suspicion. Methods to improve the sensitivity of investigation in the search of infection include the use of; sonication of implants, direct inoculation of theatre specimens into broth, and histological examination of non-union site tissue. Awareness should be given to the potential anti-osteogenic effect of bisphosphonates (in primary fracture repair) and certain classes of antibiotics. Early cases of delayed/non-union with sufficient mechanical stability and biologically active bone can be managed by stimulation of fracture healing. Late presenting non-union typically requires revision of the fixation construct and stimulation of the callus to induce fracture union.
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Affiliation(s)
- A Hamish R W Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - S T Jerry Tsang
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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108
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Ding ZC, Lin YK, Gan YK, Tang TT. Molecular pathogenesis of fracture nonunion. J Orthop Translat 2018; 14:45-56. [PMID: 30035032 PMCID: PMC6019407 DOI: 10.1016/j.jot.2018.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023] Open
Abstract
Fracture nonunion, a serious bone fracture complication, remains a challenge in clinical practice. Although the molecular pathogenesis of nonunion remains unclear, a better understanding may provide better approaches for its prevention, diagnosis and treatment at the molecular level. This review tries to summarise the progress made in studies of the pathogenesis of fracture nonunion. We discuss the evidence supporting the concept that the development of nonunion is related to genetic factors. The importance of several cytokines that regulate fracture healing in the pathogenesis of nonunion, such as tumour necrosis factor-α, interleukin-6, bone morphogenetic proteins, insulin-like growth factors, matrix metalloproteinases and vascular endothelial growth factor, has been proven in vitro, in animals and in humans. Nitric oxide and the Wnt signalling pathway also play important roles in the development of nonunion. We present potential strategies for the prevention, diagnosis and treatment of nonunion, and the interaction between genetic alteration and abnormal cytokine expression warrants further investigation. The translational potential of this article A better understanding of nonunion molecular pathogenesis may provide better approaches for its prevention, diagnosis and treatment in clinical practice.
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Affiliation(s)
- Zi-Chuan Ding
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, 639 Zhizaoju Road, Shanghai, China
| | - Yi-Kai Lin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, 639 Zhizaoju Road, Shanghai, China
| | - Yao-Kai Gan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, 639 Zhizaoju Road, Shanghai, China
| | - Ting-Ting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, 639 Zhizaoju Road, Shanghai, China
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109
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Biomimetic Implant Surface Functionalization with Liquid L-PRF Products: In Vitro Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9031435. [PMID: 29854805 PMCID: PMC5964419 DOI: 10.1155/2018/9031435] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/22/2018] [Indexed: 01/30/2023]
Abstract
Objective Platelet-rich fibrin (PRF) clots and membranes are autologous blood concentrates widely used in oral surgical procedures; less is known, however, about the liquid formulations of such products. The aim of this in vitro study is to assess the behavior of different implant surfaces when in contact with two liquid leucocyte- and platelet-rich fibrin (L-PRF) products. Methods Six commercial pure titanium discs, of 9.5 mm diameter and 1.5 mm thickness, were used. Three of these samples had a micro/nano-rough surface; three were machined. Three different protocols were tested. Protocols involved the immersion of the samples in (1) a platelets, lymphocytes, and fibrinogen liquid concentrate (PLyF) for 10 minutes, (2) an exudate obtained from L-PRF clots rich in fibronectin and vitronectin for 5 minutes, and (3) the fibronectin/vitronectin exudate for 2 minutes followed by immersion in the PLyF concentrate for further 8 minutes. After these treatments, the samples were fixed and observed using a scanning electron microscope (SEM). Results Under microscopic observation, (1) the samples treated with the PLyF concentrate revealed a dense fibrin network in direct contact with the implant surface and a significant number of formed elements of blood; (2) in the samples treated with the fibronectin/vitronectin exudates, only a small number of white and red blood cells were detectable; and (3) in samples exposed to the combined treatment, there was an apparent increase in the thickness of the fibrin layer. When compared to the machined surface, the micro/nano-rough samples showed an overall increased retention of fibrin, leading to a thicker coating. Conclusions Liquid L-PRF products promote the formation of a dense fibrin clot on micro/nano-rough implant surfaces in vitro. The adjunctive treatment of surfaces with the fibronectin/vitronectin exudate could provide support to contact of the fibrin with the surface, though it is not essential for the clot formation. Further studies are necessary to better elucidate the properties and benefits of liquid L-PRF products.
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110
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Massari L, Benazzo F, Falez F, Cadossi R, Perugia D, Pietrogrande L, Aloj DC, Capone A, D'Arienzo M, Cadossi M, Lorusso V, Caruso G, Ghiara M, Ciolli L, La Cava F, Guidi M, Castoldi F, Marongiu G, La Gattuta A, Dell'Omo D, Scaglione M, Giannini S, Fortina M, Riva A, De Palma PL, Gigante AP, Moretti B, Solarino G, Lijoi F, Giordano G, Londini PG, Castellano D, Sessa G, Costarella L, Barile A, Borrelli M, Rota A, Fontana R, Momoli A, Micaglio A, Bassi G, Cornacchia RS, Castelli C, Giudici M, Monesi M, Branca Vergano L, Maniscalco P, Bulabula M, Zottola V, Caraffa A, Antinolfi P, Catani F, Severino C, Castaman E, Scialabba C, Tovaglia V, Corsi P, Friemel P, Ranellucci M, Caiaffa V, Maraglino G, Rossi R, Pastrone A, Caldora P, Cusumano C, Squarzina PB, Baschieri U, Demattè E, Gherardi S, De Roberto C, Belluati A, Giannini A, Villani C, Persiani P, Demitri S, Di Maggio B, Abate G, De Terlizzi F, Setti S. Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1809091. [PMID: 29854729 PMCID: PMC5952440 DOI: 10.1155/2018/1809091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Affiliation(s)
- Leo Massari
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Benazzo
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Ruggero Cadossi
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
| | - Dario Perugia
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Luca Pietrogrande
- Health Sciences Department, Operative Unit of Orthopaedics and Traumatology, “San Paolo” Hospital, University of Milan, Milan, Italy
| | - Domenico Costantino Aloj
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | - Antonio Capone
- Orthopaedic Department, University of Cagliari, Cagliari, Italy
| | - Michele D'Arienzo
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Matteo Cadossi
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Ghiara
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Luigi Ciolli
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Filippo La Cava
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Marco Guidi
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Filippo Castoldi
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | | | - Alessandra La Gattuta
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Dario Dell'Omo
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Sandro Giannini
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Mattia Fortina
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Alberto Riva
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Pier Luigi De Palma
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Biagio Moretti
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Francesco Lijoi
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Giovanni Giordano
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Pier Giorgio Londini
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Danilo Castellano
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Giuseppe Sessa
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Luciano Costarella
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Antonio Barile
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Mariano Borrelli
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Attilio Rota
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Raffaele Fontana
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Alberto Momoli
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Andrea Micaglio
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Guido Bassi
- Orthopaedic and Traumatology Department, A.O. Pavia Voghera Hospital, Pavia, Italy
| | | | - Claudio Castelli
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Michele Giudici
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Mauro Monesi
- Orthopaedic and Traumatology Department, “M. Bufalini” Hospital, Cesena, Italy
| | | | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - M'Putu Bulabula
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - Vincenzo Zottola
- Traumatology and Reconstructive Surgery Functional Department, “S. Anna” Hospital, Como, Italy
| | - Auro Caraffa
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Pierluigi Antinolfi
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Fabio Catani
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Severino
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Castaman
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Carmelo Scialabba
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Venceslao Tovaglia
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Pietro Corsi
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Paolo Friemel
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Marco Ranellucci
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Vincenzo Caiaffa
- Orthopaedics and Traumatology Department, “Di Venere” Hospital, Bari, Italy
| | - Giovanni Maraglino
- Orthopaedics and Traumatology Department, “SS. Annunziata” Hospital, Taranto, Italy
| | - Roberto Rossi
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Antonio Pastrone
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Patrizio Caldora
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | - Claudio Cusumano
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | | | - Ugo Baschieri
- Orthopaedics Department, NOCSAE Hospital, Modena, Italy
| | - Ettore Demattè
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Stefano Gherardi
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Carlo De Roberto
- Orthopaedics Unit, “Santa Maria di Loreto Mare” Hospital, Loreto Mare, Napoli, Italy
| | - Alberto Belluati
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Antonio Giannini
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Ciro Villani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Pietro Persiani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Silvio Demitri
- Orthopaedic and Trauma Department, “Santa Maria della Misericordia” Hospital, AOUD Udine, Udine, Italy
| | - Bruno Di Maggio
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | - Guglielmo Abate
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | | | - Stefania Setti
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
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Markides H, McLaren JS, Telling ND, Alom N, Al-Mutheffer EA, Oreffo ROC, Zannettino A, Scammell BE, White LJ, El Haj AJ. Translation of remote control regenerative technologies for bone repair. NPJ Regen Med 2018; 3:9. [PMID: 29675269 PMCID: PMC5904134 DOI: 10.1038/s41536-018-0048-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 02/22/2018] [Accepted: 03/22/2018] [Indexed: 01/06/2023] Open
Abstract
The role of biomechanical stimuli, or mechanotransduction, in normal bone homeostasis and repair is understood to facilitate effective osteogenesis of mesenchymal stem cells (MSCs) in vitro. Mechanotransduction has been integrated into a multitude of in vitro bone tissue engineering strategies and provides an effective means of controlling cell behaviour towards therapeutic outcomes. However, the delivery of mechanical stimuli to exogenous MSC populations, post implantation, poses a significant translational hurdle. Here, we describe an innovative bio-magnetic strategy, MICA, where magnetic nanoparticles (MNPs) are used to remotely deliver mechanical stimuli to the mechano-receptor, TREK-1, resulting in activation and downstream signalling via an external magnetic array. In these studies, we have translated MICA to a pre-clinical ovine model of bone injury to evaluate functional bone repair. We describe the development of a magnetic array capable of in vivo MNP manipulation and subsequent osteogenesis at equivalent field strengths in vitro. We further demonstrate that the viability of MICA-activated MSCs in vivo is unaffected 48 h post implantation. We present evidence to support early accelerated repair and preliminary enhanced bone growth in MICA-activated defects within individuals compared to internal controls. The variability in donor responses to MICA-activation was evaluated in vitro revealing that donors with poor osteogenic potential were most improved by MICA-activation. Our results demonstrate a clear relationship between responders to MICA in vitro and in vivo. These unique experiments offer exciting clinical applications for cell-based therapies as a practical in vivo source of dynamic loading, in real-time, in the absence of pharmacological agents.
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Affiliation(s)
- Hareklea Markides
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, ST4 7QB UK
| | - Jane S. McLaren
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, NG7 2RD UK
| | - Neil D. Telling
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, ST4 7QB UK
| | - Noura Alom
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, NG7 2RD UK
| | | | - Richard O. C. Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
| | - Andrew Zannettino
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, SA 5000 Australia
| | - Brigitte E. Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Lisa J. White
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD UK
| | - Alicia J. El Haj
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, ST4 7QB UK
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Bian J, Cao D, Shen J, Jiang B, Chen D, Bian L. N-methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen-activated protein kinase signaling pathway. Exp Ther Med 2018; 15:3617-3622. [PMID: 29545891 DOI: 10.3892/etm.2018.5842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 11/15/2017] [Indexed: 01/22/2023] Open
Abstract
N-methyl pyrrolidone (NMP), a small bioactive molecule, has the potential to stimulate bone formation and inhibit osteoclast differentiation. The aim of the present study was to investigate the effect of NMP on the inflammatory response and underlying molecular mechanisms in MG-63 cells. The mRNA and protein expression of cytokines from peripheral blood in children with or without ankle fracture were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. MG-63 cells were pre-treated with/without NMP and stimulated with 1 µM bradykinin (BK). The production of cytokines from MG-63 cells was assessed by western blotting and RT-qPCR. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA and protein were measured using western blotting and/or RT-qPCR. Western blotting was used to examine the activation level of mitogen activated protein kinase. Compared with healthy children, levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β and IL-6 mRNA and protein were upregulated in children with ankle fracture. NMP treatment did not induce cytotoxicity in MG-63 cells. The BK-induced upregulation of TNF-α, IL-1β, IL-6, iNOS and COX-2 mRNA and protein was reversed in a dose-dependent manner by NMP. Furthermore, NMP downregulated the activation of c-Jun NH2-terminal kinase and p38 pathways, but not the extracellular signal-related kinase pathway. Therefore, the results of the current study demonstrate that NMP inhibits inflammation dependent on the mitogen-activated protein kinase pathway in MG-63 cells, indicating that it may be beneficial in the healing of fractures.
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Affiliation(s)
- Jun Bian
- Department of Orthopedic, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Dan Cao
- Department of Orthopedic, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Jie Shen
- Department of Orthopedic, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Bo Jiang
- Department of Orthopedic, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Dan Chen
- Department of Orthopedic, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Lanzheng Bian
- Department of Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
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Takahara S, Lee SY, Iwakura T, Oe K, Fukui T, Okumachi E, Waki T, Arakura M, Sakai Y, Nishida K, Kuroda R, Niikura T. Altered expression of microRNA during fracture healing in diabetic rats. Bone Joint Res 2018; 7:139-147. [PMID: 29437637 PMCID: PMC5895942 DOI: 10.1302/2046-3758.72.bjr-2017-0082.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) is known to impair fracture healing. Increasing evidence suggests that some microRNA (miRNA) is involved in the pathophysiology of diabetes and its complications. We hypothesized that the functions of miRNA and changes to their patterns of expression may be implicated in the pathogenesis of impaired fracture healing in DM. METHODS Closed transverse fractures were created in the femurs of 116 rats, with half assigned to the DM group and half assigned to the control group. Rats with DM were induced by a single intraperitoneal injection of streptozotocin. At post-fracture days five, seven, 11, 14, 21, and 28, miRNA was extracted from the newly generated tissue at the fracture site. Microarray analysis was performed with miRNA samples from each group on post-fracture days five and 11. For further analysis, real-time polymerase chain reaction (PCR) analysis was performed at each timepoint. RESULTS Microarray analysis showed that there were 14 miRNAs at day five and 17 miRNAs at day 11, with a greater than twofold change in the DM group compared with the control group. Among these types of miRNA, five were selected based on a comparative and extended literature review. Real-time PCR analysis revealed that five types of miRNA (miR-140-3p, miR-140-5p, miR-181a-1-3p, miR-210-3p, and miR-222-3p) were differentially expressed with changing patterns of expression during fracture healing in diabetic rats compared with controls. CONCLUSIONS Our findings provide information to further understand the pathology of impaired fracture healing in a diabetic rat model. These results may allow the potential development of molecular therapy using miRNA for the treatment of impaired fracture healing in patients with DM.Cite this article: S. Takahara, S. Y. Lee, T. Iwakura, K. Oe, T. Fukui, E. Okumachi, T. Waki, M. Arakura, Y. Sakai, K. Nishida, R. Kuroda, T. Niikura. Altered expression of microRNA during fracture healing in diabetic rats. Bone Joint Res 2018;7:139-147. DOI: 10.1302/2046-3758.72.BJR-2017-0082.R1.
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Affiliation(s)
- S Takahara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - S Y Lee
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine and Showa University School of Medicine,650-0017 Kobe, Japan and 142-8666 Tokyo, Japan
| | - T Iwakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - K Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - T Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - E Okumachi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - T Waki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - M Arakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - Y Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - K Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - R Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
| | - T Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 650-0017 Kobe, Japan
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Coric D, Bullard DE, Patel VV, Ryaby JT, Atkinson BL, He D, Guyer RD. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018; 7:124-130. [PMID: 29437635 PMCID: PMC5895946 DOI: 10.1302/2046-3758.72.bjr-2017-0221.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. METHODS Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher's exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. RESULTS In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p < 0.05, Fisher's exact test) increased the fusion rate at six and 12 months for certain high-risk subjects who had at least one clinical risk factor of being elderly, a nicotine user, osteoporotic, or diabetic; and for those with at least one clinical risk factor and who received at least a two- or three-level arthrodesis. CONCLUSION Adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis.Cite this article: D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124-130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1.
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Affiliation(s)
- D Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - D E Bullard
- Triangle Neurosurgery, 1540 Sunday Drive, Suite 214, Raleigh, North Carolina 27607, USA
| | - V V Patel
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, Colorado 80045, USA
| | - J T Ryaby
- Clinical Affairs Department, Orthofix, Inc., 3451 Plano Parkway, Lewisville, Texas 75056, USA
| | - B L Atkinson
- Atkinson Biologics Consulting, Highlands Ranch, Colorado, USA
| | - D He
- Analytical Solutions Group, Inc, North Potomac, Maryland, USA
| | - R D Guyer
- TBIRF, Texas Back Institute, 6020 West Parker Road Suite 200, Plano, Texas 75093, USA
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Hazenbiller O, Nasr S, Krawetz RJ, Duncan NA. Effect of mechanical strain on the pluripotency of murine embryonic stem cells seeded in a collagen-I scaffold. J Orthop Res 2018; 36:799-807. [PMID: 28976591 DOI: 10.1002/jor.23749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/22/2017] [Indexed: 02/04/2023]
Abstract
The use of embryonic stem cells (ESC) in regenerative medicine is restricted due to the possibility of tumorigenicity after inefficient or incomplete differentiation. Studies from our group, and others, suggest that mechanical stimuli may have a suppressive effect on the pluripotency/tumorigenesis of murine ESC (mESC). Furthermore, we have demonstrated that mESC seeded in a type I collagen scaffold, and transplanted into a murine bone fracture model, demonstrated repair without tumor formation. However, it remains unknown if mechanical factors were involved in blocking tumorigenicity of the mESC. Therefore, the aims of the current study were: (i) to characterize the mechanical environment within the transplanted construct (mESC-Col I) in an in vivo murine fracture model using computational analyses; and (ii) to reproduce this mechanical environment in vitro to elucidate the role of these mechanical factors on mESC pluripotent gene expression. It was predicted that the mESC-Col I construct was subjected to an average octahedral shear strain of ∼3.8% and a compressive strain of ∼3.1% within the fracture in vivo when the murine tibia was subjected to an axial compression load of 4 N (1 Hz). When a similar strain environment was replicated experimentally in vitro, the expression patterns of marker genes for pluripotency (Oct 4, Sox 2, Nanog, Rex 1, and oncogene ERas) were significantly down-regulated. This suggests that the local micro-mechanical environment within the fracture site in vivo may be involved in regulating stem cell fate after transplantation, and that these physical factors should be considered when developing regenerative medicine strategies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:799-807, 2018.
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Affiliation(s)
- Olesja Hazenbiller
- Biomedical Engineering Graduate Program, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Saghar Nasr
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Roman J Krawetz
- Department of Cell Biology and Anatomy, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Neil A Duncan
- Departments of Civil Engineering, Schulich School of Engineering, McCaig Institute for Bone and Joint Health, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, T2N 1N4, Canada
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Marquez-Lara A, Hutchinson ID, Nuñez F, Smith TL, Miller AN. Nonsteroidal Anti-Inflammatory Drugs and Bone-Healing: A Systematic Review of Research Quality. JBJS Rev 2018; 4:01874474-201603000-00004. [PMID: 27500434 DOI: 10.2106/jbjs.rvw.o.00055] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are often avoided by orthopaedic surgeons because of their possible influence on bone-healing. This belief stems from multiple studies, in particular animal studies, that show delayed bone-healing or nonunions associated with NSAID exposure. The purpose of this review was to critically analyze the quality of published literature that evaluates the impact of NSAIDs on clinical bone-healing. METHODS A MEDLINE and Embase search was conducted to identify all articles relating to bone and fracture-healing and the utilization of NSAIDs. All human studies, including review articles, were identified for further analysis. Non-English-language manuscripts and in vitro and animal studies were excluded. A total of twelve clinical articles and twenty-four literature reviews were selected for analysis. The quality of the clinical studies was assessed with a modified Coleman Methodology Score with emphasis on the NSAID utilization. Review articles were analyzed with regard to variability in the cited literature and final conclusions. RESULTS The mean modified Coleman Methodology Score (and standard deviation) was significantly lower (p = 0.032) in clinical studies that demonstrated a negative effect of NSAIDs on bone-healing (40.0 ± 14.3 points) compared with those that concluded that NSAIDs were safe (58.8 ± 10.3 points). Review articles also demonstrated substantial variability in the number of cited clinical studies and overall conclusions. There were only two meta-analyses and twenty-two narrative reviews. The mean number (and standard deviation) of clinical studies cited was significantly greater (p = 0.008) for reviews that concluded that NSAIDs were safe (8.0 ± 4.8) compared with those that recommended avoiding them (2.1 ± 2.1). Unanimously, all reviews admitted to the need for prospective randomized controlled trials to help clarify the effects of NSAIDs on bone-healing. CONCLUSIONS This systematic literature review highlights the great variability in the interpretation of the literature addressing the impact of NSAIDs on bone-healing. Unfortunately, there is no consensus regarding the safety of NSAIDs following orthopaedic procedures, and future studies should aim for appropriate methodological designs to help to clarify existing discrepancies to improve the quality of care for orthopaedic patients. CLINICAL RELEVANCE This systematic review highlights the limitations in the current understanding of the effects of NSAIDs on bone healing. Thus, withholding these medications does not have any proven scientific benefit to patients and may even cause harm by increasing narcotic requirements in cases in which they could be beneficial for pain management. This review should encourage further basic-science and clinical studies to clarify the risks and benefits of anti-inflammatory medications in the postoperative period, with the aim of improving patient outcomes.
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Affiliation(s)
- Alejandro Marquez-Lara
- 1Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Pharaon SK, Schoch S, Marchand L, Mirza A, Mayberry J. Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon. Trauma Surg Acute Care Open 2018; 3:e000117. [PMID: 29766123 PMCID: PMC5887772 DOI: 10.1136/tsaco-2017-000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/20/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.
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Affiliation(s)
- Shad K Pharaon
- Trauma and Acute Care Surgery, PeaceHealth Southwest Medical Center, Vancouver, Washington, USA
| | - Shawn Schoch
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Lucas Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Amer Mirza
- Orthopaedic Trauma Surgery, Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - John Mayberry
- Trauma and Acute Care Surgery, Saint Alphonsus Regional Medical Center, Boise, Idaho, USA.,Department of Surgery, WWAMI Regional Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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MacLeod A, Simpson AHRW, Pankaj P. Experimental and numerical investigation into the influence of loading conditions in biomechanical testing of locking plate fracture fixation devices. Bone Joint Res 2018; 7:111-120. [PMID: 29363522 PMCID: PMC5805837 DOI: 10.1302/2046-3758.71.bjr-2017-0074.r2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives Secondary fracture healing is strongly influenced by the stiffness of the bone-fixator system. Biomechanical tests are extensively used to investigate stiffness and strength of fixation devices. The stiffness values reported in the literature for locked plating, however, vary by three orders of magnitude. The aim of this study was to examine the influence that the method of restraint and load application has on the stiffness produced, the strain distribution within the bone, and the stresses in the implant for locking plate constructs. Methods Synthetic composite bones were used to evaluate experimentally the influence of four different methods of loading and restraining specimens, all used in recent previous studies. Two plate types and three screw arrangements were also evaluated for each loading scenario. Computational models were also developed and validated using the experimental tests. Results The method of loading was found to affect the gap stiffness strongly (by up to six times) but also the magnitude of the plate stress and the location and magnitude of strains at the bone-screw interface. Conclusions This study demonstrates that the method of loading is responsible for much of the difference in reported stiffness values in the literature. It also shows that previous contradictory findings, such as the influence of working length and very large differences in failure loads, can be readily explained by the choice of loading condition. Cite this article: A. MacLeod, A. H. R. W. Simpson, P. Pankaj. Experimental and numerical investigation into the influence of loading conditions in biomechanical testing of locking plate fracture fixation devices. Bone Joint Res 2018;7:111–120. DOI: 10.1302/2046-3758.71.BJR-2017-0074.R2.
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Affiliation(s)
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - P Pankaj
- The University of Edinburgh, School of Engineering, Institute for Bioengineering, Faraday Building, Edinburgh EH9 3DW, UK
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Treatment of critical-sized bone defects: clinical and tissue engineering perspectives. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:351-362. [PMID: 29080923 DOI: 10.1007/s00590-017-2063-0] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/08/2017] [Indexed: 12/11/2022]
Abstract
Critical-sized bone defects are defined as those that will not heal spontaneously within a patient's lifetime. Current treatment options include vascularized bone grafts, distraction osteogenesis, and the induced membrane technique. The induced membrane technique is an increasingly utilized method with favorable results including high rates of union. Tissue engineering holds promise in the treatment of large bone defects due to advancement of stem cell biology, novel biomaterials, and 3D bioprinting. In this review, we provide an overview of the current operative treatment strategies of critical-sized bone defects as well as the current state of tissue engineering for such defects.
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120
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Risk Factors for Failure of Bone Grafting of Tibia Nonunions and Segmental Bone Defects: A New Preoperative Risk Assessment Score. J Orthop Trauma 2017; 31 Suppl 5:S55-S59. [PMID: 28938394 DOI: 10.1097/bot.0000000000000982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a clinically useful prediction model of success at the time of surgery to promote bone healing for established tibial nonunion or traumatic bone defects. DESIGN Retrospective case controlled. SETTING Level 1 trauma center. PATIENTS Adult patients treated with surgery for established tibia fracture nonunion or traumatic bone defects from 2007 to 2016. Two hundred three patients met the inclusion criteria and were available for final analysis. INTERVENTION Surgery to promote bone healing of established tibia fracture nonunion or segmental defect with plate and screw construct, intramedullary nail fixation, or multiplanar external fixation. MAIN OUTCOME MEASURES Failure of the surgery to promote bone healing that was defined as unplanned revision surgery for lack of bone healing or deep infection. No patients were excluded who had a primary outcome event. RESULTS Multivariate logistic modeling identified 5 significant (P < 0.05) risk factors for failure of the surgery to promote bone healing: (1) mechanism of injury, (2) Increasing body mass index, (3) cortical defect size (mm), (4) flap size (cm), and (5) insurance status. A prediction model was created based on these factors and awarded 0 points for fall, 17 points for high energy blunt trauma (OR = 17; 95% CI, 1-286, P = 0.05), 22 points for industrial/other (OR = 22; 95% CI, 1-4, P = 0.04), and 28 points for ballistic injuries (OR = 28; 95% CI, 1-605, P = 0.04). One point is given for every 10 cm of flap size (OR = 1; 95% CI, 1-1.1, P < 0.001), 10 mm of mean cortical gap distance (OR = 1; 95% CI, 1-2, P = 0.004), and 10 units BMI, respectively (OR = 1.5; 95% CI, 1-3, P = 0.16). Two points are awarded for Medicaid or no insurance (OR = 2; 95% CI, 1-5, P = 0.035) and 3 points for Medicare (3; 95% CI, 1-9, P = 0.033). Each 1-point increase in risk score was associated with a 6% increased chance of requiring at least 1 revision surgery (P < 0.001). CONCLUSIONS This study presents a clinical score that predicts the likelihood of success after surgery for tibia fracture nonunions or traumatic bone defects and may help clinicians better determine which patients are likely to fail these procedures and require further surgery.
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Inhibition of GDF8 (Myostatin) accelerates bone regeneration in diabetes mellitus type 2. Sci Rep 2017; 7:9878. [PMID: 28852138 PMCID: PMC5575348 DOI: 10.1038/s41598-017-10404-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022] Open
Abstract
Metabolic diseases like diabetes mellitus cause bone healing deficiencies. We found significant impairment of bone regeneration, osteogenic differentiation and proliferation in diabetic bone. Moreover recent studies suggest a highly underestimated importance of GDF8 (Myostatin) in bone metabolism. Our goal was to analyze the role of GDF8 as a regulator of osteogenic differentiation, proliferation and bone regeneration. We used a murine tibial defect model in diabetic (Leprdb-/-) mice. Myostatin-Inhibitor Follistatin was administered in tibial bony defects of diabetic mice. By means of histology, immunohistochemistry and QRT-PC osteogenesis, differentiation and proliferation were analyzed. Application of Myostatin-inhibitor showed a significant improvement in diabetic bone regeneration compared to the control group (6.5 fold, p < 0.001). Immunohistochemistry revealed a significantly higher proliferation (7.7 fold, p = 0.009), osteogenic differentiation (Runx-2: 3.7 fold, p = 0.011, ALP: 9.3 fold, p < 0.001) and calcification (4.9 fold, p = 0.024) in Follistatin treated diabetic animals. Therapeutical application of Follistatin, known for the importance in muscle diseases, plays an important role in bone metabolism. Diabetic bone revealed an overexpression of the catabolic protein Myostatin. Antagonization of Myostatin in diabetic animals leads to a restoration of the impaired bone regeneration and represents a promising therapeutic option.
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Abstract
Non-union is a devastating consequence of a fracture. Non-unions cause substantial patient morbidity with patients suffering from loss of function of the affected extremity, increased pain, and a substantial decrease in the quality of life. The management is often associated with repeated, unsuccessful operations resulting in prolonged hospital stays, which has social and economic consequences to both the patient and the healthcare system. The rates of non-union following intramedullary (IM) nailing vary according to anatomical location. There is currently no consensus regarding the treatment of infected non-unions following IM nailing, but the most common procedures reported are; exchange IM nail with antibiotic suppression or excision of the non-union, (stabilisation with external fixation or less commonly plate or IM nail) and then reconstruction of the bone defect with distraction osteogenesis or the Masquelet technique. This article explores the general principles of treatment, fixation modalities and proposes a treatment strategy for the management of infected non-unions following intramedullary nailing.
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Affiliation(s)
- A Hamish Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Jerry S T Tsang
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Tucker K, Berezina N, Reinhold S, Kalmykov A, Belinskiy A, Gresky J. An accident at work? Traumatic lesions in the skeleton of a 4th millennium BCE "wagon driver" from Sharakhalsun, Russia. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:256-273. [PMID: 28615110 DOI: 10.1016/j.jchb.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
The study of ante-mortem trauma is a popular and important aspect of palaeopathological analysis. The majority of publications focus on a particular assemblage, skeletal element or type of fracture, with case studies of single individuals with multiple/unusual traumata being much rarer in the literature. This paper presents the case of an adult male from the Bronze Age site of Sharakhalsun, Russia, buried, uniquely, in a sitting position on a fully assembled wagon, who displayed evidence for multiple healed ante-mortem fractures of the cranium, axial and appendicular skeleton. The mechanisms and likely etiologies of the fractures are presented, with reference to modern and 19th century clinical literature, and possible interpretations suggested: that the individual was involved in a severe accident involving a wagon or draft animals, or both, a number of years before his death. The suggestion is also made that the unique burial position of the individual was a form of commemoration by the community of the survival and recovery of the individual from such a serious incident.
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Affiliation(s)
- K Tucker
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany.
| | - N Berezina
- Research Institute and Museum of Anthropology, Moscow State University, 123001 Moscow, Russia
| | - S Reinhold
- Eurasia Department, German Archaeological Institute, 14195 Berlin, Germany
| | | | | | - J Gresky
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany
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Does Concurrent Tibial Intramedullary Nailing and Fibular Fixation Increase Rates of Tibial Nonunion? A Matched Cohort Study. J Orthop Trauma 2017; 31:316-320. [PMID: 28538453 DOI: 10.1097/bot.0000000000000832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine if there is a difference in rates of tibial nonunion in patients undergoing tibial intramedullary (IM) nailing and fibular fixation as compared to a matched cohort undergoing tibial IM nailing alone. DESIGN Retrospective matched cohort study. SETTING Single Level 1 academic trauma center. PATIENTS Consecutive patients 18 years and older with a tibia and fibula fracture treated with tibial IM nailing and fibular fixation who were determined radiographically and clinically healed or had a minimum 1-year follow-up were included. A matched cohort who underwent tibial IM nailing without fibular fixation was used for comparison. INTERVENTION Fibular fixation at the time of tibial IM nailing. MAIN OUTCOME MEASUREMENT Tibial nonunion, defined as a persistently symptomatic fracture with no radiographic progression toward healing at 9 months on consecutive radiographs over a 2-month period. RESULTS One hundred sixty six patients met inclusion criteria for the intervention group. Mean follow-up was 21 months. There was a 12% rate of tibial nonunion. In a matched cohort of 174 patients without fibular fixation there was no significant difference in patient demographics, injury characteristics, infection rates, time to union, postoperative complications, or rates of tibial nonunion. The rate of nonunion in both groups was significantly higher in patients with high energy mechanisms, open fractures, and postoperative infections. CONCLUSION Fibular fixation did not impact rates of tibial nonunion. The rate of tibial nonunion in both cohorts is comparable with published rates of tibial nonunion after IM nailing without fibular fixation. Open fractures, high energy mechanism, and postoperative infection are significantly associated with tibial nonunion. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Simpson AHRW, Keenan G, Nayagam S, Atkins RM, Marsh D, Clement ND. Low-intensity pulsed ultrasound does not influence bone healing by distraction osteogenesis: a multicentre double-blind randomised control trial. Bone Joint J 2017; 99-B:494-502. [PMID: 28385939 DOI: 10.1302/0301-620x.99b4.bjj-2016-0559.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/02/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this double-blind prospective randomised controlled trial was to assess whether low intensity pulsed ultrasound (LIPUS) accelerated or enhanced the rate of bone healing in adult patients undergoing distraction osteogenesis. PATIENTS AND METHODS A total of 62 adult patients undergoing limb lengthening or bone transport by distraction osteogenesis were randomised to treatment with either an active (n = 32) or a placebo (n = 30) ultrasound device. A standardised corticotomy was performed in the proximal tibial metaphysis and a circular Ilizarov frame was used in all patients. The rate of distraction was also standardised. The primary outcome measure was the time to removal of the frame after adjusting for the length of distraction in days/cm for both the per protocol (PP) and the intention-to-treat (ITT) groups. The assessor was blinded to the form of treatment. A secondary outcome was to identify covariates affecting the time to removal of the frame. RESULTS There was no difference in the time to removal of the frame between the PP (difference in favour of the control group was 10.1 days/cm, 95% confidence interval (CI) -3.2 to 23.4, p = 0.054) or ITT (difference 5.0 days/cm, 95% CI -8.2 to 18.21, p = 0.226) groups. The smoking status was the only covariate which increased the time to removal of the frame (hazard ratio 0.47, 95% CI 0.22 to 0.97, p = 0.042). CONCLUSION LIPUS does not influence the rate of bone healing in patients who undergo distraction osteogenesis. Smoking may influence bone healing. Cite this article: Bone Joint J 2017;99-B:494-502.
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Affiliation(s)
- A H R W Simpson
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - G Keenan
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - S Nayagam
- Royal Liverpool Children's and Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK
| | - R M Atkins
- Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - D Marsh
- University College London, 102 Princetown Road, Bangor, BT20 3TG, UK
| | - N D Clement
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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Kim JH, Patel S. Is It Worth Discriminating Against Patients Who Smoke? A Systematic Literature Review on the Effects of Tobacco Use in Foot and Ankle Surgery. J Foot Ankle Surg 2017; 56:594-599. [PMID: 28476393 DOI: 10.1053/j.jfas.2017.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 02/03/2023]
Abstract
Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses). Smoking, as a single risk factor, was analyzed and used to compare adverse outcomes in the postoperative setting of foot and ankle surgery. We reviewed 528 abstracts that met our initial identification criteria. After an extensive review process, 46 of the articles (8.71%) met the eligibility requirements to be included in the present study. Distal bunionectomy with osteotomy, first metatarsophalangeal joint arthrodesis, Lapidus bunionectomy, toe amputation, transmetatarsal amputation, Syme's amputation, open reduction internal fixation (ORIF) of calcaneal fractures, ankle fracture ORIF, pilon fracture ORIF, subtalar arthrodesis, rearfoot arthrodesis, tibiocalcaneal arthrodesis, ankle arthrodesis, total ankle arthroplasty, and plastic surgery procedures and their respective negative association with smoking was identified and described in our review. Our systematic literature review revealed that procedures involving arthrodesis, fracture ORIF, and plastic surgery were associated with negative outcomes in smokers. Procedures that did not involve osseous unions such as total ankle arthroplasty and amputations did not appear to have negative outcomes associated with smoking.
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Affiliation(s)
- Jason H Kim
- Resident Physician, Kaiser San Francisco Bay Area Foot and Ankle Residency, Oakland, CA.
| | - Sandeep Patel
- Attending Physician, Kaiser San Francisco Bay Area Foot and Ankle Residency, Antioch, CA
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Adipose Derived Stem Cells Conditioned Media in Combination with Bioceramic-Collagen Scaffolds Improved Calvarial Bone Healing in Hypothyroid Rats. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.45516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Diao F, Chen K, Wang Y, Li Y, Xu W, Lu J, Chen YX. Involvement of small G protein RhoB in the regulation of proliferation, adhesion and migration by dexamethasone in osteoblastic cells. PLoS One 2017; 12:e0174273. [PMID: 28323887 PMCID: PMC5360316 DOI: 10.1371/journal.pone.0174273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/06/2017] [Indexed: 12/02/2022] Open
Abstract
Long-term exposure to therapeutic doses of glucocorticoids (GCs) results in bone remodeling, which frequently causes osteoporosis and fracture healing retardation because of the abnormality of osteoblastic proliferation and differentiation. The mechanisms of GCs’ effect on osteoblasts are largely unknown. In this present study, we found that dexamethasone (Dex) could induce the expression of the small G protein, RhoB, in mRNA and protein levels in the osteoblast-derived osteosarcoma cell lines MG-63. The up-regulation of RhoB mRNA by Dex mainly occurs at posttranscriptional level by increasing its mRNA stability through PI-3K/Akt and p38 mitogen-activated protein kinase signaling pathways. Over-expression of RhoB in MG-63 cells magnified while down-regulation of RhoB level by RNA interference impaired Dex-induced growth inhibition but not differentiation. What’s more, over-expression of RhoB mimicked the effect of Dex on cell adhesion and migration. And interfering RhoB expression partially suppressed Dex-induced pro-adhesion and anti-migration in MG-63 cells. In conclusion, these results indicate that RhoB plays an important role in the pathological effect of Dex on osteoblastic growth and migration, which is a part of the mechanisms of GCs’ adverse effect on bone remodeling.
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Affiliation(s)
- Fei Diao
- Department of Pathophysiology, Second Military Medical University, Shanghai, China
| | - Kangyao Chen
- Department of Orthopedics, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
- Department of -Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian Province, China
| | - Yan Wang
- Department of Pathophysiology, Second Military Medical University, Shanghai, China
| | - Yidong Li
- Department of Pathophysiology, Second Military Medical University, Shanghai, China
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Jian Lu
- Department of Pathophysiology, Second Military Medical University, Shanghai, China
- * E-mail: (JL); (YXC)
| | - Yu-Xia Chen
- Department of Pathophysiology, Second Military Medical University, Shanghai, China
- * E-mail: (JL); (YXC)
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Sivaganesan A, Chotai S, White-Dzuro G, McGirt MJ, Devin CJ. The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2719-2728. [PMID: 28283838 DOI: 10.1007/s00586-017-5021-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in postoperative pain management. However, their use in the setting of spine fusion surgery setting has long been a topic of controversy. In this review we examined relevant research, including in vivo, animal, and clinical human studies, with the aim of understanding the effect of NSAIDs on spinal fusion. STUDY DESIGN/SETTING Systematic review of study designs of all types from randomized controlled trials and meta-analyses to single-institution retrospective reviews. METHODS A search of PubMed and Embase was conducted using the keywords: "spine," "spinal fracture," NSAIDs, anti-inflammatory non-steroidal agents, bone, bone healing, fracture, fracture healing, yielding a total of 110 studies. Other 28 studies were identified by cross-referencing, resulting in total 138 studies. RESULTS There is no level I evidence from human studies regarding the use of NSAIDs on spinal fusion rates. The overall tone of the spine literature in the early 2000s was that NSAIDs increased the rate of non-union; however, nearly all human studies published after 2005 suggest that short-term (<2 weeks) postoperative use have no such effect. The dose dependency that is seen with a 2-week postoperative course is not present when NSAIDs are only used for 48 h after surgery. CONCLUSIONS NSAID appear to have dose-dependent and duration-dependent effects on fusion rates. The short-term use of low-dose NSAIDs around the time of spinal fusion surgery is reasonable. Spine surgeons can consider the incorporation of NSAIDs into pain control regimens for spinal fusion patients with the goal of improving pain control and reducing the costs and complications associated with opioids.
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Affiliation(s)
- Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Clinton J Devin
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Diaper R, Wong E, Metcalfe SA. The implications of biologic therapy for elective foot and ankle surgery in patients with rheumatoid arthritis. Foot (Edinb) 2017; 30:53-58. [PMID: 28262590 DOI: 10.1016/j.foot.2017.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/30/2016] [Accepted: 01/25/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is one of a number of inflammatory arthropathies resulting in foot pain and deformity. Patients with this disease may require surgical intervention as part of their management. Many of these patients are now taking biologic agents which pose several risks to patients in the perioperative phase. The surgical team therefore need to be aware of these associated complications and how to manage these cases. AIM This paper aims to review the current literature about perioperative needs (foot and ankle surgery) associated with patients with rheumatoid arthritis receiving biologic therapy. MAIN FINDINGS The majority of the literature discusses the perioperative complications associated with patients on anti-TNFα therapy with few studies investigating the other biologics in common use. There is conflicting evidence as to the safety of continuing or stopping biologic drug therapy prior to orthopaedic procedures. The British Society for Rheumatology (BSR) have produced guidelines for the management of patients on anti-TNFα therapy or the biologic agent Tocilizumab. These recommendations suggest the risks of post-operative infection need to be balanced against the risk of a post-operative disease flare. In essence, it is suggested anti-TNFα therapy is stopped 3-5 times the half-life of the drug whilst Tocilizumab is stopped 4 weeks prior to surgery. CONCLUSION Good communication is needed between the surgical team and the local Rheumatology department managing the patient's disease in order to optimise perioperative care. Local pathways may vary from the BSR recommendations to determine the most suitable course of action with regards to continuing or stopping biologic therapy prior to foot and ankle surgery.
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Affiliation(s)
- Ross Diaper
- Podiatry Department, Turner Centre, St. James Hospital, Locksway Road, Portsmouth PO4 8LD, UK.
| | - Ernest Wong
- Department of Rheumatology, Portsmouth Hospitals Trust, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - Stuart A Metcalfe
- Podiatry Department, Turner Centre, St. James Hospital, Locksway Road, Portsmouth PO4 8LD, UK
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Vidotto VT, Batista NA, Mariolani JRL, Belangero WD. QUANTITATIVE EVALUATION OF EXPERIMENTAL BONE REGENERATION USING INDENTATION TESTS. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642654 PMCID: PMC5474416 DOI: 10.1590/1413-785220172502164015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: To determine whether the macroindentation test can be applied to quantitatively assess bone regeneration. Methods: A 3.2 mm diameter transverse monocortical defect was created on the medial aspect of both proximal metaphyses of the tibia of male Unib-WH rats. For the macroindentation tests, we used 5.00 mm diameter indenters with a 3.2 mm tip. Defect testing was performed 1 to 12 weeks following the surgical procedures to compare the hardness of the newly developed tissue over the 12-week study period. Additional histological, morphological and physical/chemical data were obtained by optical and electronic microscopy, Raman, and energy dispersive x-ray spectrometry (EDS). Results: The mean indentation forces increased in a time-dependent manner from 4 to 12 weeks (p<0.001). Tests performed with the 5.0 mm diameter tip were not able to measure the indentation forces in the first week after the procedure. Moreover, in the second postoperative week indentation forces and the newly formed tissue within the spinal canal were greater than those measured in the fourth and eighth weeks. Conclusions: The macroindentation test can be used to quantitatively assess bone regeneration in experimental studies. The choice of indenter tip diameter should consider the study design. Level of Evidence II, Diagnostic Studies.
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Thevendran G, Shah K, Pinney SJ, Younger AS. Perceived risk factors for nonunion following foot and ankle arthrodesis. J Orthop Surg (Hong Kong) 2017; 25:2309499017692703. [PMID: 28219308 DOI: 10.1177/2309499017692703] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A major complication of foot and ankle arthrodesis is nonunion, which occurs in approximately 12% of cases. Various factors influence a patient's risk for nonunion following foot and ankle arthrodesis. We surveyed international foot and ankle surgeons to determine (1) risk factors perceived most important for nonunion, (2) factors considered absolute contraindications for arthrodesis, and (3) differences among expert groups regarding perceived risk factors and their stratification. METHODS A questionnaire was e-mailed to members of a major foot and ankle journal editorial board and four foot and ankle society executive committees. The relative risk of 18 potential nonunion risk factors was rated from 1 to 10, using smoking 1 pack/day as a benchmark score of 5.00. RESULTS The response rate was 72% (100/139); 81% declared foot and ankle surgery encompasses >90% of their practice. The highest perceived risk factors ( p < 0.001) were smoking 2 packs/day (mean score 8.69), lack of fusion site stability (8.66), and poor local vascularity (7.66). The least important risk factors ( p < 0.001) were perceived to be age >60 years (mean score 2.54), rheumatoid arthritis (3.05), and osteoporosis (3.56). The most frequently cited absolute contraindications to arthrodesis surgery were local infection (46%), poor local vascularity (41%), and smoking (32%). CONCLUSION To improve arthrodesis outcomes, resource allocation and patient and surgeon education should focus on smoking, construct stability, and local vascularity. Development of an objective nonunion risk assessment tool to identify patients at risk for nonunion using these results could help maximize the efficiency of available resources.
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Affiliation(s)
| | - Kalpesh Shah
- 2 Golden Jubilee National Hospital, Clydebank, Scotland, United Kingdom
| | - Stephen J Pinney
- 3 San Francisco Orthopaedic Surgeons Medical Group, San Francisco, CA, USA
| | - Alastair Se Younger
- 4 Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Effects of Indomethacin and Meloxicam, Nonsteroidal Anti-inflammatory Drugs, on Tibia Fracture Union in Rats. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2016. [DOI: 10.5812/jost.10701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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135
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Carter-Wale RL, Prior TD. Case Study: An intraoperative finding of black bone disease in a podiatric surgery patient. Foot (Edinb) 2016; 29:6-10. [PMID: 27888792 DOI: 10.1016/j.foot.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2016] [Accepted: 09/18/2016] [Indexed: 02/04/2023]
Abstract
Black bone disease has been recognised as a potential consequence of long-term treatment with tetracycline antibiotics. Largely documented affecting structures in the head and skull, there are few reported cases of black bone disease in the foot and ankle. The case of a 55 years old patient, who as a teenager, had undergone treatment with minocycline hydrochloride for chronic acne, and was found to have bone discolouration consistent with minocycline induced black bone disease (MIBBD) during the course of hallux valgus corrective surgery some 40 years later, is presented. In spite of the intraoperative findings, the patient's post-operative recovery and bone healing was uneventful. The literature on minocycline induced black bone disease is reviewed.
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Affiliation(s)
- Robyn L Carter-Wale
- Department of Podiatric Surgery, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom.
| | - Trevor D Prior
- Department of Podiatric Surgery, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom
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Pearson RG, Clement RGE, Edwards KL, Scammell BE. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open 2016; 6:e010303. [PMID: 28186922 PMCID: PMC5129177 DOI: 10.2106/jbjs.f.00186 10.1136/bmjopen-2015-010303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions. SETTING Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated. RESULTS The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3). CONCLUSIONS Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
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Affiliation(s)
- R G Pearson
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - R G E Clement
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - K L Edwards
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Pearson RG, Clement RGE, Edwards KL, Scammell BE. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open 2016; 6:e010303. [PMID: 28186922 PMCID: PMC5129177 DOI: 10.1136/bmjopen-2015-010303] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions. SETTING Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated. RESULTS The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3). CONCLUSIONS Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
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Affiliation(s)
- R G Pearson
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - R G E Clement
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - K L Edwards
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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138
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Almeida MI, Silva AM, Vasconcelos DM, Almeida CR, Caires H, Pinto MT, Calin GA, Santos SG, Barbosa MA. miR-195 in human primary mesenchymal stromal/stem cells regulates proliferation, osteogenesis and paracrine effect on angiogenesis. Oncotarget 2016; 7:7-22. [PMID: 26683705 PMCID: PMC4807979 DOI: 10.18632/oncotarget.6589] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/28/2015] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal Stromal/Stem Cells (MSC) are currently being explored in diverse clinical applications, including regenerative therapies. Their contribution to regeneration of bone fractures is dependent on their capacity to proliferate, undergo osteogenesis and induce angiogenesis. This study aimed to uncover microRNAs capable of concomitantly regulate these mechanisms. Following microRNA array results, we identified miR-195 and miR-497 as downregulated in human primary MSC under osteogenic differentiation. Overexpression of miR-195 or miR-497 in human primary MSC leads to a decrease in osteogenic differentiation and proliferation rate. Conversely, inhibition of miR-195 increased alkaline phosphatase expression and activity and cells proliferation. Then, miR-195 was used to study MSC capacity to recruit blood vessels in vivo. We provide evidence that the paracrine effect of MSC on angiogenesis is diminishedwhen cells over-express miR-195. VEGF may partially mediate this effect, as its expression and secreted protein levels are reduced by miR-195, while increased by anti-miR-195, in human MSC. Luciferase reporter assays revealed a direct interaction between miR-195 and VEGF 3′-UTR in bone cancer cells. In conclusion, our results suggest that miR-195 regulates important mechanisms for bone regeneration, specifically MSC osteogenic differentiation, proliferation and control of angiogenesis; therefore, it is a potential target for clinical bone regenerative therapies.
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Affiliation(s)
- Maria Ines Almeida
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal
| | - Andreia Machado Silva
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Daniel Marques Vasconcelos
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Catarina Rodrigues Almeida
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal
| | - Hugo Caires
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal
| | - Marta Teixeira Pinto
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - George Adrian Calin
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susana Gomes Santos
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Mário Adolfo Barbosa
- Instituto de Investigação e Inovação em Saúde/Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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MacLeod AR, Simpson AHRW, Pankaj P. Age-related optimization of screw placement for reduced loosening risk in locked plating. J Orthop Res 2016; 34:1856-1864. [PMID: 26872689 DOI: 10.1002/jor.23193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/28/2016] [Indexed: 02/04/2023]
Abstract
When using locked plating for bone fracture fixation, screw loosening is reported as one of the most frequent complications and is commonly attributed to an incorrect choice of screw configuration. Choosing a patient-optimized screw configuration is not straightforward as there are many interdependent variables that affect device performance. The aim of the study was to evaluate the influence that locking screw configuration has on loosening risk and how this is influenced by bone quality. This study uses finite element models that incorporate cortical bone heterogeneity, orthotropy, and geometrical nonlinearity to examine the effect of screw configuration on variables associated with loosening and interfragmentary motion. Strain levels within the bone were used as indicators of regions that may undergo loosening. The study found that, in healthy bone under axial loading, the most important variables influencing strain levels within the bone were the size of the bridging span (working length) and the plate rigidity. Unlike healthy bone, osteoporotic bone was found to be particularly sensitive to the spacing of the screws within the plate. Using two empty screw holes between the screws closest to the fracture was found to reduce the strain levels at the first screw by 49% in osteoporotic bone (compared to only 2.4% in healthy bone). The study also found that under torsional loading the total number of screws used was the most important variable with a 59% reduction in the strain around the screws closest to the fracture when using six rather than four screws in osteoporotic bone. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1856-1864, 2016.
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Affiliation(s)
- Alisdair R MacLeod
- School of Engineering, The University of Edinburgh, Edinburgh, EH9 3JL, Scotland, United Kingdom
| | - A Hamish R W Simpson
- Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, EH16 4SU, Scotland, United Kingdom
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, EH9 3JL, Scotland, United Kingdom
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140
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Abstract
RATIONALE AND OBJECTIVES In this article, we review the core principles of bone physiology alongside imaging examples that demonstrate such principles. MATERIALS AND METHODS The core principles of bone physiology are reviewed and further solidified with a corresponding abnormal pathophysiologic example. The key principles of bone physiology to be reviewed include the following: (1) formation and growth, (2) maintenance and repair, (3) metabolism and regulation, and (4) neoplastic disease. Lastly, a collection of secondary bone diseases is presented to demonstrate the skeletal manifestations of numerous systemic diseases. With this integrative method, we hope to emphasize the value of using radiology to teach physiology within a clinical context. This is especially relevant now, as many US medical schools undergo curricular reform with more emphasis on integrative interdisciplinary learning. Ultimately, we intend to provide a paradigm for incorporating radiology into the pre-clinical medical curriculum through a review of basic science physiology that underlies key radiographic findings of the skeletal system. RESULTS Radiology is known for its role in helping make diagnoses and clinical decisions. However, radiology is also well suited to enhance medical education by offering the ability to visualize physiology in action. This is especially true in skeletal radiology, where radiographic osseous changes represent a wide range of physiological processes. Therefore, skeletal radiology can be a useful tool for illustrating concepts of physiology that underlie the normal and abnormal radiologic appearances of bone. CONCLUSION Radiology is an important but underutilized tool for demonstrating concepts in bone physiology.
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141
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Mills L, Tsang J, Hopper G, Keenan G, Simpson AHRW. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016; 5:512-519. [PMID: 27784669 PMCID: PMC5108351 DOI: 10.1302/2046-3758.510.bjr-2016-0138] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. Methods Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed. Results A total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients. In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results. Conclusion Two thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion. Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016;5:512–519. DOI: 10.1302/2046-3758.510.BJR-2016-0138.
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Affiliation(s)
- L Mills
- Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - J Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's building, 49 Little France Crescent, Edinburgh, EH16 4SB
| | - G Hopper
- West of Scotland, Glasgow Royal Infirmary, Glasgow, UK
| | - G Keenan
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - A H R W Simpson
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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Harrison A, Lin S, Pounder N, Mikuni-Takagaki Y. Mode & mechanism of low intensity pulsed ultrasound (LIPUS) in fracture repair. ULTRASONICS 2016; 70:45-52. [PMID: 27130989 DOI: 10.1016/j.ultras.2016.03.016] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
It has been 30years since the first level one clinical trial demonstrated low intensity pulsed ultrasound (LIPUS) could accelerate fracture repair. Since 1994 numerous investigations have been performed on the effect of LIPUS. The majority of these studies have used the same signal parameters comprised of an intensity of 30mW/cm(2) SATA, an ultrasound carrier frequency of 1.5MHz, pulsed at 1kHz with an exposure time of 20minutes per day. These studies show that a biological response is stimulated in the cell which produces bioactive molecules. The production of these molecules, linked with observations demonstrating the enhanced effects on mineralization by LIPUS, might be considered the general manner, or mode, of how LIPUS stimulates fractures to heal. We propose a mechanism for how the LIPUS signal can enhance fracture repair by combining the findings of numerous studies. The LIPUS signal is transmitted through tissue to the bone, where cells translate this mechanical signal to a biochemical response via integrin mechano-receptors. The cells enhance the production of cyclo-oxygenese 2 (COX-2) which in turn stimulates molecules to enhance fracture repair. The aim of this review is to present the state of the art data related to LIPUS effects and mechanism.
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Affiliation(s)
| | - Sheldon Lin
- Department of Orthopedics, Rutgers, New Jersey Medical School, USA
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143
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Serbest S, Tiftikci U, Tosun HB, Gumustas SA, Uludag A. Is there a relationship between fracture healing and mean platelet volume? Ther Clin Risk Manag 2016; 12:1095-9. [PMID: 27471388 PMCID: PMC4948758 DOI: 10.2147/tcrm.s108790] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives Platelet volume has been defined to be a marker that shows thrombocyte activation and function and it is measured as mean platelet volume (MPV). MPV shows the mean volume of circulating thrombocytes and it is one of the routine parameters in complete blood count. Increased thrombocyte volume is associated with thrombocyte activation. Patients and methods This study included 76 patients who were operated on due to fractures of long tubular bones. Patients who had union without any additional interventions were defined as group I, and patients who needed additional interventions due to nonunion or inadequate union were defined as group II. The control group included healthy volunteers who did not have a fracture. Hematologic test values of the patients that were obtained at admission to emergency ward were recorded. Results The groups were not statistically different in terms of age, sex, and the affected extremity. There were significant differences between group I and group II in terms of mean erythrocyte sedimentation rate, C-reactive protein, and MPV values (P<0.001), but there were no significant differences between group I and the control group. There was also no statistically significant difference among groups in terms of hematologic and biochemical variables. Conclusion In our study, fractures in patients who had lower MPV values than controls during the inflammation process healed without any problem, but fractures in patients with high MPV values more frequently needed additional surgical interventions.
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Affiliation(s)
- Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale
| | - Ugur Tiftikci
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale
| | - Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Seyit Ali Gumustas
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Abuzer Uludag
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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LoGuidice A, Houlihan A, Deans R. Multipotent adult progenitor cells on an allograft scaffold facilitate the bone repair process. J Tissue Eng 2016; 7:2041731416656148. [PMID: 27493716 PMCID: PMC4959303 DOI: 10.1177/2041731416656148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/02/2016] [Indexed: 01/08/2023] Open
Abstract
Multipotent adult progenitor cells are a recently described population of stem cells derived from the bone marrow stroma. Research has demonstrated the potential of multipotent adult progenitor cells for treating ischemic injury and cardiovascular repair; however, understanding of multipotent adult progenitor cells in orthopedic applications remains limited. In this study, we evaluate the osteogenic and angiogenic capacity of multipotent adult progenitor cells, both in vitro and loaded onto demineralized bone matrix in vivo, with comparison to mesenchymal stem cells, as the current standard. When compared to mesenchymal stem cells, multipotent adult progenitor cells exhibited a more robust angiogenic protein release profile in vitro and developed more extensive vasculature within 2 weeks in vivo. The establishment of this vascular network is critical to the ossification process, as it allows nutrient exchange and provides an influx of osteoprogenitor cells to the wound site. In vitro assays confirmed the multipotency of multipotent adult progenitor cells along mesodermal lineages and demonstrated the enhanced expression of alkaline phosphatase and production of calcium-containing mineral deposits by multipotent adult progenitor cells, necessary precursors for osteogenesis. In combination with a demineralized bone matrix scaffold, multipotent adult progenitor cells demonstrated enhanced revascularization and new bone formation in vivo in an orthotopic defect model when compared to mesenchymal stem cells on demineralized bone matrix or demineralized bone matrix–only control groups. The potent combination of angiogenic and osteogenic properties provided by multipotent adult progenitor cells appears to create a synergistic amplification of the bone healing process. Our results indicate that multipotent adult progenitor cells have the potential to better promote tissue regeneration and healing and to be a functional cell source for use in orthopedic applications.
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Moghaddam A, Yildirim TM, Westhauser F, Danner W, Swing T, Bruckner T, Biglari B. Low intensity pulsed ultrasound in the treatment of long bone nonunions: Evaluation of cytokine expression as a tool for objectifying nonunion therapy. J Orthop 2016; 13:306-12. [PMID: 27408510 DOI: 10.1016/j.jor.2016.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/17/2016] [Accepted: 06/27/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nonunion is one of the most common complications in bone healing. After several clinical studies, the effect of low intensity pulsed ultrasound (LIPUS) in the treatment of nonunions remains unclear because of the difficulty in evaluating its effect on bone healing. In former studies, the analysis of serum cytokine expression patterns over time has proven to be an objective method for showing the bone healing process and evaluating nonunion therapies. This study evaluates LIPUS as a treatment option for patients with nonunions based on the analysis of serum cytokine expression. METHODS In this prospective, single institution study, venous blood samples from 23 patients were taken from October 2012 to October 2013 before starting LIPUS therapy and at the end of week 1 and 2 and after 1, 2, and 3 months. Patients attended clinical and radiological follow-up examinations at the same intervals. After treating all patients according to the LIPUS therapy protocol, we divided them into two groups: Group 1 consisted of patients with healing at the nonunion site, and Group 2 consisted of patients with failed nonunion therapy. We measured transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), and basic fibroblastic growth factor (bFGF) at all time-points. RESULTS The TGF-β1 serum concentration increased from the pre-treatment value to 1 week within the unsuccessful group. Otherwise, no significant differences between groups in measured cytokines during LIPUS therapy could be detected. CONCLUSION Our findings suggest that LIPUS does not lead to a significant increase in cytokine levels in patients with nonunions. It is likely that "successful" treatment can be attributed to spontaneous healing. Our results suggest that LIPUS is not a proper treatment for long bone nonunions.
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Affiliation(s)
- Arash Moghaddam
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Baden-Württemberg, Germany
| | - Timur Mert Yildirim
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Baden-Württemberg, Germany
| | - Fabian Westhauser
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Baden-Württemberg, Germany
| | - Wolfgang Danner
- BG Trauma Centre Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Rheinland-Pfalz, Germany
| | - Tyler Swing
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Baden-Württemberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Baden-Württemberg, Germany
| | - Bahram Biglari
- BG Trauma Centre Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Rheinland-Pfalz, Germany
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146
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Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables. Clin Orthop Relat Res 2016; 474:1385-95. [PMID: 27125823 PMCID: PMC4868164 DOI: 10.1007/s11999-016-4821-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research. QUESTIONS/PURPOSES We asked (1) whether data from medical records, fracture characteristics, and radiographs obtained at the time of fixation would identify features predictive of tibial fracture nonunion; and (2) whether this information could be used to create a model to assess the chance of nonunion at the time of intramedullary (IM) nail fixation of the tibia. METHODS We retrospectively reviewed all tibial shaft fractures treated at our center from 2007 to 2014. We conducted a literature review and collected data on 35 factors theorized to contribute to delayed bone healing. Patients were followed to fracture healing or surgery for nonunion. Patients with planned prophylactic nonunion surgery were excluded because their nonunions were anticipated and our focus was on unanticipated nonunions. Our cohort consisted of 382 patients treated with IM nails for tibial shaft fractures (nonunion, 56; healed, 326). Bivariate and multivariate regression techniques and stepwise modeling approaches examined the relationship between variables available at definitive fixation. Factors were included in our model if they were identified as having a modest to large effect size (odds ratio > 2) at the p < 0.05 level. RESULTS A multiple variable logistic regression model was developed, including seven factors (p < 0.05; odds ratio > 2.0). With these factors, we created the Nonunion Risk Determination (NURD) score. The NURD score assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. A NURD score of 0 to 5 had a 2% chance of nonunion; 6 to 8, 22%; 9 to 11, 42%; and > 12, 61%. CONCLUSIONS The proposed nonunion prediction model (NURDS) seems to have potential to allow clinicians to better determine which patients have a higher risk of nonunion. Future work should be directed at prospectively validating and enhancing this model. LEVEL OF EVIDENCE Level III, diagnostic study.
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Musante DB, Firtha ME, Atkinson BL, Hahn R, Ryaby JT, Linovitz RJ. Clinical evaluation of an allogeneic bone matrix containing viable osteogenic cells in patients undergoing one- and two-level posterolateral lumbar arthrodesis with decompressive laminectomy. J Orthop Surg Res 2016; 11:63. [PMID: 27233773 PMCID: PMC4884431 DOI: 10.1186/s13018-016-0392-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/25/2016] [Indexed: 02/06/2023] Open
Abstract
Background Trinity Evolution® cellular bone allograft (TE) possesses the osteogenic, osteoinductive, and osteoconductive elements essential for bone healing. The purpose of this study is to evaluate the radiographic and clinical outcomes when TE is used as a graft extender in combination with locally derived bone in one- and two-level instrumented lumbar posterolateral arthrodeses. Methods In this retrospective evaluation, a consecutive series of subject charts that had posterolateral arthrodesis with TE and a 12-month radiographic follow-up were evaluated. All subjects were diagnosed with degenerative disc disease, radiculopathy, stenosis, and decreased disc height. At 2 weeks and at 3 and 12 months, plain radiographs were performed and the subject’s back and leg pain (VAS) was recorded. An evaluation of fusion status was performed at 12 months. Results The population consisted of 43 subjects and 47 arthrodeses. At 12 months, a fusion rate of 90.7 % of subjects and 89.4 % of surgical levels was observed. High-risk subjects (e.g., diabetes, tobacco use, etc.) had fusion rates comparable to normal patients. Compared with the preoperative leg or back pain level, the postoperative pain levels were significantly (p < 0.0001) improved at every time point. There were no adverse events attributable to TE. Conclusions Fusion rates using TE were higher than or comparable to fusion rates with autologous iliac crest bone graft that have been reported in the recent literature for posterolateral fusion procedures, and TE fusion rates were not adversely affected by several high-risk patient factors. The positive results provide confidence that TE can safely replace autologous iliac crest bone graft when used as a bone graft extender in combination with locally derived bone in the setting of posterolateral lumbar arthrodesis in patients with or without risk factors for compromised bone healing. Trial registration Because of the retrospective nature of this study, the trial was not registered.
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Affiliation(s)
- David B Musante
- Triangle Orthopedics, 120 William Penn Plaza, Durham, NC, 27704, USA.
| | - Michael E Firtha
- Campbell School of Osteopathic Medicine, Campbell University, 4350 US-421, Lillington, NC, 27546, USA
| | - Brent L Atkinson
- Atkinson Biologics Consulting, 9189 Fox Fire Way, Highlands Ranch, Littleton, CO, 80129, USA
| | - Rebekah Hahn
- Orthofix Inc., 3451 Plano Parkway, Lewisville, TX, 75056, USA
| | - James T Ryaby
- Orthofix Inc., 3451 Plano Parkway, Lewisville, TX, 75056, USA
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Agbaje JO, Gemels B, Salem AS, Anumendem D, Vrielinck L, Politis C. Modified Mandibular Inferior Border Sagittal Split Osteotomy Reduces Postoperative Risk for Developing Inferior Border Defects. J Oral Maxillofac Surg 2016; 74:1062.e1-9. [DOI: 10.1016/j.joms.2016.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 12/15/2022]
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149
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Pathak JL, Verschueren P, Lems WF, Bravenboer N, Klein-Nulend J, Bakker AD, Luyten FP. Serum of patients with active rheumatoid arthritis inhibits differentiation of osteochondrogenic precursor cells. Connect Tissue Res 2016; 57:226-35. [PMID: 27050327 DOI: 10.3109/03008207.2016.1146714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Delayed fracture healing is frequently experienced in patients with systemic inflammation such as during rheumatoid arthritis (RA). The reasons for this are diverse, but could also be caused by inflammatory cytokines and/or growth factors in serum from patients with active disease. We hypothesized that serum from patients with active RA contains circulating inflammatory factors that inhibit differentiation of osteochondrogenic precursors. Serum was obtained from 15 patients with active RA (active RA-sera) and from the same patients in clinical remission 1 year later (remission RA-sera; controls). The effect of active RA-sera on osteochondrogenic differentiation of chondrogenic ATDC5 cells and primary human periosteum-derived progenitor cells (HPDC) was determined in micromass culture. In ATDC5 cells, active RA-sera reduced Ki67 transcription levels by 40% and cartilage matrix accumulation by 14% at day 14, and Alp transcription levels by 16%, and matrix mineralization by 17% at day 21 compared with remission RA-sera. In HPDCs, active RA-sera inhibited metabolic activity by 8%, SOX9 transcription levels by 14%, and cartilage matrix accumulation by 7% at day 7 compared with remission RA-sera. In conclusion, sera from patients with active RA negatively affect differentiation of osteochondrogenic precursors, and as a consequence may contribute to delayed fracture healing in these patients.
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Affiliation(s)
- Janak L Pathak
- a Department of Oral Cell Biology , Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam , Amsterdam , The Netherlands.,b Skeletal Biology and Engineering Research Center , KU Leuven, Leuven , Belgium.,c Department of Molecular and Cellular Pharmacology , School of Pharmaceutical Science and Technology (SPST), Tianjin University , Tianjin , China
| | - Patrick Verschueren
- b Skeletal Biology and Engineering Research Center , KU Leuven, Leuven , Belgium
| | - Willem F Lems
- d Department of Rheumatology , VU University Medical Center, MOVE Research Institute Amsterdam , Amsterdam , The Netherlands
| | - Nathalie Bravenboer
- e Department of Clinical Chemistry , VU University Medical Center, MOVE Research Institute Amsterdam , Amsterdam , The Netherlands
| | - Jenneke Klein-Nulend
- a Department of Oral Cell Biology , Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam , Amsterdam , The Netherlands
| | - Astrid D Bakker
- a Department of Oral Cell Biology , Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam , Amsterdam , The Netherlands
| | - Frank P Luyten
- b Skeletal Biology and Engineering Research Center , KU Leuven, Leuven , Belgium
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150
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Loi F, Córdova LA, Pajarinen J, Lin TH, Yao Z, Goodman SB. Inflammation, fracture and bone repair. Bone 2016; 86:119-30. [PMID: 26946132 PMCID: PMC4833637 DOI: 10.1016/j.bone.2016.02.020] [Citation(s) in RCA: 717] [Impact Index Per Article: 89.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/30/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The reconstitution of lost bone is a subject that is germane to many orthopedic conditions including fractures and non-unions, infection, inflammatory arthritis, osteoporosis, osteonecrosis, metabolic bone disease, tumors, and periprosthetic particle-associated osteolysis. In this regard, the processes of acute and chronic inflammation play an integral role. Acute inflammation is initiated by endogenous or exogenous adverse stimuli, and can become chronic in nature if not resolved by normal homeostatic mechanisms. Dysregulated inflammation leads to increased bone resorption and suppressed bone formation. Crosstalk among inflammatory cells (polymorphonuclear leukocytes and cells of the monocyte-macrophage-osteoclast lineage) and cells related to bone healing (cells of the mesenchymal stem cell-osteoblast lineage and vascular lineage) is essential to the formation, repair and remodeling of bone. In this review, the authors provide a comprehensive summary of the literature related to inflammation and bone repair. Special emphasis is placed on the underlying cellular and molecular mechanisms, and potential interventions that can favorably modulate the outcome of clinical conditions that involve bone repair.
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Affiliation(s)
- Florence Loi
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Luis A Córdova
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Sergio Livingstone Polhammer 943, Independencia, 8380000 Santiago, Chile.
| | - Jukka Pajarinen
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Tzu-hua Lin
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Zhenyu Yao
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Stuart B Goodman
- 300 Pasteur Drive, Edwards Building, Room R116, Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA; 300 Pasteur Drive, Edwards Building, Room R114, Department of Bioengineering, Stanford University, Stanford, CA 94305, USA.
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