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Journal articles on the topic 'Fracture healing'
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1
Engelhardt, Lucas, Frank Niemeyer, Patrik Christen, Ralph Müller, Kerstin Stock, Michael Blauth, Karsten Urban, Anita Ignatius, and Ulrich Simon. "Simulating Metaphyseal Fracture Healing in the Distal Radius." Biomechanics 1, no. 1 (February 25, 2021): 29–42. http://dx.doi.org/10.3390/biomechanics1010003.
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Simulating diaphyseal fracture healing via numerical models has been investigated for a long time. It is apparent from in vivo studies that metaphyseal fracture healing should follow similar biomechanical rules although the speed and healing pattern might differ. To investigate this hypothesis, a pre-existing, well-established diaphyseal fracture healing model was extended to study metaphyseal bone healing. Clinical data of distal radius fractures were compared to corresponding geometrically patient-specific fracture healing simulations. The numerical model, was able to predict a realistic fracture healing process in a wide variety of radius geometries. Endochondral and mainly intramembranous ossification was predicted in the fractured area without callus formation. The model, therefore, appears appropriate to study metaphyseal bone healing under differing mechanical conditions and metaphyseal fractures in different bones and fracture types. Nevertheless, the outlined model was conducted in a simplified rotational symmetric case. Further studies may extend the model to a three-dimensional representation to investigate complex fracture shapes. This will help to optimize clinical treatments of radial fractures, medical implant design and foster biomechanical research in metaphyseal fracture healing.
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Gajdobranski, Djordje, and Dragana Zivkovic. "Impaired fracture healing." Medical review 56, no. 3-4 (2003): 146–51. http://dx.doi.org/10.2298/mpns0304146g.
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Introduction Bone fracture healing is a complex cascade of events at cellular and biochemical levels, that ends by complete structural and functional restoration of a damaged bone. Impaired healing develops in 5-10% of all fractures, and manifests as delayed union or non-union. This paper deals with the problem of impaired healing as well as with methods of fracture healing enhancement. Causes of impaired fracture healing There are many factors causing impaired fracture healing (inadequate vascularization, mechanical causes, infection, etc.), and it is very important to recognize the principle cause of delayed union and non-union, since therapy is based on eliminating the factor that causes it. Fracture healing enhancement Through constant attempts to find adequate solutions and procedures in order to resolve the problem of impaired fracture healing, many alternatives in treatment of impaired healing have been developed. Some of these procedures may also be useful in treatment of fresh fractures, especially when it comes to fractures that are prone to delayed union and non-union more than usual. All currently known methods of healing enhancement may be classified as biological, mechanical and biophysical. Conclusion Certain methods are in clinical use for several decades. The newest methods, such as locally applied growth factors, composite biosynthetic grafts, gene therapy and systemic approaches are studied all around the world, and are on the verge of clinical application. Due to impressive number of therapeutic options, certain therapeutic procedures of choice will be developed for specific impairments.
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Omar, Raffal A., and S. I. Saleh. "Study of low power Laser effect on the healing of tibial fracture treated by intramedullary pin in rabbits." Iraqi Journal of Veterinary Medicine 27, no. 1 (June 28, 2003): 99–108. http://dx.doi.org/10.30539/ijvm.v27i1.1100.
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The effect of low power laser (LPL) on the healing of distal third of tibial fractures has been studied radiologically.
Fractures induced in twenty-five local breed rabbits, immobilization achieved by using Steinman intramedullary pins, which was not removed during the period of study for 7 weeks.
Irradiation with LPL was made by direct contact between the source and the site of fracture directly after the operation and then daily for fifteen days.
Each fracture was studied radiologically after the first day from the operation until complete healing occurs.
This study confirm that the healing of distal third of tibial fracture was very slow in control group and LPL accelerate the process of fracture healing in treated groups.
With notice that the surface of fractured bone exposed to the source of laser therapy (medial side) was healed better than the non - exposed surface (lateral side).
Finally there was no clear difference between treated groups.
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Wollstein, Ronit, Arie Trouw, Lois Carlson, Ilene Staff, Daniel J. Mastella, and Duffield Ashmead. "The Effect of Age on Fracture Healing Time in Metacarpal Fractures." HAND 15, no. 4 (December 2, 2018): 542–46. http://dx.doi.org/10.1177/1558944718813730.
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Background: Older patients are treated for fracture with increasing frequency. Although studies on animals suggest that older mice and rats heal fractures more slowly, the clinical implications remain unclear. A better understanding of differences in healing with age can help customize fracture treatment. Our purpose was to retrospectively evaluate metacarpal fractures for healing time looking specifically at age-related differences. Methods: A retrospective review of patients treated for metacarpal fractures was conducted. Patients with incomplete charts or inadequate follow-up were excluded. One hundred ninety-eight charts were analyzed. Demographic and other patient factors were documented. Fracture characteristics and treatment type were documented. Fracture healing was determined clinically. Plain radiographs and examination were used in decision making. Results: Age was not associated with fracture healing time as a continuous variable ( P = .09). Patients above 75 years were not associated with increased healing time ( P = .58). Fracture characteristics were related to healing time: minimally displaced and comminuted fractures healed faster than oblique fractures, spiral fractures, or transverse fractures ( P = .048). Patients undergoing surgery healed faster than those without surgery ( P = .046). Renal failure negatively affected fracture healing time ( P = .03). Diabetes, hypothyroidism, and gender were not associated with healing time. Complications were not associated with age or other patient or fracture-related factors. Conclusions: Age does not affect clinical fracture healing time in adult. Therefore, older patients do not require disparate treatment. Other fracture-related factors and considerations such as functional demand and support systems might influence treatment decisions in fracture care.
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Smith, Robert G. "Fracture Healing." Journal of the American Podiatric Medical Association 105, no. 2 (March 1, 2015): 160–72. http://dx.doi.org/10.7547/0003-0538-105.2.160.
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Background Recognizing the existence of adverse drug effects of frequently prescribed drugs can empower a clinician with knowledge to avoid dangerous adverse effects that may result in hazardous, negative patient outcomes on either fracture healing or bone health. Pharmacovigilance reports have described the influence of medications, allowing for bone health to be quite unpredictable. Methods First, mechanisms found in the medical literature of potential drug adverse effects regarding fracture healing are presented. Second, the 100 most frequently prescribed medications in 2010 are reviewed regarding adverse effects on fracture healing. These reported adverse effects are evaluated for medical causation. Last, a data table describing the 100 reviewed medications and their reported effects on fracture healing is provided. Results The actual number of different medications in the review was 72. Reported drug adverse effects on bone and fracture healing occurred with 59 of the 72 drugs (81.9%). These adverse effects are either described as a definitive statement or represented by postmarketing case reports. Thirteen of the 72 review drugs (18.1%) did not have any description of the possible effects on bone health. A total of 301 cases reports describing delayed union, malunion, and nonunion of fractures represent 31 of the 72 medications reviewed (43.1%). Conclusions This review offers the health-care provider information regarding potential adverse drug effects on bone health. Empowered with this information, clinicians may assist their patients in maximizing pharmacologic outcomes by avoiding these reported harmful adverse effects.
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Raschke, Michael, Michael Højby Rasmussen, Shunmugam Govender, David Segal, Mette Suntum, and Jens Sandahl Christiansen. "Effects of growth hormone in patients with tibial fracture: a randomised, double-blind, placebo-controlled clinical trial." European Journal of Endocrinology 156, no. 3 (March 2007): 341–51. http://dx.doi.org/10.1530/eje-06-0598.
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Objective: Investigate whether intervention with GH after tibial fracture enhances fracture healing. Design: Randomised, double-blind, placebo-controlled study in 406 patients (93 women, 313 men, age: 18–64 years) with tibial fracture. Methods: Patients were stratified by tibial fracture (open or closed) and allocated to placebo or GH treatment (15, 30 or 60 μg/kg daily, until clinically assessed healing or until 16 weeks post-surgery). Primary outcome was time from surgery until fracture healing and assessment of healing was done centrally and observer blinded. Patients reported for evaluation every 4 weeks until 24 weeks, and at 9 and 12 months. Results: GH did not accelerate time to healing in the combined group of open and closed fractures. When separately analysing the closed and open fractures, a significant difference in time to healing was observed between treatment groups, exclusively in the closed fractures (P<0.05; subgroup analysis revealed that the 60 μg/kg group was significantly different from placebo). The relative risk of fracture healing for 60 μg/kg versus placebo during the 12 month was: all fractures, 1.16; 95% CI: (0.86; 1.57) (ns); closed fractures, 1.44; 95% CI: (1.01; 2.05; P<0.05); open fractures, 0.75; 95% CI: (0.42; 1.31) (ns). The estimated median number of days before fracture healing in closed fractures was 95 with 60 μg/kg versus 129 with placebo (95% CI: (94; 129) and (94; 249)) corresponding to approximately 26% decrease in healing time. Conclusions: In the overall group of open and closed tibial fractures, no significant enhancement of fracture healing was observed with GH, whereas in closed tibial fractures, GH accelerated healing significantly.
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Johnson, Ann L., M. Chambers, C. W. Smith, S. Kneller, A. R. Twardock, D. J. Schaeffer, and S. M. Averill. "Qualitative and Quantitative Scintigraphic Imaging to Predict Fracture Healing." Veterinary and Comparative Orthopaedics and Traumatology 12, no. 03 (1999): 142–50. http://dx.doi.org/10.1055/s-0038-1632480.
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SummaryPurpose: Evaluate the value of 24- hour postoperative quantitative bone scintigraphy to identify devascularized fragments and predict delayed fracture bridging in canine clinical patients; to determine the effect of fracture type, fixation type, age, sex, and weight on fracture bridging and the quantitative scintigraphic ratios; and to evaluate the relationship between qualitative scintigraphic assessment and quantitative scintigraphic ratios. Methods: Forty-two adult dogs, with diaphyseal long bone fractures treated with minimally invasive biological or invasive surgical techniques, were evaluated with 24-hour postoperative bone scintigraphy and six and 12 week postoperative radiographs. Fractured bones were classified as simple, moderately multiple, or severely multiple. Bone scintigrams were qualitatively and quantitatively analyzed. Radiographs were made at six and 12 weeks after the operation and graded as fracture gap(s) bridged or not bridged with bone opacity material. The data was evaluated statistically to determine the relationship between age, sex, and weight of the dogs, fracture type, fixation type, and results of scintigram analysis to fracture bridging at six and 12 weeks. Results: Fourteen of the 42 fractures were bridged at six weeks after the operation and 33 at 12 weeks. Prediction of fracture healing was not possible. There was not any statistical relationship of fracture type, fixation, sex, nor weight to bridged fractures or non-bridged fractures at six and 12 weeks. There was a trend toward more of the fractures with multiple fragments treated with minimally invasive biological techniques to be bridged by 12 weeks when compared to similar fractures treated with invasive techniques. The mean age of dogs with bridged fractures at six and 12 weeks was significantly lower than the mean age of dogs with non-bridged fractures at six and 12 weeks. Qualitative scintigraphic assessment scores were not significantly related to the quantitative scintigraphic ratios or to fracture bridging. Conclusions: Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging at six or 12 weeks postoperatively.The value of 24-hour postoperative qualitative and quantitative bone scintigraphy to predict fracture bridging by 12 weeks in canine clinical patients with diaphyseal long bone fractures was evaluated. Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging by 12 weeks.Supported in part by a grant from the AO Vet Centre, Zurich, Switzerland.
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Wank, Isabel, Tanja Niedermair, Daniel Kronenberg, Richard Stange, Christoph Brochhausen, Andreas Hess, and Susanne Grässel. "Influence of the Peripheral Nervous System on Murine Osteoporotic Fracture Healing and Fracture-Induced Hyperalgesia." International Journal of Molecular Sciences 24, no. 1 (December 28, 2022): 510. http://dx.doi.org/10.3390/ijms24010510.
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Osteoporotic fractures are often linked to persisting chronic pain and poor healing outcomes. Substance P (SP), α-calcitonin gene-related peptide (α-CGRP) and sympathetic neurotransmitters are involved in bone remodeling after trauma and nociceptive processes, e.g., fracture-induced hyperalgesia. We aimed to link sensory and sympathetic signaling to fracture healing and fracture-induced hyperalgesia under osteoporotic conditions. Externally stabilized femoral fractures were set 28 days after OVX in wild type (WT), α-CGRP- deficient (α-CGRP −/−), SP-deficient (Tac1−/−) and sympathectomized (SYX) mice. Functional MRI (fMRI) was performed two days before and five and 21 days post fracture, followed by µCT and biomechanical tests. Sympathectomy affected structural bone properties in the fracture callus whereas loss of sensory neurotransmitters affected trabecular structures in contralateral, non-fractured bones. Biomechanical properties were mostly similar in all groups. Both nociceptive and resting-state (RS) fMRI revealed significant baseline differences in functional connectivity (FC) between WT and neurotransmitter-deficient mice. The fracture-induced hyperalgesia modulated central nociception and had robust impact on RS FC in all groups. The changes demonstrated in RS FC in fMRI might potentially be used as a bone traumata-induced biomarker regarding fracture healing under pathophysiological musculoskeletal conditions. The findings are of clinical importance and relevance as they advance our understanding of pain during osteoporotic fracture healing and provide a potential imaging biomarker for fracture-related hyperalgesia and its temporal development. Overall, this may help to reduce the development of chronic pain after fracture thereby improving the treatment of osteoporotic fractures.
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Bottai, Vanna, Gabriele Gariffo, Edoardo Ipponi, Roberta Cifali, Nicola Mondanelli, and Stefano Giannotti. "Use of teriparatide in preventing delayed bone healing in complex biosseous leg fracture: a case report." International Journal of Bone Fragility 1, no. 1 (March 20, 2021): 14–16. http://dx.doi.org/10.57582/ijbf.210101.014.
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Fracture nonunion is one of the greatest challenges for orthopedic surgeons. We present the case of a young man with a complex open biosseous fracture of the leg who underwent surgery and early systemic pharmacological treatment with teriparatide. Teriparatide is widely used in the treatment of osteoporosis as its anabolic effects promote the deposition of new bone tissue. Associated tibia and fibula fractures have relatively high rates of nonunion and poor long-term outcomes. In this particular case, the fracture had further negative prognostic factors, such as exposure. Two months after the trauma, the radiological healing signs were insufficient, therefore it was decided to use teriparatide, prior to the possible onset of pseudarthrosis, in order to enhance bone healing and promote adequate callus formation. Complete healing of the fracture was achieved after 99 days of treatment. The authors believe that the use of pharmacological aids may be desirable, especially in the presence of risk factors such as complex and open fractures that could seriously slow down the natural regenerative processes of the fractured bone. In this scenario, teriparatide could have an important role in preventing delayed consolidation and improving the healing of nonunion fractures.
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Raghavan, Pooja, and Elena Christofides. "Role of Teriparatide in Accelerating Metatarsal Stress Fracture Healing: A Case Series and Review of Literature." Clinical Medicine Insights: Endocrinology and Diabetes 5 (January 2012): CMED.S9663. http://dx.doi.org/10.4137/cmed.s9663.
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Bone fractures are one of the leading causes of emergency room visits worldwide, with approximately 8 million bony fractures occurring annually in the US alone. Although the majority of fractures do not cause significant long-term morbidity and mortality, approximately 10% of these fractures result in impaired fracture healing, drastically affecting quality of life in affected patients. By increasing bone formation, teriparatide, an anabolic agent used in the treatment of postmenopausal osteoporosis, has shown promise in accelerating the rate of fracture healing. We present two patients with impaired healing of metatarsal fractures who were subsequently treated with teriparatide. Both patients experienced successful bony union of the fracture after the use of teriparatide. These findings suggest that teriparatide may be useful in the clinical setting for the acceleration of fracture healing, especially in patients who are at risk for impaired fracture healing.
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Warmerdam, Elke, Marcel Orth, Tim Pohlemann, and Bergita Ganse. "Gait Analysis to Monitor Fracture Healing of the Lower Leg." Bioengineering 10, no. 2 (February 15, 2023): 255. http://dx.doi.org/10.3390/bioengineering10020255.
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Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.
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Mick, Paul, and Christian Fischer. "Delayed Fracture Healing." Seminars in Musculoskeletal Radiology 26, no. 03 (June 2022): 329–37. http://dx.doi.org/10.1055/s-0041-1740380.
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AbstractPhysiologic bone healing involves numerous parameters, such as microstability, fracture morphology, or tissue perfusion, to name just a few. Slight imbalances or a severe impairment of even one of these factors may, as the figurative weakest link in the chain, crucially or completely inhibit the regenerative potential of a fractured bone. This review revisits the physiology and pathophysiology of fracture healing and provides an insight into predispositions, subtypes, diagnostic tools, and therapeutic principles involved with delayed fracture healing and nonunions. Depending on the patients individual risk factors, nonunions may develop in a variety of subtypes, each of which may require a slightly or fundamentally different therapeutical approach. After a detailed analysis of these individual factors, additional diagnostic tools, such as magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, sonography, or contrast-enhanced ultrasonography, may be indicated to narrow down the most likely cause for the development of the nonunion and therefore help find and optimize the ideal treatment strategy.
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Wang, Yufa, Aouod Agenor, Allison Clement, Adam Hopfgartner, Cari Whyne, and Diane Nam. "Probiotics: Can it modulate fracture healing?" PLOS ONE 18, no. 8 (August 31, 2023): e0290738. http://dx.doi.org/10.1371/journal.pone.0290738.
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Objective Fractures remain a huge burden and their management adversely affects individuals’ function and productivity during the lengthy healing period. Gut microbiota exerts a systemic influence on diverse aspects of host physiology, including bone. The primary objective of this study was to evaluate if oral probiotic treatment before or after a fracture in a mouse model could increase cytokines and biomarkers essential for bone healing with subsequent improvement in the biomechanical properties of the healed callus. Methods Femoral osteotomy and intramedullary pinning were performed on C57BL/6 mice. Group 1 received either control PBS or probiotic via oral gavage for 5 weeks before fracture (pre-fracture). Group 2 received equivalent treatments for 4 weeks only after fracture (post-fracture). Fracture calluses were harvested on day 3 and 7 for RT-qPCR to quantify osteogenic-related inflammatory cytokines and bone biomarkers. Fractured femurs were evaluated day 28 post-osteotomy via microstructural analysis (μCT) and biomechanical testing (torsion). Results Mice treated with probiotics pre-fracture (group 1) showed significantly increased gene expression on day 3 of cytokines TGF-β, IL-6 and IL-17F and a corresponding increase in gene expression on day 7 for Col1 and Runx2. Significant improvement was also seen in bone volume fraction, bone mineral density, tissue mineral density, maximum yield torque, stiffness and strain energy. Mice treated with probiotics post-fracture (group 2), demonstrated no changes in cytokine or bone marker gene expression with no significant changes on microstructural analysis. However, significant increases were seen in twist angle at failure and strain energy, with a corresponding reduction in torsional stiffness. Conclusion Our results suggest that oral probiotic administration, before or after a fracture, may sufficiently alter the gut flora microenvironment leading to improved bone healing biomechanical properties. The use of probiotics may provide a cost-effective and low-risk adjunctive therapy to improve fracture healing.
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ZHOU, JIANGJUN, RUI YI, MIN ZHAO, DA LIU, RENFA LV, WEITAO YU, and CHENGFEI DU. "PERSONALIZED FINITE ELEMENT MODELING ANALYSIS OF FEMUR BONE HEALING AFTER INTRAMEDULLARY NAILING." Journal of Mechanics in Medicine and Biology 16, no. 05 (August 2016): 1650061. http://dx.doi.org/10.1142/s0219519416500615.
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Purpose: Based on rapid modeling 1 year after intramedullary nailing, personalized finite element modeling analysis was performed to predict whether the broken ends of fractured bones would break again after nail dislodgement. Methods: A total of 10 male volunteers with femur fractures who had undergone intramedullary nailing were selected 1 year after fixation and were divided into healing ([Formula: see text][Formula: see text]5) and non-healing ([Formula: see text][Formula: see text]5) groups based on X-ray analysis. We modeled each femoral fracture and performed finite element analyses after the intramedullary nail was dislodged. Static loads and constraints were applied to each model to simulate a person standing on one leg. Results: In the healing group, the von Mises stress concentrations and stress concentration point distribution were located outside the bone healing area, indicating that the stress was not concentrated at the fracture site. In the non-healing group, the maximum von Mises stress for various materials was located in the broken ends of the fractured bone, indicating that the stress was concentrated at the fracture site. Conclusion: Personalized modeling can be used to analyze bone healing before removal of a fixator to predict the stability of the fractured bone after fixator removal and to rapidly decide whether slow walking could refracture the broken ends.
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Jha, S. S., Amit B. Jain, Nilanj Dave, Alok Chaturvedi, and Sandesh Warudkar. "Teriparatide in fracture healing: Case series and review of literature." IP International Journal of Orthopaedic Rheumatology 7, no. 2 (January 15, 2022): 93–100. http://dx.doi.org/10.18231/j.ijor.2021.021.
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Teriparatide (TPTD) (recombinant Parathyroid Hormone 1-34) is one of the pioneer osteo-anabolic agents approved for management of osteoporosis. Being an anabolic agent, it increases bone mineral density by inducing formation of new bone by the action on osteoblasts. As new bone formation is an important aspect of fracture healing as well, Teriparatide has long been a product of interest with respect to its effect on the process of fracture healing. Though fracture healing is not an approved indication for Teriparatide, there is quite a substantial amount of published data related to its effectiveness in fracture healing. With an intent to better understand the role of teriparatide in fracture, we share few case reports of successful fracture healing after giving Teriparatide and also review the published evidences of union taking place in difficult delayed union and non-union cases secondary to mechanical instability, inadequate fixation support or other reasons. This article thus, intended to summarize the accumulating preclinical and clinical evidence for role of TPTD in accelerating fracture healing in various conditions like conservative management of fractures, vertebral fractures, non-unions, delayed unions and atypical femoral fractures.
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TANG, Camelia Qian Ying, Si Min CHIOW, Sean Han Sheng LAI, and Dawn Sinn Yii CHIA. "The Effect of Hand Dominance, Age, Gender, Fracture Comminution and ASA Status on Time to Fracture Healing Following Surgical Fixation of Distal Radius Fractures." Journal of Hand Surgery (Asian-Pacific Volume) 27, no. 03 (May 17, 2022): 459–65. http://dx.doi.org/10.1142/s2424835522500461.
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Background: There is recent renewed interest in the effect of hand dominance on distal radius fractures. Current studies focus on functional or patient-reported outcomes, with lack of studies pertaining to radiological outcomes. The primary aim of this study is to examine the effect of hand dominance on time to fracture healing following surgical fixation of distal radius fracture. We also looked at the effect of age, gender, fracture comminution and American Society of Anaesthesiologists (ASA) status on time to fracture healing. Methods: Patients who underwent distal radius fracture fixation surgery in our department from 1 January 2015 to 31 December 2015 were included. Time to fracture healing was taken from the day of surgery to when radiographic union was present as evidence by bridging callus or osseous bone. We looked at the effect of hand dominance, age, gender, fracture comminution and ASA status on time to fracture healing. Results: One hundred and forty-five consecutive patients (80 females and 65 males) had a mean period of 56.2 ± 41.8 days to fracture healing post-operatively. Patients with dominant hand injury had a shorter duration to fracture healing than patients with non-dominant hand injury (mean 47.3 ± 31.1 days versus 62.1 ± 46.8 days, p = 0.023). Patients ≥ 65 years and with pre-existing medical conditions (ASA Class II and above) had a longer duration to fracture healing (mean 63.7 ± 53.0 days versus 51.9 ± 33.4 days, p = 0.036 and mean 47.9 ± 30.0 days versus 62.0 ± 47.7 days, p = 0.016, respectively). In addition, patients with comminuted fractures took longer to heal than patients with non-comminuted fractures (mean 57.6 ± 33.4 days versus 48.3 ± 20.8 days, p = 0.038). Conclusion: Time to fracture healing post distal radius fracture fixation surgery was significantly related to hand dominance, as well as age, ASA classification and fracture configuration. Dominant wrist injuries had shorter time to fracture healing. Level of Evidence: Level IV (Therapeutic)
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Haffner-Luntzer, M., and A. Ignatius. "Animal models for studying metaphyseal bone fracture healing." European Cells and Materials 40 (October 29, 2020): 172–88. http://dx.doi.org/10.22203/ecm.v040a11.
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An estimated 2 million osteoporotic fractures occur annually in the US, resulting in a dramatic reduction in quality of life for affected patients and a high economic burden for society. Osteoporotic fractures are frequently located in metaphyseal bone regions. They are often associated with healing complications, because of the reduced healing capacity of the diseased bone tissue, the poor primary stability of the fracture fixation in the fragile bone, and the high frequency of comorbidities in these patients. Therefore, osteoporotic fractures require optimised treatment strategies to ensure proper bone healing. Preclinical animal models can help understanding of the underlying mechanisms and development of new therapies. However, whereas diaphyseal fracture models are widely available, appropriate animal models for metaphyseal fracture healing are scarce, although essential for translational research. This review covers large and small animal models for metaphyseal fracture healing. General requirements for suitable animal models are presented, as well as advantages and disadvantages of the current models. Furthermore, differences and similarities between metaphyseal and diaphyseal bone fracture healing are discussed. Both large- and small-animal models are available for studying metaphyseal fracture healing, which mainly differ in fracture location and geometry as well as stabilisation techniques. Most common used fracture sites are distal femur and proximal tibia. Each model found in the literature has certain advantages and disadvantages; however, many lack standardisation resulting in a high variability or poor mimicking of the clinical situation. Therefore, further refinement ofanimal models is needed especially to study osteoporotic metaphyseal fracture healing.
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Gill, P. J., G. Kernohan, I. N. Mawhinney, R. A. B. Mollan, and R. McIlhagger. "Investigation of the Mechanical Properties of Bone Using Ultrasound." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 203, no. 1 (March 1989): 61–63. http://dx.doi.org/10.1243/pime_proc_1989_203_009_01.
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This paper examines the serial use of ultrasonic velocity measurement to monitor fracture healing. New Zealand White rabbit tibiae were fractured using a constant-energy technique and the ultrasonic velocity along the bone measured in animals sacrificed at 16 day intervals up to 96 days from fracture. In parallel with these measurements the mechanical performance of the healed tibiae were determined using a three-point bending test. Regression analysis failed to show a sufficiently good correlation between ultrasonic velocity measurements and the bending properties of healing fractures for the method to be of use clinically.
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Inoue, Satoshi, Jiro Takito, and Masanori Nakamura. "Site-Specific Fracture Healing: Comparison between Diaphysis and Metaphysis in the Mouse Long Bone." International Journal of Molecular Sciences 22, no. 17 (August 27, 2021): 9299. http://dx.doi.org/10.3390/ijms22179299.
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The process of fracture healing varies depending upon internal and external factors, such as the fracture site, mode of injury, and mechanical environment. This review focuses on site-specific fracture healing, particularly diaphyseal and metaphyseal healing in mouse long bones. Diaphyseal fractures heal by forming the periosteal and medullary callus, whereas metaphyseal fractures heal by forming the medullary callus. Bone healing in ovariectomized mice is accompanied by a decrease in the medullary callus formation both in the diaphysis and metaphysis. Administration of estrogen after fracture significantly recovers the decrease in diaphyseal healing but fails to recover the metaphyseal healing. Thus, the two bones show different osteogenic potentials after fracture in ovariectomized mice. This difference may be attributed to the heterogeneity of the skeletal stem cells (SSCs)/osteoblast progenitors of the two bones. The Hox genes that specify the patterning of the mammalian skeleton during embryogenesis are upregulated during the diaphyseal healing. Hox genes positively regulate the differentiation of osteoblasts from SSCs in vitro. During bone grafting, the SSCs in the donor’s bone express Hox with adaptability in the heterologous bone. These novel functions of the Hox genes are discussed herein with reference to the site-specificity of fracture healing.
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Malinin, Theodore I., and H. Thomas Temple. "Fracture healing." Current Orthopaedic Practice 27, no. 2 (2016): 192–97. http://dx.doi.org/10.1097/bco.0000000000000348.
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Cohen, Jonathan. "Fracture Healing." Journal of Bone & Joint Surgery 70, no. 6 (July 1988): 958. http://dx.doi.org/10.2106/00004623-198870060-00030.
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Waugh, W. "Fracture healing." Current Orthopaedics 3, no. 1 (January 1989): 66–67. http://dx.doi.org/10.1016/0268-0890(89)90082-0.
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Agarwala, Sanjay, and Mayank Vijayvargiya. "Repurposing denosumab for recalcitrant bone healing." BMJ Case Reports 14, no. 2 (February 2021): e238460. http://dx.doi.org/10.1136/bcr-2020-238460.
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Fracture healing has four phases: haematoma formation, soft callus, hard callus and remodelling. Often, non-healing fractures have an arrest of one of these phases, which need resurgery. We have repurposed denosumab for impaired fracture healing cases to avoid surgical intervention. Here, we report a series of three cases of impaired fracture healing where denosumab was given 120 mg subcutaneous dosages for 3 months to enhance healing. All the three cases have shown complete bone union at a mean follow-up of 6.7 months (5–9 months) as assessed clinically and radiologically, and have observed no adverse effect of the therapy. Denosumab given in this dose aids fracture healing by increasing callus volume, density and bridges the fracture gap in recalcitrant fracture healing cases where the callus fails to consolidate.
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OSIPOV, Maksim D. "Consolidation of femoral neck fractures depending on fracture type." Medicine and Physical Education: Science and Practice, no. 11 (2021): 12–16. http://dx.doi.org/10.20310/2658-7688-2021-3-3(11)-12-16.
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We study the terms of the femoral neck fracture healing, depending on the type of fractures. Currently, the diagnosis of “hip fracture” occupies a significant place in the work of a traumatologist, since this fracture tends to increase the frequency of cases, especially among people over 60 years old. This problem has long been one of the most urgent in traumatology and orthopedics, includes many facets, among which there is a high risk of complications during the operation of these fractures among elderly and senile people, the growth of people at high risk of hip fracture due to osteoporotic changes in the composition of bone tissue. And one of the sides of this problem is the non-healing and the timing of the femoral neck fracture healing, due to its anatomical features. We present the results of studies conducted at the clinical bases of the Kotovsk City Clinical Hospital and Archbishop Luke Tambov City Clinical Hospital. Aim: to study the terms of the femoral neck fracture healing, depending on the type of fractures. Task: to conduct studies, observations, collect statistical data on the management of patients with femoral neck fracture and, based on the results obtained, to characterize and evaluate the terms of femoral neck fractures healing
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Rothom, Ronnachat, and Patchanee Chuveera. "Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography." Case Reports in Dentistry 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/2728964.
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Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.
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Takebe, Hiroaki, Nazmus Shalehin, Akihiro Hosoya, Tsuyoshi Shimo, and Kazuharu Irie. "Sonic Hedgehog Regulates Bone Fracture Healing." International Journal of Molecular Sciences 21, no. 2 (January 20, 2020): 677. http://dx.doi.org/10.3390/ijms21020677.
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Bone fracture healing involves the combination of intramembranous and endochondral ossification. It is known that Indian hedgehog (Ihh) promotes chondrogenesis during fracture healing. Meanwhile, Sonic hedgehog (Shh), which is involved in ontogeny, has been reported to be involved in fracture healing, but the details had not been clarified. In this study, we demonstrated that Shh participated in fracture healing. Six-week-old Sprague–Dawley rats and Gli-CreERT2; tdTomato mice were used in this study. The right rib bones of experimental animals were fractured. The localization of Shh and Gli1 during fracture healing was examined. The localization of Gli1 progeny cells and osterix (Osx)-positive cells was similar during fracture healing. Runt-related transcription factor 2 (Runx2) and Osx, both of which are osteoblast markers, were observed on the surface of the new bone matrix and chondrocytes on day seven after fracture. Shh and Gli1 were co-localized with Runx2 and Osx. These findings suggest that Shh is involved in intramembranous and endochondral ossification during fracture healing.
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Durak, K., G. Sonmez, B. Sarisozen, S. Ozkan, M. Kaya, and C. Ozturk. "Histological Assessment of the Effect of α-Tocopherol on Fracture Healing in Rabbits." Journal of International Medical Research 31, no. 1 (February 2003): 26–30. http://dx.doi.org/10.1177/147323000303100104.
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To investigate the effect of α-tocopherol (vitamin E) on fracture healing in rabbits, two groups of 10 rabbits were either injected with α-tocopherol (treated) or untreated (controls). The right femurs of both groups were fractured, and the treated group were injected intramuscularly with 20 mg/kg α-tocopherol daily for 5 days starting on the day of fracture. After 21 days, histological sections of the fractured region were examined and scored. Fracture healing had progressed further in the α-tocopherol group than in the control group. A statistically significant difference between the histological grading of fracture healing in the two groups was found. This difference may result from an antioxidant (α-tocopherol) effect on free oxygen radicals in the fracture area. We conclude that α-tocopherol may affect fracture healing favourably and might be useful as a therapeutic agent in clinical fracture management.
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Gajdobranski, Djordje, and Dragana Zivkovic. "Physiology of fracture healing: New aspects." Medical review 56, no. 1-2 (2003): 39–42. http://dx.doi.org/10.2298/mpns0302039g.
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Introduction Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding physiology of fracture healing is justified. Phases of fracture healing In this paper we described four phases of fracture healing. They are not clearly separated, but overlap. These data are based on contemporary literature and newest achievements in the field of fracture healing. Discussion Many data regarding this phenomenon were obtained from animal studies, but they may also be applied in human medicine since there is a great similarity between fracture healing in animal models and humans. Conclusion Full and complete knowledge of mechanisms of bioregulation of normal fracture healing process certainly presents the basic prerequisite for successful surgical and orthopedic treatment.
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Clark, Daniel, Theodore Miclau, Mary Nakamura, and Ralph Marcucio. "AGE-RELATED CHANGES TO MACROPHAGES AFFECT FRACTURE HEALING." Innovation in Aging 3, Supplement_1 (November 2019): S83. http://dx.doi.org/10.1093/geroni/igz038.321.
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Abstract Fracture healing follows a strict temporal sequence characterized by an initial inflammatory phase. Perturbation of the inflammatory phase may be responsible for the poorer fracture healing outcomes in older adults. Herein, we examine age-related changes to the macrophage during fracture healing. Macrophages regulate inflammation through pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes. Anti-inflammatory activity is promoted via activation of triggering receptor expressed on myeloid cells 2 (TREM2). Tibia fractures were made in old (24 months) and young (3 months) mice. Immune cells from the fracture callus were analyzed via RNAseq and FACS, and fracture healing was evaluated histologically. Old mice demonstrated significantly delayed fracture healing compared to young (p<0.05). The quantity of infiltrating macrophages into the fracture callus was similar in young and old mice. However, 1222 genes were significantly differentially regulated (FDR<0.1) in callus macrophages from old mice compared to young, and old macrophages demonstrated a more pro-inflammatory phenotype. TREM2 expression was increased in macrophages after fracture in both groups but was significantly less in old mice compared to young via RNAseq and FACS (FDR<0.1, p<0.05). TREM2-/- mice demonstrated increased pro-inflammatory cytokine expression within the callus with resulting significant delays in fracture healing compared to age-matched controls (p<0.05). Inhibition of macrophage infiltration into the fracture callus significantly improved fracture healing in old mice compared to age-matched controls. Age-related changes to macrophages, including increased pro-inflammatory cytokine expression and dysregulated TREM2 expression, may explain fracture healing deficits observed in older adults. Therapeutically targeting macrophages may improve management of fractures in older adults.
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Massari, Leo, Francesco Benazzo, Francesco Falez, Ruggero Cadossi, Dario Perugia, Luca Pietrogrande, Domenico Costantino Aloj, et al. "Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study." BioMed Research International 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/1809091.
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Background. Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r=0.63 (p<0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions. This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Wallace, L. J., P. T. Redig, J. E. Bechtold, R. R. Pool, V. L. King, and K. G. Mathews. "Avian Fracture Healing Following Stabilization with Intramedullary Polyglycolic Acid Rods and Cyanoacrylate Adhesive vs. Polypropylene Rods and Polymethylmethacrylate." Veterinary and Comparative Orthopaedics and Traumatology 07, no. 04 (1994): 158–69. http://dx.doi.org/10.1055/s-0038-1633090.
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SummaryAvian fracture healing was evaluated for twelve weeks following the repair of transverse mid-diaphyseal humeral fractures. Radiographic, histological, and biomechanical assessment of healing was used to compare a currently used method of repair - a permanent intramedullary polypropylene rod and polymethylmethacrylate bone cement, to a new biodegradable repair technique which utilized intramedullary polyglycolic acid rods and cyanoacry-late adhesive. Histological response to the biodegradable implants consisted of a granulomatous foreign body reaction that did not impair fracture healing. Fibrous encapsulation occurred around the permanent devices. Biodegradable repairs developed more periosteal callus, and early complications were more common following biodegradable repair, but there was little difference between the two groups biomechanically. Polyglycolic acid implants appear to be viable alternatives for the repair of some avian fractures. Investigation into the use of other biodegradable polymers for avian fracture fixation is warranted.Avian fracture healing following the repair of trans-verse humeral fractures with intramedullary biodegradable polyglycolic acid (PGA) rods and cyanoacrylate adhesive was compared to healing following repair with polypropylene rods and polymethylmethacrylate (PMMA) bone cement. Foreign body reaction to the PGA/cyanoacrylate fixation occurred, but did not impair fracture healing. Biomechanical testing revealed few differences between the two fixation methods at 0-12 weeks following fracture repair.
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Chen, Gongfa, Zongchao Liu, Yong Zhang, Jiqiao Zhang, Fangsen Cui, and Minglong Xu. "Biomechanical Assessment for Healing Progression of Fractured Long Bones: Comparisons of Various Methods Using Beam Models." International Journal of Applied Mechanics 08, no. 06 (September 2016): 1650074. http://dx.doi.org/10.1142/s1758825116500745.
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Measurements of various effective stiffnesses have been suggested as non-invasive biomechanical methods to assess healing status of a fractured long bone. This paper has compared the sensitivities of five assessment methods for fracture healing of long bones: torsion, compression, 3-point bending, 4-point bending and cantilever bending. A fractured human femur is modeled by an Euler beam and Castigliano’s theorem is used to obtain the effective stiffnesses of the fractured bone. The variations of the effective stiffnesses of the fractured bone with the healing status of the callus have been investigated. The healing process of the callus is represented by gradual increases of the Young’s modulus. The callus is divided into multiple regions. The narrowing process of the fracture gap is characterized by assigning different Young’s modulus for different regions. Our findings showed that torsional, compressional, and bending stiffnesses all perform similarly with respect to the healing process. Before the rapid increase, all effective stiffness curves show a substantial creeping stage which corresponds to the narrowing process of the fracture gap. A higher value of them indicates bony bridging of healing callus. The effective stiffnesses for cantilever bending and 3-point bending are more sensitive to the fracture location, while torsional and compressional stiffness are independent from the fracture location.
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Bush, M. A., C. Whiting, S. J. Langley-Hobbs, and J. V. Hermer. "Healing of patellar fractures in two kittens." Veterinary and Comparative Orthopaedics and Traumatology 25, no. 02 (2012): 155–59. http://dx.doi.org/10.3415/vcot-11-04-0055.
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SummaryTwo kittens aged between four and five months were presented having sustained patellar fractures. In both cases, healing was subsequently documented radiographically; this has not been reported previously in the literature.One kitten had bilateral patellar fractures – the symptomatic right stifle was treated with a pin and tension-band-wire which later failed, at which point partial patellectomy was performed. The fracture of the left patella was minimally displaced and was treated conservatively. A radiograph of the left patella taken eleven months after initial presentation showed complete healing of the fracture. The second case was treated surgically with a circumferential wire; healing of the fracture was demonstrated radiographically at twelve weeks postoperatively. Radiographic images taken five weeks postoperatively had shown some narrowing of the fracture gap.These two cases demonstrate that bony union of patellar fractures can be documented, given a long enough duration of radiographic follow-up; circumferential wire was an effective treatment in a displaced fracture, and conservative treatment resulted in complete healing of a minimally displaced fracture.
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Gao, Hui, Jinming Huang, Quan Wei, and Chengqi He. "Advances in Animal Models for Studying Bone Fracture Healing." Bioengineering 10, no. 2 (February 3, 2023): 201. http://dx.doi.org/10.3390/bioengineering10020201.
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Fracture is a common traumatic injury that is mostly caused by traffic accidents, falls, and falls from height. Fracture healing is a long-term and complex process, and the mode of repair and rate of healing are influenced by a variety of factors. The prevention, treatment, and rehabilitation of fractures are issues that urgently need to be addressed. The preparation of the right animal model can accurately simulate the occurrence of fractures, identify and observe normal and abnormal healing processes, study disease mechanisms, and optimize and develop specific treatment methods. We summarize the current status of fracture healing research, the characteristics of different animal models and the modeling methods for different fracture types, analyze their advantages and disadvantages, and provide a reference basis for basic experimental fracture modeling.
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Golubović, Zoran, Predrag Stoiljković, Ivan Golubović, Milan Pejčić, Milan Lazarević, Mihailo Ille, Ivana Golubović, Ivan Milošević, Nebojša Mitić, and Dejan Tabakavić. "Complications in the treatment of Segmental tibial fractures." Timocki medicinski glasnik 46, no. 3 (2021): 132–36. http://dx.doi.org/10.5937/tmg2103132g.
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Segmental tibial fractures belong to the group of the most severe fractures of the locomotor system. They are most common in polytraumatized patients. Treatment of segmental tibial fractures can be conservative or operative. Treatment of segmental tibial fractures is accompanied by a number of complications, such as delayed healing, dislocation of fragments in one or the other fracture point, healing of fractures in poor position, non-healing of fractures, aseptic and septic pseudoarthrosis, infection around fixator wedges, wound infection of open segmental tibial fracture, iatrogenic infection, osteomyelitis, and limb amputation. The paper presents a female patient with a severe segmental tibial fracture on two levels, who was treated with external skeletal fixation. Without opening the fracture point, repositioning was performed in the proximal and distal part and the fractures were stabilized with an external skeletal fixator. After the operation, the patient was activated with underarm crutches with relief support on the injured leg. For the purpose of stimulating fracture healing, low molecular weight heparin, Fraxiparine (to prevent thrombosis and pulmonary thromboembolism) and Forticolinn were prescribed. After the fracture healed, the external skeletal fixator was removed and the patient returned to her working and living activities. At the follow-up examination five years after the segmental tibial fracture, the patient had a stable and firm support on the injured leg.
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Mohiuddin, M., M. Hasan, M. Shohag, R. N. Ferdousy, M. M. Alam, and N. S. Juyena. "Surgical management of limb fractures in calves and goats." Bangladesh Veterinary Journal 52, no. 1-4 (December 25, 2018): 46–56. http://dx.doi.org/10.32856/bvj-2018.06.
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The study was conducted to determine the occurrence of fractures in calves and goats at Veterinary Teaching Hospital (VTH), Bangladesh Agricultural University (BAU) and to compare the efficacy of fracture treatment with external and internal fixation using splints and bone plate/wire suture respectively. Patients brought to VTH with the history of automobile accident, trauma and clinical signs suggestive of fractures were subjected to detailed physical, orthopaedic and radiographic examinations to confirm fractures. A total of 6 calves and 4 Black Bengal goats were presented to VTH with limb fractures. Fractures were treated with close reduction and external fixation with splints and bandage, and open reduction and internal fixation with wire suture and bone plate. 50% and 75% fracture cases healed properly in calves and goats respectively. Among the affected animals, 60% were females irrespective of species. Metacarpal bone was the most susceptible for limb fracture. Three were open fractures and 7 cases were closed fracture with the occurrence of 70%. The healing percentage of open fracture treated with external fixation was very poor and amputation was needed in the fractured limb. Overall treatment success rate was 60 %. Biochemical analysis revealed very significant (p<0.01) difference in serum calcium level before and after healing due to hard callus formation. This study shows that bone plating fixation give a satisfactory results to calves with fracture. Moreover, the study could help veterinarians to set up proper treatment method depending on location of fracture.
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Park, K. H. "ROLE OF POLAPREZINC IN FRACTURE HEALING BY DIFFERENTIATIONS OF OSTEOBLAST AND OSTEOCLAST." Orthopaedic Proceedings 106-B, SUPP_1 (January 2, 2024): 109. http://dx.doi.org/10.1302/1358-992x.2024.1.109.
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Fractures and related complications are a common challenge in the field of skeletal tissue engineering. Vitamin D and calcium are the only broadly available medications for fracture healing, while zinc has been recognized as a nutritional supplement for healthy bones. Here, we aimed to use polaprezinc, an anti-ulcer drug and a chelate form of zinc and L-carnosine, as a supplement for fracture healing. Polaprezinc induced upregulation of osteogenesis-related genes and enhanced the osteogenic potential of human bone marrow-derived mesenchymal stem cells and osteoclast differentiation potential of mouse bone marrow-derived monocytes. In mouse experimental models with bone fractures, oral administration of polaprezinc accelerated fracture healing and maintained a high number of both osteoblasts and osteoclasts in the fracture areas. Collectively, polaprezinc promotes the fracture healing process efficiently by enhancing the activity of both osteoblasts and osteoclasts. Therefore, we suggest that drug repositioning of polaprezinc would be helpful for patients with fractures.
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Morcos, M. W., H. Al-Jallad, J. Li, C. Farquharson, J. L. Millán, R. C. Hamdy, and M. Murshed. "PHOSPHO1 is essential for normal bone fracture healing." Bone & Joint Research 7, no. 6 (June 2018): 397–405. http://dx.doi.org/10.1302/2046-3758.76.bjr-2017-0140.r2.
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Objectives Bone fracture healing is regulated by a series of complex physicochemical and biochemical processes. One of these processes is bone mineralization, which is vital for normal bone development. Phosphatase, orphan 1 (PHOSPHO1), a skeletal tissue-specific phosphatase, has been shown to be involved in the mineralization of the extracellular matrix and to maintain the structural integrity of bone. In this study, we examined how PHOSPHO1 deficiency might affect the healing and quality of fracture callus in mice. Methods Tibial fractures were created and then stabilized in control wild-type (WT) and Phospho1-/- mice (n = 16 for each group; mixed gender, each group carrying equal number of male and female mice) at eight weeks of age. Fractures were allowed to heal for four weeks and then the mice were euthanized and their tibias analyzed using radiographs, micro-CT (μCT), histology, histomorphometry and three-point bending tests. Results The μCT and radiographic analyses revealed a mild reduction of bone volume in Phospho1-/- callus, although it was not statistically significant. An increase in trabecular number and a decrease in trabecular thickness and separation were observed in Phospho1-/- callus in comparison with the WT callus. Histomorphometric analyses showed that there was a marked increase of osteoid volume over bone volume in the Phospho1-/- callus. The three-point bending test showed that Phospho1-/- fractured bone had more of an elastic characteristic than the WT bone. Conclusion Our work suggests that PHOSPHO1 plays an integral role during bone fracture repair and may be a therapeutic target to improve the fracture healing process. Cite this article: M. W. Morcos, H. Al-Jallad, J. Li, C. Farquharson, J. L. Millán, R. C. Hamdy, M. Murshed. PHOSPHO1 is essential for normal bone fracture healing: An Animal Study. Bone Joint Res 2018;7:397–405. DOI: 10.1302/2046-3758.76.BJR-2017-0140.R2.
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Dudkiewicz, Israel, Michael Heim, Moshe Salai, and Alexander Blankstein. "ULTRASONOGRAPHIC EVALUATION OF UNION IN LONG BONES FRACTURES." Journal of Musculoskeletal Research 12, no. 02 (June 2009): 105–12. http://dx.doi.org/10.1142/s0218957709002225.
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Introduction: To follow fracture healing, radiography is commonly used, but it is not sensitive to the early stages of this healing process when nonossified callus is formed. Hence, radiography can lag behind the physiological events of bone healing by some weeks. Although the use of ultrasound for fracture diagnosis has been reported previously, mainly in children, the clinical use of ultrasound to follow fracture healing has rarely been commented on. The goal of the current study was to test the efficiency and efficacy of ultrasound as an alternative method for follow-up of fracture healing. Material and Methods: During a one-year period, 12 patients—six with proximal fibula fracture and six with proximal metatarsal fractures—were followed by ultrasonographic examination in parallel with the routine radiographs. Results: The ultrasound examinations revealed callus formation after one month, with the early signs of healing after ten days. Early callus was first seen on radiographs after a month. Conclusion: Ultrasound was found to be a good modality to follow up fracture healing in long bones. This modality can reduce the amount of radiation received by the patients in the follow-up of fractures, and may shorten the immobility period and hence the recovery time of returning to normal function.
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Sethia, Dimple, Amith Hadhimane, and Kirthi Kumar Rai. "Ultrasonography as an alternative to radiographs in assessing fracture healing." IP International Journal of Maxillofacial Imaging 9, no. 1 (April 15, 2023): 25–29. http://dx.doi.org/10.18231/j.ijmi.2023.004.
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To determine whether ultrasound can assess healing of bone and check the development of callus prior to conventional radiograph thereby enabling early diagnosis of delayed union or confirmation of union. Fracture healing was evaluated with ultrasonography and radiography on specific intervals until healing was complete; in 20 fracture sites. Based on the findings of ultrasonographic and radiographic scores were assigned to classify healing.18 out of 20 fracture sites had completely healed with mature callus formation at the end of 3 months while only 2 fracture sites showed delayed healing. In patients with normal healing, colour doppler ultrasound showed neovascularisation in the 1 month of healing. With time it was noticed that the depth and width of the fractured site was reducing and becoming more isoechoic with the adjacent normal bone sites. Assessment of these parameters being more evident on the USG were statistically significant when compared with OPG. Ultrasound can be considered as a useful guide in assessing fracture healing as a replacement to conventional imaging modalities such as the OPG, particularly in the early prediction of impaired fracture healing.
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Kyllonen, Kelsey M., Keith L. Monson, and Michael A. Smith. "Postmortem and Antemortem Forensic Assessment of Pediatric Fracture Healing from Radiographs and Machine Learning Classification." Biology 11, no. 5 (May 13, 2022): 749. http://dx.doi.org/10.3390/biology11050749.
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A timeline of pediatric bone healing using fracture healing characteristics that can be assessed solely using radiographs would be practical for forensic casework, where the fracture event may precede death by days, months, or years. However, the dating of fractures from radiographs is difficult, imprecise, and lacks consensus, as only a few aspects of the healing process are visible on radiographs. Multiple studies in both the clinical and forensic literature have attempted to develop a usable scale to assess pediatric bone healing on radiographs using various healing characteristics. In contrast to the orthopedic definition, a fracture in forensic casework is only considered to be healed when the area around the fracture has been remodeled to the point that the fracture is difficult to detect on a radiograph or on the surface of the bone itself, a process that can take several years. We subjectively assessed visible characteristics of healing in radiograms of fractures occurring in 942 living children and adolescents. By dividing these assessments into learning and test (validation) sets, the accuracy of a newly proposed fracture healing scale was compared to a previous study. Two machine learning models were used to test predictions of the new scale. All three models produced similar estimates with substantial imprecision. Results corroborate the Malone model with an independent dataset and support the efficacy of using less complex models to estimate fracture age in children.
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Cain, Jarrett D., Michelle Titunick, Patricia McLaughlin, and Ian Zagon. "Effects of Local Opioid Antagonist on Diabetic Fracture Rat Model." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0017. http://dx.doi.org/10.1177/2473011418s00178.
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Category: Diabetes Introduction/Purpose: Complications associated with the diabetes include increased incidence of fracture healing, delayed fracture healing, delayed osteoblasts cell replication, decreased angiogenesis, migration and/or osteoblast cell differentiation. The cellular events involved in bone healing are adversely affected by diabetes; however, can be modulated by the Opioid Growth Factor (OGF)–OGF receptor (OGFr) is an inhibitory peptide that downregulates DNA synthesis in a tissue nonspecific manner. Diabetes is associated with elevated serum levels of OGF and dysregulation of the OGFr leading to multiple complications related to healing, sensitivity, and regeneration. This study explores the presence and function of the OGF-OGFr axis in bone tissue from type 1 diabetic rats examining intact and fractured femurs during early phases of the repair process Methods: Seven-week-old Sprague Dawley rats were injected with streptozotocin (40mg/kg i.p.) to induce T1D; other rats received buffer only and served as controls. After one month, hyperglycemia rats underwent surgery to produce a fracture at the distal third of the femur. Four diabetic rats received opioid antagoinist (naltrexone) and calcium sulfate and all remaining rats received calcium sulfate with water only. X-rays were taken immediately after surgery and after rats were euthanized on post-surgery; femur and tibia were collected for protein isolation, western blot analysis along with frozen or paraffin-embedded for histological analysis Results: Immunofluorescence indicated approximately 90% increase in opioid growth factor receptor expression in diabetic femurs compared to age-matched normal femurs. Western Blotting also suggested an increase in the receptor protein in diabetic bones relative to normal bone. TRAP staining for osteoclasts was greater in control and opioid antagonist-treated diabetic fractures when compared to the number of osteoclasts in vehicle-treated diabetic fractured femurs. Safranin O stained sections revealed approximately more bone in opioid growth receptor antagonist-treated diabetic bone fractures than in vehicle-treated bone fractures Conclusion: These data support our hypothesis that expression levels of OGFr are dysregulated in the bone of diabetic patients leading to complications in bone healing. Moreover, modulation of the OGF-OGFr pathway with receptor antagonists restored some aspects of bone healing. With further study, these preliminary results support the role of the OGF-OGFr axis in treatment of diabetic bone healing. New therapies to target dysregulation of the OGF-OGFr regulatory pathway in diabetes would provide a safe and effective disease-modifying treatment for delayed bone healing.
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Huang, Yan, Yongqiang Xu, Siyin Feng, Pan He, Bing Sheng, and Jiangdong Ni. "miR-19b enhances osteogenic differentiation of mesenchymal stem cells and promotes fracture healing through the WWP1/Smurf2-mediated KLF5/β-catenin signaling pathway." Experimental & Molecular Medicine 53, no. 5 (May 2021): 973–85. http://dx.doi.org/10.1038/s12276-021-00631-w.
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AbstractBone marrow mesenchymal stem cell (BMSC)-derived exosomes have been found to enhance fracture healing. In addition, microRNAs contributing to the healing of various bone fractures have attracted widespread attention in recent years, but knowledge of the mechanisms by which they act is still very limited. In this study, we clarified the function of altered microRNA-19b (miR-19b) expression in BMSCs in fracture healing. We modulated miR-19b expression via mimics/inhibitors in BMSCs and via agomirs in mice to explore the effects of these changes on osteogenic factors, bone cell mineralization and the healing status of modeled fractures. Through gain- and loss-of function assays, the binding affinity between miR-19b and WWP1/Smurf2 was identified and characterized to explain the underlying mechanism involving the KLF5/β-catenin signaling pathway. miR-19b promoted the differentiation of human BMSCs into osteoblasts by targeting WWP1 and Smurf2. Overexpression of WWP1 or Smurf2 degraded the target protein KLF5 in BMSCs through ubiquitination to inhibit fracture healing. KLF5 knockdown delayed fracture healing by modulating the Wnt/β-catenin signaling pathway. Furthermore, miR-19b enhanced fracture healing via the KLF5/β-catenin signaling pathway by targeting WWP1 or Smurf2. Moreover, miR-19b was found to be enriched in BMSC-derived exosomes, and treatment with exosomes promoted fracture healing in vivo. Collectively, these results indicate that mesenchymal stem cell-derived exosomal miR-19b represses the expression of WWP1 or Smurf2 and elevates KLF5 expression through the Wnt/β-catenin signaling pathway, thereby facilitating fracture healing.
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West, P. G., G. R. Rowland, S. C. Budsberg, and D. N. Aron. "Histomorphometric and angiographic analysis of bone healing in the humerus of pigeons." American Journal of Veterinary Research 57, no. 7 (July 1, 1996): 1010–15. http://dx.doi.org/10.2460/ajvr.1996.57.07.1010.
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Abstract Objective To evaluate the vascular supply and quantitatively compare the periosteal and endosteal callus formed during fracture healing. Design 36 pigeons were allotted to 2 groups. In each bird, 1 humerus was surgically osteotomized. The wing with the fractured humerus in birds of the first group was infused with a microparticle barium solution, and the humerus was harvested for angiography. Pigeons of the second group were injected with the labels oxytetracycline and calcein. The fractured humerus in each of these birds was harvested for histomorphometry. Animals 36 nine-month-old pigeons, consisting of 19 male and 17 female birds. Procedure 1 humerus from each of the 36 pigeons was osteotomized in the center of the bone by use of an obstetrical wire. All fractured wings were placed in a figure-of-8 bandage after surgery. The specimens harvested for angiography were decalcified, radiographed, and sectioned for H&E-stamed tissue slides. Humeruses harvested for histomorphometry were cross-sectioned for tissue slides, which were measured, using a morphometric analyzing system for original and new bone areas. Results A continuous intramedullary circulation was not present at any point in the healing process, although 2 of the 42-day-old fractures had a bridging callus. Quantitatively, the periosteal surface formed the largest amount of callus, though the endosteal surface was also active. Conclusions Reformation of the intramedullary circulation may not be imperative for osseous union of the pigeon humerus. Fluorochrome labels cannot be accurately measured at the fracture site. However, subjective evaluation of the endosteal surface indicates it is active during the fracture-healing process even though the periosteal surface provides the largest amount of callus formation. Clinical Relevance Figure-of-8 coaptation is contraindicated for humeral fractures. The endosteal surface's contribution to the healing process should be considered when avian humeral fractures are stabilized. (Am J Vet Res 1996;57:1010–1015)
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ÇOKCOŞKUN YILMAZ, Çağıl, and Cenk YARDIMCI. "Minimally invasive plate osteosynthesis (MİPO) in veterinary orthopedics." Journal of Istanbul Veterinary Sciences 6, no. 2 (August 31, 2022): 47–51. http://dx.doi.org/10.30704/http-www-jivs-net.1111320.
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The current increase in the numbers of fracture treatment by plate osteosynthesis in veterinary medicine is leading to the production of specific plates for different types of fractures. Recent studies about fracture healing show that MIPO procedure is superior for faster union and healing by decreased contamination risk, faster return of function, lower complication rates and blood supply preservation. By now, indirect reduction technics are more valuable in preservation of the biological structure of bone than full anatomic reduction techniques. Day by day, MIPO becomes more popular in veterinary orthopedics. Basicly the method is applying a plate without opening the fractured area to make a bridging between the proximal and distal metaphysis/diaphysis of the fragments. The success of the procedure relies on the type of the fracture and the fracture area. The procedure can be applied especially diaphyseal segmental fractures with success but to be avoided in articular fractures. The procedure has been being used usually in the diaphyseal tibial and radial fractures of the cats and dogs. But nowadays it has started to be used in femoral and humeral fractures as well. The disadvantages of the procedure is the difficulty of the application and the need of the intraoperative radiography or fluoroscopy for the correct positioning of the fractures.
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Ekegren, Christina, Elton Edwards, Richard de Steiger, and Belinda Gabbe. "Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture." International Journal of Environmental Research and Public Health 15, no. 12 (December 13, 2018): 2845. http://dx.doi.org/10.3390/ijerph15122845.
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Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
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Çevik, Tuğçe, and İlker Şen. "Fracture Healing and Current Adjuvant Approaches to Fracture Healing." International Journal of Academic Medicine and Pharmacy Volum: 3, Issue: 3, Volum: 3, Issue: 3 (2021): 281–87. http://dx.doi.org/10.29228/jamp.52103.
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Bastos, Hugo José Santos, Key Fabiano Souza Pereira, Luiz Fernando Tomazinho, Marcos Roberto dos Santos Frozoni, and Élida Boaventura Mendes. "Spontaneous healing response of oblique root fracture: case report with 4-year follow-up." Research, Society and Development 10, no. 3 (March 17, 2021): e30710313144. http://dx.doi.org/10.33448/rsd-v10i3.13144.
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Root fractures can involve the dentin, cementum, and pulp and commonly can occur as oblique fractures with varying orientations. The aim of this study was to demonstrate the maintenance of pulp health in a tooth with a fractured root without any endodontic treatment and to discuss the advantage of cone-bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of oblique root fractures. Intra-oral radiography of tooth 11 revealed a horizontal root fracture at the level of the apical third, while the sagittal CBCT slice reveals a complete fracture line running obliquely from the apical third on the buccal aspect through the cervical third on the palatal aspect. Four years follow-up, the tooth has kept its pulp vitality, no tooth discoloration or discrepancy in arch position, without endodontic treatment. This result illustrates spontaneous healing of root fracture including preservation of pulp health. In addition, it confirms the importance of exams in 3 dimensions to correctly locate the fracture and assist in the treatment decision.
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M. Abdulla, Osman, Firas H. Aboushaar, and Naif M. Alshaeri. "Enhancing Tibial and Fibular Fracture Healing: A Case Report on the Value of Dynamization." JOURNAL OF HEALTHCARE SCIENCES 03, no. 11 (2023): 498–503. http://dx.doi.org/10.52533/johs.2023.31107.
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Background: Tibial and fibular fractures, commonly resulting from high-energy traumas such as road traffic accidents, present difficulties in their management due to displacement, instability, and the requirement for surgical intervention. Case presentation: We present a 27-year-old male patient with a tibial and fibular fracture managed with intramedullary nail fixation and subsequent dynamization. The aim is to highlight the clinical significance of dynamization in addressing delayed healing and non-union in fractures. Clinical assessment and radiographic evaluation were performed to diagnose the tibial and fibular fractures. The patient underwent intramedullary nail fixation followed by dynamization. The utilization of intramedullary nail fixation demonstrated consistent outcomes with established literature. However, delayed healing and non-union were observed. The introduction of dynamization after failed healing attempts led to significant improvements in callus formation and fracture healing. Conclusions: This case emphasizes the value of dynamization as a strategy to enhance fracture healing, particularly in cases of delayed union or non-union. Dynamization represents a promising adjunctive approach in orthopedic fracture management.
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Ying, Jun, Qinwen Ge, Songfeng Hu, Cheng Luo, Fengyi Lu, Yikang Yu, Taotao Xu, et al. "Amygdalin Promotes Fracture Healing through TGF-β/Smad Signaling in Mesenchymal Stem Cells." Stem Cells International 2020 (September 7, 2020): 1–13. http://dx.doi.org/10.1155/2020/8811963.
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Chondrogenesis and subsequent osteogenesis of mesenchymal stem cells (MSCs) and angiogenesis at injured sites are crucial for bone fracture healing. Amygdalin, a cyanogenic glycoside compound derived from bitter apricot kernel, has been reported to inhibit IL-1β-induced chondrocyte degeneration and to stimulate blood circulation, suggesting a promising role of amygdalin in fracture healing. In this study, tibial fractures in C57BL/6 mice were treated with amygdalin. Fracture calluses were then harvested and subjected to radiographic, histological, and biomechanical testing, as well as angiography and gene expression analyses to evaluate fracture healing. The results showed that amygdalin treatment promoted bone fracture healing. Further experiments using MSC-specific transforming growth factor- (TGF-) β receptor 2 conditional knockout (KO) mice (Tgfbr2Gli1-Cre) and C3H10 T1/2 murine mesenchymal progenitor cells showed that this effect was mediated through TGF-β/Smad signaling. We conclude that amygdalin could be used as an alternative treatment for bone fractures.