Increased Callus Formation Research Articles

Titanium versus stainless steel alloy bridge plates for distal femur fractures: Does callus form earlier with titanium?

Distal femur fractures account for 3-6% of all femur fractures. Internal fixation of most distal femur fractures with an anatomic lateral locking plate should permit some motion at the metaphyseal portion of the fracture when secondary bone healing is planned by the operating surgeon. While several studies have been performed evaluating union rates for distal femur fractures with stainless steel and titanium plates, the timing of callus formation between stainless steel and titanium implants used as bridge plates for distal femur fractures (AO/OTA 33-A and -C) has been investigated to a lesser extent. We hypothesize that callus will be visualized earlier with post-operative radiographs with titanium versus stainless steel bridge plates. We retrospectively reviewed a consecutive cohort of patients over 18 years of age with acute AO/OTA 33-A and 33-C fracture patterns treated with an isolated stainless steel or titanium lateral bridge plate within 4 weeks of injury by a single fellowship-trained orthopedic trauma surgeon from 2011 to 2020 at one academic Level 1 trauma center. An independent, fellowship-trained orthopedic trauma attending surgeon reviewed anterior-posterior (AP) and lateral radiographs from every available post-operative clinic visit and graded them using the Modified Radiographic Score for Tibia (mRUST). Twenty-five subjects were included in the study with 10 with stainless steel and 15 with titanium plates. There were no significant differences in demographics between both groups, including age, sex, BMI, injury classification, open versus closed, mechanism, and laterality. Statistically significant increased mRUST scores, indicating increased callus formation, were seen on 12-week radiographs (8.4 vs. 11.9, p = 0.02) when titanium bridge plates were used. There were no statistically significant differences in mRUST scores at 6 or 24-weeks, but scores in the titanium group were higher in at every timepoint. In conclusion, we observed greater callus formation at 12 weeks after internal fixation of 33-A and 33-C distal femur fractures treated with titanium locked lateral distal femoral bridge plates compared to stainless steel plates. Our data suggest that titanium metallurgy may have quicker callus formation compared to stainless steel if an isolated, lateral locked bridge plate is chosen for distal femur fracture fixation.

Growth of leaf cutting of malay apple (Syzygium malaccense (L.) Merr & Perry) with coconut water treatmen

Malay apple (Syzygium malaccense (L.) Merr & Perry) is a fruit plant in the Myrtaceae family, which has high economic value and nutritional content. The aim of this study was to determine the growth response of guava leaf cuttings to treatment with coconut water concentrations. The research design used was a randomized block design with 5 treatment levels and 5 replications. The treatment consisted of 5 levels namely control, water immersion, 25% coconut water, 50% coconut water, and 75% coconut water. Coconut water treatment was given to cuttings by soaking for 2 hours. Furthermore, leaf cuttings are planted in polybags that have been doused with water and then given a plastic cover. Parameters observed included the percentage of live cuttings, the percentage of formed roots, the percentage of shoots formed, the percentage of petiole damage, the percentage of petiole swelling and the percentage of petiole callus formation, the percentage of damaged leaves, and the symptoms of leaf damage. The results showed that the control treatment, water immersion and coconut water treatment showed the percentage of live cuttings was 100%, the leaf cuttings had not yet formed roots and shoots. Coconut water treatment reduced the percentage of petiole and leaf blade damage, increased the percentage of petiole swelling and increased callus formation, but was not able to stimulate root and shoot formation. Treatment of 75% coconut water showed the lowest percentage of damage to leaf cuttings with the highest percentage of swelling and callus formation.

The effect of ultrasound on bone healing across a bone gap, an experimental study of a delayed union model

The aim of the study is to determine whether ultrasound accelerates bone repair across a bone gap. To replicate the clinical situation of bone repair in a severe tibial fracture, such as Gustilo grade three, we designed an experimental model to determine whether ultrasound can promote bone healing in the presence of a bone gap. The effect of ultrasound on bone healing of a tibial bone gap held in an external fixator was studied. 60 New Zealand White rabbits were divided into four groups. In one group of 6 animals, a tibial osteotomy was closed or compressed and studied at six weeks (Comparative Group). In 3 groups of 18 animals each, a tibial bone gap was maintained and was untreated, treated with ultrasound or mock ultrasound (Control Group). The repair of the bone gaps was studied in 3 animals each at 2,4,6,8,10 and 12 weeks. Investigation was by histology, angiography, radiography and densitometry. Three of the 18 untreated group progressed to delayed union, compared with 4 in the ultrasound and 3 in the mock ultrasound group (Control Group). Statistical analysis showed no difference between the three groups. 5 of the 6 closed/compressed osteotomies (Comparative Group) united faster at 6 weeks. The healing pattern of the bone gap groups were similar. We recommend this as a delayed union model. We found no evidence that ultrasound accelerated bone healing, reduced the rate of delayed union or increased callus formation in this model of delayed union. This study simulates delayed union following a compound tibial fracture and has clinical relevance concerning treatment of a delay in union with ultrasound.

Lysine 27 of histone H3.3 is a fine modulator of developmental gene expression and stands as an epigenetic checkpoint for lignin biosynthesis in Arabidopsis.

Chromatin is a dynamic platform within which gene expression is controlled by epigenetic modifications, notably targeting amino acid residues of histone H3. Among them is lysine 27 of H3 (H3K27), the trimethylation of which by the Polycomb Repressive Complex 2 (PRC2) is instrumental in regulating spatiotemporal patterns of key developmental genes. H3K27 is also subjected to acetylation and is found at sites of active transcription. Most information on the function of histone residues and their associated modifications in plants was obtained from studies of loss-of-function mutants for the complexes that modify them. To decrypt the genuine function of H3K27, we expressed a non-modifiable variant of H3 at residue K27 (H3.3K27A ) in Arabidopsis, and developed a multi-scale approach combining in-depth phenotypical and cytological analyses, with transcriptomics and metabolomics. We uncovered that the H3.3K27A variant causes severe developmental defects, part of them are reminiscent of PRC2 mutants, part of them are new. They include early flowering, increased callus formation and short stems with thicker xylem cell layer. This latest phenotype correlates with mis-regulation of phenylpropanoid biosynthesis. Overall, our results reveal novel roles of H3K27 in plant cell fates and metabolic pathways, and highlight an epigenetic control point for elongation and lignin composition of the stem.

Influence of sodium salicylate on adventitious organogenesis of a commercial cucumber cultivar

Cucumber is an important vegetable crop belonging to the Cucurbitaceae family. An optimized regeneration system is required to address different biotechnological approaches in this species, such as large-scale multiplication, as well as genome editing and genetic transformation techniques. The aim of this study was to investigate the effect of different concentrations of the phenolic compound sodium salicylate (NaSA), a salicylic acid derivative, on in vitro callus and shoot regeneration of a commercial cultivar of cucumber. Four-day-old cotyledon explants from the slicing cultivar 'Marketer' were employed. Murashige and Skoog (MS)-derived shoot induction medium containing 0.5 mg L-1 indole-3-acetic acid (IAA) and 2.5 mg L-1 6-benzylaminopurine (BAP) was supplemented with NaSA. Frequency and shoot number were enhanced by 1.5-fold with NaSA at 0.1 µM. Higher salicylate levels led to increased callus formation and decreased shoot regeneration. The application of sodium salicylate at a specific concentration showed a positive trend in in vitro adventitious organogenesis of a commercial cucumber cultivar. Some probable mechanisms that may underlie the beneficial effects of salicylic acid/salicylates on in vitro regeneration were also discussed.

Water soaking and benzyladenine treatment for higher grafting success in grapevine

The grafting of grapevines has become essential to overcome biotic and abiotic stresses. Also, stimulating the grafting union's rapid formation is the key to grafting success. This investigation was an attempt to study the effect of removing growth inhibitors through soaking of scion wood in water for 24 hours versus adding growth stimulation through fast dipping in 250 ppm benzyl adenine (BA) for 30 seconds before grafting, on the grafting success of Flame Seedless and Early Sweet scions (Vitis vinifera) grafted onto Freedom rootstock (Vitis champinii x 1613C) in addition to the control treatment. Water soaking was the best and followed by the treatment of 250 ppm BA, which significantly improved the grafting success of both cultivars. Grafting success was positively associated with increasing callus formation at the grafting zone, accompanied by the highest total indols content, the lowest total phenols content and peroxidase activity above and below the grafting zone. However, water soaking significantly increased total indols and decreased total phenols content of the ungrafted cuttings. This study suggests that applying water soaking to grape scion before grafting is an environmentally friendly, sustainable and alternative practice for synthetic growth regulators to improve grafted cuttings success.

The effect of bone graft substitute in healing fractures with bone defects through examination of alkaline phosphatase and radiology in the murine model (Rattus norvegicus) Wistar strain

Background: A significant bone defect is a condition wherein the bone cannot repair spontaneously. Therefore, replacing bone defects with bone substitution remains a reconstructive concern for orthopaedic surgeons. Bone Graft Substitution (BGS) are classified broadly, such as bone grafts (autograft, allograft, and xenograft) synthetic ceramics (hydroxyapatite, calcium sulphate). This study aims to determine the effect of various Bone Graft Substitute on the healing process of bone defects assessed based on the area of callus formation and levels of alkaline phosphatase (ALP). Methods: The study design was an in vivo laboratory experimental approach with a randomized post-test only control group design. The 20 experimental animals that matched the inclusion criteria were divided into five groups, in each one of control positive group, one of control negative group, and three of treatment group. The bone graft substitution used in this study is a synthetic ceramic, namely Synthetic HA-Ca10(PO4)6(OH)2 - BONGROS®, Bone Graft Substitution Nanocrystalline HA-CaSO4-PEROSSAL®, and also hydroxyapatite Bovine. After selecting rats, we performed osteotomy on the femur to the made bone defect. After 30 days, murine models were harvested. Then, we measure callus formation using radiological examination and ALP level serum Results: From Callus formation, Nanocrystalline HA-CaSO4 is the highest (86.54 ± 4.24604) compared with other groups and significantly (p:0.021) increase in callus formation than the other experimental groups. Then, from the ALP level, Bovine is the highest (9.287 ± 0.58586) but did not significantly compare with K-neg, and the second one is Nanocrystalline HA-CaSO4 higher than KP-1, and it has a significantly higher levels serum ALP rather than K-Neg. Conclusion: Bone Graft Substituted using Nanocrystalline HA-CaSO4 is a good material that can repair and increase callus formation in fracture model rats with bone defects.

English

BACKGROUND Chronic leg and foot ulcers are a major health problem and leads to negative physical, social and psychological impact on patients and families. A high percentage of chronic ulcers do not adequately heal or quickly relapse with conventional treatment. They need advanced treatment modalities. Emerging cellular therapies such as platelet-rich concentrate therapy is an advanced modality. Platelet rich fibrin (PRF) is a second-generation platelet concentrate, consists of fibrin three-dimensional polymerized matrix, with the incorporation of platelets and leukocytes. The objective of the study was to assess clinical outcome of chronic leg and foot ulcers treated with autologous platelet rich fibrin. METHODS This prospective study included 30 patients with chronic leg or foot ulcers of various aetiologies, 19 patients had diabetic foot ulcers, 7 venous ulcers, 1 trophic ulcer, 2 pressure ulcers and 1 traumatic ulcer. Autologous PRF treatment outcome was measured by percentage of improvement in area and volume of the ulcer. We also studied other ulcer characteristics including exudate type, pus culture and sensitivity status, presence of undermining, type of tissue in ulcer bed and comorbidities. RESULTS From the 30 ulcers treated with PRF, the mean percentage of improvement in area and volume of ulcers were 98.3% and 98.8% respectively at the end of 2 months. 80% ulcers healed completely. There was also reduction of pain and exudate after first week of treatment. Other than increased callus formation in some ulcers, no other adverse events were reported following PRF treatment. CONCLUSIONS PRF is a safe, easy-to-use, cost-effective treatment method with significant potential for healing chronic ulcers. KEY WORDS PRF-Platelet Rich Fibrin

Imersão em água e benziladenina como estratégia para melhorar o sucesso da enxertia em videira

Abstract The grafting of grapevines has become essential to overcome biotic and abiotic stresses because permits access to the benefits of the agronomical characteristics of different rootstocks. Stimulating the rapid formation of the grafting union is the key to grafting success. This investigation studied the effect of removing growth inhibitors through soaking in water for 24 hours versus adding growth stimulate through fast dipping in 250 mg/L benzyladenine (BA) for 30 seconds of graft wood before grafting on the grafting success of ‘Flame Seedless’ and ‘Early Sweet’ scions (Vitis vinifera) grafted onto ‘Freedom’ rootstock (Vitis champinii x 1613C). Water soaking came first and followed by treatment of 250 mg/L BA, which significantly improved the grafting success of both cultivars. Grafting success was positively associated with increasing callus formation at the grafting zone, which was accompanied with the highest total indols content, the lowest total phenols content, and peroxidase activity above and below the grafting zone. However, water soaking significantly increased total indols and decreased the total phenols content of the ungrafted cuttings. In this study, it was suggested that the application of water soaking to grafted cuttings prior to grafting is an environmentally friendly and alternative practice for synthetic growth regulators to improve grafted cuttings success.

The Effects of TMP Treatment and High Fat Diet on Bone Fracture Healing

Delayed and impaired bone fracture healing are associated with diabetic populations. This is a challenging problem for orthopaedic surgeons especially in the US where the percentage of type 2 diabetic patients continues to climb at an alarming rate. Limited treatment options exist for orthopaedic surgeons to improve fracture healing, and the most commonly used therapies involve placement of proteins (bone morphogenetic protein), graft tissue, or demineralized bone matrix at the fracture site. We have previously demonstrated that local administration of the main megakaryocyte growth factor, thrombopoietin, enhances bone healing. Here we demonstrate the utility of systemically administering thrombopoietin mimetic peptides (TMPs) to improve impaired fracture healing in a mouse model of type 2 diabetes. Briefly, 120 male mice on a C57BL/6 background were placed on a low fat diet (LFD) or high fat diet (HFD) for 12 weeks prior to undergoing a surgically created femoral fracture. Mice were treated with 33 nmol/kg of TMP or saline immediately after surgery and daily for the following week. Mice were euthanized at 1, 2, and 4 weeks post-surgery (n=10/group). Here, we confirmed that HFD resulted in impaired fracture healing. We also showed accelerated bone union and increased callus formation in TMP treated mice compared to saline groups, irrespective of diet (p<0.05). Among TMP groups that were fed either a HFD or LFD, the HFD TMP group showed greater improvements in bone healing compared to the HFD saline control mice. Further study on TMP should include alternative routes of administration and providing treatment when a surgical repair appears to be deteriorating. Although there is more to be understood about the clinical importance and mechanism by which systemic TMP treatment enhances fracture healing, these data appear promising.

Genetic variation of doubled haploids derived from anther culture of M1 red rice plants

Abstract. Nurmansyah, Setyadi AH, Fatumi NC, Fatmawati Y, Wulandari RA, Purwantoro A. 2021. Genetic variation of doubled haploids derived from anther culture of M1 red rice plants. Biodiversitas 22: 4923-4929. The doubled haploid (DH) technology when integrated with induced mutation could accelerate development of local rice cultivars with several desirable traits. Anthers from the first generation of mutant (M1) plants were utilized for DH production. However, the effectiveness of inducing and fixing mutation requires detailed evaluation with the help of molecular techniques for its accuracy and reliability than that of morphological or biochemical assessments. The objective of this research was to develop and detect genetic variation of DH plants derived from anther culture of M1 plants. Seeds of local red rice cultivar, Cempo Abang, were treated with four gamma-ray doses (0, 100, 200, 300 Gy) and planted to produce the M1 plants. Panicles at the booting stage of the M1 plants were collected and used as donor anthers. The present study suggested that gamma irradiation treatments indirectly could increase callus formation. However, it also reduced the number of callus producing plantlets due to higher frequency of brown calli. Eleven spontaneous DH plants obtained in the study along with parental plants were assessed to determine the occurrence of genetic variation using six RAPD primers. The RAPD primers generated 51 bands, of which 34 alleles or 66.7% were polymorphic with an average of 5.6 polymorphic alleles per primer. The genetic similarity among parent and 11 DH lines based on Jaccard’s similarity index ranged from 0.622 to 0.902. The DNA polymorphism among the DH plants demonstrated the effect of gamma irradiation to create genetic variation. Therefore, this method could be used as an alternative for rice breeding programs especially to develop preferred traits in the local rice cultivars.

STING inhibition accelerates the bone healing process while enhancing type H vessel formation.

The stimulator of interferon genes (STING), one of the critical factors of innate immunity, is indicated to be closely related to angiogenesis. This study examined STING's role in angiogenesis and the formation of type H vessels, a specific subtype of bone vessels that regulates bone healing. Different concentrations of 2',3'-cGAMP, and H-151 or C-176 were applied to activate or inhibit STING, respectively. Human umbilical vein endothelial cells were used to examine the effect of STING on angiogenesis in vitro; cell viability, cell migration, and quantitative real-time polymerase chain reactions were performed. Also, the metatarsal experiment was applied as ex vivo proof. Bone fracture or defect mice models were used to examine the effect of STING in vivo; the bone healing process was evaluated by radiography weekly and by μCT on the 14th day after surgery. The formation of type H vessels (CD31hi Emcnhi endothelial cells) and osteogenesis (OCN-positive cells) was assessed using the cryosection and paraffin section. STING activation inhibited angiogenesis both in vitro and ex vivo and slowed down the bone healing process in vivo. Histological analysis showed an increased callus formation, fewer type H vessels, and almost no callus mineralization in the STING activation group compared to the control group. By contrast, H-151 (a hsSTING inhibitor) promoted angiogenesis at a low dose. Moreover, inhibition of mmSTING by C-176 enhanced type H vessels' formation, implying osteogenesis promotion in bone healing (higher bone volume density and more OCN-positive cells). Our data suggested that STING inhibition accelerates the bone healing process while enhancing type H vessel formation.

The role of intermittent PTH administration in conjunction with allogenic stem cell treatment to stimulate fracture healing.

AimsA growing number of fractures progress to delayed or nonunion, causing significant morbidity and socioeconomic impact. Localized delivery of stem cells and subcutaneous parathyroid hormone (PTH) has been shown individually to accelerate bony regeneration. This study aimed to combine the therapies with the aim of upregulating fracture healing.MethodsA 1.5 mm femoral osteotomy (delayed union model) was created in 48 female juvenile Wistar rats, aged six to nine months, and stabilized using an external fixator. At day 0, animals were treated with intrafracture injections of 1 × 106 cells/kg bone marrow mesenchymal stem cells (MSCs) suspended in fibrin, daily subcutaneous injections of high (100 μg/kg) or low (25 μg/kg) dose PTH 1-34, or a combination of PTH and MSCs. A group with an empty gap served as a control. Five weeks post-surgery, the femur was excised for radiological, histomorphometric, micro-CT, and mechanical analysis.ResultsCombination therapy treatment led to increased callus formation compared to controls. In the high-dose combination group there was significantly greater mineralized tissue volume and trabecular parameters compared to controls (p = 0.039). This translated to significantly improved stiffness (and ultimate load to failure (p = 0.049). The high-dose combination therapy group had the most significant improvement in mean modified Radiographic Union Score for Tibia fractures (RUST) compared to controls (13.8 (SD 1.3) vs 5.8 (SD 0.5)). All groups demonstrated significant increases in the radiological scores – RUST and Allen score – histologically compared to controls.ConclusionWe demonstrate the beneficial effect of localized MSC injections on fracture healing combined with low- or high-dose teriparatide, with efficacy dependent on PTH dose.Cite this article: Bone Joint Res 2021;10(10):659–667.

Tanshinone IIA Regulates Osteoblast Differentiation and Promotes Fracture Healing via Mammalian Target of Rapamycin Complex 1 Signaling Pathway

This study assessed the effect and potential molecular mechanism of tanshinone IIA on fracture healing. Mice model with fracture were established. Digital radiographic photographic system was used to detect callus formation after treatment with tanshinone II A (Tan IIA) and alkaline phosphatase (ALP) staining analyzed ALP activity. Osteoblast proliferation was also measured. Western blot and Quantitative real-time PCR (qRT-PCR) measured osteogenic markers expression. Compared with control group, Tan IIA treatment could increase callus formation, stimulate osteoblast proliferation, osteogenic proteins and genes expression, and activate mTORC1 signaling pathway. However, Tan IIA’s effects were significantly inhibited after rapamycin treatment. Tan IIA regulates osteoblast differentiation by mTORC1 signaling and promotes intramembranous ossification in the process of callus formation, which accelerates bone healing.

Strategies to Improve Bone Healing: Innovative Surgical Implants Meet Nano-/Micro-Topography of Bone Scaffolds.

Successful fracture healing is dependent on an optimal mechanical and biological environment at the fracture site. Disturbances in fracture healing (non-union) or even critical size bone defects, where void volume is larger than the self-healing capacity of bone tissue, are great challenges for orthopedic surgeons. To address these challenges, new surgical implant concepts have been recently developed to optimize mechanical conditions. First, this review article discusses the mechanical environment on bone and fracture healing. In this context, a new implant concept, variable fixation technology, is introduced. This implant has the unique ability to change its mechanical properties from “rigid” to “dynamic” over the time of fracture healing. This leads to increased callus formation, a more homogeneous callus distribution and thus improved fracture healing. Second, recent advances in the nano- and micro-topography of bone scaffolds for guiding osteoinduction will be reviewed, particularly emphasizing the mimicry of natural bone. We summarize that an optimal scaffold should comprise micropores of 50–150 µm diameter allowing vascularization and migration of stem cells as well as nanotopographical osteoinductive cues, preferably pores of 30 nm diameter. Next to osteoinduction, such nano- and micro-topographical cues may also reduce inflammation and possess an antibacterial activity to further promote bone regeneration.

In vitro and in vivo investigation of osteogenic properties of self-contained phosphate-releasing injectable purine-crosslinked chitosan-hydroxyapatite constructs

Bone fracture repair is a multifaceted, coordinated physiological process that requires new bone formation and resorption, eventually returning the fractured bone to its original state. Currently, a variety of different approaches are pursued to accelerate the repair of defective bones, which include the use of 'gold standard' autologous bone grafts. However, such grafts may not be readily available, and procedural complications may result in undesired outcomes. Considering the ease of use and tremendous customization potentials, synthetic materials may become a more suitable alternative of bone grafts. In this study, we examined the osteogenic potential of guanosine 5′-diphosphate-crosslinked chitosan scaffolds with the incorporation of hydroxyapatite, with or without pyrophosphatase activity, both in vitro and in vivo. First, scaffolds embedded with cells were characterized for cell morphology, viability, and attachment. The cell-laden scaffolds were found to significantly enhance proliferation for up to threefold, double alkaline phosphatase activity and osterix expression, and increase calcium phosphate deposits in vitro. Next, chitosan scaffolds were implanted at the fracture site in a mouse model of intramedullary rod-fixed tibial fracture. Our results showed increased callus formation at the fracture site with the scaffold carrying both hydroxyapatite and pyrophosphatase in comparison to the control scaffolds lacking both pyrophosphatase and hydroxyapatite, or pyrophosphatase alone. These results indicate that the pyrophosphatase-hydroxyapatite composite scaffold has a promising capacity to facilitate bone fracture healing.

The use of bisphosphonates to meet orthopaedic challenges.

The anti-resorptive properties of bisphosphonates have been explored to manage several conditions that traditionally have required a surgical solution. In osteonecrosis, their use is predicated on the principle that bone collapse occurs during the revascularisation phase of the disease. If the associated resorptive activity were modulated, the resultant preserved joint architecture may improve clinical outcome and reduce the need for joint replacement. Pre-clinical and small-scale clinical studies have given non-conclusive support for this principle. Adequately powered clinical trials with relevant long-term endpoints are still required to firmly clarify the clinical efficacy of this treatment. Several clinical studies have shown that bisphosphonates can reduce periprosthetic bone loss and, in some situations, enhance implant fixation in the early period after joint replacement. This may be advantageous in settings where osseointegration is problematic. However, the ultimate goals of their use in joint replacement has been to reduce the incidence of late periprosthetic inflammatory osteolysis, the main cause of prosthesis failure. Population-based observational studies have associated bisphosphonate use with a lower incidence of revision surgery, supported by pre-clinical data. However, clinical trials have, to date, failed to demonstrate any efficacy for the human disease. The timing of bisphosphonate administration for secondary prevention after acute osteoporotic fracture has been subject to extensive investigation, with pre-clinical studies showing increased callus formation but decreased remodelling and no effect on the restoration of mechanical integrity of bone. Meta-analysis of clinical trial data indicates that early administration of bisphosphonate after acute fracture does not adversely affect fracture union, pain or functional outcomes. Finally, bisphosphonates have also been explored as a treatment for complex regional pain syndrome type-I. A recent meta-analysis has shown a beneficial effect on visual analogue scale pain scores, but an increase in mild adverse events.

Evaluation of callus formation in distal femur fractures after carbon fiber composite versus stainless steel plate fixation.

Carbon-fiber-reinforced polyetheretherketone (CFR) composite plates have a more favorable stress modulus than stainless steel (SS) plates that may confer an advantage to bridge plating. The purpose of this study was to compare callus formation after CFR and SS plating of distal femur fractures. A retrospective review identified distal femoral fractures treated with CFR (n = 10) and SS (n = 21) plate fixation. Callus formation was measured using the modified Radiographic Union Score for Tibia (mRUST) at 3- and 6-month follow-up by three orthopedic trauma surgeons. Loss of alignment, implant failure, and revision surgeries were reviewed. At 3months, the mRUST in the CFR and SS groups was 9.0 (range, 6.3-12.3) and 6.9 (range, 4.3-11.7), respectively (p = 0.01). At 6months, the mRUST in the CFR and SS groups was 11.4 (range, 7.7-16.0) and 10.5 (range, 6.0-15.7), respectively (p = 0.3). CFR and SS groups had a loss of fracture alignment in 1 (10%) and 1 (5%) patient, respectively (p = 0.5), and an unplanned revision surgery in 0 (0%) and 3 (15%) patients, respectively (p = 0.2). All three revisions surgeries in the SS group were for nonunion repair. Treatment of distal femur fractures with CFR versus SS plating resulted in greater callus formation at 3months. At 6months, there was no difference in callus formation between groups. A larger series of patients is necessary to determine if the observed early increased callus formation confers a benefit to clinical outcomes. Therapeutic level III.

A review on interventions to prevent osteoporosis and improve fracture healing in osteoporotic patients

Introduction Proportion of aged people has increased due to improvement in longevity. With advancing age bones loose mass, get weakened, become more prone to osteoporotic fractures. Development of osteoporosis is silent with reduction in total bone mineral content. Bone mineral density is the most important parameter which can measure gravity of OP. The T-score of −2.5 or below indicates OP leading to fractures commonly in bones of spine, hip and distal extremities. Objective Purpose of this review is to find out currently available as well as future approaches those could be beneficial in faster recoveries. Method Major databases were searched from inception to till January 2020. Relevant main articles and cross references were evaluated. In addition, findings were compared to a previously published review. Pharmacological and bio-molecule interventions decrease bone depletion by reducing bone resorption and enhancing bone formation process, and other external stimuli like strengthening muscular and skeletal tissues are employed to prevent OP and accelerate fracture healing and normal functioning. Results A literature review of such interventions showed that bisphosphonates and selective estrogen receptor modulator treatment reduces fracture risks in osteoporosis and increase callus formation during fracture repair but do not reduce total time of fracture healing. Parathyroid hormone (PTH) and its analogues prevent OP by promoting callus formation as well as osteogenesis, enhance coupled remodelling and amount of mineralized tissue. When PTH is combined with bone morphogenetic proteins (BMP) improve mechanical functioning by integrating new bone tissue with old bone tissue. Restraining and supportive therapies like the physical exercises could be beneficial to minimize gravity of osteoporosis. Electromagnetic field therapy and pulsed ultrasonic therapy could be useful after surgical management of fracture or delayed union. Conclusion To identify the quantitative effect of these therapies in isolation or in combination, clinical trials under proper experimental settings are especially important. Unlike the therapies for fracture repair in non-osteoporotic patients, the line of treatment and duration of each therapy in isolation or in combination with pharmacological agents, biomolecules, physical stimuli, exercises and lifestyles are necessary.

MicroRNA-186 improves fracture healing through activating the bone morphogenetic protein signalling pathway by inhibiting SMAD6 in a mouse model of femoral fracture: An animal study.

ObjectivesMicroRNAs (miRNAs) have been reported as key regulators of bone formation, signalling, and repair. Fracture healing is a proliferative physiological process where the body facilitates the repair of a bone fracture. The aim of our study was to explore the effects of microRNA-186 (miR-186) on fracture healing through the bone morphogenetic protein (BMP) signalling pathway by binding to Smad family member 6 (SMAD6) in a mouse model of femoral fracture.MethodsMicroarray analysis was adopted to identify the regulatory miR of SMAD6. 3D micro-CT was performed to assess the bone volume (BV), bone volume fraction (BVF, BV/TV), and bone mineral density (BMD), followed by a biomechanical test for maximum load, maximum radial degrees, elastic radial degrees, and rigidity of the femur. The positive expression of SMAD6 in fracture tissues was measured. Moreover, the miR-186 level, messenger RNA (mRNA) level, and protein levels of SMAD6, BMP-2, and BMP-7 were examined.ResultsMicroRNA-186 was predicted to regulate SMAD6. Furthermore, SMAD6 was verified as a target gene of miR-186. Overexpressed miR-186 and SMAD6 silencing resulted in increased callus formation, BMD and BV/TV, as well as maximum load, maximum radial degrees, elastic radial degrees, and rigidity of the femur. In addition, the mRNA and protein levels of SMAD6 were decreased, while BMP-2 and BMP-7 levels were elevated in response to upregulated miR-186 and SMAD6 silencing.ConclusionIn conclusion, the study indicated that miR-186 could activate the BMP signalling pathway to promote fracture healing by inhibiting SMAD6 in a mouse model of femoral fracture.Cite this article: Bone Joint Res 2019;8:550–562.