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Li D, Liu C, Wang H, Li Y, Wang Y, An S, Sun S. The Role of Neuromodulation and Potential Mechanism in Regulating Heterotopic Ossification. Neurochem Res 2024; 49:1628-1642. [PMID: 38416374 DOI: 10.1007/s11064-024-04118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
Heterotopic ossification (HO) is a pathological process characterized by the aberrant formation of bone in muscles and soft tissues. It is commonly triggered by traumatic brain injury, spinal cord injury, and burns. Despite a wide range of evidence underscoring the significance of neurogenic signals in proper bone remodeling, a clear understanding of HO induced by nerve injury remains rudimentary. Recent studies suggest that injury to the nervous system can activate various signaling pathways, such as TGF-β, leading to neurogenic HO through the release of neurotrophins. These pathophysiological changes lay a robust groundwork for the prevention and treatment of HO. In this review, we collected evidence to elucidate the mechanisms underlying the pathogenesis of HO related to nerve injury, aiming to enhance our understanding of how neurological repair processes can culminate in HO.
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Affiliation(s)
- Dengju Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong First Medical University, Jinan, Shandong, China
| | - Changxing Liu
- Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Haojue Wang
- Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yunfeng Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yaqi Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Senbo An
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
- Shandong First Medical University, Jinan, Shandong, China.
| | - Shui Sun
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
- Shandong First Medical University, Jinan, Shandong, China.
- Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
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Ritter K, Baalmann M, Dolderer C, Ritz U, Schäfer MKE. Brain-Bone Crosstalk in a Murine Polytrauma Model Promotes Bone Remodeling but Impairs Neuromotor Recovery and Anxiety-Related Behavior. Biomedicines 2024; 12:1399. [PMID: 39061973 PMCID: PMC11274630 DOI: 10.3390/biomedicines12071399] [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: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Traumatic brain injury (TBI) and long bone fractures are a common injury pattern in polytrauma patients and modulate each other's healing process. As only a limited number of studies have investigated both traumatic sites, we tested the hypothesis that brain-bone polytrauma mutually impacts neuro- and osteopathological outcomes. Adult female C57BL/6N mice were subjected to controlled cortical impact (CCI), and/or osteosynthetic stabilized femoral fracture (FF), or sham surgery. Neuromotor and behavioral impairments were assessed by neurological severity score, open field test, rotarod test, and elevated plus maze test. Brain and bone tissues were processed 42 days after trauma. CCI+FF polytrauma mice had increased bone formation as compared to FF mice and increased mRNA expression of bone sialoprotein (BSP). Bone fractures did not aggravate neuropathology or neuroinflammation assessed by cerebral lesion size, hippocampal integrity, astrocyte and microglia activation, and gene expression. Behavioral assessments demonstrated an overall impaired recovery of neuromotor function and persistent abnormalities in anxiety-related behavior in polytrauma mice. This study shows enhanced bone healing, impaired neuromotor recovery and anxiety-like behavior in a brain-bone polytrauma model. However, bone fractures did not aggravate TBI-evoked neuropathology, suggesting the existence of outcome-relevant mechanisms independent of the extent of brain structural damage and neuroinflammation.
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Affiliation(s)
- Katharina Ritter
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (K.R.); (M.B.)
| | - Markus Baalmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (K.R.); (M.B.)
| | - Christopher Dolderer
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (C.D.); (U.R.)
| | - Ulrike Ritz
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (C.D.); (U.R.)
| | - Michael K. E. Schäfer
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (K.R.); (M.B.)
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3
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Dehghani M, Pourmontaseri H. Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review. Int Wound J 2024; 21:e14788. [PMID: 38420873 PMCID: PMC10902764 DOI: 10.1111/iwj.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.
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Affiliation(s)
- Mohammadreza Dehghani
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
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Parker RS, Nazzal MK, Morris AJ, Fehrenbacher JC, White FA, Kacena MA, Natoli RM. Role of the Neurologic System in Fracture Healing: An Extensive Review. Curr Osteoporos Rep 2024; 22:205-216. [PMID: 38236509 PMCID: PMC10912173 DOI: 10.1007/s11914-023-00844-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Despite advances in orthopedics, there remains a need for therapeutics to hasten fracture healing. However, little focus is given to the role the nervous system plays in regulating fracture healing. This paucity of information has led to an incomplete understanding of fracture healing and has limited the development of fracture therapies that integrate the importance of the nervous system. This review seeks to illuminate the integral roles that the nervous system plays in fracture healing. RECENT FINDINGS Preclinical studies explored several methodologies for ablating peripheral nerves to demonstrate ablation-induced deficits in fracture healing. Conversely, activation of peripheral nerves via the use of dorsal root ganglion electrical stimulation enhanced fracture healing via calcitonin gene related peptide (CGRP). Investigations into TLR-4, TrkB agonists, and nerve growth factor (NGF) expression provide valuable insights into molecular pathways influencing bone mesenchymal stem cells and fracture repair. Finally, there is continued research into the connections between pain and fracture healing with findings suggesting that anti-NGF may be able to block pain without affecting healing. This review underscores the critical roles of the central nervous system (CNS), peripheral nervous system (PNS), and autonomic nervous system (ANS) in fracture healing, emphasizing their influence on bone cells, neuropeptide release, and endochondral ossification. The use of TBI models contributes to understanding neural regulation, though the complex influence of TBI on fracture healing requires further exploration. The review concludes by addressing the neural connection to fracture pain. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Reginald S Parker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Murad K Nazzal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashlyn J Morris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jill C Fehrenbacher
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fletcher A White
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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Nazzal MK, Morris AJ, Parker RS, White FA, Natoli RM, Kacena MA, Fehrenbacher JC. Do Not Lose Your Nerve, Be Callus: Insights Into Neural Regulation of Fracture Healing. Curr Osteoporos Rep 2024; 22:182-192. [PMID: 38294715 PMCID: PMC10912323 DOI: 10.1007/s11914-023-00850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Fractures are a prominent form of traumatic injury and shall continue to be for the foreseeable future. While the inflammatory response and the cells of the bone marrow microenvironment play significant roles in fracture healing, the nervous system is also an important player in regulating bone healing. RECENT FINDINGS Considerable evidence demonstrates a role for nervous system regulation of fracture healing in a setting of traumatic injury to the brain. Although many of the impacts of the nervous system on fracture healing are positive, pain mediated by the nervous system can have detrimental effects on mobilization and quality of life. Understanding the role the nervous system plays in fracture healing is vital to understanding fracture healing as a whole and improving quality of life post-injury. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Murad K Nazzal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashlyn J Morris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Reginald S Parker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fletcher A White
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Jill C Fehrenbacher
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Hart DA. Regulation of Bone by Mechanical Loading, Sex Hormones, and Nerves: Integration of Such Regulatory Complexity and Implications for Bone Loss during Space Flight and Post-Menopausal Osteoporosis. Biomolecules 2023; 13:1136. [PMID: 37509172 PMCID: PMC10377148 DOI: 10.3390/biom13071136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
During evolution, the development of bone was critical for many species to thrive and function in the boundary conditions of Earth. Furthermore, bone also became a storehouse for calcium that could be mobilized for reproductive purposes in mammals and other species. The critical nature of bone for both function and reproductive needs during evolution in the context of the boundary conditions of Earth has led to complex regulatory mechanisms that require integration for optimization of this tissue across the lifespan. Three important regulatory variables include mechanical loading, sex hormones, and innervation/neuroregulation. The importance of mechanical loading has been the target of much research as bone appears to subscribe to the "use it or lose it" paradigm. Furthermore, because of the importance of post-menopausal osteoporosis in the risk for fractures and loss of function, this aspect of bone regulation has also focused research on sex differences in bone regulation. The advent of space flight and exposure to microgravity has also led to renewed interest in this unique environment, which could not have been anticipated by evolution, to expose new insights into bone regulation. Finally, a body of evidence has also emerged indicating that the neuroregulation of bone is also central to maintaining function. However, there is still more that is needed to understand regarding how such variables are integrated across the lifespan to maintain function, particularly in a species that walks upright. This review will attempt to discuss these regulatory elements for bone integrity and propose how further study is needed to delineate the details to better understand how to improve treatments for those at risk for loss of bone integrity, such as in the post-menopausal state or during prolonged space flight.
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Affiliation(s)
- David A Hart
- Department of Surgery, Faculty of Kinesiology, and McCaig Institute for Bone & Joint Research, University of Calgary, Calgary, AB T2N 4N1, Canada
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Paul MM, Mieden HJ, Lefering R, Kupczyk EK, Jordan MC, Gilbert F, Meffert RH, Sirén AL, Hoelscher-Doht S. Impact of a Femoral Fracture on Outcome after Traumatic Brain Injury-A Matched-Pair Analysis of the TraumaRegister DGU ®. J Clin Med 2023; 12:jcm12113802. [PMID: 37297997 DOI: 10.3390/jcm12113802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU® to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI.
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Affiliation(s)
- Mila M Paul
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
- Department of Neurophysiology, Institute for Physiology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany
- Department of Neurosurgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Hannah J Mieden
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Eva K Kupczyk
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Martin C Jordan
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Fabian Gilbert
- LMU Klinikum Campus Innenstadt, University of München, 80336 Munich, Germany
| | - Rainer H Meffert
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Anna-Leena Sirén
- Department of Neurophysiology, Institute for Physiology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany
- Department of Neurosurgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Stefanie Hoelscher-Doht
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
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Schurman CA, Burton JB, Rose J, Ellerby LM, Alliston T, Schilling B. Molecular and Cellular Crosstalk between Bone and Brain: Accessing Bidirectional Neural and Musculoskeletal Signaling during Aging and Disease. J Bone Metab 2023; 30:1-29. [PMID: 36950837 PMCID: PMC10036181 DOI: 10.11005/jbm.2023.30.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 03/24/2023] Open
Abstract
Molecular omics technologies, including proteomics, have enabled the elucidation of key signaling pathways that mediate bidirectional communication between the brain and bone tissues. Here we provide a brief summary of the clinical and molecular evidence of the need to study the bone-brain axis of cross-tissue cellular communication. Clear clinical and molecular evidence suggests biological interactions and similarities between bone and brain cells. Here we review the current mass spectrometric techniques for studying brain and bone diseases with an emphasis on neurodegenerative diseases and osteoarthritis/osteoporosis, respectively. Further study of the bone-brain axis on a molecular level and evaluation of the role of proteins, neuropeptides, osteokines, and hormones in molecular pathways linked to bone and brain diseases is critically needed. The use of mass spectrometry and other omics technologies to analyze these cross-tissue signaling events and interactions will help us better understand disease progression and comorbidities and potentially identify new pathways and targets for therapeutic interventions. Proteomic measurements are particularly favorable for investigating the role of signaling and secreted and circulating analytes and identifying molecular and metabolic pathways implicated in age-related diseases.
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Affiliation(s)
| | | | - Jacob Rose
- Buck Institute for Research on Aging, Novato, CA,
USA
| | | | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA,
USA
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Shim DW, Hong H, Cho KC, Kim SH, Lee JW, Sung SY. Accelerated tibia fracture healing in traumatic brain injury in accordance with increased hematoma formation. BMC Musculoskelet Disord 2022; 23:1110. [PMID: 36539743 PMCID: PMC9764518 DOI: 10.1186/s12891-022-06063-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has been known to accelerate bone healing. Many cells and molecules have been investigated but the exact mechanism is still unknown. The neuroinflammatory state of TBI has been reported recently. We aimed to investigate the effect of TBI on fracture healing in patients with tibia fractures and assess whether the factors associated with hematoma formation changed more significantly in the laboratory tests in the fractures accompanied with TBI. METHODS We retrospectively investigated patients who were surgically treated for tibia fractures and who showed secondary bone healing. Patients with and without TBI were divided for comparative analyses. Radiological parameters were time to callus formation and the largest callus ratio during follow-up. Preoperative levels of complete blood count and chemical battery on admission were measured in all patients. Subgroup division regarding age, gender, open fracture, concomitant fracture and severity of TBI were compared. RESULTS We included 48 patients with a mean age of 44.9 (range, 17-78), of whom 35 patients (72.9%) were male. There were 12 patients with TBI (Group 1) and 36 patients without TBI (Group 2). Group 1 showed shorter time to callus formation (P < 0.001), thicker callus ratio (P = 0.015), leukocytosis and lymphocytosis (P ≤ 0.028), and lower red blood cell counts (RBCs), hemoglobin, and hematocrit (P < 0.001). Aging and severity of TBI were correlated with time to callus formation and callus ratio (P ≤ 0.003) while gender, open fracture, and concomitant fracture were unremarkable. CONCLUSION Tibia fractures with TBI showed accelerated bone healing and superior measurements associated with hematoma formation (lymphocytes, RBCs, hemoglobin, hematocrit). Promoted fracture healing in TBI was correlated with the enhanced proinflammatory state. LEVEL OF EVIDENCE III, case control study.
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Affiliation(s)
- Dong Woo Shim
- grid.496063.eDepartment of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711 South Korea
| | - Hyunjoo Hong
- Department of Radiology, Severance Health Check-up, 10, Tongil-ro, Jung-gu, Seoul, Republic of Korea
| | - Kwang-Chun Cho
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Severance Hospital 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do Republic of Korea
| | - Se Hwa Kim
- grid.496063.eDepartment of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711 South Korea
| | - Jin Woo Lee
- grid.415562.10000 0004 0636 3064Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 South Korea
| | - Seung-Yong Sung
- grid.496063.eDepartment of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711 South Korea
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10
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Kübler IC, Kretzschmar J, Brankatschk M, Sandoval-Guzmán T. Local problems need global solutions: The metabolic needs of regenerating organisms. Wound Repair Regen 2022; 30:652-664. [PMID: 35596643 PMCID: PMC7613859 DOI: 10.1111/wrr.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
The vast majority of species that belong to the plant or animal kingdom evolved with two main strategies to counter tissue damage-scar formation and regeneration. Whereas scar formation provides a fast and cost-effective repair to exit life-threatening conditions, complete tissue regeneration is time-consuming and requires vast resources to reinstall functionality of affected organs or structures. Local environments in wound healing are widely studied and findings have provided important biomedical applications. Less well understood are organismic physiological parameters and signalling circuits essential to maintain effective tissue repair. Here, we review accumulated evidence that positions the interplay of local and systemic changes in metabolism as essential variables modulating the injury response. We particularly emphasise the role of lipids and lipid-like molecules as significant components long overlooked.
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Affiliation(s)
- Ines C. Kübler
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jenny Kretzschmar
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK
| | - Marko Brankatschk
- Department of Molecular, Cell and Developmental Biology, Technische Universität Dresden, Dresden, Germany
| | - Tatiana Sandoval-Guzmán
- Department of Internal Medicine III, Center for Healthy Aging, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of Helmholtz Centre Munich, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Yeung P, Zarnett O, Lefaivre KA, Guy P. Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures: A Systematic Review. JBJS Rev 2022; 10:01874474-202209000-00005. [PMID: 36137013 DOI: 10.2106/jbjs.rvw.20.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment with nonsteroidal anti-inflammatory drugs or radiation therapy remain controversial. While several factors have been related to the development of HO, there is considerable uncertainty regarding their importance or effect size in the setting of acetabular surgery. Therefore, this systematic review aims to summarize the risk factors for HO following the operative fixation of acetabular fractures and clarify their interrelationships. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, MEDLINE, Embase, and CINAHL databases were searched from inception to February 2021. Studies that assessed factors related to HO development among patients with operatively repaired acetabular fractures were included. Outcomes were risk factors and their effect size (p values, odds ratios, and 95% confidence intervals). RESULTS Twenty-five studies and 1 conference abstract with a total of 3,940 patients were included. The following risk factors for HO were identified. Patient factors were increased body mass index, male sex, and increased age. Injury factors were intensive care unit (ICU) admission and length of stay, non-ICU hospitalization for >10 days, the need for mechanical ventilation for ≥2 days, abdominal and/or chest injuries, the number and type of associated fractures, traumatic brain injuries, T-type acetabular fractures, pelvic ring injuries, and hip dislocation. Care factors were a delay to surgery, extensile and posterior surgical approaches to the hip, trochanteric osteotomy, postoperative step-off of >3 mm, and a delay to prophylaxis following injury or surgery. Ethnicity, Injury Severity Score, cause of the fracture, femoral head injuries, degloving injuries, comminution, intra-articular debris, the type of bone void filler, gluteus minimus muscle preservation, prolonged operative time, and intraoperative patient position were not risk factors for developing HO. CONCLUSIONS HO following operative fixation of acetabular fractures is not uncommon, with severe-grade HO associated with substantial disability. Careful consideration of the risk factor effect sizes and interdependencies could aid physicians in identifying patients at risk for developing HO and guide their prophylactic management. The results of this study could establish a framework for future studies. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Phillip Yeung
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oren Zarnett
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Xia W, Xie J, Cai Z, Liu X, Wen J, Cui ZK, Zhao R, Zhou X, Chen J, Mao X, Gu Z, Zou Z, Zou Z, Zhang Y, Zhao M, Mac M, Song Q, Bai X. Damaged brain accelerates bone healing by releasing small extracellular vesicles that target osteoprogenitors. Nat Commun 2021; 12:6043. [PMID: 34654817 PMCID: PMC8519911 DOI: 10.1038/s41467-021-26302-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/27/2021] [Indexed: 01/15/2023] Open
Abstract
Clinical evidence has established that concomitant traumatic brain injury (TBI) accelerates bone healing, but the underlying mechanism is unclear. This study shows that after TBI, injured neurons, mainly those in the hippocampus, release osteogenic microRNA (miRNA)-enriched small extracellular vesicles (sEVs), which targeted osteoprogenitors in bone to stimulate bone formation. We show that miR-328a-3p and miR-150-5p, enriched in the sEVs after TBI, promote osteogenesis by directly targeting the 3'UTR of FOXO4 or CBL, respectively, and hydrogel carrying miR-328a-3p-containing sEVs efficiently repaires bone defects in rats. Importantly, increased fibronectin expression on sEVs surface contributes to targeting of osteoprogenitors in bone by TBI sEVs, thereby implying that modification of the sEVs surface fibronectin could be used in bone-targeted drug delivery. Together, our work unveils a role of central regulation in bone formation and a clear link between injured neurons and osteogenitors, both in animals and clinical settings.
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Affiliation(s)
- Wei Xia
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Jing Xie
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhiqing Cai
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xuhua Liu
- State Key Laboratory of Organ Failure Research, Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, 510630, China
| | - Jing Wen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhong-Kai Cui
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Run Zhao
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xiaomei Zhou
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Jiahui Chen
- State Key Laboratory of Organ Failure Research, Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, 510630, China
| | - Xinru Mao
- Department of Clinical laboratory, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhengtao Gu
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhimin Zou
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhipeng Zou
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yue Zhang
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Ming Zhao
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Maegele Mac
- Institute for Research in Operative Medicine, Private University of Witten-Herdecke, Cologne Merheim Medical Center, Ostmerheimerstr 200, D-51109, Cologne, Germany
| | - Qiancheng Song
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Xiaochun Bai
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
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13
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Chen H, Lu H, Huang J, Wang Z, Chen Y, Zhang T. Calcitonin Gene-Related Peptide Influences Bone-Tendon Interface Healing Through Osteogenesis: Investigation in a Rabbit Partial Patellectomy Model. Orthop J Sports Med 2021; 9:23259671211003982. [PMID: 34345631 PMCID: PMC8280850 DOI: 10.1177/23259671211003982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Calcitonin gene-related peptide (CGRP), which has been shown to play an
important role in osteogenesis during fracture repair, is also widely
distributed throughout the tendon and ligament. Few studies have focused on
the role of CGRP in repair of the bone-tendon interface (BTI). Purpose: To explore the effect of CGRP expression on BTI healing in a rabbit partial
patellectomy model. Study Design: Controlled laboratory study. Methods: A total of 60 mature rabbits were subjected to a partial patellectomy and
then randomly assigned to CGRP, CGRP-antagonist, and control groups. In the
CGRP-antagonist group, the CGRP receptor antagonist BIBN4096BS was
administered to block CGRP receptors. The patella–patellar tendon complex
was harvested at 8 and 16 weeks postoperatively and subjected to
radiographic, microlaser Raman spectroscopy, histologic, and biomechanical
evaluation. Results: Radiographic data showed that local CGRP expression improved the growth
parameters of newly formed bone, including area and volumetric bone mineral
density (P < .05 for both). Raman spectroscopy revealed
that the relative bone mineral composition increased in the CGRP group
compared with in the control group and the CGRP-antagonist group
(P < .05 for both). Histologic testing revealed that
the CGRP group demonstrated better integration, characterized by
well-developed trabecular bone expansion from the residual patella and
marrow cavity formation, at the 8- and 16-week time points. Mechanical
testing demonstrated that the failure load, ultimate strength, and stiffness
in the CGRP group were significantly higher than those in the control group
(P < .05 for all), whereas these parameters in the
CGRP-antagonist group were significantly lower compared with those in the
control group at 16 weeks after surgery (P < .05 for
all). Conclusion: Increasing the local concentration of CGRP in the early stages of BTI healing
enhanced osteogenesis in a rabbit partial patellectomy model and promoted
healing of the BTI injury, whereas treatment using a CGRP antagonist had the
opposite effect. However, exogenous CGRP expression did not induce novel
bone remolding. Clinical Relevance: CGRP may have potential as a new therapy for BTI injuries or may be added to
postoperative regimens to facilitate healing.
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Affiliation(s)
- Huabin Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Jianjun Huang
- Department of Orthopaedics, Ningde Affiliated Hospital, Fujian Medical University, Ningde, Fujian, People's Republic of China
| | - Zhanwen Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
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14
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Hu L, Liu J, Xue H, Panayi AC, Xie X, Lin Z, Wang T, Xiong Y, Hu Y, Yan C, Chen L, Abududilibaier A, Zhou W, Mi B, Liu G. miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition. MOLECULAR THERAPY. NUCLEIC ACIDS 2021; 23:1345-1359. [PMID: 33717654 PMCID: PMC7920808 DOI: 10.1016/j.omtn.2021.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 02/08/2021] [Indexed: 01/20/2023]
Abstract
Patients who sustain concomitant fractures and traumatic brain injury (TBI) are known to have significantly quicker fracture-healing rates than patients with isolated fractures. The mechanisms underlying this phenomenon have yet to be identified. In the present study, we found that the upregulation of microRNA-92a-3p (miRNA-92a-3p) induced by TBI correlated with a decrease in integrin binding sialoprotein (IBSP) expression in callus formation. In vitro, overexpressing miRNA-92a-3p inhibited IBSP expression and accelerated osteoblast differentiation, whereas silencing of miRNA-92a-3p inhibited osteoblast activity. A decrease in IBSP facilitated osteoblast differentiation via the Phosphatidylinositol 3-kinase/threonine kinase 1 (PI3K/AKT) signaling pathway. Through luciferase assays, we found evidence that IBSP is a miRNA-92a-3p target gene that negatively regulates osteoblast differentiation. Moreover, the present study confirmed that pre-injection of agomiR-92a-3p leads to increased bone formation. Collectively, these results indicate that miRNA-92a-3p overexpression may be a key factor underlying the improved fracture healing observed in TBI patients. Upregulation of miRNA-92a-3p may therefore be a promising therapeutic strategy for promoting fracture healing and preventing nonunion.
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Affiliation(s)
- Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Adriana C Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02215, USA
| | - Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Tiantian Wang
- Department of Emergency, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yiqiang Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Chengcheng Yan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Abudula Abududilibaier
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
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15
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Kazezian Z, Bull AMJ. A review of the biomarkers and in vivo models for the diagnosis and treatment of heterotopic ossification following blast and trauma-induced injuries. Bone 2021; 143:115765. [PMID: 33285256 DOI: 10.1016/j.bone.2020.115765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022]
Abstract
Heterotopic ossification (HO) is the process of de novo bone formation in non-osseous tissues. HO can occur following trauma and burns and over 60% of military personnel with blast-associated amputations develop HO. This rate is far higher than in other trauma-induced HO development. This suggests that the blast effect itself is a major contributing factor, but the pathway triggering HO following blast injury specifically is not yet fully identified. Also, because of the difficulty of studying the disease using clinical data, the only sources remain the relevant in vivo models. The aim of this paper is first to review the key biomarkers and signalling pathways identified in trauma and blast induced HO in order to summarize the molecular mechanisms underlying HO development, and second to review the blast injury in vivo models developed. The literature derived from trauma-induced HO suggests that inflammatory cytokines play a key role directing different progenitor cells to transform into an osteogenic class contributing to the development of the disease. This highlights the importance of identifying the downstream biomarkers under specific signalling pathways which might trigger similar stimuli in blast to those of trauma induced formation of ectopic bone in the tissues surrounding the site of the injury. The lack of information in the literature regarding the exact biomarkers leading to blast associated HO is hampering the design of specific therapeutics. The majority of existing blast injury in vivo models do not fully replicate the combat scenario in terms of blast, fracture and amputation; these three usually happen in one insult. Hence, this paper highlights the need to replicate the full effect of the blast in preclinical models to better understand the mechanism of blast induced HO development and to enable the design of a specific therapeutic to supress the formation of ectopic bone.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
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16
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Wong KR, Mychasiuk R, O'Brien TJ, Shultz SR, McDonald SJ, Brady RD. Neurological heterotopic ossification: novel mechanisms, prognostic biomarkers and prophylactic therapies. Bone Res 2020; 8:42. [PMID: 33298867 PMCID: PMC7725771 DOI: 10.1038/s41413-020-00119-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Neurological heterotopic ossification (NHO) is a debilitating condition where bone forms in soft tissue, such as muscle surrounding the hip and knee, following an injury to the brain or spinal cord. This abnormal formation of bone can result in nerve impingement, pain, contractures and impaired movement. Patients are often diagnosed with NHO after the bone tissue has completely mineralised, leaving invasive surgical resection the only remaining treatment option. Surgical resection of NHO creates potential for added complications, particularly in patients with concomitant injury to the central nervous system (CNS). Although recent work has begun to shed light on the physiological mechanisms involved in NHO, there remains a significant knowledge gap related to the prognostic biomarkers and prophylactic treatments which are necessary to prevent NHO and optimise patient outcomes. This article reviews the current understanding pertaining to NHO epidemiology, pathobiology, biomarkers and treatment options. In particular, we focus on how concomitant CNS injury may drive ectopic bone formation and discuss considerations for treating polytrauma patients with NHO. We conclude that understanding of the pathogenesis of NHO is rapidly advancing, and as such, there is the strong potential for future research to unearth methods capable of identifying patients likely to develop NHO, and targeted treatments to prevent its manifestation.
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Affiliation(s)
- Ker Rui Wong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
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17
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Crosstalk of Brain and Bone-Clinical Observations and Their Molecular Bases. Int J Mol Sci 2020; 21:ijms21144946. [PMID: 32668736 PMCID: PMC7404044 DOI: 10.3390/ijms21144946] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As brain and bone disorders represent major health issues worldwide, substantial clinical investigations demonstrated a bidirectional crosstalk on several levels, mechanistically linking both apparently unrelated organs. While multiple stress, mood and neurodegenerative brain disorders are associated with osteoporosis, rare genetic skeletal diseases display impaired brain development and function. Along with brain and bone pathologies, particularly trauma events highlight the strong interaction of both organs. This review summarizes clinical and experimental observations reported for the crosstalk of brain and bone, followed by a detailed overview of their molecular bases. While brain-derived molecules affecting bone include central regulators, transmitters of the sympathetic, parasympathetic and sensory nervous system, bone-derived mediators altering brain function are released from bone cells and the bone marrow. Although the main pathways of the brain-bone crosstalk remain ‘efferent’, signaling from brain to bone, this review emphasizes the emergence of bone as a crucial ‘afferent’ regulator of cerebral development, function and pathophysiology. Therefore, unraveling the physiological and pathological bases of brain-bone interactions revealed promising pharmacologic targets and novel treatment strategies promoting concurrent brain and bone recovery.
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18
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Abdulkarim A, Hu SY, Walker BR, Krkovic M. Cambridge experience in spontaneous bone regeneration after traumatic segmental bone defect: a case series and review of literature. BMJ Case Rep 2020; 13:13/4/e232482. [PMID: 32327456 DOI: 10.1136/bcr-2019-232482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
High-energy traumatic long bone defects are some of the most challenging to reconstruct. Although cases of spontaneous bone regeneration in these defects have been reported, we are aware of no management guidelines or recommendations for when spontaneous bone regeneration should be considered a viable management option. We aim to identify how certain patient characteristics and surgical factors may help predict spontaneous bone regeneration. A total of 26 cases with traumatic segmental defects were treated at our institution, with eight cases (30.8%) undergoing spontaneous regeneration. We discuss four in detail. Six (75%) reported a degree of periosteal preservation, four (50%) were associated with traumatic brain injury and none were complicated by infection. The average time to spontaneous bone regeneration was 2.06 months. According to our cases, patients with favourable characteristics may benefit from delaying surgical treatment by 6 weeks to monitor for any signs of spontaneous bone formation.
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Affiliation(s)
- Ali Abdulkarim
- Department Of Trauma and Orthopaedic Surgery, Cambridge University Hospital / Addenbrooke's Hospital, Cambridge, UK
| | - Shu Yang Hu
- Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendon R Walker
- Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matija Krkovic
- Department Of Trauma and Orthopaedic Surgery, Cambridge University Hospital / Addenbrooke's Hospital, Cambridge, UK
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19
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Hofman M, Andruszkow H, Heyer FL, Kobbe P, Hildebrand F, Poeze M. Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries. Eur J Trauma Emerg Surg 2020; 47:1903-1910. [PMID: 32140749 PMCID: PMC8629802 DOI: 10.1007/s00068-020-01335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/18/2020] [Indexed: 12/01/2022]
Abstract
Purpose Concomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union. Methods Patients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS). Results The total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development. Conclusion Our results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
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Affiliation(s)
- Martijn Hofman
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frans L. Heyer
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Philipp Kobbe
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Martijn Poeze
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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20
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Zhang X, Shui W, Ni W, Hu Z, Huang W, Luo G, Qiao B, Guo S. Minimally invasive treatment of old femoral fractures in adults. Injury 2019; 50:956-961. [PMID: 30878260 DOI: 10.1016/j.injury.2019.03.002] [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] [Received: 11/21/2018] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Extensive incision associated with large-scale callus exfoliation and internal fixation is the common therapeutic approach employed by the majority of orthopaedists in the treatment of old femoral fractures. Inspired by the surgical techniques of intramedullary fixation and reduction by traction, the present study attempted to treat old femoral fractures with minimally invasive methods utilising the principles of biological osteosynthesis (BO). METHODS A retrospective analysis involving 16 patients with old femoral fractures treated with combined traction, small incision, limited callus treatment, reduction by leverage and intramedullary fixation was conducted. The operative effect was evaluated by the operation time, intraoperative blood loss, bone grafting, healing time of fractures during follow-up, VAS score, and Harris hip score. RESULTS Intraoperative observation revealed an average operation time of 1.53 ± 0.34 h and average blood loss of 268.13 ± 97.29 ml without bone grafting in all patients. All enrolled patients had outcomes resulting in effective fixation restoration of limb alignment. Of the 16 enrolled patients, 13 patients completed follow-up with an average follow-up time of 7.42 ± 3.29 months. The average healing time for proximal femoral fractures was 3 months. The average healing time of femoral shaft fractures was 4 ± 1.09 months; two of these cases took 4 months to heal, whereas 1 case demonstrated a delayed healing time of 6 months. The VAS score was 1.15 ± 1.70, 1 patient experienced sciatica, and the Harris hip score was 92.92 ± 5.42. There were no complications of malunion, nonunion or infection among any of the patients who completed follow-up. CONCLUSIONS Minimally invasive treatment is feasible for most patients with old femoral fractures of the trochanter and femoral shaft. This finding is consistent with BO principles, thereby providing a possible new method for the treatment of old femoral fractures.
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Affiliation(s)
- Xiang Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
| | - Wei Shui
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
| | - Weidong Ni
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Zhenming Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Gang Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Bo Qiao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Shuquan Guo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
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21
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Bioinformatics Analysis of the Molecular Mechanism of Aging on Fracture Healing. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7530653. [PMID: 30643820 PMCID: PMC6311305 DOI: 10.1155/2018/7530653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 01/08/2023]
Abstract
Increasing age negatively affects different phases of bone fracture healing. The present study aimed to explore underlying mechanisms related to bone fracture repair in the elderly. GSE17825 public transcriptome data from the Gene Expression Omnibus database were used for analysis. First, raw data were normalized and differentially expressed genes (DEGs) were identified. Next, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses were implemented to evaluate pathways and DEGs. A protein-protein interaction (PPI) network was then constructed. A total of 726, 861, and 432 DEGs were identified between the young and elderly individuals at 1, 3, and 5 days after fracture, respectively. The results of GO, KEGG, and PPI network analyses suggested that the inflammatory response, Wnt signaling pathway, vascularization-associated processes, and synaptic-related functions of the identified DEGs are markedly enriched, which may account for delayed fracture healing in the elderly. These findings provide valuable clues for investigating the effects of aging on fracture healing but should be validated through further experiments.
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Bajwa NM, Kesavan C, Mohan S. Long-term Consequences of Traumatic Brain Injury in Bone Metabolism. Front Neurol 2018; 9:115. [PMID: 29556212 PMCID: PMC5845384 DOI: 10.3389/fneur.2018.00115] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/15/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) leads to long-term cognitive, behavioral, affective deficits, and increase neurodegenerative diseases. It is only in recent years that there is growing awareness that TBI even in its milder form poses long-term health consequences to not only the brain but to other organ systems. Also, the concept that hormonal signals and neural circuits that originate in the hypothalamus play key roles in regulating skeletal system is gaining recognition based on recent mouse genetic studies. Accordingly, many TBI patients have also presented with hormonal dysfunction, increased skeletal fragility, and increased risk of skeletal diseases. Research from animal models suggests that TBI may exacerbate the activation and inactivation of molecular pathways leading to changes in both osteogenesis and bone destruction. TBI has also been found to induce the formation of heterotopic ossification and increased callus formation at sites of muscle or fracture injury through increased vascularization and activation of systemic factors. Recent studies also suggest that the disruption of endocrine factors and neuropeptides caused by TBI may induce adverse skeletal effects. This review will discuss the long-term consequences of TBI on the skeletal system and TBI-induced signaling pathways that contribute to the formation of ectopic bone, altered fracture healing, and reduced bone mass.
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Affiliation(s)
- Nikita M Bajwa
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States
| | - Chandrasekhar Kesavan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Subburaman Mohan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States.,Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA, United States
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23
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Huang H, Cheng WX, Hu YP, Chen JH, Zheng ZT, Zhang P. Relationship between heterotopic ossification and traumatic brain injury: Why severe traumatic brain injury increases the risk of heterotopic ossification. J Orthop Translat 2017; 12:16-25. [PMID: 29662775 PMCID: PMC5866497 DOI: 10.1016/j.jot.2017.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/12/2017] [Accepted: 10/18/2017] [Indexed: 01/01/2023] Open
Abstract
Heterotopic ossification (HO) is a pathological phenomenon in which ectopic lamellar bone forms in soft tissues. HO involves many predisposing factors, including congenital and postnatal factors. Postnatal HO is usually induced by fracture, burn, neurological damage (brain injury and spinal cord injury) and joint replacement. Recent studies have found that patients who suffered from bone fracture combined with severe traumatic brain injury (S-TBI) are at a significantly increased risk for HO occurrence. Thus, considerable research focused on the influence of S-TBI on fracture healing and bone formation, as well as on the changes in various osteogenic factors with S-TBI occurrence. Brain damage promotes bone formation, but the exact mechanisms underlying bone formation and HO after S-TBI remain to be clarified. Hence, this article summarises the findings of previous studies on the relationship between S-TBI and HO and discusses the probable causes and mechanisms of HO caused by S-TBI. The translational potential of this article: A better understanding of the probable causes of traumatic brain injury-induced HO can provide new perspectives and ideas in preventing HO and may support to design more targeted therapies to reduce HO or enhance the bone formation.
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Affiliation(s)
- Huan Huang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wen-Xiang Cheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yi-Ping Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jian-Hai Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zheng-Tan Zheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China
| | - Peng Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China
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Zhang C, Deng K, Guo Y, Wang Z, Yu G. [Research progress of correlation between traumatic brain injury and fracture healing]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:885-889. [PMID: 29798537 DOI: 10.7507/1002-1892.201612048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the current status and advances of the correlation between traumatic brain injury (TBI) and fracture healing. Methods The related domestic and abroad literature about the correlation between TBI and fracture healing was extensively reviewed and analyzed. Results There are a variety of studies on the correlation between TBI and fracture healing, which can be divided into two major aspects: revascularization and osteogenesis; the local and systemic changes of the neuropeptide and hormone after TBI. Conclusion TBI facilitates callus formation, the further research is needed to clarify the exact mechanism.
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Affiliation(s)
- Chong Zhang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Kai Deng
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Yongchun Guo
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Zhe Wang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Guorong Yu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071,
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25
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Davies OG, Liu Y, Player DJ, Martin NRW, Grover LM, Lewis MP. Defining the Balance between Regeneration and Pathological Ossification in Skeletal Muscle Following Traumatic Injury. Front Physiol 2017; 8:194. [PMID: 28421001 PMCID: PMC5376571 DOI: 10.3389/fphys.2017.00194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/15/2017] [Indexed: 12/15/2022] Open
Abstract
Heterotopic ossification (HO) is characterized by the formation of bone at atypical sites. This type of ectopic bone formation is most prominent in skeletal muscle, most frequently resulting as a consequence of physical trauma and associated with aberrant tissue regeneration. The condition is debilitating, reducing a patient's range of motion and potentially causing severe pathologies resulting from nerve and vascular compression. Despite efforts to understand the pathological processes governing HO, there remains a lack of consensus regarding the micro-environmental conditions conducive to its formation, and attempting to define the balance between muscle regeneration and pathological ossification remains complex. The development of HO is thought to be related to a complex interplay between factors released both locally and systemically in response to trauma. It develops as skeletal muscle undergoes significant repair and regeneration, and is likely to result from the misdirected differentiation of endogenous or systemically derived progenitors in response to biochemical and/or environmental cues. The process can be sequentially delineated by the presence of inflammation, tissue breakdown, adipogenesis, hypoxia, neo-vasculogenesis, chondrogenesis and ossification. However, exactly how each of these stages contributes to the formation of HO is at present not well understood. Our previous review examined the cellular contribution to HO. Therefore, the principal aim of this review will be to comprehensively outline changes in the local tissue micro-environment following trauma, and identify how these changes can alter the balance between skeletal muscle regeneration and ectopic ossification. An understanding of the mechanisms governing this condition is required for the development and advancement of HO prophylaxis and treatment, and may even hold the key to unlocking novel methods for engineering hard tissues.
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Affiliation(s)
- Owen G Davies
- School of Sport, Exercise and Health Sciences, Loughborough UniversityLoughborough, UK.,School of Chemical Engineering, University of BirminghamBirmingham, UK
| | - Yang Liu
- Wolfson School of Mechanical and Manufacturing Engineering, Loughborough UniversityLoughborough, UK
| | - Darren J Player
- School of Sport, Exercise and Health Sciences, Loughborough UniversityLoughborough, UK
| | - Neil R W Martin
- School of Sport, Exercise and Health Sciences, Loughborough UniversityLoughborough, UK
| | - Liam M Grover
- School of Chemical Engineering, University of BirminghamBirmingham, UK
| | - Mark P Lewis
- National Centre for Sport and Exercise Medicine, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, School of Sport, Exercise and Health Sciences, Loughborough UniversityLoughborough, UK
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26
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Ferree S, Hietbrink F, van der Meijden OAJ, Verleisdonk EJMM, Leenen LPH, Houwert RM. Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture. J Shoulder Elbow Surg 2017; 26:42-48. [PMID: 27521136 DOI: 10.1016/j.jse.2016.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. METHODS A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. RESULTS A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. CONCLUSION Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation.
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Affiliation(s)
- Steven Ferree
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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27
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Zhang Y, Xu J, Ruan YC, Yu MK, O'Laughlin M, Wise H, Chen D, Tian L, Shi D, Wang J, Chen S, Feng JQ, Chow DHK, Xie X, Zheng L, Huang L, Huang S, Leung K, Lu N, Zhao L, Li H, Zhao D, Guo X, Chan K, Witte F, Chan HC, Zheng Y, Qin L. Implant-derived magnesium induces local neuronal production of CGRP to improve bone-fracture healing in rats. Nat Med 2016; 22:1160-1169. [PMID: 27571347 PMCID: PMC5293535 DOI: 10.1038/nm.4162] [Citation(s) in RCA: 499] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/13/2016] [Indexed: 12/13/2022]
Abstract
Orthopedic implants containing biodegradable magnesium have been used for fracture repair with considerable efficacy; however, the underlying mechanisms by which these implants improve fracture healing remain elusive. Here we show the formation of abundant new bone at peripheral cortical sites after intramedullary implantation of a pin containing ultrapure magnesium into the intact distal femur in rats. This response was accompanied by substantial increases of neuronal calcitonin gene-related polypeptide-α (CGRP) in both the peripheral cortex of the femur and the ipsilateral dorsal root ganglia (DRG). Surgical removal of the periosteum, capsaicin denervation of sensory nerves or knockdown in vivo of the CGRP-receptor-encoding genes Calcrl or Ramp1 substantially reversed the magnesium-induced osteogenesis that we observed in this model. Overexpression of these genes, however, enhanced magnesium-induced osteogenesis. We further found that an elevation of extracellular magnesium induces magnesium transporter 1 (MAGT1)-dependent and transient receptor potential cation channel, subfamily M, member 7 (TRPM7)-dependent magnesium entry, as well as an increase in intracellular adenosine triphosphate (ATP) and the accumulation of terminal synaptic vesicles in isolated rat DRG neurons. In isolated rat periosteum-derived stem cells, CGRP induces CALCRL- and RAMP1-dependent activation of cAMP-responsive element binding protein 1 (CREB1) and SP7 (also known as osterix), and thus enhances osteogenic differentiation of these stem cells. Furthermore, we have developed an innovative, magnesium-containing intramedullary nail that facilitates femur fracture repair in rats with ovariectomy-induced osteoporosis. Taken together, these findings reveal a previously undefined role of magnesium in promoting CGRP-mediated osteogenic differentiation, which suggests the therapeutic potential of this ion in orthopedics.
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Affiliation(s)
- Yifeng Zhang
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Ye Chun Ruan
- Epithelial Cell Biology Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Mei Kuen Yu
- Epithelial Cell Biology Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Micheal O'Laughlin
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Helen Wise
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Di Chen
- Department of Biochemistry, Rush University, Chicago, USA
| | - Li Tian
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dufang Shi
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jiali Wang
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sihui Chen
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jian Q Feng
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Texas, USA
| | - Dick Ho Kiu Chow
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Xinhui Xie
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Lizhen Zheng
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Le Huang
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Shuo Huang
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Kwoksui Leung
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Na Lu
- Division of Life Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, PR China
| | - Lan Zhao
- Department of Biochemistry, Rush University, Chicago, USA
| | - Huafang Li
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dewei Zhao
- Department of Orthopedics, Dalian University Zhongshan Hospital, Dalian, PR China
| | - Xia Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Kaiming Chan
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Frank Witte
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hsiao Chang Chan
- Epithelial Cell Biology Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, PR China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopedics &Traumatology, The Chinese University of Hong Kong, Hong Kong, PR China
- Translational Medicine Research &Development Center, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Shenzhen, PR China
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Wang L, Sun S, Yang L, Lu C, Cao XJ. Effects of leptin on femoral fracture in rats. J Biomed Res 2016; 32:130-135. [PMID: 28550273 PMCID: PMC5895567 DOI: 10.7555/jbr.31.20160077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this study, our objective was to evaluate effects of leptin on fracture healing in rats. Seventy two male Sprague-Dawley (SD) rats were randomized into 3 groups. Standardized femoral fractures were created in all the rats. Group A was treated with 1 mL normal saline (NS), group B with 0.3 μg/kg leptin in 1 mL NS, and group C with 0.5 μg/kg leptin in 1 mL NS for 2 weeks intraperitoneally. Each group was divided into three subgroups including 8 rats for evaluation at 2, 4 and 8 weeks. Radiological evaluation showed that callus formation of group B and C was all significantly higher than group A at 8 weeks (P=0.04 and P=0.013, respectively). There was no statistically significant difference in fracture healing between group B and group C at 8 weeks (P=0.197). Histological evaluation revealed fracture healing of group B and C was better than group A at 4 weeks (P=0.01 and P=0.002, respectively) and 8 weeks (P=0.008 and P=0.003, respectively). Micro-computed tomography (Micro-CT) analysis demonstrated that greater amounts of bony callus and evidence of bone fusion were observed in group B and C at 4 weeks (P=0.02 and P=0.04, respectively) and 8 weeks (P=0.005 and P=0.001, respectively) compared to group A. Group C also had better fracture healing than group B at 8 weeks (P=0.01). In conclusion, leptin has a positive effect on rat femoral fracture healing.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Sixin Sun
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lei Yang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chun Lu
- Department of Immunology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Xiao-Jian Cao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Khallaf FG, Kehinde EO, Hussein S. Bone Healing and Hormonal Bioassay in Patients with Long-Bone Fractures and Concomitant Head Injury. Med Princ Pract 2016; 25:336-42. [PMID: 26954461 PMCID: PMC5588422 DOI: 10.1159/000445250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 03/07/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate healing of fractures in patients with concomitant head injuries and to measure blood hormone levels to elucidate the mechanism of a possible accelerated osteogenesis. MATERIALS AND METHODS One hundred and sixty-two patients were included in this study and divided into 3 cohorts: group A with head injuries only (n = 52); group B with head injuries as well as long-bone fractures (n = 50); group C with long-bone fractures only (n = 60). Fracture-healing parameters including time of appearance and thickness of the bridging callus, and blood hormonal assays were measured and compared using Student's t test. RESULTS The mean time to healing was significantly lower in cohort B (6.9 ± 2.9 weeks) than C (22.4 ± 8.7 weeks; p = 0.001). The mean thickness of the healing callus was significantly higher in cohort B (26.3 ± 9.7 mm) than C (8.1 ± 5.9 mm; p = 0.002). The mean healing rate was also higher in cohort B (4.5 ± 2.3 mm/week) than C (0.38 ± 0.21 mm/week; p = 0.001). Blood hormonal assays in group B showed higher values of parathyroid hormone and growth hormone than in group C. However, adrenaline and noradrenaline values were lower in group B than in group C at all measured time intervals, and correspondingly leptin was lower in all groups (p = 0.001). Corticosteroid values were normal in group B compared to slightly higher values in group C, also at all measured time intervals. CONCLUSION In this study, healing of fractures in patients with concomitant head injuries was accelerated, thereby indicating an involvement of a combined neurohormonal mechanism.
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Affiliation(s)
- Fathy G. Khallaf
- Department of Orthopaedic Surgery, Jahra Hospital, Kuwait, Jabriya
- *Dr. Fathy G. Khallaf, FRCS Glasgow, Department of Orthopaedic Surgery, Jahra Hospital, Ministry of Health, Kuwait (Kuwait), E-Mail
| | - Elijah O. Kehinde
- Department of Surgery, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Sundus Hussein
- Department of Pathology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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30
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Khallaf FG, Kehinde EO. Histopathological examination of bone debris from reaming of interlocking intra-medullary nail fixation of long bone fractures with concomitant head injury. J Orthop 2015; 12:217-21. [PMID: 26566322 DOI: 10.1016/j.jor.2015.05.010] [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] [Received: 05/16/2015] [Accepted: 05/24/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUD/AIM The aim of study was to test, for the presence of osteoblasts in the reaming debris of intramedullary nailing of femoral and tibial fracture in patients with and without severe head injury. METHODS Two groups of patients were studied. Group A (n = 32) had long bone fractures in addition to having head injuries. Group B (n = 35) had only long bone fractures. The fractures in the 2 groups of patients was treated by inter medullary nailing. Osteoblasts in the debris of the inter medullary nailing was compared between the 2 groups of patients. RESULTS The results demonstrated that histopathological specimens from reaming debris of fractured femur and tibia in patients with head injury showed osteoblasts in (82.9%) and in (27.5%) of patients with isolated long bone fractures (p < 0.001). CONCLUSION Healing indicators in diaphyseal fractures and concomitant head injury confirm fast and adequate healing in these patients and the presence of plenty of osteoblasts in their reaming debris may reflect a proof of accelerated fracture healing environment.
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Affiliation(s)
- Fathy G Khallaf
- Dept of Orthopaedic Surgery, Jahra Hospital, Ministry of Health, Kuwait
| | - Elijah O Kehinde
- Dept of Surgery, Faculty of Medicine, Kuwait University, PO Box 234923, 13110 Kuwait
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Genêt F, Minooee K, Jourdan C, Ruet A, Denormandie P, Schnitzler A. Troublesome heterotopic ossification and stroke: Features and risk factors. A case control study. Brain Inj 2015; 29:866-71. [PMID: 25915823 DOI: 10.3109/02699052.2015.1005133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. RESEARCH DESIGN A case control study (risk factor of a rare event using retrospective analysis). METHODS AND PROCEDURES Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO after stroke. Matching criteria were age (±3.5 years) and sex. Data recorded were time from stroke to surgery, ischaemic or haemorrhagic stroke and presence of HO risk factors. MAIN OUTCOMES AND RESULTS Mean age at time of stroke = 46.02 ± 11.4 years (15.9-76.3) for the case sub-group. Time from stroke to surgery = 23.4 ± 27.8 months (3.6-150.0). There was a significant relationship between haemorrhagic stroke and HO development (OR = 3.01; 95% CI = 1.14-7.98; p < 0.05), but not for ischaemic stroke. This became non-significant when all matching and risk factors were included in the model (adjusted OR = 1.98; 95% CI = 0.60-6.54; p = 0.26). CONCLUSION Haemorrhagic stroke appears to increase the risk of HO development. Further studies are required to determine if this risk factor is independent from other comorbid factors.
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Affiliation(s)
- François Genêt
- Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré , Garches , France
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32
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Improved fracture healing in patients with concomitant traumatic brain injury: proven or not? Mediators Inflamm 2015; 2015:204842. [PMID: 25873754 PMCID: PMC4385630 DOI: 10.1155/2015/204842] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/19/2015] [Indexed: 01/08/2023] Open
Abstract
Over the last 3 decades, scientific evidence advocates an association between traumatic brain injury (TBI) and accelerated fracture healing. Multiple clinical and preclinical studies have shown an enhanced callus formation and an increased callus volume in patients, respectively, rats with concomitant TBI. Over time, different substances (cytokines, hormones, etc.) were in focus to elucidate the relationship between TBI and fracture healing. Until now, the mechanism behind this relationship is not fully clarified and a consensus on which substance plays the key role could not be attained in the literature. In this review, we will give an overview of current concepts and opinions on this topic published in the last decade and both clinical and pathophysiological theories will be discussed.
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Factors affecting the incidence of aseptic nonunion after surgical fixation of humeral diaphyseal fracture. J Orthop Sci 2014; 19:973-7. [PMID: 25196794 DOI: 10.1007/s00776-014-0640-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although aseptic nonunion of humeral diaphyseal fracture is rare, it often is debilitating for the patient. Treatment is challenging for the surgeon when nonunion occurs. The purpose of this study was to analyze and identify independent risk factors for aseptic nonunion among patients with humeral diaphyseal fracture undergoing surgical fixation. METHODS The medical records of all humeral diaphyseal fracture patients who underwent surgical fixation from January 2005 to January 2011 were reviewed to identify those who developed aseptic nonunion. We performed univariate and multivariate logistic regression to identify independent associations of potential risk factors for aseptic nonunion among patients with surgical humeral diaphyseal fracture. RESULTS A total of 686 patients were identified, with 659 meeting our inclusion criteria. Among these 659 cases there were 24 cases of septic nonunion, an incidence of 3.6%. The patients were followed for 9-24 months, with an average follow-up period of 14.8 months. In the final regression model, advanced age (odds ratio, 1.09; 95% CI: 1.03-1.14, P = 0.001), smoking (odds ratio, 5.34; 95% CI: 1.05-27.00, P = 0.043), use of NSAIDs (odds ratio, 2.51; 95% CI: 1.80-3.50, P < 0.001), and ASA score (odds ratio, 3.04; 95% CI: 1.06-8.74, P = 0.039) were risk factors for aseptic nonunion of humeral diaphyseal fracture after surgical fixation. CONCLUSIONS This analysis confirms advanced age, smoking, use of NSAIDs, and ASA score were related to an increased risk of aseptic nonunion of humeral diaphyseal fracture after surgical fixation. Patients who have the risk factors identified in this study should be counseled about the possibility of aseptic nonunion occurring after surgical fixation.
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Wang L, Yao X, Xiao L, Tang X, Ding H, Zhang H, Yuan J. The effects of spinal cord injury on bone healing in patients with femoral fractures. J Spinal Cord Med 2014; 37:414-9. [PMID: 24621032 PMCID: PMC4116725 DOI: 10.1179/2045772313y.0000000155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Orthopedic literature states that fractures of long bones, when associated with traumatic brain injuries, frequently heal with excessive callus and faster than normal. Few studies, however, have reported these phenomena being induced by spinal cord injury (SCI). Our objective is to compare the extent of callus and the rate of healing of long-bone fractures in patients with or without SCI. Subgroup comparisons were performed among the patients with SCI in terms of different levels of SCI. METHODS The final mean volume of callus formation and the rate of union of nailed fractures of the femur were determined radiologically in 22 femoral fracture patients with SCI (seven cervical, six thoracic, and nine lumbar spine injury) and compared with those in a group of 22 patients with similar types of fractures but without SCI. RESULTS The final mean callus volume in the fracture/SCI group was significantly higher than the fracture-only group (P < 0.001). The fractures in the fracture/SCI group united in an average time of 22.86 weeks compared with 25.04 weeks in the fracture-only group (P < 0.05). We observed 84.6% (11 of 13) of patients with cervical and thoracic SCI patients with accelerated fracture healing (cervical 6 of 7, thoracic 5 of 6), but only 44.4% (4 of 9) of patients with lumbar SCI appeared to show this phenomenon (P < 0.05). CONCLUSIONS These results confirm that SCI may be associated with accelerated fracture healing and enhanced callus formation. Furthermore, our study revealed a trend toward enhanced osteogenesis in cervical or thoracic SCI compared with lumbar SCI.
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Affiliation(s)
| | | | | | | | | | | | - Jishan Yuan
- Correspondence to: Yuan Jishan, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China.
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Zhuang YF, Li J. Serum EGF and NGF levels of patients with brain injury and limb fracture. ASIAN PAC J TROP MED 2014; 6:383-6. [PMID: 23608378 DOI: 10.1016/s1995-7645(13)60043-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/15/2013] [Accepted: 05/01/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore the expression and significance of human epidermal growth factor (EGF) and nerve growth factor (NGF) in patients with knee osteoarthritis. METHODS RT-PCR and enzyme-linked immunosorbent assay were used to measure the serum EGF and NGF expression levels of patients with limb fracture and brain trauma injurry after 1 d, 3 d, 7 d, 14 d and the relationship between them was analyzed. The level was compared among the simple fracture group, traumatic brain injury group and the normal control group, with 40 cases in each group. RESULTS The serum NGF levels were significantly different among three groups. Serum NGF, EGF mRNA and protein levels gradually decreased with the increasing injury time in the limb fracture combined with brain injury group, traumatic brain injury group, the simple fracture group and the health control group (P<0.05). CONCLUSIONS The serum of NGF, EGF levels significantly increased when limb fracture combined with brain injury, so EGF and NGF may be involved in the process of fracture healing.
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Affiliation(s)
- Yan-Feng Zhuang
- Department of Orthopedic, Fuzhou General Hospital, Fuzhou 350000, Fujian Province, China
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Ding J, Chen YF, Zhang CQ, Zeng BF. Multiple heterotopic ossification of scar following degloving injury: a case report. Orthop Surg 2013; 5:149-52. [PMID: 23658053 DOI: 10.1111/os.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jian Ding
- Department of Orthopaedics, The 6th Affiliated People's Hospital of Shanghai Jiaotong University, Shanghai, China.
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Yan H, Zhang HW, Fu P, Liu BL, Jin WZ, Duan SB, Xue J, Liu K, Sun ZM, Zeng XW. Leptin's effect on accelerated fracture healing after traumatic brain injury. Neurol Res 2013; 35:537-44. [PMID: 23594570 DOI: 10.1179/1743132813y.0000000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate mechanisms behind the faster rehabilitation of limb fractures when associated with traumatic brain injury (TBI). METHODS New Zealand rabbits were divided into TBI group and sham-operation group for four studies as follows: (1) blood and cerebrospinal fluid (CSF) were drawn on days 1, 3, and 7 to demonstrate changes in serum leptin, growth hormone (GH), insulin-like growth factor 1 (IGF-1), and CSF leptin; (2) bone defection was created by drilling in the tibial bone and either leptin or normal saline was injected into rabbit's cerebellomedullary cistern. X-ray was taken at 1 days, 2 weeks, and 5 weeks and evaluated by criteria to determine rate of bone healing; (3) FITC-labeled rabbit leptin was injected into TBI and sham-operation groups, and frozen sections of rabbit brain were observed to identify differences in central nervous system (CNS) leptin by fluorescence; (4) polymerase chain reaction (PCR) was used to evaluate the expression of leptin production by brain tissue. RESULTS Serum and CSF leptin, GH, and IGF-1 concentrations were found to be higher in the TBI group than the sham-operation group at days 1, 3, and 7 (P<0·05). CSF leptin of the TBI group was positively correlated with serum leptin on day 1 (P<0·05), and positively correlated with GH and IGF-1 on days 3 and 7 (P<0·05). X-ray criteria demonstrated that leptin administration caused significantly faster healing calluses at 3 and 5 weeks as compared to control animals (P<0·05). FITC-labeled leptin study demonstrated that TBI animals had stronger expression of leptin in the brain than sham-operated animals. However, PCR of brain tissue leptin showed no significant differences between TBI and sham-operated animals in the expression of leptin. CONCLUSIONS Our study suggests that increased CSF leptin, likely from blood-brain barrier breakdown, combined with elevated serum GH and IGF-1 after TBI, leads to accelerated fracture healing.
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Affiliation(s)
- Hua Yan
- Department of Neurosurgery, Tianjin Huanhu Hospital, China
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Sullivan MP, Torres SJ, Mehta S, Ahn J. Heterotopic ossification after central nervous system trauma: A current review. Bone Joint Res 2013; 2:51-7. [PMID: 23610702 PMCID: PMC3626201 DOI: 10.1302/2046-3758.23.2000152] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/10/2013] [Indexed: 11/17/2022] Open
Abstract
Neurogenic heterotopic ossification (NHO) is
a disorder of aberrant bone formation affecting one in five patients sustaining
a spinal cord injury or traumatic brain injury. Ectopic bone forms
around joints in characteristic patterns, causing pain and limiting
movement especially around the hip and elbow. Clinical sequelae
of neurogenic heterotopic ossification include urinary tract infection,
pressure injuries, pneumonia and poor hygiene, making early diagnosis
and treatment clinically compelling. However, diagnosis remains
difficult with more investigation needed. Our pathophysiological
understanding stems from mechanisms of basic bone formation enhanced
by evidence of systemic influences from circulating humor factors
and perhaps neurological ones. This increasing understanding guides
our implementation of current prophylaxis and treatment including
the use of non-steroidal anti-inflammatory drugs, bisphosphonates,
radiation therapy and surgery and, importantly, should direct future, more
effective ones.
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Affiliation(s)
- M P Sullivan
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA
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Leblanc E, Drouin G, Grenier G, Faucheux N, Hamdy R. From skeletal to non skeletal: The intriguing roles of BMP-9: A literature review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/abb.2013.410a4004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yang S, Ma Y, Liu Y, Que H, Zhu C, Liu S. Arachidonic acid: a bridge between traumatic brain injury and fracture healing. J Neurotrauma 2012; 29:2696-705. [PMID: 22867040 DOI: 10.1089/neu.2012.2442] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with enhanced osteogenesis. The aim of this study was to investigate the effect of serum from TBI rats on fracture healing. Results from this study showed that the serum from TBI rats enhanced the expression of bone gamma carboxyglutamate protein (BGLAP), and promoted in vitro proliferation of MC3T3-E1 cells, a mouse osteoblastic cell line. Furthermore, gas chromatography/mass spectrometry (GC/MS) coupled with multivariate statistical analysis was used to identify the changes in global serum metabolites after TBI. We found that arachidonic acid (AA) was significantly enhanced in serum metabolites in TBI subjects, while hydroxybutyric acid, leucine, malic acid, 5-oxyproline, isocitric acid, mannose, and uric acid were reduced. Finally, we examined the effects of AA on BGLAP expression and cell proliferation in MC3T3-E1 cells. We found that BGLAP expression and proliferation of osteoblasts were positively regulated in the presence of AA. These findings suggest that the increased AA in serum after TBI may play a key role in enhancing the speed of fracture healing.
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Affiliation(s)
- Shuguang Yang
- State Key Laboratory of Proteomics and Department of Neurobiology, Department of Neurobiology, Institute of Basic Medical Sciences, Beijing, China
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Huang W, Li Z, Li Z, Yang R. Does traumatic brain injury result in accelerated mandibular fracture healing? J Oral Maxillofac Surg 2012; 70:2135-42. [PMID: 22907111 DOI: 10.1016/j.joms.2012.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/05/2012] [Accepted: 04/09/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the occurrence of accelerated bone healing evidenced by early callus formation in patients with mandibular fractures and traumatic brain injury (TBI). MATERIALS AND METHODS A retrospective cohort study was performed in patients who presented for mandibular fracture evaluation and management over a 6-year period. Subjects eligible for the study included those who underwent a computed tomographic examination of the mandible more than 2 weeks after the injury and had not undergone surgery with rigid internal fixation. TBI was used as the predictor variable. Time to callus formation as detected on computed tomographic scans was recorded as the primary outcome variable. Other variables considered included age, gender, coma duration, and fracture distribution. Appropriate statistical analyses were performed to determine the influencing factors. RESULTS Forty-five patients with mandibular fractures (24 with severe TBI and 21 without TBI) were retrospectively analyzed. Twelve patients with TBI and 6 without TBI exhibited a visible callus on their computed tomographic scans. Statistical analysis showed no significant differences in age, gender, examination time, and fracture distribution between the groups. Cox proportional hazards regression analysis indicated a positive correlation of time to callus formation with TBI and coma duration but not with age, gender, and fracture distribution. CONCLUSIONS These findings suggest that patients with severe TBI and mandibular fractures exhibit increased fracture healing as evidenced by early callus formation. A more exhaustive study is required to advance the understanding of this phenomenon and provide additional clinical significance.
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Affiliation(s)
- Wei Huang
- School and Hospital of Stomatology, Wuhan University, Wuhan City, Hubei Province, China
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Yang TY, Wang TC, Tsai YH, Huang KC. The effects of an injury to the brain on bone healing and callus formation in young adults with fractures of the femoral shaft. ACTA ACUST UNITED AC 2012; 94:227-30. [PMID: 22323691 DOI: 10.1302/0301-620x.94b2.28193] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In patients with traumatic brain injury and fractures of long bones, it is often clinically observed that the rate of bone healing and extent of callus formation are increased. However, the evidence has been unconvincing and an association between such an injury and enhanced fracture healing remains unclear. We performed a retrospective cohort study of 74 young adult patients with a mean age of 24.2 years (16 to 40) who sustained a femoral shaft fracture (AO/OTA type 32A or 32B) with or without a brain injury. All the fractures were treated with closed intramedullary nailing. The main outcome measures included the time required for bridging callus formation (BCF) and the mean callus thickness (MCT) at the final follow-up. Comparative analyses were made between the 20 patients with a brain injury and the 54 without brain injury. Subgroup comparisons were performed among the patients with a brain injury in terms of the severity of head injury, the types of intracranial haemorrhage and gender. Patients with a brain injury had an earlier appearance of BCF (p < 0.001) and a greater final MCT value (p < 0.001) than those without. There were no significant differences with respect to the time required for BCF and final MCT values in terms of the severity of head injury (p = 0.521 and p = 0.153, respectively), the types of intracranial haemorrhage (p = 0.308 and p = 0.189, respectively) and gender (p = 0.383 and p = 0.662, respectively). These results confirm that an injury to the brain may be associated with accelerated fracture healing and enhanced callus formation. However, the severity of the injury to the brain, the type of intracranial haemorrhage and gender were not statistically significant factors in predicting the rate of bone healing and extent of final callus formation.
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Affiliation(s)
- T-Y. Yang
- Chang Gung Memorial Hospital at Chiayi,
Chang Gung University College of Medicine, Department
of Orthopaedics, No. 6, West
Sec., Chia-Pu Road, Pu-Tz
City, Chia-Yi 613, Taiwan
| | - T-C. Wang
- Chang Gung Memorial Hospital at Chiayi,
Chang Gung University College of Medicine, Department
of Neurosurgery, No. 6, West
Sec., Chia-Pu Road, Pu-Tz
City, Chia-Yi 613, Taiwan
| | - Y-H. Tsai
- Chang Gung Memorial Hospital at Chiayi,
Chang Gung University College of Medicine, Department
of Orthopaedics, No. 6, West
Sec., Chia-Pu Road, Pu-Tz
City, Chia-Yi 613, Taiwan
| | - K-C. Huang
- Chang Gung Memorial Hospital at Chiayi,
Chang Gung University College of Medicine, Department
of Orthopaedics, No. 6, West
Sec., Chia-Pu Road, Pu-Tz
City, Chia-Yi 613, Taiwan
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Effect of rat brain tissue extracts on osteoblast proliferation and differentiation. INTERNATIONAL ORTHOPAEDICS 2011; 36:887-93. [PMID: 22159657 DOI: 10.1007/s00264-011-1423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The reason for enhanced fracture healing in traumatic brain injury patients is not clearly understood. It is possible that factors inherent in the brain passing through the blood-brain barrier to the peripheral circulation, or a disruption of central nervous system (CNS) control of the sympathetic nervous system (SNS), stimulates the process of fracture healing. METHODS In this study, we assessed proliferation [using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay] and differentiation [using alkaline phosphatase (ALP)] in rat osteoblasts incubated with gray matter or other tissue extracts with and without the addition of an α- or β-adrenergic receptor blocker (phentolamine or propranolol). RESULTS Gray matter extract from normal brain caused a dose-dependent increase in osteoblast proliferation and differentiation. Serum from normal rats enhanced differentiation but not proliferation. Alpha-receptor blockade had no effect on proliferation or differentiation. Beta-receptor blockade caused a partial, but statistically significant, decrease in gray matter stimulation of osteoblast differentiation. CONCLUSION The results of this study indicate that gray matter extract from normal brain increases osteoblast proliferation and differentiation and that β receptors may be involved in differentiation under these conditions.
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Lin SH, Chiu CC, Wang CY, Chen CH, Chang KH. Subdural hygroma-related heterotopic ossification in a patient with a stroke: a case report. Brain Inj 2011; 25:624-8. [PMID: 21534740 DOI: 10.3109/02699052.2011.571228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study presents a patient with a stroke who had total paralysis of his left-side limbs after intracranial haemorrhaging, who later experienced partial weakness of the right-side limbs after a subdural hygroma. Both conditions occurred without major trauma. He received two separate operations, a craniotomy and placement of a ventriculoperitoneal shunt, before the appearance of the subdural hygroma. CASE STUDY According to the literature, heterotopic ossification is often reported with major trauma-associated diseases, but is less frequently found in patients with non-traumatic conditions, from which this patient suffered. Although the patient had experienced no major trauma, he had multiple heterotopic ossifications on the side of the subdural hygroma-affected limbs, which exhibited better motor control and were less spastic than those of the opposite side. These heterotopic ossifications were around joints of the hip, knee and shoulder on his right side, as proven by plain radiography and a triple-phase bone scan and resulted in marked limitations of joint motions. This patient thus had major disabilities of his limbs bilaterally. CONCLUSIONS The occurrence of heterotopic ossifications in the less-paretic limbs might have worsened this patient's functional outcome.
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Affiliation(s)
- Shih-Han Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei, Taiwan
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Genêt F, Jourdan C, Schnitzler A, Lautridou C, Guillemot D, Judet T, Poiraudeau S, Denormandie P. Troublesome heterotopic ossification after central nervous system damage: a survey of 570 surgeries. PLoS One 2011; 6:e16632. [PMID: 21304993 PMCID: PMC3031592 DOI: 10.1371/journal.pone.0016632] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 01/06/2011] [Indexed: 11/18/2022] Open
Abstract
Background Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. Methodology/Principal Findings We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%–7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7). Conclusions/Significance In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence.
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Affiliation(s)
- François Genêt
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.
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Recombinant myostatin (GDF-8) propeptide enhances the repair and regeneration of both muscle and bone in a model of deep penetrant musculoskeletal injury. ACTA ACUST UNITED AC 2010; 69:579-83. [PMID: 20173658 DOI: 10.1097/ta.0b013e3181c451f4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myostatin (GDF-8) is known as a potent inhibitor of muscle growth and development, and myostatin is also expressed early in the fracture healing process. The purpose of this study was to test the hypothesis that a new myostatin inhibitor, a recombinant myostatin propeptide, can enhance the repair and regeneration of both muscle and bone in cases of deep penetrant injury. METHODS We used a fibula osteotomy model with associated damage to lateral compartment muscles (fibularis longus and brevis) in mice to test the hypothesis that blocking active myostatin with systemic injections of a recombinant myostatin propeptide would improve muscle and bone repair. Mice were assigned to two treatment groups after undergoing a fibula osteotomy: those receiving either vehicle (saline) or recombinant myostatin propeptide (20 mg/kg). Mice received one injection on the day of surgery, another injection 5 days after surgery, and a third injection 10 days after surgery. Mice were killed 15 days after the osteotomy procedure. Bone repair was assessed using microcomputed tomography (micro-CT) and histologic evaluation of the fracture callus. Muscle healing was assessed using Masson trichrome staining of the injury site, and image analysis was used to quantify the degree of fibrosis and muscle regeneration. RESULTS Three propeptide injections over a period of 15 days increased body mass by 7% and increased muscle mass by almost 20% (p < 0.001). Micro-CT analysis of the osteotomy site shows that by 15 days postosteotomy, bony callus tissue was observed bridging the osteotomy gap in 80% of the propeptide-treated mice but only 40% of the control (vehicle)-treated mice (p < 0.01). Micro-CT quantification shows that bone volume of the fracture callus was increased by ∼ 30% (p < 0.05) with propeptide treatment, and the increase in bone volume was accompanied by a significant increase in cartilage area (p = 0.01). Propeptide treatment significantly decreased the fraction of fibrous tissue in the wound site and increased the fraction of muscle relative to fibrous tissue by 20% (p < 0.01). CONCLUSIONS Blocking myostatin signaling in the injured limb improves fracture healing and enhances muscle regeneration. These data suggest that myostatin inhibitors may be effective for improving wound repair in cases of orthopaedic trauma and extremity injury.
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Cadosch D, Thyer M, Gautschi OP, Lochnit G, Frey SP, Zellweger R, Filgueira L, Skirving AP. Functional and proteomic analysis of serum and cerebrospinal fluid derived from patients with traumatic brain injury: a pilot study. ANZ J Surg 2010; 80:542-7. [DOI: 10.1111/j.1445-2197.2010.05268.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Affiliation(s)
- Young-Jo Kim
- Children's Hospital-Boston, Boston, MA 02115, USA.
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Pasupathy S, Yuvaraj V. Poliomyelitis causing TMJ ankylosis?--report of two intriguing cases. Oral Maxillofac Surg 2010; 14:243-6. [PMID: 20145964 DOI: 10.1007/s10006-010-0203-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Temporomandibular joint (TMJ) ankylosis is one of the common diseases which affect the TMJ especially in children. We are reporting two rare cases of TMJ ankylosis which occurred along with poliomyelitis and which are not reported in literature so far. DISCUSSION In this article, we discussed about the most probable causes which resulted in TMJ ankylosis in these patients.
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Affiliation(s)
- Sanjay Pasupathy
- Department of Oral and Maxillofacial Surgery, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry (Union Territory), India.
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