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Feng D, Zhang Y, Wu W, Jia H, Ma C. Docking site complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects. J Orthop Surg Res 2023; 18:889. [PMID: 37993906 PMCID: PMC10666420 DOI: 10.1186/s13018-023-04356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Treating long bone defects of the extremities caused by trauma, infection, tumours, and nonunion has been challenging for clinical orthopaedic surgeons. Bone transport techniques have the potential to treat bone defects. However, inevitable docking site complications related to bone transport techniques have been reported in many studies. The purpose of this study was to investigate the risk factors associated with docking site complications in patients who underwent the Ilizarov bone transport technique for the treatment of tibial bone defects. METHODS This retrospective study included 103 patients who underwent bone transport for the treatment of large bone defects in the tibia from October 2012 to October 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, univariate analysis and logistic regression analysis were used to analyse the factors that may affect the development of docking site complications in patients with tibial bone defects treated with the Ilizarov bone transport technique. The clinical outcomes were evaluated using the Association for the Study and Application of the Ilizarov criteria (ASAMI) at the last clinical follow-up. RESULTS All 103 patients with an average follow-up of 27.5 months. The docking site complications rate per patient was 0.53, and delayed union occurred in 22 cases (21.4%), axial deviation occurred in 19 cases (18.4%) and soft tissue incarceration occurred in 10 cases (9.7%). According to the results of the logistic regression analysis, the bone defect length (P = 0.001, OR = 1.976), and bone defect of distal 1/3 (P = 0.01, OR = 1.976) were significantly correlated with delayed union. Bone defect length (P < 0.001, OR = 1.981) and external fixation time (P = 0.012, OR = 1.017) were significantly correlated with axial deviation. Soft tissue defects (P = 0.047, OR = 6.766) and the number of previous operations (P = 0.001, OR = 2.920) were significantly correlated with soft tissue incarceration. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.1% and a rate of excellent functional results of 90.3%. CONCLUSION The Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect length, external fixation time, the number of previous operations, soft tissue defects and the bone defect of distal 1/3 are statistically significantly associated with the occurrence of docking site complications.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Yaxin Zhang
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Weize Wu
- Department of Joint Surgery, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
| | - Chuang Ma
- Department of Orthopaedic, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Thakeb MF, Kozman MA, ElGebeily MA, Baraka MM, Al Kersh MA. Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial. J Orthop Trauma 2023; 37:462-468. [PMID: 37074808 DOI: 10.1097/bot.0000000000002613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects. DESIGN Prospective, randomized, controlled study. SETTING Tertiary-level center. PARTICIPANTS Thirty patients with infected nonunited long-bone fractures of lower limbs were included. INTERVENTION Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B. OUTCOME MEASUREMENTS The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification. RESULTS The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index ( P value 0.08). CONCLUSIONS This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mootaz F Thakeb
- Division of Limb Reconstruction Surgery, Department of Orthopedic Surgery, Faculty of Medicine, Ain-Shams University, Abbasia, Cairo, Egypt
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Zeng Y, Huang C, Duan D, Lou A, Guo Y, Xiao T, Wei J, Liu S, Wang Z, Yang Q, Zhou L, Wu Z, Wang L. Injectable temperature-sensitive hydrogel system incorporating deferoxamine-loaded microspheres promotes H-type blood vessel-related bone repair of a critical size femoral defect. Acta Biomater 2022; 153:108-123. [PMID: 36115651 DOI: 10.1016/j.actbio.2022.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/01/2022]
Abstract
Insufficient vascularization is a major challenge in the repair of critical-sized bone defects. Deferoxamine (DFO) has been reported to play a potential role in promoting the formation of H-type blood vessels, a specialized vascular subtype with coupled angiogenesis and osteogenesis. However, whether DFO promotes the expression of H-type vessels in critical femoral defects with complete periosteal damage remains unknown. Moreover, stable drug loading systems need to be designed owing to the short half-life and high-dose toxic effects of DFO. In this study, we developed an injectable DFO-gelatin microspheres (GMs) hydrogel complex as a stable drug loading system for the treatment of critical femoral defects in rats. Our results showed that sustained release of DFO in critical femoral defects stimulated the generation of functional H-type vessels. The DFO-GMs hydrogel complex effectively promoted proliferation, formation, and migration of human umbilical vein endothelial cells in vitro. In vivo, the application of the DFO-GMs hydrogel complex expanded the distribution range and prolonged the expression time of H-type vessels in the defect area and was positively correlated with the number of osterix+ cells and new bone tissue. Topical application of the HIF-1α inhibitor PX-478 partially blocked the stimulation of H-type vessels by DFO, whereas the osteogenic potential of the latter was also weakened. Our results extended the local application of DFO and provided a theoretical basis for targeting H-type vessels to treat large femoral defects. STATEMENT OF SIGNIFICANCE: Abundant functional blood vessels are essential for bone repair. The H-type blood vessel is a functional subtype with angiogenesis and osteogenesis coupling potential. A drug loading system with long-term controlled release was first used to investigate the formation of H-type blood vessels in critical femoral defects and promotion of bone repair. Our results showed that the application of DFO-GMs hydrogel complex expanded the distribution range and expression time of H-type vessels, and was positively correlated with the number of osteoblasts and volume of new bone tissue. These results expanded the local application approach of DFO and provide a theoretical basis for targeting H-type vessels to treat large femoral defects.
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Affiliation(s)
- Yuwei Zeng
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Chuang Huang
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Dongming Duan
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Aiju Lou
- Department of Rheumatology, Liwan Central Hospital of Guangzhou, 35 Liwan Road, Guangzhou 510030, China
| | - Yuan Guo
- Department of Stomatology, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Tianhua Xiao
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Jianguo Wei
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Song Liu
- Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Zhao Wang
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Qihao Yang
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China
| | - Lei Zhou
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China.
| | - Zenghui Wu
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China.
| | - Le Wang
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China; Department of Orthopaedic Surgery, The Third Affiliated Hospital, Guangzhou Medical University, 63 Duobao Road, Guangzhou 510150, China.
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The effect of NSAIDs on postfracture bone healing: a meta-analysis of randomized controlled trials. OTA Int 2021; 4:e092. [PMID: 34746650 PMCID: PMC8568409 DOI: 10.1097/oi9.0000000000000092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/18/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023]
Abstract
To determine whether nonsteroidal anti-inflammatory drugs (NSAIDs) have an adverse effect on bone healing by evaluating all available human randomized controlled trials (RCTs) on this subject. Data Sources A comprehensive search of electronic databases (PubMed, MEDLINE, and Cross-References) until October 2018 comparing the occurrence of nonunion in patients who received NSAIDs to the control group through RCTs. Study Selection Inclusion criteria were English-only studies, and the type of studies was restricted to RCTs. Data Extraction Two authors independently extracted data from the selected studies, and the data collected were compared to verify agreement. Data Synthesis Nonunion was the main outcome evaluated in each study. Regression analysis was used to estimate the relative risk comparing the duration and the type of NSAIDs by calculating the odds ratio (OR) for dichotomous variables. Studies were weighed by the inverse of the variance of the outcome, and a fixed-effects model was used for all analyses. Conclusions Six RCTs (609 patients) were included. The risk of nonunion was higher in the patients who were given NSAIDs after the fracture with an OR of 3.47. However, once the studies were categorized into the duration of treatment with NSAIDs, those who received NSAIDs for a short period (<2 weeks) did not show any significant risk of nonunion compared to those who received NSAIDs for a long period (>4 weeks). Indomethacin was associated with a significant higher nonunion rate and OR ranging from 1.66 to 9.03 compared with other NSAIDs that did not show a significant nonunion risk.
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Toy VE, Dundar S, Bozoglan A. The effects of a nonsteroidal anti-inflammatory drug on the degree of titanium implant osseointegration. J Oral Biol Craniofac Res 2020; 10:333-336. [PMID: 32714785 PMCID: PMC7371907 DOI: 10.1016/j.jobcr.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to histologically examine the effects of a nonsteroidal anti-inflammatory drug, namely diclofenac sodium (DCS), on the extent of the bone-implant contact (BIC) of titanium implants after four weeks of osseointegration period in a rodent model. MATERIAL & METHODS Fourteen female Sprague-Dawley rats were divided into two groups: the control (n = 7) and experimental (DCS) groups. Fourteen machine-surfaced titanium implants were placed in the right tibial bones of the rats. The DCS (2 mg/kg) was administered by means of oral gavage to the experimental group for 14 days after four weeks of osseointegration. No medication was administered to the control group throughout the six-week study period. At the end of the study, the rodents were sacrificed and block sections were obtained for histologic evaluation. RESULTS The mean BIC ratios for the control and DCS groups were 64.15 ± 6.31% and 61.10 ± 6.08%, respectively. No statistically significant difference in terms of the BIC ratios was found between the two groups. CONCLUSION The results of this study demonstrate that DCS did not impair the BIC of the implants after four weeks of osseointegration.
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Affiliation(s)
- Vesile Elif Toy
- Inonu University, Faculty of Dentistry, Department of Periodontology, Malatya, Turkey
| | - Serkan Dundar
- Firat University, Faculty of Dentistry, Department of Periodontology, Elazig, Turkey
| | - Alihan Bozoglan
- Firat University, Faculty of Dentistry, Department of Periodontology, Elazig, Turkey
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Rothe R, Schulze S, Neuber C, Hauser S, Rammelt S, Pietzsch J. Adjuvant drug-assisted bone healing: Part I – Modulation of inflammation. Clin Hemorheol Microcirc 2020; 73:381-408. [DOI: 10.3233/ch-199102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca Rothe
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sabine Schulze
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christin Neuber
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sandra Hauser
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - Jens Pietzsch
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
- Technische Universität Dresden, School of Science, Faculty of Chemistry and Food Chemistry, Dresden, Germany
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Bifocal Compression-Distraction for Combined Bone and Soft-Tissue Defects in Post-traumatic Tibial Nonunion. J Orthop Trauma 2019; 33:e372-e377. [PMID: 31469753 DOI: 10.1097/bot.0000000000001514] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. DESIGN Nonrandomized prospective, case series, single-center study. SETTING Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt. PARTICIPANTS Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. INTERVENTION Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique. OUTCOME MEASUREMENTS The external fixation index (EFI); functional and bone results; and complication rates. RESULTS All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups. CONCLUSIONS Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Prodinger PM, Bürklein D, Foehr P, Kreutzer K, Pilge H, Schmitt A, Eisenhart-Rothe RV, Burgkart R, Bissinger O, Tischer T. Improving results in rat fracture models: enhancing the efficacy of biomechanical testing by a modification of the experimental setup. BMC Musculoskelet Disord 2018; 19:243. [PMID: 30025531 PMCID: PMC6053723 DOI: 10.1186/s12891-018-2155-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/25/2018] [Indexed: 01/06/2023] Open
Abstract
Background Animal fracture models, primarily performed in rats, are crucial to investigate normal and pathological bone healing. However, results of biomechanical testing representing a major outcome measure show high standard deviations often precluding statistical significance. Therefore, the aim of our study was a systematical examination of biomechanical characteristics of rat femurs during three-point bending. Furthermore, we tried to reduce variation of results by individually adapting the span of bearing and loading areas to the bone’s length. Methods We examined 40 paired femurs of male Wistar-rats by DXA (BMD and BMC of the whole femur) and pQCT-scans at the levels of bearing and loading areas of the subsequent biomechanical three-point bending test. Individual adjustment of bearing and loading bars was done respecting the length of each specimen. Subgroups of light (< 400 g, n = 22) and heavy (> 400 g, n = 18) animals were formed and analysed separately. We furthermore compared the results of the individualised bending-setting to 20 femurs tested with a fix span of 15 mm. Results Femurs showed a length range of 34 to 46 mm. The failure loads ranged from 116 to 251 N (mean 175.4 ± 45.2 N; heavy animals mean 221 ± 18.9 N; light animals mean 138.1 ± 16.4 N) and stiffness ranged from 185 N/mm to 426 N/mm (mean 315.6 ± 63 N/mm; heavy animals mean 358.1 ± 34.64 N/mm; light animals mean 280.8 ± 59.85 N/mm). The correlation of densitometric techniques and failure loads was high (DXA R2 = 0.89 and pQCT R2 = 0.88). In comparison to femurs tested with a fix span, individual adaptation of biomechanical testing homogenized our data significantly. Most notably, the standard deviation of failure loads (221 ± 18.95 N individualized setting vs. 205.5 ± 30.36 N fixed) and stiffness (358.1 ± 34.64 N/mm individualized setting vs. 498.5 ± 104.8 N/mm fixed) was reduced by at least one third. Conclusions Total variation observed in any trait reflects biological and methodological variation. Precision of the method hence affects the statistical power of the study. By simply adapting the setting of the biomechanical testing, interindividual variation could be reduced, which improves the precision of the method significantly. Electronic supplementary material The online version of this article (10.1186/s12891-018-2155-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Michael Prodinger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Dominik Bürklein
- Abteilung für Fuß- und Sprunggelenkchirurgie, Klinik Volkach, Volkach, Germany
| | - Peter Foehr
- Abteilung für Biomechanik, Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Kilian Kreutzer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Hakan Pilge
- Orthopädische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Andreas Schmitt
- Abteilung für Sportorthopädie, Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Rüdiger V Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Rainer Burgkart
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Oliver Bissinger
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Tischer
- Orthopädische Klinik und Poliklinik der Universität Rostock, Rostock, Germany
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Alzahrani MM, Anam E, AlQahtani SM, Makhdom AM, Hamdy RC. Strategies of enhancing bone regenerate formation in distraction osteogenesis. Connect Tissue Res 2018; 59:1-11. [PMID: 28165797 DOI: 10.1080/03008207.2017.1288725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distraction osteogenesis (DO) is a commonly used technique in multiple orthopedic sub-specialties, including trauma, oncology and pediatrics. This technique aims to produce new bone formation in the distraction gap in a controlled manner. The issue with this technique has been the high risk of complications, one of which is poor regenerate formation during the distraction process. Although several factors (including patient and operative factors) and techniques (including surgical, mechanical and pharmacological) have been described to ensure successful regenerate formation during the process of DO, these factors are sometimes difficult to control clinically. Our aim from this review is to highlight the different factors that affect DO, modalities to assess the regenerate and review treatment options for poor regenerate in the distraction gap. In addition, we propose a management protocol derived from the available literature that can be used to facilitate the management of inadequate regenerate formation.
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Affiliation(s)
- Mohammad Mesfer Alzahrani
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,b Department of Orthopaedic Surgery , University of Dammam , Dammam , Saudi Arabia
| | - Emad Anam
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,c Department of Orthopaedic Surgery , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Saad M AlQahtani
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,b Department of Orthopaedic Surgery , University of Dammam , Dammam , Saudi Arabia
| | - Asim M Makhdom
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,c Department of Orthopaedic Surgery , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Reggie C Hamdy
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada
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Hatipoglu MG, Inal S, Kabay S, Cayci MK, Deger A, Kuru HI, Altikat S, Akkas G. The Influence of Different Nonsteroidal Anti-Inflammatory Drugs on Alveolar Bone in Rats: An Experimental Study. Acta Stomatol Croat 2016; 49:325-30. [PMID: 27688417 DOI: 10.15644/asc49/4/8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
THE AIM The aim of this study was to investigate the effect of dexketoprofen trometamol, meloxicam, diclofenac sodium on any untreated alveolar bone when they are used as drugs for another indication. MATERIALS AND METHODS Twenty eight male Spraque-Dawley rats were randomized into four groups as dexketoprofen trometamol (Group I), meloxicam (Group II), diclofenac sodium (Group III) and control group. Nonsteroidal anti-inflammatory drugs (NSAID) were administered after a fibula fracture for 10 days. Untreated alveolar bone was histopathologically examined for spongious bone density, osteoclastic density and osteoblastic density. RESULTS Spongious bone density was lower in study groups (Group I, group II and group III) than the control group (p<0.05). In contrast, the increase in osteoclastic density was observed in other groups apart from the control group (p<0.05). Osteoblastic density was evaluated and it was determined that group II and group III had lower results than the control group (p<0.05) but group I was equal to the control group. CONCLUSION This study showed that systemically administrated NSAIDs have the potential to affect untreated alveolar bone. This should also be considered in long term use of NSAIDs.
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Affiliation(s)
- Mujgan Gungor Hatipoglu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Dumlupinar University, Kutahya, Turkey
| | - Sermet Inal
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Dumlupinar University, Kutahya. Turkey
| | - Sahin Kabay
- Department of Urology, Medical Faculty, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Muhammet Kasim Cayci
- Department of Biology, Faculty of Arts and Science, Dumlupinar University, Kutahya,Turkey
| | - Ayşenur Deger
- Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Halil Isa Kuru
- Department of Medical Laboratory Techniques, Simav Vocational High School, Dumlupinar University, Kutahya, Turkey
| | - Sayit Altikat
- Department of Department of Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Gizem Akkas
- Department of Pathology, Ministry of Health, Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Kutahya, Turkey
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Cai WX, Ma L, Zheng LW, Kruse-Gujer A, Stübinger S, Lang NP, Zwahlen RA. Influence of non-steroidal anti-inflammatory drugs (NSAIDs) on osseointegration of dental implants in rabbit calvaria. Clin Oral Implants Res 2014; 26:478-483. [PMID: 24684486 DOI: 10.1111/clr.12392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Abstract
AIM Until recently, adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on osseointegration of dental implants were unknown. Hence, this study investigated the short- and long-term effects of a 7-day regimen of parecoxib and diclofenac sodium on osseointegration of dental implants in calvarial bone. MATERIAL AND METHODS Eighteen New Zealand White rabbits were randomly allocated into three groups (each n = 6): Control group with no postoperative pain killers (Group A), diclofenac group (Group B) and parecoxib group (Group C). In each animal, one dental implant was placed into the calvarial bone (total n = 18). Three rabbits from each group were sacrificed in Week 4. The other three rabbits from each group were sacrificed in Week 12 postoperatively. The implant together with the calvarial bone and dura mater was harvested and subjected to micro-computed tomography (micro-CT) and histomorphometric analysis. RESULTS Quantitative analysis of micro-CT data and histomorphometric data neither revealed any statistically significant (P ≤ 0.05) differences between the three different groups related to osseointegration nor between different time points of observation. CONCLUSION In rabbits, a 7-day regimen of appropriate doses of diclofenac sodium and parecoxib did not adversely affect osseointegration of dental implants and bone healing in calvaria, neither short nor long term (12 weeks).
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Affiliation(s)
- Wei Xin Cai
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Li Ma
- Discipline of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Li Wu Zheng
- Discipline of Oral Diagnosis and Polyclinics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Astrid Kruse-Gujer
- Division of Craniomaxillofacial and Oral Surgery, University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Stübinger
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
| | - Niklaus P Lang
- The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong, China.,University of Zurich, Zurich, Switzerland
| | - Roger A Zwahlen
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Inal S, Kabay S, Cayci MK, Kuru HI, Altikat S, Akkas G, Deger A. Comparison of the effects of dexketoprofen trometamol, meloxicam and diclofenac sodium on fibular fracture healing, kidney and liver: an experimental rat model. Injury 2014; 45:494-500. [PMID: 24246878 DOI: 10.1016/j.injury.2013.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/08/2013] [Accepted: 10/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly used in patients with bone fractures, but there are limited studies on whether one NSAID is superior to another. In this study, we used histopathological and biochemical parameters to determine whether there are differences between the effects of the administration of clinical doses of dexketoprofen trometamol (DEXT), meloxicam (MEL) and diclofenac sodium (DIC) on the healing of closed fibular fractures and the toxicity of both the liver and kidney. METHODS Twenty-eight male Sprague-Dawley rats were randomly divided into four groups of seven each. Closed diaphyseal fractures were formed in the left fibulas of all of the rats. The NSAIDs dexketoprofen trometamol (DEXT) (Arveles(®)), meloxicam (MEL) (Melox(®)) and diclofenac sodium (DIC) (Voltaren(®)) were intramuscularly administered to Groups I, II, and III, respectively, for a period of 10 days after the fibular fractures were performed. No pharmacological agents were administered to Group IV (Control group). Blood samples were collected from all of the rats after the fractures were performed, and the rats were sacrificed on day 28. The histopathological findings were compared, and the blood samples were evaluated to determine any differences between the levels of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). RESULTS Our results suggest that DEXT and MEL impair the healing of bone fractures and that DIC does not histopathologically affect the healing process of bone fractures. We also found that DEXT, MEL, and DIC impaired the renal histopathology compared with the control group. However, the liver histopathological analysis showed that DEXT and MEL caused a higher degree of parenchymal necrosis compared with DIC. CONCLUSION Based on our results, DIC can be considered a relatively safe medication in patients with fractures.
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Affiliation(s)
- Sermet Inal
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - Sahin Kabay
- Department of Urology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - M Kasim Cayci
- Department of Biology, Faculty of Arts and Science, Dumlupinar University, Kutahya, Turkey.
| | - H Isa Kuru
- Department of Medical Laboratory Techniques, Simav Vocational High School, Dumlupinar University, Turkey.
| | - Sayit Altikat
- Department of Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - Gizem Akkas
- Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - Aysenur Deger
- Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
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13
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Erdem M, Gulabi D, Sen C, Sahin SA, Bozdag E. Effects of caffeic acid phenethyl ester and melatonin on distraction osteogenesis: an experimental study. SPRINGERPLUS 2014; 3:8. [PMID: 25674422 PMCID: PMC4320175 DOI: 10.1186/2193-1801-3-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/12/2013] [Indexed: 11/13/2022]
Abstract
Aim The aim of this experimental animal model study is to investigate the effects of caffeic acid phenethyl ester (CAPE) and melatonin on the maturation of newly-formed regenerated bone in distraction osteogenesis. Methods Unilateral femoral lengthening(extension) was applied to 39 adult male Wistar albino rats, which were randomly allocated to 3 groups of 13; control, melatonin and CAPE groups. Through a 7-day latent waiting period and 15 days of distraction, melatonin of 25 mg/kg and CAPE of 10 μmol/kg were administered to the respective groups. The animals were sacrificed on Day 82. Radiographic, histological and biomechanical evaluations were made and measurements were taken. Results At the end of 82 days, the distraction osteogenesis area was seen to be completely filled with new bone formation in all 3 groups both radiologically and histologically. Biomechanically, the maximum torsional fracture strength (Maximum Torque (N-m)) of the melatonin group was higher compared to that of the control group, although it was not statistically significant (p > 0.05). The maximum torsional momentum of the CAPE group was statistically significantly high (p < 0.05). The degree of rigidity (N-m/deg) of both the melatonin and CAPE groups was higher than that of the control group and the CAPE group was found to be statistically significantly higher than the melatonin group (p < 0.05). Conclusion Melatonin and CAPE increase the maturation of new bone in distraction osteogenesis. These effects are probably due to the reducing effect on bone resorption by inhibiting NF-κB and free oxygen radicals.
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Affiliation(s)
- Mehmet Erdem
- Orthopaedic and Traumatology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Deniz Gulabi
- Orthopaedic and Traumatology Clinique, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Semsi Denizer Cad. E-5 Yanyol, Cevizli Sapagi, 34890 Kartal, Istanbul, Turkey
| | - Cengiz Sen
- Orthopaedic and Traumatology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seyit Ahmet Sahin
- Orthopaedic and Traumatology Clinique, Erbaa State Hospital, Tokat, Turkey
| | - Ergun Bozdag
- Mechanical Engineering Department, Istanbul Technical Faculty, Istanbul, Turkey
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14
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Autologous rabbit adipose tissue-derived mesenchymal stromal cells for the treatment of bone injuries with distraction osteogenesis. Cytotherapy 2013; 15:690-702. [PMID: 23522867 DOI: 10.1016/j.jcyt.2013.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/23/2012] [Accepted: 02/03/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AIMS Adipose tissue-derived mesenchymal stromal cells (MSCs) have a higher capacity for proliferation and differentiation compared with other cell lineages. Although distraction osteogenesis is the most important therapy for treating bone defects, this treatment is restricted in many situations. The aim of this study was to examine the therapeutic potential of adipose tissue-derived MSCs and osteoblasts differentiated from adipose tissue-derived MSCs in the treatment of bone defects. METHODS Bone defects were produced in the tibias of New Zealand rabbits that had previously undergone adipose tissue extraction. Tibial osteotomy was performed, and a distractor was placed on the right leg of the rabbits. The rabbits were placed in control (group I), stem cell (group II) and osteoblast-differentiated stem cell (group III) treatment groups. The rabbits were sacrificed, and the defect area was evaluated by radiologic, biomechanical and histopathologic tests to examine the therapeutic effects of adipose tissue-derived MSCs. RESULTS Radiologic analyses revealed that callus density and the ossification rate increased in group III compared with group I and group II. In biomechanical tests, the highest ossification rate was observed in group III. Histopathologic studies showed that the quality of newly formed bone and the number of cells active in bone formation were significantly higher in group III rabbits compared with group I and group II rabbits. CONCLUSIONS These data reveal that osteoblasts differentiated from adipose tissue-derived MSCs shorten the consolidation period of distraction osteogenesis. Stem cells could be used as an effective treatment for bone defects.
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Pountos I, Georgouli T, Calori GM, Giannoudis PV. Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. ScientificWorldJournal 2012; 2012:606404. [PMID: 22272177 PMCID: PMC3259713 DOI: 10.1100/2012/606404] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 10/18/2011] [Indexed: 12/21/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) play an essential part in our approach to control pain in the posttraumatic setting. Over the last decades, several studies suggested that NSAIDs interfere with bone healing while others contradict these findings. Although their analgesic potency is well proven, clinicians remain puzzled over the potential safety issues. We have systematically reviewed the available literature, analyzing and presenting the available in vitro animal and clinical studies on this field. Our comprehensive review reveals the great diversity of the presented data in all groups of studies. Animal and in vitro studies present so conflicting data that even studies with identical parameters have opposing results. Basic science research defining the exact mechanism with which NSAIDs could interfere with bone cells and also the conduction of well-randomized prospective clinical trials are warranted. In the absence of robust clinical or scientific evidence, clinicians should treat NSAIDs as a risk factor for bone healing impairment, and their administration should be avoided in high-risk patients.
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Affiliation(s)
- Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS1 3EX, UK
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Blum ALL, BongioVanni JC, Morgan SJ, Flierl MA, dos Reis FB. Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. ACTA ACUST UNITED AC 2010; 92:565-70. [PMID: 20357336 DOI: 10.1302/0301-620x.92b4.23475] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistent pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications.
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Affiliation(s)
- A L L Blum
- Department of Orthopaedics and Traumatology, Federal University, Rua Borges Lagoa, São Paulo, Brazil
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