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Sample records for metaphyseal fracture healing

  1. A special healing pattern in stable metaphyseal fractures.

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    Chen, Wen Tao; Han, Da Cheng; Zhang, Pei Xun; Han, Na; Kou, Yu Hui; Yin, Xiao Feng; Jiang, Bao Guo

    2015-04-01

    Metaphyseal fractures heal in a rapid fashion that is different from the bone shaft healing process. Animal studies have focused on diaphyseal fractures. We investigated the metaphyseal fracture-healing process in rabbits. 60 rabbits (divided into 12 groups) underwent proximal tibial osteotomy, anatomical reduction, and fixation with screws. After surgery, the proximal tibiae were harvested at different time points for histology. No obvious osteonecrosis or bone resorption were found 2 weeks after surgery. From day 5 to week 5, woven bone or new trabeculae formed. From week 2, remodeling into lamellar bone started and reached a peak at week 6. These 3 stages overlapped. Histomorphometry showed that the structure changed as a unimodal curve. The healing process of metaphyseal fractures appears to differ from the commonly studied healing process in diaphyseal fractures. It is rapid, and can be divided into 4 histological stages: cellular activation and differentiation, formation of woven bone, transformation of woven bone into lamellar bone, and further remodeling.

  2. Low-energy extracorporeal shockwave therapy (ESWT) improves metaphyseal fracture healing in an osteoporotic rat model.

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    Mackert, Gina A; Schulte, Matthias; Hirche, Christoph; Kotsougiani, Dimitra; Vogelpohl, Julian; Hoener, Bernd; Fiebig, Teresa; Kirschner, Stefanie; Brockmann, Marc A; Lehnhardt, Marcus; Kneser, Ulrich; Harhaus, Leila

    2017-01-01

    As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT), was evaluated as a treatment option for the improvement of osteoporotic fracture healing. A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic) groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2) as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period) were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR) analysis, histomorphometric analysis and biomechanical analysis. The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2) ESWT and with fewer treatment applications per healing period. In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

  3. Low-energy extracorporeal shockwave therapy (ESWT improves metaphyseal fracture healing in an osteoporotic rat model.

    Directory of Open Access Journals (Sweden)

    Gina A Mackert

    Full Text Available As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT, was evaluated as a treatment option for the improvement of osteoporotic fracture healing.A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2 as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR analysis, histomorphometric analysis and biomechanical analysis.The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2 ESWT and with fewer treatment applications per healing period.In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

  4. Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study.

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    Vicenti, G; Pesce, V; Tartaglia, N; Abate, A; Mori, C M; Moretti, B

    2014-12-01

    The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats.

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    Thormann, Ulrich; El Khawassna, Thaqif; Ray, Seemun; Duerselen, Lutz; Kampschulte, Marian; Lips, Katrin; von Dewitz, Helena; Heinemann, Sascha; Heiss, Christian; Szalay, Gabor; Langheinrich, Alexander C; Ignatius, Anita; Schnettler, Reinhard; Alt, Volker

    2014-03-01

    Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n=14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n=14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p=0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3mm lever span biomechanical testing and histology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. A new metaphyseal bone defect model in osteoporotic rats to study biomaterials for the enhancement of bone healing in osteoporotic fractures.

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    Alt, Volker; Thormann, Ulrich; Ray, Seemun; Zahner, Daniel; Dürselen, Lutz; Lips, Katrin; El Khassawna, Thaqif; Heiss, Christian; Riedrich, Alina; Schlewitz, Gudrun; Ignatius, Anita; Kampschulte, Marian; von Dewitz, Helena; Heinemann, Sascha; Schnettler, Reinhard; Langheinrich, Alexander

    2013-06-01

    The intention of this study was to establish a new critical size animal model that represents clinically relevant situations with osteoporotic bone status and internally fixated metaphyseal defect fractures in which biomaterials for the enhancement of fracture healing in osteoporotic fracture defects can be studied. Twenty-eight rats were ovariectomized (OVX) and treated with a calcium-, phosphorus-, vitamin D3-, soy- and phytoestrogen-free diet. After 3months Dual-energy X-ray absorptiometry measurements showed statistically significant reductions in bone mineral density of the spine of -25.9% and of the femur of -21.3% of the OVX rats compared with controls, confirming osteoporosis in the OVX rats. The OVX rats then underwent either 3 or 5mm wedge-shaped osteotomy of the distal metaphyseal area of the femur that was internally stabilized with a T-shaped mini-plate. After 42days biomechanical testing yielded completely unstable conditions in the 5mm defect femora (bending stiffness 0Nmm(-2)) and a bending stiffness of 12,500Nmm(-2) in the 3mm defects, which showed the beginning of fracture consolidation. Micro-computed tomography showed statistically significant more new bone formation in the 3mm defects (4.83±0.37mm(2)), with bridging of the initial fracture defect area, compared with the 5mm defects (2.68±0.34mm(2)), in which no bridging of the initial defect was found. These results were confirmed by histology. In conclusion, the 5mm defect can be considered as a critical size defect model in which biomaterials can be tested. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  7. A systematic review of current osteoporotic metaphyseal fracture animal models.

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    Wong, R M Y; Choy, M H V; Li, M C M; Leung, K-S; K-H Chow, S; Cheung, W-H; Cheng, J C Y

    2018-01-01

    The treatment of osteoporotic fractures is a major challenge, and the enhancement of healing is critical as a major goal in modern fracture management. Most osteoporotic fractures occur at the metaphyseal bone region but few models exist and the healing is still poorly understood. A systematic review was conducted to identify and analyse the appropriateness of current osteoporotic metaphyseal fracture animal models. A literature search was performed on the Pubmed, Embase, and Web of Science databases, and relevant articles were selected. A total of 19 studies were included. Information on the animal, induction of osteoporosis, fracture technique, site and fixation, healing results, and utility of the model were extracted. Fracture techniques included drill hole defects (3 of 19), bone defects (3 of 19), partial osteotomy (1 of 19), and complete osteotomies (12 of 19). Drill hole models and incomplete osteotomy models are easy to perform and allow the study of therapeutic agents but do not represent the usual clinical setting. Additionally, biomaterials can be filled into drill hole defects for analysis. Complete osteotomy models are most commonly used and are best suited for the investigation of therapeutic drugs or noninvasive interventions. The metaphyseal defect models allow the study of biomaterials, which are associated with complex and comminuted osteoporotic fractures. For a clinically relevant model, we propose that an animal model should satisfy the following criteria to study osteoporotic fracture healing: 1) induction of osteoporosis, 2) complete osteotomy or defect at the metaphysis unilaterally, and 3) internal fixation. Cite this article : R. M. Y. Wong, M. H. V. Choy, M. C. M. Li, K-S. Leung, S. K-H. Chow, W-H. Cheung, J. C. Y. Cheng. A systematic review of current osteoporotic metaphyseal fracture animal models. Bone Joint Res 2018;7:6-11. DOI: 10.1302/2046-3758.71.BJR-2016-0334.R2. © 2018 Wong et al.

  8. Metaphyseal impaction fractures in acute lymphoblastic leukemia

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    Manson, D.; Cockshott, W.P.; Martin, R.F.

    1989-01-01

    Patients with acute lymphatic leukaemia frequently are osteoporotic. A small subset of these develop disabling metaphyseal transverse fractures, usually bilateral and in the lower limb. These impaction fractures have a characteristic appearance and develop in recently laid down bone. They may develop ab initio of during therapy, Magnesium deficiency is found in these patients.

  9. Fracture healing in osteoporotic bone.

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    Cheung, Wing Hoi; Miclau, Theodore; Chow, Simon Kwoon-Ho; Yang, Frank F; Alt, Volker

    2016-06-01

    As the world population rises, osteoporotic fracture is an emerging global threat to the well-being of elderly patients. The process of fracture healing by intramembranous ossification or/and endochondral ossification involve many well-orchestrated events including the signaling, recruitment and differentiation of mesenchymal stem cells (MSCs) during the early phase; formation of a hard callus and extracellular matrix, angiogenesis and revascularization during the mid-phase; and finally callus remodeling at the late phase of fracture healing. Through clinical and animal research, many of these factors are shown to be impaired in osteoporotic bone. Animal studies related to post-menopausal estrogen deficient osteoporosis (type I) have shown healing to be prolonged with decreased levels of MSCs and decreased levels of angiogenesis. Moreover, the expression of estrogen receptor (ER) was shown to be delayed in ovariectomy-induced osteoporotic fracture. This might be related to the observed difference in mechanical sensitivity between normal and osteoporotic bones, which requires further experiments to elucidate. In mice fracture models related to senile osteoporosis (type II), it was observed that chondrocyte and osteoblast differentiation were impaired; and that transplantation of juvenile bone marrow would result in enhanced callus formation. Other factors related to angiogenesis and vasculogenesis have also been noted to be impaired in aged models, affecting the degradation of cartilaginous matrixes and vascular invasion; the result is changes in matrix composition and growth factors concentrations that ultimately impairs healing during age-related osteoporosis. Most osteoporotic related fractures occur at metaphyseal sites clinically, and reports have indicated that differences exist between diaphyseal and metaphyseal fractures. An animal model that satisfies three main criteria (metaphyseal region, plate fixation, osteoporosis) is suggested for future research for

  10. Metaphyseal fractures mimicking abuse during treatment for clubfoot

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    Grayev, A.M.; Boal, D.K.B. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States); Wallach, D.M.; Segal, L.S. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States)

    2001-08-01

    Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

  11. Metaphyseal fractures mimicking abuse during treatment for clubfoot

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    Grayev, A.M.; Boal, D.K.B.; Wallach, D.M.; Segal, L.S.

    2001-01-01

    Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

  12. Metaphyseal locking plate as an external fixator for open tibial fracture: Clinical outcomes and biomechanical assessment.

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    Ma, Ching-Hou; Wu, Chin-Hsien; Jiang, Jiun-Ru; Tu, Yuan-Kun; Lin, Ting-Sheng

    2017-02-01

    This study aimed to evaluate the outcome of using a metaphyseal locking plate as a definitive external fixator for treating open tibial fractures based on biomechanical experiments and analysis of clinical results. A metaphyseal locking plate was used as an external fixator in 54 open tibial fractures in 52 patients. The mean follow-up was 38 months (range, 20-52 months). Moreover, static axial compression and torsional tests were performed to evaluate the strength of the fixation techniques. The average fracture healing time was 34.5 weeks (range, 12-78 weeks). At 4 weeks postoperatively and at the final follow-up, the average Hospital for Special Surgery knee score was 85 (range, 81-100) and 94 (range, 88-100), respectively, and the American Orthopaedic Foot and Ankle Society score was 88 (range, 80-100) and 96 (range, 90-100), respectively. Based on the static test result, the axial stiffness was significantly different among groups (p=0.002), whereas the torsional stiffness showed no significant difference (p=0.068). Clinical outcomes show that the use of locking plate as a definitive external fixator is an alternative choice for tibial fractures after obtaining appropriate fracture reduction. However, external locked plating constructs were not as strong as standard locked plating constructs. Therefore, the use of external locked plating constructs as a definitive treatment warrants further biomechanical study for construct strength improvement. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Current concepts of fracture healing.

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    Hulth, A

    1989-12-01

    The current concepts of fracture healing are mainly based on two variables: blood supply and stability. The effect of electricity on delayed union has not been explained. Possible individual differences in the primary osteogenetic activity and the effect of soft-tissue injuries are seldom considered. In recent years, interesting data have revealed how biomechanical forces and electric currents can be translated to biochemical mediators such as prostaglandins (PGE2), morphogens, and growth factors. It is likely that the fracture ends emit osteogenic signal substances (such as bone morphogenetic protein) to the exudate in addition to those mediators (interleukin-1, growth factors) which are released from the blood clot as in wound healing. Movement of the fragments increases the fracture exudate with its migrating cells and sprouting vessels, resulting in exuberant callus. Cartilage is formed in the well-vascularized granulation tissue due to its ability to repel vessels. Rigid fixation minimizes granulation tissue and external callus. Rigid plates may also retard effusion of morphogens and growth factors from bone ends. Reaming of the intramedullary canal and nailing may cause additional bone damage, which may increase the osteogenetic activity. Weight bearing stimulates growth factors and PGE2. The molecular activity of the fracture exudate is the most decisive factor for bone healing. This activity can be impeded by diastasis, infections, and soft-tissue crushing injuries that cause extensive activation of macrophages and activate mediators, disturbing the osteogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. The healing of fractured bones

    Energy Technology Data Exchange (ETDEWEB)

    Bacon, G.E. [Central Electricity Generating Board, Cheltenham (United Kingdom)

    1997-04-01

    A method utilising neutron beams of width 1 mm, used on D1B (2.4 A) and D20 (1.3 A) to study the healing of fractured bones is presented. It is found that the callus bone uniting the fractured tibia of a sheep, whose healing had been encouraged by daily mechanical vibration over a period of three months, showed no trace of the large preferential vertical orientation of the apatite crystals which is characteristic of the normal bone. Nevertheless the bone had regained about 60% of its mechanical strength and the callus bone, although not oriented, was well crystallized. It is considered that the new monochromator for D20, expected to give increased intensity at 2.5 A, will be of considerable advantage. (author). 2 refs.

  15. Absence of positive effect of black cohosh (Cimicifuga racemosa) on fracture healing in osteopenic rodent model.

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    Kolios, Leila; Daub, Florian; Sehmisch, Stephan; Frosch, Karl-Heinz; Tezval, Mohammed; Stuermer, Klaus Michael; Wuttke, Wolfgang; Stuermer, Ewa Klara

    2010-12-01

    The healing of predominantly metaphyseal fractures in postmenopausal osteoporosis is delayed and comparatively poor. Due to the potential side effects of HRT, natural alternatives are appealing. The aim of this study was to determine whether Cimicifuga racemosa extract BNO 1055 improves metaphyseal fracture healing in severe osteopenic bone in rats. Thirty-three 12-week-old female rats developed severe osteopenia during 10 weeks after ovariectomy. After metaphyseal tibial-osteotomy and standardized T-plate-osteosynthesis, the healing periods in ovariectomized rats (C), 17-α-estradiol (E) and Cimicifuga racemosa (CR) supplemented diets were assessed for 35 days. Changes in callus morphology were evaluated qualitatively by biomechanical testing and quantitatively in microradiographies and fluorochrome-labeled histological sections. The CR-supplementation slightly improved callus quality and trabecular bone formation. It significantly enhanced the endosteal callus density compared to C group (Cl.Dn.e C: 59.08 ± 21.89, E: 45.95 ± 18.39, CR: 60.85 ± 18.66*), though most of the other morphological parameters examined showed no improvement. The time course of fracture healing did not change due to CR. Estrogen-supplementation enhanced the biomechanical properties of the fracture site. Trabecular bone was improved indicating the physiological endosteal healing process. The CR-supplementation did not exhibit positive effects in severe (senile) osteopenic fracture healing as seen in early (postmenopausal) osteoporosis in rats. Callus formation was slightly improved under CR. Estrogen improved fracture healing in severe osteopenic bone, while the extent of callus formation played a minor role. Copyright © 2010 John Wiley & Sons, Ltd.

  16. How do bisphosphonates affect fracture healing?

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    Kates, Stephen L; Ackert-Bicknell, Cheryl L

    2016-01-01

    Bisphosphonates (BPs) have been in use for many years for the treatment of osteoporosis, multiple myeloma, Paget's disease, as well as a variety of other diseases in which there is reduced bone mineral density. Given that bisphosphonates inhibit bone resorption, an important stage of fracture healing; this class of compounds has been widely studied in preclinical models regarding their influence on fracture healing. In animal models, bisphosphonate treatment is associated with a larger fracture callus, coincident with a delay in remodeling from primary woven bone to lamellar bone, but there is no delay in formation of the fracture callus. In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing. Rarely, patients with long term use of Bisphosphonates may develop an atypical fracture and delay in fracture healing has been observed. In summary, bisphosphonates appear safe for use in the setting of acute fracture management in the upper and lower extremity in humans. While much remains unknown about the effects on healing of long-term bisphosphonates, use prior to "typical" fracture, in the special case of atypical fracture, evidence suggests that bisphosphonates negatively influence healing. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Physiology of fracture healing: New aspects

    OpenAIRE

    Gajdobranski Đorđe R.; Živković Dragana 1

    2003-01-01

    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 p...

  18. Delayed Fracture Healing in Diabetics with Distal Radius Fractures.

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    Pscherer, S; Sandmann, G H; Ehnert, S; Nussler, A K; Stöckle, U; Freude, T

    2017-01-01

    PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.

  19. Muscle-bone Interactions During Fracture Healing

    Science.gov (United States)

    2015-03-01

    fracture heal - ing. The rate of delayed union or non-union in tibial fractures with associated compartment syndrome was 55...complications of open tibial shaft fractures stratified as per the Gustilo–Ander- son classification. Injury 2011;42:1408-15. 121. Giannoudis PV, Harwood PJ...Kontakis G, et al. Long- term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture , grade

  20. Impaired Fracture Healing after Hemorrhagic Shock

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    Philipp Lichte

    2015-01-01

    Full Text Available Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP of 35 mmHg for 90 minutes. Serum cytokines (IL-6, KC, MCP-1, and TNF-α were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  1. Chance Fracture Secondary to a Healed Kyphotic Compression Osteoporotic Fracture

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    Teh KK

    2009-11-01

    Full Text Available Chance fracture is an unstable vertebral fracture, which usually results from a high velocity injury. An elderly lady with a previously healed osteoporotic fracture of the T12 and L1 vertebra which resulted in a severe kyphotic deformity subsequently sustained a Chance fracture of the adjacent L2 vertebrae after a minor fall. The previously fracture left her with a deformity which resulted in significant sagittal imbalance therefore predisposing her to this fracture. This case highlights the importance of aggressive treatment of osteoporotic fractures in order to prevent significant sagittal imbalance from resultant (i.e. kyphotic deformity.

  2. Biological Perspectives of Delayed Fracture Healing

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    Hankenson, KD; Zmmerman, G; Marcucio, R

    2014-01-01

    Fracture healing is a complex biological process that requires interaction among a series of different cell types. Maintaining the appropriate temporal progression and spatial pattern is essential to achieve robust healing. We can temporally assess the biological phases via gene expression, protein analysis, histologically, or non-invasively using biomarkers as well as imaging techniques. However, determining what leads to normal verses abnormal healing is more challenging. Since the ultimate...

  3. Lower trabecular volumetric BMD at metaphyseal regions of weight-bearing bones is associated with prior fracture in young girls.

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    Farr, Joshua N; Tomás, Rita; Chen, Zhao; Lisse, Jeffrey R; Lohman, Timothy G; Going, Scott B

    2011-02-01

    Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump-In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual-energy X-ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1-1.9) and 1.3 (1.0-1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls. Copyright © 2011 American Society for Bone and Mineral Research.

  4. Fracture healing with osteopathy in traditional Mongolian medicine.

    Science.gov (United States)

    Zhao, Namula; Wang, Mei; Li, Xueen

    2013-02-01

    To explore the concept and norm of fracture healing with osteopathy in traditional Mongolian medicine (TMM). Based on the correspondence between man and the universe (including psychosomatic integration) in fracture healing with osteopathy in TMM, we used modern physio-psychological and biomechanical principles and methods to probe the integrated, dynamic and functional characteristics of fracture healing. Based on the integration of limbs and the body, unification of the body and function and harmony of man and nature (including psychosomatic integration), fracture healing with osteopathy in TMM comprises the concept of natural functional healing of fractures, and follows the norm of considering physiological healing and psychological function as well as limb healing and motor function. Fracture healing with osteopathy in TMM is characterized by a lack of trauma without future complications. This therapy makes the concept of fracture healing develop in the direction of humanity, behaviorism and integration.

  5. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    External and internal fixators use bone screws that are locked to a plate or bar to prevent periosteal compression and associated impairment of blood supply. Both osteosynthesis techniques rely on secondary bone healing with callus formation with the exception of compression plating of simple...

  6. Inhibition of Midkine Augments Osteoporotic Fracture Healing.

    Directory of Open Access Journals (Sweden)

    Melanie Haffner-Luntzer

    Full Text Available The heparin-binding growth and differentiation factor midkine (Mdk is proposed to negatively regulate osteoblast activity and bone formation in the adult skeleton. As Mdk-deficient mice were protected from ovariectomy (OVX-induced bone loss, this factor may also play a role in the pathogenesis of postmenopausal osteoporosis. We have previously demonstrated that Mdk negatively influences bone regeneration during fracture healing. Here, we investigated whether the inhibition of Mdk using an Mdk-antibody (Mdk-Ab improves compromised bone healing in osteoporotic OVX-mice. Using a standardized femur osteotomy model, we demonstrated that Mdk serum levels were significantly enhanced after fracture in both non-OVX and OVX-mice, however, the increase was considerably greater in osteoporotic mice. Systemic treatment with the Mdk-Ab significantly improved bone healing in osteoporotic mice by increasing bone formation in the fracture callus. On the molecular level, we demonstrated that the OVX-induced reduction of the osteoanabolic beta-catenin signaling in the bony callus was abolished by Mdk-Ab treatment. Furthermore, the injection of the Mdk-Ab increased trabecular bone mass in the skeleton of the osteoporotic mice. These results implicate that antagonizing Mdk may be useful for the therapy of osteoporosis and osteoporotic fracture-healing complications.

  7. Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence.

    Science.gov (United States)

    Iqbal, H J; Pidikiti, P

    2013-09-01

    Treatment of distal tibia metaphyseal fractures is challenging. The purpose of this study was to systematically review the recent literature regarding management of extra-articular distal tibia fractures with a view to compare the outcome of intramedullary nailing with plate fixation. Advanced literature search was performed using Medline (Ovid), Embase (Ovid) and Cochrane databases. Data were extracted regarding number of participants, fracture fixation devices, percentage of open fractures, malunions, nonunions, wound infections and metal removal etc. After inclusion, exclusion criteria, two RCTs and four retrospective comparative studies were deemed suitable for this review. The overall results showed relatively higher rate of infection in plating group as compared to intramedullary nailing. However malalignment was more common with intramedullary nailing. Both techniques can provide adequate treatments in appropriately selected patients. None of the studies had sufficient power to show clinically significant difference. Further studies are required to compare new locking plates with intramedullary nails. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  8. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia.

    Science.gov (United States)

    Guo, J J; Tang, N; Yang, H L; Tang, T S

    2010-07-01

    We compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a distal metaphyseal fracture in a prospective study. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). Pre-operative variables included the patients' age and the side and pattern of the fracture. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems, the time to union of the fracture, the functional American Orthopaedic Foot and Ankle surgery score and removal of hardware. We found no significant difference in the pre-operative variables or in the time to union in the two groups. However, the mean radiation time and operating time were significantly longer in the locked compression plate group (3.0 vs 2.12 minutes, p Foot and Ankle surgery scores, although the differences were not statistically significant (p = 0.234, p = 0.157, p = 0.897, p = 0.177 respectively). Three (6.8%) patients in the intramedullary nailing group and six (14.6%) in the locked compression plate group showed delayed wound healing, and 37 (84.1%) in the former group and 38 (92.7%) in the latter group expressed a wish to have the implant removed. We conclude that both closed intramedullary nailing and a percutaneous locked compression plate can be used safely to treat Orthopaedic Trauma Association type-43A distal metaphyseal fractures of the tibia. However, closed intramedullary nailing has the advantage of a shorter operating and radiation time and easier removal of the implant. We therefore prefer closed intramedullary nailing for patients with these fractures.

  9. A MicroRNA-124 Polymorphism is Associated with Fracture Healing via Modulating BMP6 Expression

    Directory of Open Access Journals (Sweden)

    Lin Zou

    2017-04-01

    Full Text Available Background: miR-124-3p has been reported to be involved in the pathogenesis of many diseases by modulating a variety of signaling pathways. In this study, we aimed to understand the impact of miR-124-3p expression level on the fracture healing in the patients of metaphyseal fracture of distal tibia, who received minimal invasive percutaneous plate osteosynthesis. Methods: We firstly collected 195 patients of metaphyseal fracture of distal tibia, and the genotype of rs531564 was determined: GG (n=124 and GC+CC (n=71. We collected information of the participants including age, gender, total in-hospital time, smoking and alcohol consumption. Subsequently, we searched the miRNA database online to identify the possible binding sequence of miR-124-3p located within the 3’-UTR of the target gene. We did correlation analysis and luciferase to understand the regulatory relationship between miR-124-3p and BMP6. Meanwhile, we also conducted real time PCR and western blotting analysis to study the mRNA and protein expression level of BMP6 in different genotype groups. We then treated the cells with scramble control, miR-124-3p mimics, BMP6 siRNA and miR-124-3p inhibitors to investigate the influence of miR-124-3p on the expression of BMP6, viability and apoptosis of cells. Results: Total in-hospital time was significantly longer in GC+CC group than GG group. MiR-124-3p was up-regulated in GG group than GC and CC groups. BMP6 was virtual target of miR-124-3p. There existed negative regulatory relationship betweenmiR-124-3p and BMP6. The mRNA and protein expression level of BMP6 decreased in GG group. MiR-124-3p decreased the expression of BMP6. MiR-124-3p negatively interfered with the viability of cells and BMP6 positively interfered with the viability of cells. MiR-124-3p reduced apoptosis and BMP6 promoted apoptosis. Conclusion: These data proved the expression of miR-124-3p was associated with the healing of metaphyseal fracture of distal tibia, and

  10. Treatment of epiphyseo-metaphyseal fractures in children with an original implant. The threaded pin with an adjustable lock (Fixano).

    Science.gov (United States)

    Gicquel, Philippe; Giacomelli, Marie-Christine; Karger, Claude; Clavert, Jean-Michel

    2005-02-01

    Improvement of stability of internal fixation of epiphyseo-metaphyseal fractures in children with an implant characterized by its small diameter, easy utilization and its versatility. It avoids the drawbacks of screw fixation particularly in respect to the growth plate. Potentially all epiphyseo-metaphyseal fractures in children. None. Crossing of the growth cartilage by small pins (screwed on a special key is slid over the end of the pin and put in contact with bone. It is squeezed until the key breaks off. The pins are then shortened. Since November 1999 these pins have been used for six olecranon fractures. In January 2002 we extended the indication to other fracture sites. Between January 2002 and July 2003 this system has been used 37 times (six olecranon fractures, eleven lateral condylar fractures and 13 medial epicondylar fractures of the elbow, and seven fractures of the ankle). A total of 43 fractures were treated (20 girls, 23 boys, average age 9.8 +/- 3.6 years) Average duration of follow-up 16.8 +/- 4.7 months. The assessment of results was based on technical, radiographic, and functional aspects. The overall results were good, in particular in respect to the stability of implants and the functional results. No secondary displacement, nor nonunion were observed; the pins were removed in all children at 6 weeks. The ease of handling the implants and the good clinical and radiologic results led us to propose these pins for routine use in epiphyseal and epiphyseo-metaphyseal fractures in children. Some improvements, however, are indicated principally, in particular in respect to the control of compression achieved by the adjustable lock.

  11. The science of ultrasound therapy for fracture healing

    Directory of Open Access Journals (Sweden)

    Della Rocca Gregory

    2009-01-01

    Full Text Available Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  12. The science of ultrasound therapy for fracture healing.

    Science.gov (United States)

    Della Rocca, Gregory J

    2009-01-01

    Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS) has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl) for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  13. Effects of anti-osteoporosis medications on fracture healing

    DEFF Research Database (Denmark)

    Jørgensen, Niklas R; Schwarz, Peter

    2011-01-01

    A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, postmenopausal women, and in people with malnutrition. At present, no pharmacologic treatments are available. Thus, there is an unmet need for medications that can...... stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis and, intriguingly, a number of animal studies prove the ability of PTH to induce fracture healing. PTH may therefore be a potential novel treatment option in humans with impaired...... healing. However, more randomized clinical trials documenting the clinical efficacy of PTH as a promoter of fracture healing in the clinical setting are warranted. Also, strontium ranelate seems to have beneficial effects on fracture healing under conditions with impaired healing. However, no clinical...

  14. Self-healing in fractured GaAs nanowires

    International Nuclear Information System (INIS)

    Wang Jun; Lu Chunsheng; Wang Qi; Xiao Pan; Ke Fujiu; Bai Yilong; Shen Yaogen; Wang Yanbo; Chen Bin; Liao Xiaozhou; Gao Huajian

    2012-01-01

    Molecular dynamics simulations are performed to investigate a spontaneous self-healing process in fractured GaAs nanowires with a zinc blende structure. The results show that such self-healing can indeed occur via rebonding of Ga and As atoms across the fracture surfaces, but it can be strongly influenced by several factors, including wire size, number of healing cycles, temperature, fracture morphology, oriented attachment and atomic diffusion. For example, it is found that the self-healing capacity is reduced by 46% as the lateral dimension of the wire increases from 2.3 to 9.2 nm, and by 64% after 24 repeated cycles of fracture and healing. Other factors influencing the self-healing behavior are also discussed.

  15. Experimental fracture protocols in assessments of potential agents for osteoporotic fracture healing using rodent models.

    Science.gov (United States)

    Ibrahim, Nurul 'Izzah; Mohamad, Sharlina; Mohamed, Norazlina; Shuid, Ahmad Nazrun

    2013-12-01

    Osteoporosis may cause bone fracture even under slight trauma. Osteoporotic fracture has become a major public health problem but until today, the treatments available are not satisfactory. Many pre-clinical testings on animals were done to find new agents that can be sourced from natural products and synthetic drugs for osteoporotic fracture healing. Animal models are more appropriate for fracture healing study than human subject due to several reasons including the ethical issues involved. The bones of rodents are similar to human in term of their morphological change and response to therapy. Small rodents such as rats and mice are suitable animal models for fracture healing studies as they have a similar bone remodeling system to human. To date, there is no specific guideline to carry out fracture healing studies in animal models for the evaluation of new agents. This paper highlights the protocols of various fracture and fixation methods for experimental osteoporotic fracture healing using rodent models.

  16. Time course of 25(OHD3 vitamin D3 as well as PTH (parathyroid hormone during fracture healing of patients with normal and low bone mineral density (BMD

    Directory of Open Access Journals (Sweden)

    Wöfl Christoph

    2013-01-01

    Full Text Available Abstract Background Until now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OHD3 (Vitamin D as well as PTH (Parathyroid Hormone the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing. Methods In the presented study, we analyse the time course of 25(OHD3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OHD3 and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant. Results Serum levels of 25(OHD3 showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study. Conclusions The time course of 25(OHD3 and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for

  17. Bisphosphonates and their influence on fracture healing: a systematic review.

    Science.gov (United States)

    Molvik, H; Khan, W

    2015-04-01

    Bisphosphonates are commonly used in osteoporosis, but concerns have been raised about possible negative effects on fracture healing. We systematically reviewed the literature and found that bisphosphonates significantly prolong union times of distal radius fractures but not femoral fractures. The timing of bisphosphonate introduction does not affect fracture union time. Bisphosphonates are the most commonly prescribed drugs in patients suffering from and at higher risk of developing osteoporosis. However, concerns have been raised as to whether these drugs have a negative effect on fracture healing. The aim of this systematic review is to explore further these concerns. A literature review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All relevant articles found via MEDLINE, Cochrane, CINAHL, EMBASE and Google Scholar were screened. Studies with information on bisphosphonates' effect on fracture healing in humans were included and systematically reviewed. Patients with distal radius fractures on bisphosphonates had a significantly longer union time compared with controls, but not patients with femoral fractures. No correlation between timing of bisphosphonate introduction and union time for fractures was found. Although one study reported a higher humeral non-union associated with bisphosphonate introduction following the fracture, there was no evidence that bisphosphonate introduction, timing or dose resulted in a significant delay in union following other fractures. This systematic review has shown that bisphosphonates significantly prolong union times of distal radius fractures. Some clinical findings are in contrast with preclinical studies highlighting the need to develop better animal models to study osteoporosis, treatment and fracture healing. There is also a need for more well-constructed studies looking at the clinical effect of bisphosphonate on fracture healing in a large number

  18. Metaphyseal Distal Tibia Fractures: A Cohort, Single-Surgeon Study Comparing Outcomes of Patients Treated With Minimally Invasive Plating Versus Intramedullary Nailing.

    Science.gov (United States)

    Barcak, Eric; Collinge, Cory A

    2016-05-01

    The purpose of this study was to compare clinical and functional outcomes of patients with distal tibia fractures treated with minimally invasive plating (MIPO) or intramedullary nailing (IMN). Cohort study. Level II regional trauma center. Overall, 86 patients with metaphyseal distal fractures (within 5 cm of joint) with simple or no articular involvement treated by a single, fellowship trained, orthopedic trauma surgeon from 2002 to 2013. Intramedullary nailing or minimally invasive plate osteosynthesis. Clinical and radiographic results were evaluated at a minimum of 1-year follow-up. Limb-specific outcomes (American Orthopedic Foot and Ankle Surgeons' ankle-hindfoot instrument) and whole-person measures [Short Form 36 (SF-36) instrument] were assessed at the final follow-up. We studied 86 patients with distal tibia fractures treated with MIPO (43 patients) and IMN (43 patients). Thirty-seven patients in the MIPO group and 27 in the IMN group met inclusion criteria. All patients ultimately healed, with the average time to union of 23 weeks in both the groups. Complications were similar between the 2 groups (MIPO vs. IMN, respectively), including nonunion (8% vs. 7%), malalignment (3.6% vs. 3%), wound complications (3.6% vs. 3%), and infection (0% vs. 3.6%). The need for secondary procedures for the removal of implants was 25.9% in the IMN group (distal locking screws only in 6/7) versus 8.3% in the MIPO group (P = 0.05). Additionally, the American Orthopedic Foot and Ankle Surgeons and all SF-36 version 2 domain scores were quantitatively higher for the IMN group, although only Role Emotional reached a level of statistical superiority between the groups. Similar clinical results and marginally enhanced functional outcomes were seen when treating nonarticular or minimally articular metaphyseal distal tibia fractures with IMN compared with MIPO. However, patients treated with IMN required more frequent secondary surgeries for the removal of painful distal locking

  19. The Ameloblastin extracellular matrix molecule enhances bone fracture resistance and promotes rapid bone fracture healing

    Science.gov (United States)

    Lu, Xuanyu; Li, Wenjin; Fukumoto, Satoshi; Yamada, Yoshihiko; Evans, Carla; Diekwisch, Thomas G.H.; Luan, Xianghong

    2016-01-01

    The extracellular matrix (ECM) provides structural support, cell migration anchorage, cell differentiation cues, and fine-tuned cell proliferation signals during all stages of bone fracture healing, including cartilaginous callus formation, callus remodeling, and bony bridging of the fracture gap. In the present study we have defined the role of the extracellular matrix protein ameloblastin (AMBN) in fracture resistance and fracture healing of mouse long bones. To this end, long bones from WT and AMBNΔ5-6 truncation model mice were subjected to biomechanical analysis, fracture healing assays, and stem cell colony formation comparisons. The effect of exogenous AMBN addition to fracture sites was also determined. Our data indicate that lack of a functional AMBN in the bone matrix resulted in 31% decreased femur bone mass and 40% reduced energy to failure. On a cellular level, AMBN function inhibition diminished the proliferative capacity of fracture repair callus cells, as evidenced by a 58% reduction in PCNA and a 40% reduction in Cyclin D1 gene expression, as well as PCNA immunohistochemistry. In terms of fracture healing, AMBN truncation was associated with an enhanced and prolonged chondrogenic phase, resulting in delayed mineralized tissue gene expression and delayed ossification of the fracture repair callus. Underscoring a role of AMBN in fracture healing, there was a 6.9-fold increase in AMBN expression at the fracture site one week after fracture, and distinct AMBN immunolabeling in the fracture gap. Finally, application of exogenous AMBN protein to bone fracture sites accelerated callus formation and bone fracture healing (33% increase in bone volume and 19% increase in bone mineral density), validating the findings of our AMBN loss of function studies. Together, these data demonstrate the functional importance of the AMBN extracellular matrix protein in bone fracture prevention and rapid fracture healing. PMID:26899203

  20. Metaphysics I

    OpenAIRE

    Lebech, Mette

    2003-01-01

    Metaphysics I is a course currently taught in the Faculty of Philosophy, NUIM. It attempts to answer three questions: 'What is metaphysics?', 'What happened as metaphysics was Christianised?' and 'What happenerd as metaphysics was Modernized?', while discussing texts of Aristotle, Thomas Aquinas, Edmund Husserl and Edith Stein.

  1. Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

    Directory of Open Access Journals (Sweden)

    Tsukada Sachiyuki

    2012-07-01

    Full Text Available Abstract Background Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure. Methods The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity. Results All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient. Conclusions There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

  2. The reliability of plain radiography in experimental fracture healing

    NARCIS (Netherlands)

    Blokhuis, T. J.; de Bruine, J. H.; Bramer, J. A.; den Boer, F. C.; Bakker, F. C.; Patka, P.; Haarman, H. J.; Manoliu, R. A.

    2001-01-01

    To investigate the reliability of radiographs in the evaluation of healing of closed fractures. A closed midshaft tibial fracture was created in 40 goats and stabilized with an external fixator. The animals were assigned to four groups: no injection, injection of 1 mg osteogenic protein-1 (OP-1), 1

  3. Reaming and the healing of fractures | Umebese | Nigerian Journal ...

    African Journals Online (AJOL)

    OBJECTIVE: We quantified fracture healing response in the intramedullary nailed fractures of femur. PATIENTS AND METHOD: By a simple method of measuring size and mass of callus formation radiologically in 30 patients who had undergone open retrograde intramedullary Kuntscher nailing. We then compared the ...

  4. Radiographic features of teriparatide-induced healing of femoral fractures

    Directory of Open Access Journals (Sweden)

    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  5. Exposure to Secondhand Smoke Impairs Fracture Healing in Rats.

    Science.gov (United States)

    Santiago, Hildemberg A R; Zamarioli, Ariane; Sousa Neto, Manoel D; Volpon, Jose B

    2017-03-01

    Nonsmokers may be affected by environmental tobacco smoke (secondhand smoke), but the effects of such exposure on fracture healing have not been well studied. To explore the possible effects of passive inhalation of tobacco smoke on the healing of a diaphyseal fracture in femurs of rats. We hypothesized that secondhand exposure to tobacco smoke adversely affects fracture healing. A mid-diaphyseal fracture was created in the femur of 41 female Wistar rats and fixed with an intramedullary metallic pin; 14 rats were excluded (nine for inadequate fractures and five for K wire extrusion). Tobacco exposure was provided by a smoking machine on a daily basis of four cigarettes a day. Each cigarette yielded 10 mg tar and 0.8 mg nicotine, and was puffed by alternating injections of fresh air for 30 seconds and smoke air for 15 seconds. The smoke exposure was previously adjusted to provide serum levels of cotinine similar to human secondhand tobacco exposure. Cotinine is a predominant catabolite of nicotine that is used as a biological biomarker for exposure to tobacco smoke. In one group (n = 11), the animals were intermittently exposed to tobacco smoke before sustaining the fracture but not afterward. In another group (n = 7), the exposure occurred before and after the fracture. The control group (n = 9) was sham-exposed before and after the fracture. We evaluated the specimens 28 days after bone fracture. The callus quality was measured by dual-energy x-ray absorptiometry (bone mineral density [BMD], bone mineral content [BMC], and callus area), μCT (callus volume and woven bone fraction), and mechanical bending (maximum force and stiffness). Tobacco exposure resulted in delayed bone callus formation, which is represented by decreased BMD (Control: 0.302 ± 0.008 g/cm 2 vs Preexposed: 0.199 ± 0.008 g/cm 2 and Pre- and Postexposed: 0.146 ± 0.009 g/cm 2 ; mean difference = 0.103 g/cm 2 , 95% CI, 0.094-0.112 g/cm 2 and mean difference = 0.156 g/cm 2 , 95% CI, 0.147-0.167 g

  6. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    Science.gov (United States)

    2006-12-01

    USA Corresponding author Belinda R. Beck, Ph.D. Griffith University School of Physiotherapy and Exercise Science, PMB 50 Gold Coast Mail Centre Q...accelerate tibial stress fracture healing? Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2006 2. Beck B.R., Bergman G., Arendt E...Predicting Recovery from Tibial Stress Fracture Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2007 (submitted) 15 Presentations

  7. Endogenous PTH deficiency impairs fracture healing and impedes the fracture-healing efficacy of exogenous PTH(1-34.

    Directory of Open Access Journals (Sweden)

    Yongxin Ren

    Full Text Available Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH.Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/- mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/- mice compared to vehicle-treated wild-type and Pth(-/- mice.Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing.

  8. Local drug delivery for enhancing fracture healing in osteoporotic bone.

    Science.gov (United States)

    Kyllönen, Laura; D'Este, Matteo; Alini, Mauro; Eglin, David

    2015-01-01

    Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  9. HEALING OF ARTICULAR AND PERIARTICULAR METACARPAL AND PHALANGEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Aleksandar Kruščić

    2003-12-01

    ligamentotaxis were without significant slides, the fragments healing in good position. End functional results were satisfactory. We had only one decubitus, which healed per primam after reshaping of the splint.Conclusions. The application of local analgesia and ligamentotaxis represents a simple and safe method of treatment. It allows individual biomechanical neutralization of the pathologic activity of kinetic energy vectors on the fracture. Repositioning and physiological positioning of the hand in Softcast plaster is simple, there is no need to hospitalize the patient for surgery. This makes the method less costly as well. There are less fracture slides, and repairs due to decubitus are simpler as there is no need for total immobilization removal. Therefore ligamentotaxis is the method of choice.

  10. Low-intensity pulsed ultrasound affects RUNX2 immunopositive osteogenic cells in delayed clinical fracture healing

    NARCIS (Netherlands)

    Rutten, S.; Nolte, P.A.; Korstjens, C.M.; Klein-Nulend, J.

    2009-01-01

    Introduction: Osteogenic cell proliferation and differentiation play an important role in adequate fracture healing, and is target for osteoinductive therapies in delayed fracture healing. The aim of this study was to investigate whether low-intensity pulsed ultrasound enhances fracture healing at

  11. Implant removal after fracture healing : facts and fiction

    NARCIS (Netherlands)

    Vos, D.I.

    2013-01-01

    A frequently asked question to trauma and orthopaedic surgeons is whether and if yes, when an implant will be removed? Although implant removal after fracture healing is daily practice, a scientific basis doesn’t exist. All studies in this thesis were performed to unravel the facts and fiction of

  12. Teriparatide and vertebral fracture healing in Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Izolda Biro

    2017-12-01

    This case is unique as complete healing was achieved without preceding surgical intervention. Further exploration of the use of Teriparatide in spinal fractures in patients with AS is recommended to support the theories generated by this and other existing cases in the literature.

  13. Evaluating fracture healing using digital x-ray image analysis

    African Journals Online (AJOL)

    2011-03-02

    Mar 2, 2011 ... of Edinburgh, developing techniques for assessing fracture healing using digital X-ray image analysis. She currently works in ... Digital X-ray combined with image analysis could provide a simple and cost-effective solution to this problem. .... output in which post-processing can be controlled. If digital X-ray ...

  14. Biomechanical Characteristics of Osteoporotic Fracture Healing in Ovariectomized Rats: A Systematic Review.

    Science.gov (United States)

    Chen, Lin; Yang, Long; Yao, Min; Cui, Xue-Jun; Xue, Chun-Chun; Wang, Yong-Jun; Shu, Bing

    2016-01-01

    Biomechanical tests are widely used in animal studies on osteoporotic fracture healing. However, the biomechanical recovery process is still unknown, leading to difficulty in choosing time points for biomechanical tests and in correctly assessing osteoporotic fracture healing. To determine the biomechanical recovery process during osteoporotic fracture healing, studies on osteoporotic femur fracture healing with biomechanical tests in ovariectomized rat (OVX) models were collected from PUBMED, EMBASE, and Chinese databases. Quadratic curves of fracture healing time and maximum load were fitted with data from the analyzed studies. In the fitted curve for normal fractures, the predicted maximum load was 145.56 N, and the fracture healing time was 88.0 d. In the fitted curve for osteoporotic fractures, the predicted maximum load was 122.30 N, and the fracture healing time was 95.2 d. The maximum load of fractured femurs in OVX rats was also lower than that in sham rats at day 84 post-fracture (D84 PF). The fracture healing time was prolonged and maximum load at D84 PF decreased in OVX rats with closed fractures. The maximum load of Wister rats was higher than that of Sprague-Dawley (SD) rats, but the fracture healing time of SD and Wister rats was similar. Osteoporotic fracture healing was delayed in rats that were 12 weeks old at ovariectomy. There was no significant difference in maximum load at D84 PF between rats with an osteoporosis modeling time = 12 weeks. In conclusion, fracture healing was delayed and biomechanical property decreased by osteoporosis. Time points around D95.2 PF should be considered for biomechanical tests of osteoporotic femur fracture healing in OVX rat models. Osteoporotic fracture healing in OVX rats was affected by the fracture type but not by the strain of the rat.

  15. Outcome of Displaced Fractures of the Distal Metaphyseal-Diaphyseal Junction of the Humerus in Children Treated With Elastic Stable Intramedullary Nails.

    Science.gov (United States)

    Marengo, Lorenza; Canavese, Federico; Cravino, Mattia; De Rosa, Vincenzo; Rousset, Marie; Samba, Antoine; Mansour, Mounira; Andreacchio, Antonio

    2015-09-01

    The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced distal humeral metaphyseal-diaphyseal junction fractures in children treated by elastic stable intramedullary nailing (ESIN). During the study period, 14 consecutive children with fractures of the distal humeral metaphyseal-diaphyseal junction were surgically treated by ESIN. All patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus. One year after the index surgery, patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). During the study period, fractures of the distal metaphyseal-diaphyseal humeral junction represented 1.5% (16/1100) of all humeral fractures. Fourteen patients underwent surgery and met the inclusion criteria. The male to female ratio was 1:1. The average patient age at the time of injury was 9.7 years (range, 3.6 to 13.7 y). The left and right sides were equally affected. The mean follow-up was 28.1 months (range, 20 to 38 mo).Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, nonunion, or refracture was noted. None of the patients showed signs of growth arrest on either radiologic or clinical assessment.All patients returned to their previous daily and sport activities without discomfort or difficulty, and they were free of pain at their last follow-up visits. The injured elbow range of motion was comparable with that of the contralateral side at the last follow-up visit in all patients. The mean Quick DASH score was 0.81 (range, 0 to 6.8). We recommend surgery for displaced fractures of the distal humeral metaphyseal-diaphyseal junction. ESIN results in stable reduction, good rotational control, and faster mobilization. Level IV.

  16. The Effect of Low Molecular Weight Heparins on Fracture Healing.

    Science.gov (United States)

    Kapetanakis, Stylianos; Nastoulis, Evangelos; Demesticha, Theano; Demetriou, Thespis

    2015-01-01

    Venous Thromboembolism is a serious complication in the trauma patient. The most commonly studied and used anticoagulant treatment in prophylaxis of thrombosis is heparin. The prolonged use of unfractionated heparin has been connected with increased incidence of osteoporotic fractures. Low molecular-weight-heparins (LMWHs) have been the golden rule in antithrombotic therapy during the previous two decades as a way to overcome the major drawbacks of unfractioned heparin. However there are few studies reporting the effects of LMWHs on bone repair after fractures. This review presents the studies about the effects of LMWHs on bone biology (bone cells and bone metabolism) and underlying the mechanisms by which LMWHs may impair fracture healing process. The authors' research based on literature concluded that there are no facts and statistics for the role of LMWHs on fracture healing process in humans and the main body of evidence of their role comes from in vitro and animal studies. Further large clinical studies designed to compare different types of LMWHs, in different dosages and in different patient or animal models are needed for exploring the effects of LMWHs on fracture healing process.

  17. The effect of immunonutrition (glutamine, alanine on fracture healing

    Directory of Open Access Journals (Sweden)

    Abdullah Küçükalp

    2014-11-01

    Full Text Available Background: There have been various studies related to fracture healing. Glutamine is an amino acid with an important role in many cell and organ functions. This study aimed to make a clinical, radiological, and histopathological evaluation of the effects of glutamine on fracture healing. Methods: Twenty rabbits were randomly allocated into two groups of control and immunonutrition. A fracture of the fibula was made to the right hind leg. All rabbits received standard food and water. From post-operative first day for 30 days, the study group received an additional 2 ml/kg/day 20% L-alanine L-glutamine solution via a gastric catheter, and the control group received 2 ml/kg/day isotonic via gastric catheter. At the end of 30 days, the rabbits were sacrificed and the fractures were examined clinically, radiologically, and histopathologically in respect to the degree of union. Results: Radiological evaluation of the control group determined a mean score of 2.5 according to the orthopaedists and 2.65 according to the radiologists. In the clinical evaluation, the mean score was 1.875 for the control group and 2.0 for the study group. Histopathological evaluation determined a mean score of 8.5 for the control group and 9.0 for the study group. Conclusion: One month after orally administered glutamine–alanine, positive effects were observed on fracture healing radiologically, clinically, and histopathologically, although no statistically significant difference was determined.

  18. Fracture and Healing of Rock Salt Related to Salt Caverns

    International Nuclear Information System (INIS)

    Chan, K.S.; Fossum, A.F.; Munson, D.E.

    1999-01-01

    In recent years, serious investigations of potential extension of the useful life of older caverns or of the use of abandoned caverns for waste disposal have been of interest to the technical community. All of the potential applications depend upon understanding the reamer in which older caverns and sealing systems can fail. Such an understanding will require a more detailed knowledge of the fracture of salt than has been necessary to date. Fortunately, the knowledge of the fracture and healing of salt has made significant advances in the last decade, and is in a position to yield meaningful insights to older cavern behavior. In particular, micromechanical mechanisms of fracture and the concept of a fracture mechanism map have been essential guides, as has the utilization of continuum damage mechanics. The Multimechanism Deformation Coupled Fracture (MDCF) model, which is summarized extensively in this work was developed specifically to treat both the creep and fracture of salt, and was later extended to incorporate the fracture healing process known to occur in rock salt. Fracture in salt is based on the formation and evolution of microfractures, which may take the form of wing tip cracks, either in the body or the boundary of the grain. This type of crack deforms under shear to produce a strain, and furthermore, the opening of the wing cracks produce volume strain or dilatancy. In the presence of a confining pressure, microcrack formation may be suppressed, as is often the case for triaxial compression tests or natural underground stress situations. However, if the confining pressure is insufficient to suppress fracture, then the fractures will evolve with time to give the characteristic tertiary creep response. Two first order kinetics processes, closure of cracks and healing of cracks, control the healing process. Significantly, volume strain produced by microfractures may lead to changes in the permeability of the salt, which can become a major concern in

  19. Effect of tenoxicam on fracture healing in rat tibiae.

    Science.gov (United States)

    Giordano, Vincenzo; Giordano, Marcos; Knackfuss, Irocy G; Apfel, Mara Ibis R; Gomes, Renato Das C

    2003-02-01

    Nonsteroidal anti-inflammatory drugs have been implicated in the development of delayed unions and nonunion after fractures in animal models. Previous investigations have identified two important factors as determinants of delayed fracture healing: early drug administration and a dose-dependent effect. The purpose of this investigation was to study the effect of tenoxicam, a nonsteroidal anti-inflammatory drug, on the fracture healing process in rat tibiae. Fifty-eight Wistar rats were randomly divided in four groups (I, II, III, and IV). Group I (control group, n=12) was given 0.1ml saline solution per day intramuscularly. Groups II (n=12), III (n=12), and IV (n=12) were administered 10mg per kg per day of tenoxicam intramuscularly. Administration of substances was begun on a week before to 48h after the fracturing procedure and continued during the entire experiment. Callus formation was studied histologically and histomorphologically, using light microscopy. In addition, a histologic grading based on the morphologic stage of fracture healing was carried out at 4 weeks, according to the criteria proposed by Allen et al. There was a significant difference in treatment effect between Group I (saline solution) and Groups II, III, and IV (tenoxicam) (P=0.07). Histologically and histomorphologically, there were qualitative and quantitative delay in callus formation at all tenoxicam groups. This was more pronounced the earlier the nonsteroidal anti-inflammatory drug was started, although no significant difference could be detected between Groups II, III, and IV (P>(alpha=10%)). Four weeks after fracture, Group I (n=3) showed complete osseous union, Groups II (n=3) and III (n=3), complete cartilaginous union, and Group IV (n=3), incomplete osseous union, according to Allen et al. By using this rating scale, the difference between control and drug-treated groups was statistically significant (P<0.1). Under studied conditions, this investigation shows that administration

  20. Role of Teriparatide in Accelerating Metatarsal Stress Fracture Healing: A Case Series and Review of Literature

    Directory of Open Access Journals (Sweden)

    Pooja Raghavan

    2012-01-01

    Full Text Available 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.

  1. Intramedullary nailing and plate osteosynthesis for fractures of the distal metaphyseal tibia and fibula.

    Science.gov (United States)

    Krishan, Ajay; Peshin, Chetan; Singh, Dara

    2009-12-01

    To assess the results of concurrent intramedullary nailing plus plate osteosynthesis for fractures of the distal tibia and fibula. 15 men and 10 women (mean age, 35 years) with concurrent fractures of the distal tibia and fibula underwent intramedullary nailing (for the tibia) and plate osteosynthesis (for the fibula). 17 fractures were type A1, 6 type A2, and 2 type A3. Compound type IIIB or more extensive fractures were excluded. The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. Six patients underwent dynamisation and 4 bone grafting. Two patients had malalignment (angulation of >5 degrees in any plane), but none was rotational. No patient had shortening, hardware breakdown, or deep-seated infection. Two patients had superficial cellulitis at the site of the distal locking screws. Concurrent intramedullary nailing and plate osteosynthesis for fractures of the distal tibia and fibula is effective in preventing malalignment. Plate osteosynthesis for the fibula provides additional stability even when a single distal locking bolt is used to fix the intramedullary nail to the tibia.

  2. Modeling the effects of inflammation in bone fracture healing

    Science.gov (United States)

    Kojouharov, H. V.; Trejo, I.; Chen-Charpentier, B. M.

    2017-10-01

    A new mathematical model is presented to study the early inflammatory effects in bone healing. It consists of a system of nonlinear ordinary differential equations that represents the interactions among macrophages, mesenchymal stem cells, and osteoblasts. A qualitative analysis of the model is performed to determine the equilibria and their corresponding stability properties. A set of numerical simulations is performed to support the theoretical results. The model is also used to numerically monitor the evolution of a broken bone for different types of fractures and to explore possible treatments to accelerate bone healing by administrating anti-inflammatory drugs.

  3. Endogenous PTH Deficiency Impairs Fracture Healing and Impedes the Fracture-Healing Efficacy of Exogenous PTH(1-34)

    Science.gov (United States)

    Feng, Yuxu; Shu, Lei; Cao, Xiaojian; Karaplis, Andrew; Goltzman, David; Miao, Dengshun

    2011-01-01

    Background Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s) whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH. Methodology/Principal Findings Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth −/−) mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg) for 1–4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth −/− mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth −/− mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth −/− mice compared to vehicle-treated wild-type and Pth −/− mice. Conclusions/Significance Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing. PMID:21829585

  4. The Impact of Type 2 Diabetes on Bone Fracture Healing

    Directory of Open Access Journals (Sweden)

    Carlos Marin

    2018-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.

  5. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  6. HIV infection and its effects on fracture healing: a literature review

    African Journals Online (AJOL)

    transmission from mother to child during childbirth or breastfeeding. The World Health Organization (WHO) ... infection has on the healing process of open and closed fractures. It also attempts to explore the effects that HIV ... open fractures are associated with complications in both wound healing and fracture union.

  7. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2011-01-01

    evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n = 1...... = 0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p 

  8. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2010-01-01

    evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n¿=¿1......¿=¿0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p¿

  9. Compartment syndrome like picture in metaphyseal comminuted fracture of tibia treated by locking plate due to tight closure

    Directory of Open Access Journals (Sweden)

    Prafulla Herode

    2013-01-01

    Full Text Available A 22-year-old male came to casualty on 5 th May 2012 after a fall from motorcycle. He complained of excruciating pain and swelling over right knee. There was an open wound of 7 × 2 cm over supra-patellar region and diffuse swelling over knee joint with severe tenderness over proximal aspect of right tibia. X-ray showed intra-articular fracture of proximal tibia extending to diaphysis classified as type 6 by Schatzker classification for proximal tibia, with fibula shaft transverse fracture. The skin over the fracture was contused. Debridement with primary wound closure was done in emergency. Skeletal traction was applied through a lower tibial Steinman pin. Patient was operated after 15 days when wound healed and swelling subsided. Locking plate was applied on medial aspect using Minimally invasive percutaneous plate osteosysthesis (MIPPO technique. Post-operatively over 4 hours patient developed severe pain and swelling in operated leg which mimicked compartment syndrome. Suture removal was done immediately in the ward from the distal aspect, which relieved the symptoms but lead to exposure of the plate. A rotational flap was done to cover the plate in coordination with a plastic surgeon on the next day.

  10. Laboratory investigation of crushed salt consolidation and fracture healing

    International Nuclear Information System (INIS)

    1987-01-01

    A laboratory test program was conducted to investigate the consolidation behavior of crushed salt and fracture healing in natural and artificial salt. Crushed salt is proposed for use as backfill in a nuclear waste repository in salt. Artificial block salt is proposed for use in sealing a repository. Four consolidation tests were conducted in a hydrostatic pressure vessel at a maximum pressure of 2500 psi (17.2 MPa) and at room temperature. Three 1-month tests were conducted on salt obtained from the Waste Isolation Pilot Plant and one 2-month test was conducted on salt from Avery Island. Permeability was obtained using argon and either a steady-state or transient method. Initial porosities ranged from 0.26 to 0.36 and initial permeabilities from 2000 to 50,000 md. Final porosities and permeabilities ranged from 0.05 to 0.19 and from -5 md to 110 md, respectively. The lowest final porosity (0.05) and permeability ( -5 md) were obtained in a 1-month test in which 2.3% moisture was added to the salt at the beginning of the test. The consolidation rate was much more rapid than in any of the dry salt tests. The fracture healing program included 20 permeability tests conducted on fractured and unfractured samples. The tests were conducted in a Hoek cell at hydrostatic pressures up to 3000 psi (20.6 MPa) with durations up to 8 days. For the natural rock salt tested, permeability was strongly dependent on confining pressure and time. The effect of confining pressure was much weaker in the artificial salt. In most cases the combined effects of time and pressure were to reduce the permeability of fractured samples to the same order of magnitude (or less) as the permeability measured prior to fracturing

  11. Therapeutic ultrasound in fracture healing: The mechanism of osteoinduction

    Directory of Open Access Journals (Sweden)

    John P

    2008-01-01

    Full Text Available Background: Ultrasound has been used therapeutically for accelerating fracture healing since many years. However, the controversy on the exact mechanism of osteoinduction still continues. In this study, we try to bring out the exact biomolecular mechanism by which ultrasound induces fracture healing. Materials and Methods: The study was conducted in two phases: animal experiments and clinical study. In the first phase, we induced fractures on the left tibia of Wistar strain rats under anaesthesia. They were divided into two groups. One of the groups was given low-intensity, pulsed ultrasound (30 MW/cm 2 20 min a day for 10 days. Tissue samples and radiographs were taken weekly for 3 weeks from both the groups. In the second phase of our study, ten patients with fractures of the distal end of the radius (ten fractures were included. Five of these were treated as cases, and five were treated as controls. Ultrasound was given 30 MW/cm 2 for 20 min every day for 2 weeks. The patients were assessed radiologically and sonologically before and after ultrasound therapy. Tissue samples were studied with thymidine incorporation test with and without adding various neurotransmitter combinations. Results: Radiological findings revealed that there was an increased callus formation in the ultrasound group. At the cellular level, there was an increased thymidine incorporation in the ultrasound group. When various neurotransmitters were added to the cells, there was an increased thymidine incorporation in the ultrasound group. In the second phase of the study, radiological and sonological assessments showed that there was an increased callus formation in the ultrasound group. In cytological study, thymidine incorporation was found to be increased in the ultrasound group. Conclusions: The results of animal and clinical studies demonstrated an early and increased callus formation in the ultrasound group. Cytological studies revealed increased thymidine

  12. Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability

    Directory of Open Access Journals (Sweden)

    Leandro Viecili

    2015-02-01

    Full Text Available OBJECTIVES: To evaluate the functional results from patients with surgical neck fractures treated with a locked metaphyseal intramedullary nail and angular stability.METHODS: Twenty-two patients between the ages of 21 and 69 years were evaluated prospectively between January 2010 and January 2011. Their time taken for consolidation, age, sex, complications and functional results were correlated using the modified protocol of the University of California at Los Angeles (UCLA.RESULTS: The mean time taken for consolidation was 9.26 weeks ± confidence interval (CI of 0.40 weeks. One case (4.5% did not become consolidated. There were no cases of infection. There was one case (4.5% of adhesive capsulitis with good evolution through clinical treatment. Five patients (22.7% presented occasional mild pain and one case (4.5% reported medium-intensity pain associated with the subacromial impact of the implant. The mean score on the modified UCLA scale was 30.4 ± CI 1.6 points, obtained at the end of 12 weeks of evaluation: 18 cases (81.8% with "excellent" and "good" scores, three cases (13.6% with "fair" scores and one case (4.5% with a "poor" score.CONCLUSION: In the group of patients evaluated, treatment of two-part surgical neck fractures by means of a locked metaphyseal intramedullary nail and angular stability demonstrated satisfactory functional results and a low complication rate, similar to what is seen in the literature.

  13. Effects of local vanadium delivery on diabetic fracture healing.

    Science.gov (United States)

    Ippolito, Joseph A; Krell, Ethan S; Cottrell, Jessica; Meyer, Ryan; Clark, Devin; Nguyen, Daniel; Sudah, Suleiman; Muñoz, Maximillian; Lim, Elisha; Lin, Anthony; Lee, Thomas Jae Hoon; O'Connor, James Patrick; Benevenia, Joseph; Lin, Sheldon S

    2017-10-01

    This study evaluated the effect of local vanadyl acetylacetonate (VAC), an insulin mimetic agent, upon the early and late parameters of fracture healing in rats using a standard femur fracture model. Mechanical testing, and radiographic scoring were performed, as well as histomorphometry, including percent bone, percent cartilage, and osteoclast numbers. Fractures treated with local 1.5 mg/kg VAC possessed significantly increased mechanical properties compared to controls at 6 weeks post-fracture, including increased torque to failure (15%; p = 0.046), shear modulus (89%; p = 0.043), and shear stress (81%; p = 0.009). The radiographic scoring analysis showed increased cortical bridging at 4 weeks and 6 weeks (119%; p = 0.036 and 209%; p = 0.002) in 1.5 mg/kg VAC treated groups. Histomorphometry of the fracture callus at days 10 and 14 showed increased percent cartilage (121%; p = 0.009 and 45%; p = 0.035) and percent mineralized tissue (66%; p = 0.035 and 58%; p = 0.006) with local VAC treated groups compared to control. Additionally, fewer osteoclasts were observed in the local VAC treated animals as compared to controls at day 14 (0.45% ± 0.29% vs. 0.83% ± 0.36% of callus area; p = 0.032). The results suggest local administration of VAC acts to modulate osteoclast activity and increase percentage of early callus cartilage, ultimately enhancing mechanical properties comparably to non-diabetic animals treated with local VAC. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2174-2180, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Zhongju Shi

    Full Text Available Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn't come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing.We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs which concerned the treatment of teriparatide for fracture healing.Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain.This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed.

  15. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Shi, Zhongju; Zhou, Hengxing; Pan, Bin; Lu, Lu; Liu, Jun; Kang, Yi; Yao, Xue; Feng, Shiqing

    2016-01-01

    Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn't come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing. We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs) which concerned the treatment of teriparatide for fracture healing. Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain. This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed.

  16. Immunohistochemical localization of key arachidonic acid metabolism enzymes during fracture healing in mice.

    Directory of Open Access Journals (Sweden)

    Hsuan-Ni Lin

    Full Text Available This study investigated the localization of critical enzymes involved in arachidonic acid metabolism during the initial and regenerative phases of mouse femur fracture healing. Previous studies found that loss of cyclooxygenase-2 activity impairs fracture healing while loss of 5-lipoxygenase activity accelerates healing. These diametric results show that arachidonic acid metabolism has an essential function during fracture healing. To better understand the function of arachidonic acid metabolism during fracture healing, expression of cyclooxygenase-1 (COX-1, cyclooxygenase -2 (COX-2, 5-lipoxygenase (5-LO, and leukotriene A4 hydrolase (LTA4H was localized by immunohistochemistry in time-staged fracture callus specimens. All four enzymes were detected in leukocytes present in the bone marrow and attending inflammatory response that accompanied the fracture. In the tissues surrounding the fracture site, the proportion of leukocytes expressing COX-1, COX-2, or LTA4H decreased while those expressing 5-LO remained high at 4 and 7 days after fracture. This may indicate an inflammation resolution function for 5-LO during fracture healing. Only COX-1 was consistently detected in fracture callus osteoblasts during the later stages of healing (day 14 after fracture. In contrast, callus chondrocytes expressed all four enzymes, though 5-LO appeared to be preferentially expressed in newly differentiated chondrocytes. Most interestingly, osteoclasts consistently and strongly expressed COX-2. In addition to bone surfaces and the growth plate, COX-2 expressing osteoclasts were localized at the chondro-osseous junction of the fracture callus. These observations suggest that arachidonic acid mediated signaling from callus chondrocytes or from callus osteoclasts at the chondro-osseous junction regulate fracture healing.

  17. High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.

    Science.gov (United States)

    Schilcher, Jörg

    2015-12-01

    Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. We searched the orthopaedic surgical registry in Östergötland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to

  18. Scintigraphic control of bone-fracture healing under ultrasonic stimulation: An animal experimental study

    International Nuclear Information System (INIS)

    Klug, W.; Franke, W.G.; Knoch, H.G.

    1986-01-01

    In a model of closed lower-leg fracture in rabbits and of secondary bone-fracture healing, scintigraphic control until biological healing was performed. Biological fracture healing was assumed for a region of interest (ROI)-activity ratio close to 1.0. After application of sup(99m)Tc-HEDP, 151 examinations were performed. ROI activity increased significantly until day 14 p.i. and reached the maximum value (Q=6.44) on day 14 postfracture. Sixty-one lower leg fractures were treated by ultrasound from days 14-28 postfractures. These stimulated fractures were biologically healed on day 168 postfracture. The fractures that were not treated by ultrasound could not be detected by scanning after day 203 postfracture. (orig.)

  19. Femoral neck fractures after removal of hardware in healed trochanteric fractures.

    Science.gov (United States)

    Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés

    2017-12-01

    Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or

  20. Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate.

    Science.gov (United States)

    Kim, Dohyun; Yue, Wonyoung; Yoon, Tai-Cheol; Park, Sung-Ho; Kim, Euiseong

    2016-02-01

    The purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material. The clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen. Of the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing. Within the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  1. Biological methods to enhance bone healing and fracture repair.

    Science.gov (United States)

    Verdonk, René; Goubau, Yannick; Almqvist, Fredrik K; Verdonk, Peter

    2015-04-01

    This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Outcome of displaced distal tibial metaphyseal fractures in children between 6 and 15 years of age treated by elastic stable intramedullary nails.

    Science.gov (United States)

    Cravino, Mattia; Canavese, Federico; De Rosa, Vincenzo; Marengo, Lorenza; Samba, Antoine; Rousset, Marie; Mansour Khamallah, Mounira; Andreacchio, Antonio

    2014-12-01

    From June 1995 to August 2012, 18 children were treated surgically using elastic stable intramedullary nails for displaced closed fractures of the distal metaphysis of the tibia. The patients were followed radiographically and clinically on a regular basis until union was clinically and radiographically achieved. Thirteen boys and five girls with a mean age at trauma of 11 ± 2.9 years (range 6-15) were included in the study. Radiographically, all fractures healed without evidence of delayed union, re-fracture, hardware migration. All patients were pain free at last follow-up and all regained full, normal activities including sports. IV.

  3. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Chuang, Po-Yao; Lin, Shih-Jie; Lee, Chien-Yin; Huang, Kuo-Chin; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-05-01

    Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications

  4. A metaphysical and neuropsychological assessment of musical tones to affect the brain, relax the mind and heal the body

    Directory of Open Access Journals (Sweden)

    Mark Pretorius

    2017-01-01

    Full Text Available It has been empirically established through many controlled studies that one of the most rewarding experiences known to humanity is listening to music, especially because it affects various parts of the brain and causes emotional arousal. The aim of this article is to do a succinct study on music and its effect on, especially, the nervous system, by referring to various empirical studies undertaken on the subject. The article, therefore, has a twofold purpose: (1 to show that throughout history, music has played a special role in various cultures and religions, especially as a healing tool and (2 to demonstrate that sound frequencies and vibrations found in music have the potential to realign the emotions of the nervous system and bring the body back into harmony by reducing stress.Intradisciplinary and/or interdisciplinary implications: The article�s challenge and purpose are to show that science and religion are not in conflict, but rather that together they can benefit both disciplines and make better sense of complicated topics, especially those related to how natural science and religion deal with the human body and health, and its relationship to the mind.

  5. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Directory of Open Access Journals (Sweden)

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  6. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  7. Metaphyseal bands in osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Suresh S

    2010-01-01

    Full Text Available An increasing number of patients with osteogenesis imperfecta are undergoing pamidronate therapy to prevent the incidence of fragility fractures. The authors herein report a child aged 3 years who received five cycles of pamidronate, resulting in metaphyseal bands, known as "zebra lines."

  8. Fracture behaviour of a self-healing microcapsule-loaded epoxy system

    Directory of Open Access Journals (Sweden)

    2011-03-01

    Full Text Available The effect of temperature on the fracture behaviour of a microcapsule-loaded epoxy matrix was investigated. Microencapsulated epoxy and mercaptan-derivative healing agents were incorporated into an epoxy matrix to produce a polymer composite capable of self-healing. Maximum fracture loads were measured using the double-torsion method. Thermal aging at 55 and 110°C for 17 hours [hrs] was applied to heal the pre-cracked samples. The addition of microcapsules appeared to increase significantly the load carrying capacity of the epoxy after healing. Once healed, the composites achieved as much as 93–171% of its virgin maximum fracture load at 18, 55 and 110°C. The fracture behavior of the microcapsule- loaded epoxy matrix was influenced by the healing temperature. The high self-healing efficiency may be attributed to the result of the subsurface micro-crack pinning or deviation, and to a stronger microencapsulated epoxy and mercaptanderivative binder than that of the bulk epoxy. The results show that the healing temperature has a significant effect on recovery of load transferring capability after fracture.

  9. The effect of PTH(1-34) on fracture healing during different loading conditions

    DEFF Research Database (Denmark)

    Ellegaard Larsen, Maria; Kringelbach, Tina; Syberg, Susanne

    2013-01-01

    Parathyroid hormone (PTH) and PTH(1-34) have been shown to promote bone healing in several animal studies. It is known that the mechanical environment is important in fracture healing. Furthermore, PTH and mechanical loading has been suggested to have synergistic effects on intact bone. The aim...... of the present study was to investigate whether the effect of PTH(1-34) on fracture healing in rats was influenced by reduced mechanical loading. For this purpose, we used female, 25-week-old ovariectomized rats. Animals were subjected to closed midshaft fracture of the right tibia 10 weeks after ovariectomy...... injections of hPTH(1-34) (20 µg/kg/day) and the other half received vehicle treatment. Fracture healing was assessed by radiology, dual-energy X-ray absorptiometry (DXA), histology, and bone strength analysis. We found that unloading reduced callus area significantly, whereas no effects of PTH(1...

  10. Sensitivities of biomechanical assessment methods for fracture healing of long bones.

    Science.gov (United States)

    Chen, G; Wu, F Y; Zhang, J Q; Zhong, G Q; Liu, F

    2015-07-01

    There is a controversy as to whether the biomechanical methods are feasible to assess fracture healing of long bones. This paper investigated the sensitivities of two biomechanical methods, torsion and bending, for assessing fracture healing of long bones; both a simplified beam model and finite element model of an artificial femur were employed. The results demonstrated that, in the initial healing stage, the whole-bone stiffness of the fractured bone is extremely sensitive to the variation of the callus stiffness at the fracture site; when the shear (or Young's) modulus of the callus reaches 15% that of the intact bone, the whole-bone stiffness rises up to 90% that of the intact bone. After that, the whole-bone torsional (or bending) stiffness increases slowly; it becomes less sensitive to the variation of the callus stiffness. These results imply that the whole-bone stiffness is of limited reliability to assess the healing quality particular at late stages of the healing process. The simplified model in this paper provided a theoretical framework to explain why the whole-bone stiffness is insensitive to the healing process of fractured long bones in the late stage of healing. The conclusions obtained from the simplified model were verified with the finite element simulations of the artificial femur. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  11. Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study

    Directory of Open Access Journals (Sweden)

    Ellen A. Almirol

    2016-09-01

    Conclusions: In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine the effects of TPTD treatment on stress fracture healing in premenopausal women.

  12. The Changed Route of Anterior Tibial Artery due to Healed Fracture

    Directory of Open Access Journals (Sweden)

    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  13. Acetylcholinesterase inhibitors and healing of hip fracture in Alzheimer's disease patients: a retrospective cohort study.

    Science.gov (United States)

    Eimar, H; Perez Lara, A; Tamimi, I; Márquez Sánchez, P; Gormaz Talavera, I; Rojas Tomba, F; García de la Oliva, T; Tamimi, F

    2013-12-01

    This study was designed to assess effects of cholinergic stimulation using acetylcholinesterase inhibitors (AChEIs), a group of drugs that stimulate cholinergic receptors and are used to treat Alzheimer's disease (AD), on healing of hip fractures. A retrospective cohort study was performed using 46-female AD patients, aged above 75 years, who sustained hip fractures. Study analyses included the first 6-months after hip fracture fixation procedure. Presence of AChEIs was used as predictor variable. Other variables that could affect study outcomes: age, body mass index (BMI), mental state or type of hip fracture, were also included. Radiographic union at fracture site (Hammer index), bone quality (Singh index) and fracture healing complications were recorded as study outcomes. The collected data was analyzed by student's-t, Mann-Whitney-U and chi-square tests. No significant differences in age, BMI, mental state or type of hip fracture were observed between AChEIs-users and nonusers. However, AChEIs-users had better radiographic union at the fracture site (relative risk (RR),2.7; 95%confidence interval (CI),0.9-7.8), better bone quality (RR,2.0; 95%CI,1.2-3.3) and fewer healing complications (RR,0.8; 95%CI,0.7-1.0) than nonusers. In elderly female patients with AD, the use of AChEIs might be associated with an enhanced fracture healing and minimized complications.

  14. Role of Medicinal Plants and Natural Products on Osteoporotic Fracture Healing

    Directory of Open Access Journals (Sweden)

    Mohd Azri Abd Jalil

    2012-01-01

    Full Text Available Popularly known as “the silent disease” since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases—hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world’s largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali, Labisia pumila (Kacip Fatimah, and Piper sarmentosum (Kaduk are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  15. Role of medicinal plants and natural products on osteoporotic fracture healing.

    Science.gov (United States)

    Abd Jalil, Mohd Azri; Shuid, Ahmad Nazrun; Muhammad, Norliza

    2012-01-01

    Popularly known as "the silent disease" since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases-hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world's largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali), Labisia pumila (Kacip Fatimah), and Piper sarmentosum (Kaduk) are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  16. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

    International Nuclear Information System (INIS)

    Dunn, Andrew J.; Campbell, Robert S.D.; Mayor, Peter E.; Rees, Dai

    2008-01-01

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  17. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, Andrew J.; Campbell, Robert S.D. [Royal Liverpool and Broadgreen University Teaching Hospitals, Department of Medical Imaging, Liverpool (United Kingdom); Mayor, Peter E. [Leighton Hospital, Department of Medical Imaging, Crewe, Cheshire (United Kingdom); Rees, Dai [Robert Jones and Agnes-Hunt Orthopaedic Hospital, Department of Orthopaedic Surgery, Oswestry, Shropshire (United Kingdom)

    2008-05-15

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  18. The effects of alpha-tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model

    Directory of Open Access Journals (Sweden)

    Sharlina Mohamad

    2012-09-01

    Full Text Available OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle, whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone.

  19. Local manganese chloride treatment accelerates fracture healing in a rat model.

    Science.gov (United States)

    Hreha, Jeremy; Wey, Aaron; Cunningham, Catherine; Krell, Ethan S; Brietbart, Eric A; Paglia, David N; Montemurro, Nicholas J; Nguyen, Daniel A; Lee, Yung-Jae; Komlos, Daniel; Lim, Elisha; Benevenia, Joseph; O'Connor, J Patrick; Lin, Sheldon S

    2015-01-01

    This study investigated the effects of local delivery of manganese chloride (MnCl2), an insulin-mimetic compound, upon fracture healing using a rat femoral fracture model. Mechanical testing, histomorphometry, and immunohistochemistry were performed to assess early and late parameters of fracture healing. At 4 weeks post-fracture, maximum torque to failure was 70% higher (P<0.05) and maximum torsional rigidity increased 133% (P<0.05) in animals treated with 0.125 mg/kg MnCl2 compared to saline controls. Histological analysis of the fracture callus revealed percent new mineralized tissue was 17% higher (P<0.05) at day 10. Immunohistochemical analysis of the 0.125 mg/kg MnCl2 treated group, compared to saline controls, showed a 379% increase in the density of VEGF-C+ cells. In addition, compared to saline controls, the 0.125 mg/kg MnCl2 treated group showed a 233% and 150% increase in blood vessel density in the subperiosteal region at day 10 post-fracture as assessed by detection of PECAM and smooth muscle α actin, respectively. The results suggest that local MnCl2 treatment accelerates fracture healing by increasing mechanical parameters via a potential mechanism of amplified early angiogenesis leading to increased osteogenesis. Therefore, local administration of MnCl2 is a potential therapeutic adjunct for fracture healing. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  20. Metaphysics of Logical Realism

    OpenAIRE

    محمدرضا عبداله نژاد

    2016-01-01

    Despite the often false impression that the analytic philosophy as an anti-metaphysical movement has nothing to do with metaphysics, there can be found good reasons to grant the metaphysical dispositions of analytic philosophers, and thereby, to minimize the anti-metaphysical nature of analytic philosophy in its all phases. Since analytic philosophy is a historical movement the main nature of which developed through several stages, the very kinds of metaphysical dispositions within each one o...

  1. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  2. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  3. Laboratory tests of hydraulic fracturing and swell healing

    DEFF Research Database (Denmark)

    Thunbo, Christensen Claes; Foged, Christensen Helle; Foged, Niels

    1998-01-01

    New laboratory test set-ups and test procedures are described - for testing the formation of hydraulically induced fractures as well as the potential for subsequent fracture closurefrom the relase of a swelling potential. The main purpose with the tests is to provide information on fracturing...... stresses and whether or not the material in question possesses the potential for fracture closure....

  4. Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture.

    Science.gov (United States)

    Androjna, Caroline; Fort, Brian; Zborowski, Maciej; Midura, Ronald J

    2014-09-01

    Delayed bone healing has been noted in osteoporosis patients and in the ovariectomized (OVX) rat model of estrogen-depletion osteopenia. Pulsed electromagnetic field (PEMF) devices are clinically approved as an adjunct to cervical fusion surgery in patients at high risk for non-fusion and for the treatment of fracture non-unions. These bone growth stimulating devices also accelerate the healing of fresh fracture repair in skeletally mature normal rats but have not been tested for efficacy to accelerate and/or enhance the delayed bone repair process in OVX rats. The current study tested the hypothesis that daily PEMF treatments would improve the fracture healing response in skeletally mature OVX rats. By 6 weeks of healing, PEMF treatments resulted in improved hard callus elastic modulus across fibula fractures normalizing the healing process in OVX rats with respect to this mechanical property. Radiographic evidence showed an improved hard callus bridging across fibula fractures in OVX rats treated with PEMF as compared to sham treatments. These findings provide a scientific rationale for investigating whether PEMF might improve bone-healing responses in at-risk osteoporotic patients. © 2014 Wiley Periodicals, Inc.

  5. Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review

    DEFF Research Database (Denmark)

    Hermund, Niels Ulrich; Hillerup, Søren; Kofod, Thomas

    2008-01-01

    The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus...... of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies...... showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies...

  6. Fracture healing: Quantitative three-phase bone scintigraphy as a prognostic factor

    International Nuclear Information System (INIS)

    Dodig, D.; Kasal, B.; Kragic-Pranic, A.; Predic, P.

    2002-01-01

    Aim: Careful clinical examination and conventional radiography, together with other standard methods for evaluation of bone fracture healing, are frequently inconclusive. Furthermore, it is difficult to predict the complications of healing on the basis of clinical and radiographic findings only. Bone scintigraphy plays an important role in detecting bone fractures. This method is very sensitive, but not enough specific. The aim of this work was to evaluate the role of three-phase bone scintigraphy in the healing prognosis of long bone fractures. Material and Methods: We evaluated the three elements (perfusion, blood pool and static image) of three-phase bone scintigraphy in early prognosis of the course of fracture healing in patients with fractures of femur or tibia. Three-phase bone scintigraphy was performed in 73 patients. The patients were divided into 4 groups according to X-ray and clinical examination: 1) Non operated patients with stable fracture, 2) Operated patients with unstable fracture (infection), 3) Fractures with delayed union, 4) Patients with pseudoarthrosis. Using region of interest (ROI) method we compared the activity on the site of fracture with the activity on the symmetrical place in the healthy bone. The relative indices for each group of patients and for each element of three-bone scintigraphy were calculated in order to make possible the follow up of the fracture healing and to obtain data for prognosis and evaluation of possible complications. Results: The most valuable results were obtained by quantitative analysis of perfusion data immediately after trauma and 2-3 weeks later. Our results show a high diagnostic accuracy in identifying infection by perfusion scintigrams immediately after trauma. The perfusion indices obtained immediately and after 2-3 weeks could predict delayed union after the trauma. Quantitative analysis of blood pool phase gave no data of clinical significance in distinguishing various pathologies. Conclusion: Our

  7. SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

    OpenAIRE

    A. N. Erokhin; V. T. Tarchokov

    2017-01-01

    Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age...

  8. Macrophages in bone fracture healing: Their essential role in endochondral ossification.

    Science.gov (United States)

    Schlundt, Claudia; El Khassawna, Thaqif; Serra, Alessandro; Dienelt, Anke; Wendler, Sebastian; Schell, Hanna; van Rooijen, Nico; Radbruch, Andreas; Lucius, Richard; Hartmann, Susanne; Duda, Georg N; Schmidt-Bleek, Katharina

    2018-01-01

    In fracture healing, skeletal and immune system are closely interacting through common cell precursors and molecular mediators. It is thought that the initial inflammatory reaction, which involves migration of macrophages into the fracture area, has a major impact on the long term outcome of bone repair. Interestingly, macrophages reside during all stages of fracture healing. Thus, we hypothesized a critical role for macrophages in the subsequent phases of bone regeneration. This study examined the impact of in vivo induced macrophage reduction, using clodronate liposomes, on the different healing phases of bone repair in a murine model of a standard closed femoral fracture. A reduction in macrophages had no obvious effect on the early fracture healing phase, but resulted in a delayed hard callus formation, thus severely altering endochondral ossification. Clodronate treated animals clearly showed delayed bony consolidation of cartilage and enhanced periosteal bone formation. Therefore, we decided to backtrack macrophage distribution during fracture healing in non-treated mice, focusing on the identification of the M1 and M2 subsets. We observed that M2 macrophages were clearly prevalent during the ossification phase. Therefore enhancement of M2 phenotype in macrophages was investigated as a way to further bone healing. Induction of M2 macrophages through interleukin 4 and 13 significantly enhanced bone formation during the 3week investigation period. These cumulative data illustrate their so far unreported highly important role in endochondral ossification and the necessity of a fine balance in M1/M2 macrophage function, which appears mandatory to fracture healing and successful regeneration. Copyright © 2016. Published by Elsevier Inc.

  9. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly.

    Science.gov (United States)

    Guo, Jiong Jiong; Yang, Huilin; Qian, Haixin; Huang, Lixin; Guo, Zhongxing; Tang, Tiansi

    2010-03-01

    It has been well recognized that malnutrition causes wounds to heal inadequately and incompletely. Malnutrition is often observed in the elderly, and it appears to be more severe in patients with hip fracture than in the general aging population. Few prospective studies give a detailed account of the identification and classification of nutritional status in the elderly. The objective of this study was to evaluate the effects of different nutritional measurements on wound healing status after hip fracture in the elderly. From September 2002 to December 2007, 207 hip fracture patients older than 60 y treated surgically were reviewed for preoperative nutritional status. There were 81 males and 126 females with an average age of 75.93 y (62-91 y); 131 cases with femoral neck fractures, 76 cases with intertrochanteric fractures. Parameters indicative of nutritional status (serum albumin, serum transferrin, serum pre-albumin, and total lymphocyte count levels) at the time of admission were assessed, along with anthropometric measurements, Rainey MacDonald nutritional index, and MNA tool. Suture removal was performed on postoperative day 14. Delayed wound healing complicated 46 (22.2%) of the 207 cases. The preoperative serum transferring total lymphocyte count levels, MNA total score, and Rainey MacDonald nutritional index were significantly lower for patients who subsequently had delayed wound healing. When all variables were subjected to multivariate analysis, only total lymphocyte count levels and MNA total score showed significant value in predicting which patients would have delayed wound healing. Through prophylactic antibiotics and adherence to strict aseptic precautions, on follow-up, wound healing was normal in all patients. Patients at risk for delayed wound healing problems after hip fracture can be identified using relatively inexpensive laboratory test such as TLC and MNA tool. The clinician must be aware of the risk values of both measurements. We believe

  10. The effect of dexketoprofen trometamol on the healing of diaphysis fractures of rat tibia.

    Science.gov (United States)

    Sevimli, Raşit; Uzel, Murat; Sayar, Hamide; Kalender, Ali Murat; Dökmeci, Ozer

    2013-01-01

    The aim of this study was to analyze the effect of dexketoprofen trometamol, a non-steroidal anti-inflammatory drug, on fracture healing. Closed tibia fracture was created in the right tibia of 60 male Wistar albino rats. Fixation was achieved by closed reduction and 0.5 mm intramedullary nails. Intramuscular dexketoprofen trometamol was administered at a dose of 5 mg/kg daily to the 30 rats in the study group. Rats were sacrificed in groups of 10 at the 2nd, 4th, and 6th weeks following the fracture. Fracture healing was compared mechanically, radiologically, and histopathologically between the groups. There was no statistically significant difference between the study and control groups in terms of mean values of radiological or histopathological scores at the 2nd, 4th and 6th weeks (p>0.05). Biomechanical evaluation could not be conducted in all rats in the study and control groups at the 2nd week due to early stage fracture healing. Mean biomechanical examination values were not statistically significant at the 4th and 6th weeks between the study and control groups (p>0.05). No radiological, biomechanical, and histological effects were detected in the healing of closed fractures of the tibia fixed with intramedullary nail with the long-term use of dexketoprofen trometamol. Dexketoprofen trometamol may be used in patients undergoing surgical fixation for traumatic fractures, taking into account other drugs administered together.

  11. Histomorphometric study of trabecular bone remodeling during condylar process fracture healing in the growing period: experimental study.

    Science.gov (United States)

    Yasuoka, T; Oka, N

    1991-09-01

    Trabecular bone remodeling during condylar fracture healing in the growing period was analyzed by histomorphometry with a synchronous system. Data from the study showed displacement of the fractured condyle was compensated by the changes in remodeling ascribed to the pubertal spurt of growth, and that such remodeling still continued even after clinical healing. The regional acceleratory phenomenon, evolved to potentiate tissue healing, was observed 1 week after induction of the fracture. Mesenchymal cells were presumably modulated into chondroblasts that promoted endochondral ossification. It was concluded that trabecular bone remodeling plays an important role in healing of condylar fractures during the growth period.

  12. Immunosuppression with FK506 has no influence on fracture healing in the rat.

    Science.gov (United States)

    Voggenreiter, Gregor; Siozos, Patrizia; Hunkemöller, Eva; Heute, Stefan; Schwarz, Markus; Obertacke, Udo

    2005-08-01

    Immunosuppressant drugs like cyclosporine A and FK506 are widely used for solid organ transplantation. They are accelerating bone remodeling but cause net bone loss. The aim of this study was to investigate the effect of FK506 on fracture healing in the rat. Eighty Lewis rats were divided into four groups, which received FK506 (1 mg/kg BW) or no treatment for 2 or 4 weeks, beginning after production of a closed, nondisplaced unilateral tibial fracture. Radiographic, histological, and biomechanical studies were used to evaluate fracture healing and histomorphometric analysis of the tibial metaphysis of the intact contralateral side was performed. Radiographs revealed no difference of the healing of the control fractures compared with the fractures in the FK506-treated group at 2 and 4 weeks. The mechanical parameters of the tested contralateral intact tibiae and of the fracture callus demonstrated no difference between control and immunosuppressed animals. Tibial bone histomorphometry revealed increased measures of bone formation and bone resorption, accompanied by a significant reduction of percent trabecular area. At 4 weeks, the fractures showed osseous healing with woven bone at the fracture site and only minimal amounts of cartilage. Histological grading was not different between the control and the FK506 group at both time points. We conclude that systemic application of FK506 has no biomechanical and histological effects of experimental fracture healing in the rat. However, resorption far in excess of formation leads to a net bone loss in the trabecular bone of the tibia that has no effect on the stability of the intact bone.

  13. Laboratory tests of hydraulic fracturing and swell healing

    DEFF Research Database (Denmark)

    Thunbo, Christensen Claes; Foged, Christensen Helle; Foged, Niels

    1998-01-01

    New laboratory test set-ups and test procedures are described - for testing the formation of hydraulically induced fractures as well as the potential for subsequent fracture closurefrom the relase of a swelling potential. The main purpose with the tests is to provide information on fracturing...

  14. An interface finite element model can be used to predict healing outcome of bone fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; García-Aznar, J M

    2014-01-01

    After fractures, bone can experience different potential outcomes: successful bone consolidation, non-union and bone failure. Although, there are a lot of factors that influence fracture healing, experimental studies have shown that the interfragmentary movement (IFM) is one of the main regulators for the course of bone healing. In this sense, computational models may help to improve the development of mechanical-based treatments for bone fracture healing. Hence, based on this fact, we propose a combined repair-failure mechanistic computational model to describe bone fracture healing. Despite being a simple model, it is able to correctly estimate the time course evolution of the IFM compared to in vivo measurements under different mechanical conditions. Therefore, this mathematical approach is especially suitable for modeling the healing response of bone to fractures treated with different mechanical fixators, simulating realistic clinical conditions. This model will be a useful tool to identify factors and define targets for patient specific therapeutics interventions. © 2013 Published by Elsevier Ltd.

  15. Backstroke technique: an effective way to improve the healing of tibia fracture.

    Science.gov (United States)

    Lee, Qi; Zeng, Bing-Fang; Luo, Cong-Feng; Wang, Jin-Wu; Lu, Nan-Ji

    2006-10-01

    To assess the method and results of applying a backstroke technique, we treated 43 patients with tibial shaft fracture using unreamed tibial nails (UTN). Of these patients, 27 suffered a closed fracture and 16 an open fracture. After the operation, the effect of treatment was evaluated: 42 of 43 cases were followed up from four to 18 months, averaging 13.6 months. The four-month and 12-month healing rates of open fracture were 54.6 and 80.9%, respectively, the former of which is significantly higher than the average rate of the AO/ASIF multicentre study. Our results indicate that applying a backstroke technique in treating tibial shaft fracture with UTN can improve the healing rate and reduce complications.

  16. Deferoxamine restores callus size, mineralization, and mechanical strength in fracture healing after radiotherapy.

    Science.gov (United States)

    Donneys, Alexis; Ahsan, Salman; Perosky, Joseph E; Deshpande, Sagar S; Tchanque-Fossuo, Catherine N; Levi, Benjamin; Kozloff, Ken M; Buchman, Steven R

    2013-05-01

    Therapeutic augmentation of fracture-site angiogenesis with deferoxamine has proven to increase vascularity, callus size, and mineralization in long-bone fracture models. The authors posit that the addition of deferoxamine would enhance pathologic fracture healing in the setting of radiotherapy in a model where nonunions are the most common outcome. Thirty-five Sprague-Dawley rats were divided into three groups. Fracture, irradiated fracture, and irradiated fracture plus deferoxamine. The irradiated fracture and irradiated fracture plus deferoxamine groups received a human equivalent dose of radiotherapy [7 Gy/day for 5 days, (35 Gy)] 2 weeks before mandibular osteotomy and external fixation. The irradiated fracture plus deferoxamine group received injections of deferoxamine into the fracture callus after surgery. After a 40-day healing period, mandibles were dissected, clinically assessed for bony union, imaged with micro-computed tomography, and tension tested to failure. Compared with irradiated fractures, metrics of callus size, mineralization, and strength in deferoxamine-treated mandibles were significantly increased. These metrics were restored to a level demonstrating no statistical difference from control fractures. In addition, the authors observed an increased rate of achieving bony unions in the irradiated fracture plus deferoxamine-treated group when compared with irradiated fracture (67 percent and 20 percent, respectively). The authors' data demonstrate nearly total restoration of callus size, mineralization, and biomechanical strength, and a threefold increase in the rate of union with the use of deferoxamine. The authors' results suggest that the administration of deferoxamine may have the potential for clinical translation as a new treatment paradigm for radiation-induced pathologic fractures.

  17. Altered expression of SDF-1 and CXCR4 during fracture healing in diabetes mellitus.

    Science.gov (United States)

    Arakura, Michio; Lee, Sang Yang; Takahara, Shunsuke; Okumachi, Etsuko; Iwakura, Takashi; Fukui, Tomoaki; Nishida, Kotaro; Kurosaka, Masahiro; Kuroda, Ryosuke; Niikura, Takahiro

    2017-06-01

    Diabetes mellitus (DM) is known to impair fracture healing. The purpose of this study was to elucidate and compare the gene expression patterns and localization of stromal cell-derived factor 1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) during fracture healing of the femur in rats with and without DM. Closed transverse fractures were created in the femurs of rats equally divided into a DM group and control group; DM was induced by streptozotocin. At post-fracture days five, seven, 11, 14, 21 and 28, total RNA was extracted from the fracture callus and mRNA expression levels of SDF-1 and CXCR4 were measured by real-time polymerase chain reaction. Localization of SDF-1 and CXCR4 proteins at the fracture site was determined by immunohistochemistry at days 21 and 28. SDF-1 expression was significantly lower in the DM group than in the healthy group on days 21 and 28, and showed a significant difference between days 14 and 21 in the healthy group. There was no significant difference in CXCR4 expression levels between the healthy and DM groups at any time point. On day 21 immunoreactivity of SDF-1 and CXCR4 was detected at the fracture site of the healthy group but no immunoreactivity was observed in the DM group. On day 28, immunoreactivity of SDF-1 and CXCR4 was detected at the fracture site in both groups. Gene expression and localization of SDF-1 and CXCR4 was altered during fracture healing, which may contribute to the impaired fracture healing in DM.

  18. Novel perfused compression bioreactor system as an in vitro model to investigate fracture healing

    Directory of Open Access Journals (Sweden)

    Waldemar eHoffmann

    2015-02-01

    Full Text Available Secondary bone fracture healing is a physiological process that leads to functional tissue regeneration via endochondral bone formation. In vivo studies have demonstrated that early mobilization and the application of mechanical loads enhances the process of fracture healing. However, the influence of specific mechanical stimuli and particular effects during specific phases of fracture healing remain to be elucidated. In this work, we have developed and provided proof-of-concept of an in vitro human organotypic model of physiological loading of a cartilage callus, based on a novel perfused compression bioreactor system (PCB. We then used the fracture callus model to investigate the regulatory role of dynamic mechanical loading. Our findings provide a proof-of-principle that dynamic mechanical loading applied by the PCB can enhance the maturation process of mesenchymal stromal cells towards late hypertrophic chondrocytes and the mineralization of the deposited extracellular matrix. The PCB provides a promising tool to study fracture healing and for the in vitro assessment of alternative fracture treatments based on engineered tissue grafts or pharmaceutical compounds, allowing for the reduction of animal experiments.

  19. Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

    Science.gov (United States)

    Kim, Sang-Min; Kang, Kyung-Chung; Kim, Ji Wan; Lim, Seung-Jae

    2017-01-01

    Background The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. Methods We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. Results This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. Conclusions Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials. PMID:28326303

  20. Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography

    Directory of Open Access Journals (Sweden)

    Ronnachat Rothom

    2017-01-01

    Full Text Available 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.

  1. Backstroke technique: an effective way to improve the healing of tibia fracture

    OpenAIRE

    Lee, Qi; Zeng, Bing-fang; Luo, Cong-Feng; Wang, Jin-Wu; Lu, Nan-Ji

    2006-01-01

    To assess the method and results of applying a backstroke technique, we treated 43 patients with tibial shaft fracture using unreamed tibial nails (UTN). Of these patients, 27 suffered a closed fracture and 16 an open fracture. After the operation, the effect of treatment was evaluated: 42 of 43 cases were followed up from four to 18 months, averaging 13.6 months. The four-month and 12-month healing rates of open fracture were 54.6 and 80.9%, respectively, the former of which is significantly...

  2. TGF-beta1 as a marker of delayed fracture healing.

    Science.gov (United States)

    Zimmermann, G; Henle, P; Küsswetter, M; Moghaddam, A; Wentzensen, A; Richter, W; Weiss, S

    2005-05-01

    Mitogens of the TGF-beta superfamily have been shown to be crucial local and systemic regulatory molecules involved in fracture healing. However, there exists only little information about systemic regulation of bone regeneration by growth factors and no reports comparing serum levels of bone growth factors between normal and failed fracture healing have been published so far. We hypothesized that quality of fracture healing might be reflected by systemic alterations of key regulatory growth factors involved in bone formation and remodeling. Therefore, the aim of this study was to evaluate possible differences in serum levels of BMP-2, BMP-4, and TGF-beta1 in patients with normal and delayed fracture healing. 103 patients with diaphyseal fractures of long bones were recruited prospectively. Peripheral blood samples were collected over a period of 6 months following a standardized time schedule. At the end of the individual investigation period, growth factor serum levels were measured using commercially available enzyme immunoassays. For the elimination of disturbing influences, patients in both groups were matched by gender, age, fracture type, and localization as well as applied technique of osteosynthesis. During a study period of 1 year, 10 patients with an atrophic type of delayed union could be retrieved and matched to 10 patients with normal fracture healing. The diagnosis of delayed union was assumed in case of failed consolidation 4 months after trauma. We found an increase of TGF-beta1 serum levels up to 2 weeks after fracture in both groups with a following return to the reference value within 6 weeks after trauma. However, decline of serum concentration occurred earlier in patients with delayed fracture healing. At 4 weeks after trauma, serum levels of TGF-beta1 were significantly lower in patients of the delayed union group. Serum levels of BMP-2 and BMP-4 were below detection level in all patients, respectively. These findings support the critical

  3. Fractures of the distal tibia treated with polyaxial locking plating.

    Science.gov (United States)

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2009-03-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.

  4. Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures.

    Science.gov (United States)

    Yin, Wenjing; Xu, Zhengliang; Sheng, Jiagen; Zhang, Changqing; Zhu, Zhenhong

    2016-05-16

    To evaluate the potential risk factors of the development of femoral head osteonecrosis after healed intertrochanteric fractures. We retrospectively reviewed all patients who were operated upon with closed reduction and internal fixation for intertrochanteric fractures by our medical group from December 1993 to December 2012. Patients with healed fractures were identified. Age, gender, comorbidities favouring osteonecrosis, causes of injuries, fracture patterns, the location of the primary fracture line, time from injury to surgery, fixation methods, and the development of femur head osteonecrosis of these patients were summarised. Univariate and multivariate logistic regression analysis were performed to evaluate the correlation between potential risk factors and the development of femoral head osteonecrosis. A total of 916 patients with healed intertrochanteric fractures were identified. Femoral head osteonecrosis was found in 8 cases (0.87%). According to the results of univariate logistic regression, a more proximal fracture line, fixation with dynamic hip screws and age were found to be statistically significant factors. The results of multivariate logistic regression analysis indicated that the statistically significant predictors of femoral head osteonecrosis were younger age (odds ratio [OR] = 17.103; 95% confidence interval [CI], 1.988-147.111), a more proximal fracture line (OR = 31.439; 95% CI, 3.700-267.119) and applying dynamic hip screw as the internal fixation (OR = 11.114; 95% CI, 2.064-59.854). Regular follow-up is commended in young patients with a proximal fracture line who underwent closed reduction and internal fixation with dynamic hip screw, even though the bone had healed.

  5. Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.

    Science.gov (United States)

    Snäll, Johanna; Kormi, Eeva; Lindqvist, Christian; Suominen, Anna Liisa; Mesimäki, Karri; Törnwall, Jyrki; Thorén, Hanna

    2013-12-01

    Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Extracorporeal shock wave therapy for non-unions and delayed fracture healing

    Science.gov (United States)

    Schaden, Wolfgang; Fischer, Andreas; Sailler, Andreas; Karadas, Ender

    2005-04-01

    Although the primary management of fractures is highly developed in Central Europe 1% of fractures develop a non-union. After successful pilot studies the Traumacenter Meidling started in December 1998 to treat non-unions regularly with shock wave therapy. From December 1998 to August 2004, 1153 patients with non-union and delayed healing fractures were treated. The results of 755 patients are available up to September 2004. The patients consisted of 250 (33%) female and 505 (67%) male. The mean age was 44.1 years (10; 90). The mean age of the non-union was 15.5 months. In 74 (10%) osteomyelitis was present before shockwave therapy. Out of 755 non-unions 593 (79%) achieved bony healing. As expected, the subgroup of 284 delayed unions (shockwave therapy 3-6 months after the trauma or the last surgery concerning the bone) showed the best results. 245 (86%) healed. Out of 471 non-unions being older than 6 months 348 (72%) achieved bony healing. Because of the efficacy and the lack of complications as well as the economic advantage in comparison to surgery, shockwave therapy is considered as therapy of first choice in the treatment of non-union and delayed healing fractures.

  7. Vitamin E and the Healing of Bone Fracture: The Current State of Evidence

    Directory of Open Access Journals (Sweden)

    Boekhtiar Borhanuddin

    2012-01-01

    Full Text Available Background. The effect of vitamin E on health-related conditions has been extensively researched, with varied results. However, to date, there was no published review of the effect of vitamin E on bone fracture healing. Purpose. This paper systematically audited past studies of the effect of vitamin E on bone fracture healing. Methods. Related articles were identified from Medline, CINAHL, and Scopus databases. Screenings were performed based on the criteria that the study must be an original study that investigated the independent effect of vitamin E on bone fracture healing. Data were extracted using standardised forms, followed by evaluation of quality of reporting using ARRIVE Guidelines, plus recalculation procedure for the effect size and statistical power of the results. Results. Six animal studies fulfilled the selection criteria. The study methods were heterogeneous with mediocre reporting quality and focused on the antioxidant-related mechanism of vitamin E. The metasynthesis showed α-tocopherol may have a significant effect on bone formation during the normal bone remodeling phase of secondary bone healing. Conclusion. In general, the effect of vitamin E on bone fracture healing remained inconclusive due to the small number of heterogeneous and mediocre studies included in this paper.

  8. The role of impairment of mesenchymal stem cell function in osteoporotic bone fracture healing.

    Science.gov (United States)

    Zhang, Lihai; Miramini, Saeed; Richardson, Martin; Mendis, Priyan; Ebeling, Peter

    2017-09-01

    With demographic change and increasing life expectancy, osteoporotic fractures have become one of the most prevalent trauma conditions seen in daily clinical practice. A variety of factors are known to affect the rate of healing in osteoporotic conditions (e.g. both biochemical and biomechanical environment of callus cells). However, the influence of impairment of mesenchymal stem cell function in the osteoporotic condition on bone fracture healing has not been fully understood. In the present study, we develop a mathematical model that quantifies the change in biological processes within the fracture callus as a result of osteoporosis. The model includes special features of osteoporosis such as reduction in mesenchymal stem cell (MSC) number in osteoporotic bone, impaired response of osteoporotic MSCs to their biomechanical microenvironment and the effects of configuration of locking compression plate (LCP) system on healing in this context. The results presented here suggest that mechanically-mediated MSCs differentiation at early stages of healing are significantly affected under osteoporotic conditions, while it is predicted that the flexible fixation achieved by increasing bone-plate distance of LCP could alleviate the negative effects of osteoporosis on healing. The outcomes of this study could potentially lead to patient specific surgical solutions, and thus achieve optimal healing outcomes in osteoporotic conditions.

  9. Time-dependent changes in bone healing capacity of scaphoid fractures and non-unions.

    Science.gov (United States)

    Schmidle, Gernot; Ebner, Hannes Leonhard; Klima, Günter; Pfaller, Kristian; Fritz, Josef; Hoermann, Romed; Gabl, Markus

    2018-02-27

    The scaphoid is the most frequently fractured carpal bone and prone to non-union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non-union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate-resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = -0.427, P = 0.026) and decreasing healing activity for the gap region (r = -0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non

  10. The impact of clinical data on the evaluation of tibial fracture healing

    Directory of Open Access Journals (Sweden)

    Dijkman Bernadette G

    2011-11-01

    Full Text Available Abstract Background Radiographic healing is a common outcome measure in orthopedic trials and adjudication by outcome assessors is often conducted on the basis of plain films alone. The degree to which this process reflects clinical practice, in which both plain films and clinical notes are available, is uncertain. We explored the effect of adding clinical notes to radiographs in the adjudication process of a feasibility trial of tibial shaft fractures. Methods Radiographic and clinical data from a multicenter randomized controlled trial of 51 patients with operatively treated tibial fractures formed the basis of the study data. At the completion of the trial, serial radiographs (anteroposterior and lateral were independently evaluated for progression of fracture healing, defined as bridging of at least 3 of 4 cortices, by an adjudication committee comprised of 3 blinded orthopaedic trauma surgeons. Immediately after determination of radiographic time to healing, each surgeon was provided with clinical notes associated with each radiographic follow up visit and asked to re-visit their initial impression. Consensus was achieved for both adjudications. We calculated the percentage of time to healing consensus decisions that changed after evaluation of clinical notes. We further examined the contents of clinical notes and their relative influence on the committee's decisions. Results 47 of 51 patients were determined to have healed radiographically during the trial follow-up period, and consideration of clinical notes resulted in a change of 40% (19 of 47 of time to healing consensus decisions; however, revised decisions were equally likely to support an earlier or a later time to healing. Clinical notes that resulted in a change to either a 'healed' or a 'not healed' decision contained significantly more comments of either pain resolution or deterioration, respectively, resumption of or failure to resume weightbearing, or either return or no

  11. Teriparatide treatment of femoral fracture nonunion that autogenous bone grafting failed to heal: a case report.

    Science.gov (United States)

    Yu, Wei; Guo, Xiaodong

    2017-12-01

    Management of fracture nonunion is challenging as another surgical intervention for the patient is often a necessity, which has a huge impact on both quality of life and economic burden of the patient. Thus, a less aggressive and better accepted treatment for nonunion is required. We gave teriparatide to a 45-year-old man with femoral fracture nonunion 1 year after he underwent surgery with autogenous bone grafting that failed to heal his initial nonunion. Successful union was obtained after once-daily administration of teriparatide for 9 months. Our case showed teriparatide could successfully treat a femoral fracture nonunion that autogenous bone grafting failed to heal. Teriparatide may provide an alternative treatment for fracture nonunion.

  12. DESCRIPTION OF HISTOPATOLOGICAL FEMORAL FRACTURES HEALING WITH EXCESSIVE OF CALCIUM-CARBONATE TREATMENT IN MALE RAT

    Directory of Open Access Journals (Sweden)

    Ira Sari Yudaniayanti

    2008-12-01

    Full Text Available Fracture healing is a complex process that requires the ordered synthesis of matrix proteins and deposition of mineral. Complications such as delayed union or non-union may arise from excessive flexibility bone because low mineral content of bone or apposition of both fracture fragments is not complete yet. The aim of this study is to determine the effect of excessive calcium carbonate (CaCO3 on the healing femoral fracture in rat by examining histopathological change of femoral fracture. Twelve male Sprague Dawley rats, 12 weeks old were subjected to this investigation. The entire rats model at 13 weeks old were treated reposition of femoral dexter fractures with intramedullary pin fixation. The rats model were evenly randomly divided into three groups of four at 15 weeks old ; group I treated with normal diet, group II with normal diet + CaCO3 supplement 75 mg/day, group III with normal diet + CaCO3 supplement 225 mg/day per oral. At the end of the experiment (19 weeks old, the rats were killed, subsequently dexter femur were taken out for determining the histopathological examination. The results showed that excessive suplementation CaCO3 to description of histopathological fracture healing on group III had even better, callus was able to bridge the fracture fragment with completely. The proportion woven bone and trabeculae were higher, while group II were cartilage dominate in callus, and group I were higher fibrous tissue. From the results can be concluded that given CaCO3 225 mg/ day accelerate the healing process of femoral fractures.

  13. Exogenous PTHrP Repairs the Damaged Fracture Healing of PTHrP+/− Mice and Accelerates Fracture Healing of Wild Mice

    Directory of Open Access Journals (Sweden)

    Yinhe Wang

    2017-02-01

    Full Text Available Bone fracture healing is a complicated physiological regenerative process initiated in response to injury and is similar to bone development. To demonstrate whether an exogenous supply of parathyroid hormone–related protein (PTHrP helps in bone fracture healing, closed mid-diaphyseal femur fractures were created and stabilized with intramedullary pins in eight-week-old wild-type (WT PTHrP+/+ and PTHrP+/− mice. After administering PTHrP for two weeks, callus tissue properties were analyzed at one, two, and four weeks post-fracture (PF by various methods. Bone formation–related genes and protein expression levels were evaluated by real-time reverse transcriptase–polymerase chain reaction and Western blots. At two weeks PF, mineral density of callus, bony callus areas, mRNA levels of alkaline phosphatase (ALP, type I collagen, Runt-related transcription factor 2 (Runx-2, and protein levels of Runx-2 and insulin-like growth factor-1 decreased in PTHrP+/− mice compared with WT mice. At four weeks PF, total collagen-positive bony callus areas, osteoblast number, ALP-positive areas, and type I collagen-positive areas all decreased in PTHrP+/− mice. At both two and four weeks PF, tartrate-resistant acid phosphatase–positive osteoclast number and surface decreased a little in PTHrP+/− mice. The study indicates that exogenous PTHrP provided by subcutaneous injection could redress impaired bone fracture healing, leading to mutation of activated PTHrP by influencing callus areas, endochondral bone formation, osteoblastic bone formation, and bone turnover.

  14. Correlation between RUST assessments of fracture healing to structural and biomechanical properties.

    Science.gov (United States)

    Cooke, Margaret E; Hussein, Amira I; Lybrand, Kyle E; Wulff, Alexander; Simmons, Erin; Choi, Jeffrey H; Litrenta, Jody; Ricci, William M; Nascone, Jason W; O'Toole, Robert V; Morgan, Elise F; Gerstenfeld, Louis C; Tornetta, Paul

    2018-03-01

    Radiographic Union Score for Tibia (RUST) and modified RUST (mRUST) are radiographic tools for quantitatively evaluating fracture healing using a cortical scoring system. This tool has high intra-class correlation coefficients (ICCs); however, little evidence has evaluated the scores against the physical properties of bone healing. Closed, stabilized fractures were made in the femora of C3H/HeJ male mice (8-12 week-old) of two dietary groups: A control and a phosphate restricted diet group. Micro-computed tomography (µCT) and torsion testing were carried out at post-operative days (POD) 14, 21, 35, and 42 (n = 10-16) per group time-point. Anteroposterior and lateral radiographic views were constructed from the µCT scans and scored by five raters. The raters also indicated if the fracture were healed. ICCs were 0.71 (mRUST) and 0.63 (RUST). Both RUST scores were positively correlated with callus bone mineral density (BMD) (r = 0.85 and 0.80, p RUST scores positively correlated with callus strength (r = 0.35 and 0.26, p RUST ≥10 and had excellent relationship to structural and biomechanical metrics. Effect of delayed healing due to phosphate dietary restrictions was found at later time points with all mechanical properties (p RUST scores (p > 0.318). Clinical relevance of this study is both RUST scores showed high correlation to physical properties of healing and generally distinguished healed vs. non-healed fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:945-953, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. Teriparatide (human PTH1-34) compensates for impaired fracture healing in COX-2 deficient mice.

    Science.gov (United States)

    Yukata, Kiminori; Xie, Chao; Li, Tian-Fang; Brown, Matthew L; Kanchiku, Tsukasa; Zhang, Xinping; Awad, Hani A; Schwarz, Edward M; Beck, Christopher A; Jonason, Jennifer H; O'Keefe, Regis J

    2018-05-01

    Genetic ablation of cyclooxygenase-2 (COX-2) in mice is known to impair fracture healing. To determine if teriparatide (human PTH 1-34 ) can promote healing of Cox-2-deficient fractures, we performed detailed in vivo analyses using a murine stabilized tibia fracture model. Periosteal progenitor cell proliferation as well as bony callus formation was markedly reduced in Cox-2 -/- mice at day 10 post-fracture. Remarkably, intermittent PTH 1-34 administration increased proliferation of periosteal progenitor cells, restored callus formation on day 7, and enhanced bone formation on days 10, 14 and 21 in Cox-2-deficient mice. PTH 1-34 also increased biomechanical torsional properties at days 10 or 14 in all genotypes, consistent with enhanced bony callus formation by radiologic examinations. To determine the effects of intermittent PTH 1-34 for callus remodeling, TRAP staining was performed. Intermittent PTH 1-34 treatment increased the number of TRAP positive cells per total callus area on day 21 in Cox-2 -/- fractures. Taken together, the present findings indicate that intermittent PTH 1-34 treatment could compensate for COX-2 deficiency and improve impaired fracture healing in Cox-2-deficient mice. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Histomorphometrical analysis on the effects of two therapeutic ultrasound intensities on fracture healing in aged rats

    Directory of Open Access Journals (Sweden)

    Jeronimo Rafael Skau

    Full Text Available Introduction Experimental studies conducted in young animals show that therapeutic ultrasound (TUS has been successfully used to shorten the healing time of bone fractures. However, they were not found in the literature, studies comparing the effect of different intensities of UST in aged animals. Objective To test the efficacy of intensity 1.0 W/cm2 and of 0.5 W/cm2 in the consolidation of experimental fracture of the tibia from aged Wistar rats. Materials and methods Three groups of 15 month old rats were submitted to a midshaft osteotomy of the tibia and then, the hind member was immobilized with a metal splint and plaster of Paris, wrapping the knee and ankle joint. One group (L, received ultrasound at 0.5 W/cm2; the other group (I, were exposed to ultrasound at 1.0 W/cm2. One control group (C, did not receive the ultrasound. Fifteen animals (five from each group were euthanatized at the end of the first week and fifteen (five from each group at the end of the third week. The progress of the fracture healing was performed for each group by morphometric analysis of histological sections of the fracture region. Results and conclusion The results showed that fractures treated with ultrasound at 1.0 W/cm2 healed significantly faster than did the fractures treated with ultrasound at 0.5 W/cm2 and the control.

  17. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

    Science.gov (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  18. Distal phalanx fractures in horses: a survey of 274 horses with radiographic assessment of healing in 36 horses

    International Nuclear Information System (INIS)

    Honnas, C.M.; O'Brien, T.R.; Linford, R.L.

    1988-01-01

    The case records of 274 horses with fractures of the distal phalanx were reviewed. Fifty-two horses had bilateral forelimb fractures, for a total of 326 distal phalanx fractures. The fractures were classified into one of five previously described types, based on the radiographic anatomic configuration of the fracture. Solar margin fractures, which have been briefly described in other reports and previously classified as type V fractures, were identified in 132 horses. This type of fracture is distinct from other distal phalanx fractures. Due to the high incidence of solar margin fractures, these fractures were classified as a separate type (type VI). Follow-up radiographic examinations to assess fracture healing were available for 36 horses. Twenty-two horses with distal phalanx fractures (three type I, nine type II, two type III, one type IV, one type V, and six type VI) had radiographic evidence of complete bony union of the fracture at a mean of 11 months after injury. Eight horses with conplete type II fractures involving the articular surface had bony union of the body and solar margin, but not the subchondral bone at the articular surface, a mean of 11 months after injury. Six horses (four type II and two type IV) had little radiographic evidence of bony healing during the follow-up period. All fractures that eventually healed had evidence of progression toward bony union by 6 months after injury

  19. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2004-01-01

    A convenience sample based on availability of tibial stress fracture cases a% local Sports Medicine Clinics will be selected over 4 years until forty subjects (20 male, 20 female) have been treated...

  20. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2002-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  1. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2003-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  2. Laboratory study of fracture healing in Topopah Spring tuff: Implications for near field hydrology

    International Nuclear Information System (INIS)

    Lin, Wunan; Daily, W.D.

    1989-09-01

    Seven Topopah Spring tuff samples were studied to determine water permeability in this rock under pressure and temperature conditions similar to those expected in the near field of a nuclear waste package. Six of the seven samples were studied under isothermal condition; the other was subjected to a thermal gradient. Four of the six fractured samples contained a reopened, healed, natural fracture; one contained an induced tensile fracture and the other contained a saw-cut. The fracture surfaces were examined using scanning electron microscope (SEM) before and after the experiments and the water that flowed through the samples was sampled for chemical analysis. The experimental durations ranged from about 3 months to almost 6 months. Water permeability of the fractured samples was found to decrease by more than three orders of magnitude when the sample temperature increased to 150 degree C. The sharpest decrease in permeability occurred when the temperature was increased above 90 degree C. Permeability of the intact sample did not change significantly under the similar experimental conditions. When the temperature returned to room conditions, the water permeability did not recover. The mechanical strength of one healed sample was about half that of the intact rock. SEM studies of the fracture surfaces and water chemical analysis of the water suggested that both dissolution and deposition occurred on the fracture surfaces. Smoothing of fracture asperities because of dissolution and deposition was probably the main cause of the permeability decrease. Deposition of dissolved silica was probably the main cause of fracture healing. 12 refs., 6 figs., 1 tab

  3. Indications for implant removal after fracture healing: a review of the literature

    NARCIS (Netherlands)

    D.I. Vos (Dagmar); M.H.J. Verhofstad (Michiel)

    2013-01-01

    textabstractIntroduction: The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist. Methods: A literature search was performed. Results: Though there are several

  4. [Research on promotory effect of traditional Chinese medicine on fracture healing in cell and molecular level].

    Science.gov (United States)

    Zhang, Kun; Niu, Liang-Chen; Yuan, Fu-Jie; Liu, Shen-Peng

    2017-08-25

    Traditional Chinese medicine is widely used in the treatment of fractures, osteoporosis, other bone related diseases for thousands of years. There are many animal experiments and clinical trials demonstrating that the traditional Chinese medicine such as epimedium, Drynaria and other traditional Chinese medicine can stimulate bone regeneration and inhibit bone resorption, accelerating the fracture healing. In recent years many cell experiments have shown that these herbal ingredients up-regulated the expression of intracellular osteogenic transcription factors and osteogenic related genes, and then induced osteoblastic differentiation and stimulated the proliferation of osteoblasts, bone nodule formation and matrix mineralization. Meanwhile these herbal ingredients up-regulated the expression of intracellular osteoclastic transcription factors and osteoclast related genes, inhibited osteoclast differentiation and bone resorption of osteoclasts. In addition, intracellular signaling pathways regulated these herbal ingredients by might be involved in the above effects. We can have a conclusion that the genes expression regulated by transcription factors in pre-osteoblast and pre-osteoclast and these signaling pathways are the major molecular mechanisms and research hotspots of traditional Chinese medicine in promoting fracture healing. Based on these molecular mechanisms to review, this review provides not only the foundation for the study of traditional Chinese medicine in promoting fracture healing, but also the basis for clinical treatment of fracture. Copyright© 2017 by the China Journal of Orthopaedics and Traumatology Press.

  5. [Clinical observation on the influence of earthquake crush injury on postoperative wound healing of extremity fractures].

    Science.gov (United States)

    Chen, Fu-hong; Chen, Ze; Duan, Heng-qiong; Wan, Zhong-xian

    2008-10-01

    To observe the influence of earthquake crush injury on postoperative wound healing of extremity fractures. The study involved 85 patients with extremities fracture underwent internal fixation operation in 3 group, including 28 earthquake casualties with crush injuries in observation group, 27 earthquake casualties without crush injuries in control I group and 30 local patients during the same period in control II group. Urine routine, blood creatine kinase (CK) and wound conditions of patients in 3 groups were observed respectively. There was no significant difference in Urine routine and blood CK between 3 groups and was significant difference in wound conditions between observation group and each control group. Earthquake crush injuries can influence the postoperative wound healing of extremity fractures.

  6. Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures.

    Science.gov (United States)

    Litrenta, Jody; Tornetta, Paul; Mehta, Samir; Jones, Clifford; OʼToole, Robert V; Bhandari, Mohit; Kottmeier, Stephen; Ostrum, Robert; Egol, Kenneth; Ricci, William; Schemitsch, Emil; Horwitz, Daniel

    2015-11-01

    To determine the reliability of the Radiographic Union Scale for Tibia (RUST) score and a new modified RUST score in quantifying healing and to define a value for radiographic union in a large series of metadiaphyseal fractures treated with plates or intramedullary nails. Healing was evaluated using 2 methods: (1) evaluation of interrater agreement in a series of radiographs and (2) analysis of prospectively gathered data from 2 previous large multicenter trials to define thresholds for radiographic union. Part 1: 12 orthopedic trauma surgeons evaluated a series of radiographs of 27 distal femur fractures treated with either plate or retrograde nail fixation at various stages of healing in random order using a modified RUST score. For each radiographic set, the reviewer indicated if the fracture was radiographically healed. Part 2: The radiographic results of 2 multicenter randomized trials comparing plate versus nail fixation of 81 distal femur and 46 proximal tibia fractures were reviewed. Orthopaedic surgeons at 24 trauma centers scored radiographs at 3, 6, and 12 months postoperatively using the modified RUST score above. Additionally, investigators indicated if the fracture was healed or not healed. The intraclass correlation coefficient (ICC) with 95% confidence intervals was determined for each cortex, the standard and modified RUST score, and the assignment of union for part 1 data. The RUST and modified RUST that defined "union" were determined for both parts of the study. ICC: The modified RUST score demonstrated slightly higher ICCs than the standard RUST (0.68 vs. 0.63). Nails had substantial agreement, whereas plates had moderate agreement using both modified and standard RUST (0.74 and 0.67 vs. 0.59 and 0.53). The average standard and modified RUST at union among all fractures was 8.5 and 11.4. Nails had higher standard and modified RUST scores than plates at union. The ICC for union was 0.53 (nails: 0.58; plates: 0.51), which indicates moderate

  7. Tooth in the line of angle fractures: the impact in the healing process. A retrospective study of 112 patients.

    Science.gov (United States)

    Zanakis, Stylianos; Tasoulas, Jason; Angelidis, Ioannis; Dendrinos, Christos

    2015-01-01

    There is no consensus regarding the prophylactic removal of mandibular third molars (TM) in fracture lines to facilitate healing. Recent evidence suggests that poor healing is attributed to the limited use of antimicrobials, delayed care and semi-rigid fixation as a treatment method, favoring retention of TM. A retrospective cohort study of all patients presenting with mandibular angle fractures at the Hippokration General Hospital of Athens (2006-2011) was designed to examine the association between the presence versus absence of TMs in the line of mandibular fractures and the fracture healing process. Development of complications during the healing process was the outcome of interest. Additional factors considered were patient age, sex, and fracture etiology. Data were extracted from a retrospective chart review, including information from clinical and radiological examinations. The analytical sample included 112 patients with 121 angle fractures. Bivariate methods including Fisher's exact and chi-square tests were used to test the association between TM presence in the fracture line and healing complications. This study found no association between the presence of mandibular TM in the fracture line and postoperative complications and the healing process when combined with light intermaxillary fixation for 15 days. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Metaphysics and medical ethics.

    Science.gov (United States)

    Parkin, C

    1995-01-01

    I take issue with Frank Leavitt's sketch of a pragmatic criterion for the relevance of metaphysics to medical ethics. I argue that appeal to the potential for confusion generated by metaphysical subtlety establishes a need for better communication rather than shows philosophical insight beside the point. I demonstrate that the proposed Criterion of Relevance has absurd consequences, and I claim that the relevance of philosophical doctrines, whether ethical or metaphysical, is best accounted for in terms of improved understanding. PMID:7608933

  9. Assessment of crushed salt consolidation and fracture healing processes in a nuclear waste repository in salt

    International Nuclear Information System (INIS)

    1984-11-01

    For a nuclear waste repository in salt, two aspects of salt behavior are expected to contribute to favorable conditions for waste isolation. First, consolidation of crushed salt backfill due to creep closure of the underground openings may result in a backfill barrier with low permeability. Second, fractures created in the salt by excavation may heal under the influence of stress and temperature following sealing. This report reviews the status of knowledge regarding crushed salt consolidation and fracture healing, provides analyses which predict the rates at which the processes will occur under repository conditions, and develops requirements for future study. Analyses of the rate at which crushed salt will consolidate are found to be uncertain because of unexplained wide variation in the creep properties of crushed salt obtained from laboratory testing, and because of uncertainties in predictions of long term closure rates of openings in salt. This uncertainty could be resolved to a large degree by additional laboratory testing of crushed salt. Similarly, additional testing of fracture healing processes is required to confirm that healing will be effective under repository conditions. Extensive references, 27 figures, 5 tables

  10. Cancer and metaphysics.

    Science.gov (United States)

    Zajicek, G

    2001-08-01

    Metaphysics, is generally a pleasant, and harmless intellectual endeavor. Even if leading to wrong conclusions, nobody is hurt. Suppose that contrary to general belief, the Big Bang (1) never happened and the world is eternal. No harm is done. Some philosophers, like Kant, enjoyed life despite the fact that, nature, or the thing in itself, eluded their understanding (2). But suppose that the thing in itself is your patient, and you apply metaphysical reasoning for his treatment, metaphysics may occasionally be damaging. This is particularly pertinent to cancer, a disease that is haunted by false metaphysical statements. Since cancer is part of medicine, the present discourse deals with medical metaphysics. Medicine provides a simple way, or rule of thumb, for distinguishing between correct and wrong medical metaphysical statements. If they harm the patient, they are wrong, and if they aid him, they are correct. Statements that do not affect a patient's well being, e.g., 'Big Bang may be hazardous to your health', are of no apparent value and doubtful. Since treatment outcome is generally uncertain, the physician continually searches for new ideas that may aid his patient, even if they are metaphysical. In diseases, like cancer, that elude his understanding, his adherence to metaphysics intensifies, and he is ready to consider even doubtful suggestions for treatment. Yet by relaxing the rules of thumb for evaluating metaphysical concepts, he gradually slips into the irrational domain. Copyright 2001 Harcourt Publishers Ltd.

  11. Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial.

    Science.gov (United States)

    Bhandari, Mohit; Jin, Ling; See, Kyoungah; Burge, Russel; Gilchrist, Nigel; Witvrouw, Richard; Krohn, Kelly D; Warner, Margaret R; Ahmad, Qasim I; Mitlak, Bruce

    2016-05-01

    There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo(®)/ Forsteo(®), recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing. We wished to test the hypotheses that treatment with teriparatide versus placebo would improve femoral neck fracture healing after internal fixation as measured by (1) frequency of revision surgery, (2) radiographic fracture healing, and (3) other outcomes including pain control, gait speed, and safety. We initiated two separate, but identically designed, clinical trials to meet FDA requirements to provide substantial evidence to support approval of a new indication. The two prospective, randomized double-blind, placebo-controlled Phase III studies were designed to evaluate the effect of subcutaneous teriparatide (20 μg/day) for 6 months versus placebo on fracture healing at 24 months. The trials were conducted concurrently with a planned enrollment of 1220 patients per trial. However, enrollment was stopped owing to very slow patient accrual, and an a priori decision was made to pool the results of those studies for statistical analyses before study completion; pooling was specified in both protocols. Randomization was stratified by fixation (sliding hip screw or multiple cancellous screws) and fracture type (displaced or nondisplaced). An independent Central Adjudication Committee reviewed revision surgical procedures and radiographs. A total of 159 patients were randomized in the two trials (81 placebo, 78 teriparatide). The combined program had very low power to detect the originally expected treatment effect but had approximately 80% power to detect a larger difference of 12% between treatment groups for risk of revision surgery. The proportion of

  12. Determining the Role of Sost and Sostdc1 During Fracture Healing

    Energy Technology Data Exchange (ETDEWEB)

    Yee, Cristal Sook Ngei [Univ. of California, Merced, CA (United States)

    2016-01-01

    The bone is a dynamic organ, often changing throughout the course of the human lifespan with its continuous remodeling, laying down new bone and resorbing old bone. With age, the bone becomes increasingly porous and mechanically unstable, leading to the development of osteoporosis in some individuals. Elderly patients with osteoporosis are at an increased risk of fracturing their bones which contributes to a higher mortality rate. Recent studies have revealed that type 1 diabetic mellitus (T1DM) patients also have an osteoporotic bone phenotype and impaired fracture healing, independent of age. Currently, there is a lack of available treatments that can improve impaired healing and directly enhance bone formation. Therefore, there is a great need for developing new therapies that can not only aid type 1 diabetic patients with osteoporosis to improve bone phenotype, but that could also aid patients with difficult or impaired fracture healing. In this thesis, I will be discussing the role of Wnt signaling and Sclerostin, a Wnt antagonist that negatively regulates bone formation, in the content of fracture repair.

  13. Exposure to 100% Oxygen Abolishes the Impairment of Fracture Healing after Thoracic Trauma.

    Directory of Open Access Journals (Sweden)

    Julia Kemmler

    Full Text Available In polytrauma patients a thoracic trauma is one of the most critical injuries and an important trigger of post-traumatic inflammation. About 50% of patients with thoracic trauma are additionally affected by bone fractures. The risk for fracture malunion is considerably increased in such patients, the pathomechanisms being poorly understood. Thoracic trauma causes regional alveolar hypoxia and, subsequently, hypoxemia, which in turn triggers local and systemic inflammation. Therefore, we aimed to unravel the role of oxygen in impaired bone regeneration after thoracic trauma. We hypothesized that short-term breathing of 100% oxygen in the early post-traumatic phase ameliorates inflammation and improves bone regeneration. Mice underwent a femur osteotomy alone or combined with blunt chest trauma 100% oxygen was administered immediately after trauma for two separate 3 hour intervals. Arterial blood gas tensions, microcirculatory perfusion and oxygenation were assessed at 3, 9 and 24 hours after injury. Inflammatory cytokines and markers of oxidative/nitrosative stress were measured in plasma, lung and fracture hematoma. Bone healing was assessed on day 7, 14 and 21. Thoracic trauma induced pulmonary and systemic inflammation and impaired bone healing. Short-term exposure to 100% oxygen in the acute post-traumatic phase significantly attenuated systemic and local inflammatory responses and improved fracture healing without provoking toxic side effects, suggesting that hyperoxia could induce anti-inflammatory and pro-regenerative effects after severe injury. These results suggest that breathing of 100% oxygen in the acute post-traumatic phase might reduce the risk of poorly healing fractures in severely injured patients.

  14. Experimental study on healing process of rat mandibular bone fracture examined by radiological procedures

    Energy Technology Data Exchange (ETDEWEB)

    Iuchi, Yukio; Furumoto, Keiichi (Nippon Dental Univ., Tokyo (Japan))

    1994-06-01

    The healing process of rat mandibular fractures was stereoscopically observed daily, using plain roentgenography in the lateral-oblique and tooth axis directions and bone scintigraphy using 99m-Tc-methylene diphosphoric acid (Tc-99m-MDP). The findings were compared with microradiograms of regional polished specimens. X-ray findings included the following. Up to 3 days after bone fracture, the fracture mesiodistally showed distinct radiolucency, with sharp and irregular fracture stump. Radiopacity of the fracture site gradually increased 7 days or later, and bone trabecular formation by callus and stump bridging started to occur at 14 days. Findings similar to those in the control group were observed 49 days or later. The inside was difficult to differentiate, irrespective of the observation time. Bone scans in the mesiodistal and buccolingual planes revealed tracer uptake in the areas of mandibular and soft tissue damage one day after bone fracture. Tracer uptake began to be seen in the fracture site 3 days later, and became marked at 14 days. Then Tc-99m DMP began to be localized and returned to the findings similar to those at 49 days. Bone scanning tended to show wider areas earlier than roentgenography. Microradiographic mesiodistal examination revealed distinct radiopacy of the fracture line for 3 days after bone fracture. Seven days later, bone resorption cavity occurred in the cortical bone around the fracture stump, along with neogenesis of callus. Neogenesis and calcification began to occur gradually, and 14 days later, the fracture osteoremodeling of the internal bone trabeculae was observed. Bone trabecular formation within the bone, however, occurred later. (N.K.).

  15. Effect of Asparagus racemosus on fracture healing in rabbits: a radiographic and angiographic study

    International Nuclear Information System (INIS)

    Singh, Sunil; Singh, H.N.; Gangwar, A.K.; Devi, Kh. Sangeeta; Waghay, J.Y.

    2009-01-01

    New Zealand white rabbits (18) were randomly divided into groups I and II (control) having 9 animals in each group. The fracture of ulna was created in each animal under general anaesthesia using thiopental sodium (2.5%). Radius acted as a natural splint. The animals of group I were fed with powdered Asparagus racemosus along with rabbit feed throughout the study period. However, in group II animals only powdered rabbit feed was given. Healing at the fracture site was assessed by plain radiography and angiography at 7th, 14th, 21st and 28th day interval. Radiographical observation revealed a well organized and dense callus at 21st day in animals of group I whereas in animals of group II, callus of slightly less radiographic density was observed at this interval. Angiographic observation revealed hypervascularity at the fracture site at 7th and 14th day interval in group I animals. On day 14, in group II animals major vessels lack continuity along with reduced vascularity around the fracture site. The results of present study suggest that feeding of dry root powder of Asparagus racemosus promotes early fracture healing in rabbits

  16. Evaluation of simvastatin in the process of fracture healing in tibiae of rats

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-04-01

    Full Text Available OBJECTIVE: Evaluate the effects of simvastatin in the process of fracture healing in rat tibia. METHODS: Thirty-six rats were subjected to diaphyseal fracture of the leg bones and divided in the statin group (GE and control group (GC, being subdivided into three subgroups according to days post-fracture (7th, 14th and 28th day to assess bone healing. In GE was administered by gavage a solution of simvastatin to the sacrifice. In the control group was administered saline by the same route of SG. Immobilization was not used. After the sacrifice was made to limb amputation in the distal femur and conducted the clinical, radiological and histological analysis. Clinical evaluation was made as to the mobility of the fracture. Then the samples were radiographed and evaluated for callus diameter. Histological examination was performed with cuts of 5 micrometers and stained with hematoxylin-eosin, Masson's trichrome and Alcian blue pH 2.5. The level of significance to exclude the null hypothesis was 5%. RESULTS: All GE animals showed greater stability of the fracture and higher callus area. There were no significant changes in the histological study. CONCLUSION: Simvastatin accelerates the consolidation process by increasing the callus, but does not alter the histology of the newly formed bone.

  17. MRT letter: Contrast-enhanced computed tomographic imaging of soft callus formation in fracture healing.

    Science.gov (United States)

    Hayward, Lauren Nicole Miller; de Bakker, Chantal Marie-Jeanne; Lusic, Hrvoje; Gerstenfeld, Louis Charles; Grinstaff, Mark W; Morgan, Elise Feng-I

    2012-01-01

    Formation of a cartilaginous soft callus at the site of a bone fracture is a pivotal stage in the healing process. Noninvasive, or even nondestructive, imaging of soft callus formation can be an important tool in experimental and pre-clinical studies of fracture repair. However, the low X-ray attenuation of cartilage renders the soft callus nearly invisible in radiographs. This study utilized a recently developed, cationic, iodinated contrast agent in conjunction with micro-computed tomography to identify cartilage in fracture calluses in the femora of C57BL/6J and C3H/HeJ mice. Fracture calluses were scanned before and after incubation in the contrast agent. The set of pre-incubation images was registered against and then subtracted from the set of post-incubation images, resulting in a three-dimensional map of the locations of cartilage in the callus, as labeled by the contrast agent. This map was then compared to histology from a previous study. The results showed that the locations where the contrast agent collected in relatively high concentrations were similar to those of the cartilage. The contrast agent also identified a significant difference between the two strains of mice in the percentage of the callus occupied by cartilage, indicating that this method of contrast-enhanced computed tomography may be an effective technique for nondestructive, early evaluation of fracture healing. Copyright © 2011 Wiley Periodicals, Inc.

  18. Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing: an experimental study.

    Science.gov (United States)

    Xu, Wei-zhou; Guo, Xiao-dong; Zhao, Ju-cai; Wang, Yi-jin

    2006-06-01

    To investigate the effect of autocontrol micromotion locking nail (AMLN) on experimental fracture healing and its mechanism. 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail, respectively. The follow-up time was 7, 14, 28 and 56 days. Roentgenographic, biomechanical, histological, scanning electromicroscopic and biochemical analyses were done. (1) The strength of anticompression, antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P<0.01). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group (P<0.05). (3) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the fracture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P<0.05). (4) 7-14 days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding. Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt. None of the above findings was observed in the GK nail-fixed group. The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable, the disturbance to the physical stress

  19. Self-healing of Fractures in Argillaceous Media from the Geomechanical Point of View

    International Nuclear Information System (INIS)

    Horseman, Steve

    2001-01-01

    Presently, there is no established theory describing fracture self-healing and self-sealing processes in mud-rocks (clays, mud-stones and shales) and no methodology to assess the conditions under which these processes might be important. The author suggests that the modified Cam-Clay approach provides a useful conceptual and theoretical framework for the analysis of the largely hydro-mechanical process of self-sealing. Three basic hypotheses are proposed and applied to the problem of fracture self-sealing in the repository EDZ and to the more general question of fault sealing. (author)

  20. Metaphysics and Learning

    Science.gov (United States)

    Verran, Helen

    2007-01-01

    Is it possible to learn and simultaneously articulate the metaphysical basis of that learning? In my contribution to the forum I tell of how I came to recognise that bilingual Yoruba children could articulate the contrasting metaphysical framings of Yoruba and English numbering. The story introduces an arena I call "ontics" that recognises the…

  1. An ultrasound wearable system for the monitoring and acceleration of fracture healing in long bones.

    Science.gov (United States)

    Protopappas, Vasilios C; Baga, Dina A; Fotiadis, Dimitrios I; Likas, Aristidis C; Papachristos, Athanasios A; Malizos, Konstantinos N

    2005-09-01

    An ultrasound wearable system for remote monitoring and acceleration of the healing process in fractured long bones is presented. The so-called USBone system consists of a pair of ultrasound transducers, implanted into the fracture region, a wearable device and a centralized unit. The wearable device is responsible to carry out ultrasound measurements using the axial-transmission technique and initiate therapy sessions of low-intensity pulsed ultrasound. The acquired measurements and other data are wirelessly transferred from the patient-site to the centralized unit, which is located in a clinical setting. The evaluation of the system on an animal tibial osteotomy model is also presented. A dataset was constructed for monitoring purposes consisting of serial ultrasound measurements, follow-up radiographs, quantitative computed tomography-based densitometry and biomechanical data. The animal study demonstrated the ability of the system to collect ultrasound measurements in an effective and reliable fashion and participating orthopaedic surgeons accepted the system for future clinical application. Analysis of the acquired measurements showed that the pattern of evolution of the ultrasound velocity through healing bones over the postoperative period monitors a dynamic healing process. Furthermore, the ultrasound velocity of radiographically healed bones returns to 80% of the intact bone value, whereas the correlation coefficient of the velocity with the material and mechanical properties of the healing bone ranges from 0.699 to 0.814. The USBone system constitutes the first telemedicine system for the out-hospital management of patients sustained open fractures and treated with external fixation devices.

  2. Influence of 1800 MHz GSM-like electromagnetic radiation exposure on fracture healing.

    Science.gov (United States)

    Aslan, Ahmet; Kırdemır, Vecihi; Kocak, Ahmet; Atay, Tolga; Baydar, Metin Lütfi; Özerdemoglu, Remzi Arif; Aydogan, Nevres Hürriyet

    2014-02-01

    In this study, we aimed to investigate whether 1800 MHz frequency electromagnetic radiation (EMR) has an effect on bone healing. A total of 30 Wistar albino rats were divided into two equal groups. Fractures were created in the right tibias of all rats; next, intramedullary fixations with K-wire were performed. A control group (Group I) was kept under the same experimental conditions except without EMR exposure. Rats in Group II were exposed to an 1800 MHz frequency EMR for 30 min a day for 5 days a week. Next, radiological, mechanical, and histological examinations were performed to evaluate tibial fracture healing. Radiological, histological and mechanical scores were not significantly different between groups (respectively, p = 0.114, p = 0.184 and p = 0.083), and all of these scores were lower than those of the controls. EMR at 1800 MHz frequency emitted from cellular phones has no effect on bone fracture healing. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

  3. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2017-02-01

    Conclusion: PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial hematoma effect in the initial phase of healing in open or failed closed intramedullary nailing.

  4. Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results.

    Science.gov (United States)

    Moed, B R; Subramanian, S; van Holsbeeck, M; Watson, J T; Cramer, K E; Karges, D E; Craig, J G; Bouffard, J A

    1998-01-01

    Based on the results of a pilot study indicating the potential value of ultrasound (US) as a diagnostic tool for the early assessment of fracture healing and the related need for secondary operative procedures in patients treated by statically locked intramedullary (IM) nailing without reaming, a protocol was established for a larger scale prospective trial. The purpose of this study was to evaluate the outcome of this follow-up trial. All skeletally mature patients admitted to the Henry Ford Hospital (Detroit, Michigan) from January 1993 to August 1994 who had sustained an acute fracture of the tibial shaft and who were treated by statically locked IM nailing, without reaming, were candidates for study. Forty-seven patients with fifty fractures that could be evaluated by US were included. The adopted determinants for fracture healing were complete disappearance of the IM nail on US examination performed at six weeks postoperatively, or progressive disappearance of the nail noted between the initial six-week study and a second nine-week US examination, both in conjunction with periosteal callus formation. Radiographs were obtained to monitor maintenance of reduction and to further evaluate fracture healing. Of thirty-eight fractures with a positive US (thirty-two at six weeks, six at nine weeks), thirty-seven healed uneventfully, a positive predictive value of 97 percent. Radiographic fracture healing was not evident until, on average, nineteen weeks after injury. The single false-positive fracture progressed to nonunion. Of the twelve fractures with negative US studies, ten underwent secondary procedures (nine dynamization, one bone graft), with four progressing to nonunion. Two patients refused secondary surgery; screw failure occurred in both. Otherwise, there were no hardware failures in this series. The results of this study indicate that US may provide important prognostic information concerning fracture healing after unreamed tibial nailing, upon which

  5. Locally applied simvastatin improves fracture healing at late period in osteoporotic rat

    Science.gov (United States)

    Tian, Faming; Zhang, Liu; Kang, Yuchuan; Zhang, Junshan; Ao, Jiao; Yang, Fang

    effect of simvastatin locally applied from a bioactive polymer coating of implants on osteoporotic fracture healing at late period. Methods:Femur fracture model was established on normal or osteotoporotic mature female SD rats, intramedullary stabilization was achieved with uncoated titanium Kirschnerwires in normal rats(group A),with polymer-only coated vs. polymer plus simvastatin coated titanium Kirschner wires in osteoporotic rats(group B and C, respectively).Femurs were harvested after 12 weeks, and underwent radiographic and histologic analysis, as well as immunohistochemical evaluation for BMP-2 expression. Results:Radiographic results demonstrated progressed callus in the simvastatin-treated groups compared to the uncoated group.The histologic analysis revealed a significantly processed callus with irregular-shaped newly formed bone trabeculae in simvastatin-treated group. Immunohistochemical evaluation showed markedly higher expression levels of B:MP-2 in simvastatin-treated group.Conclusions: The present study revealed a improved fracture healing under local application of simvastatin in osteoporotic rat,which might partially from upregulation of the B:MP-2 expression at fractured site.

  6. Fracture Healing Is Delayed in Immunodeficient NOD/scid‑IL2Rγcnull Mice.

    Directory of Open Access Journals (Sweden)

    Anna E Rapp

    Full Text Available Following bone fracture, the repair process starts with an inflammatory reaction at the fracture site. Fracture healing is disturbed when the initial inflammation is increased or prolonged, whereby, a balanced inflammatory response is anticipated to be crucial for fracture healing, because it may induce down-stream responses leading to tissue repair. However, the impact of the immune response on fracture healing remains poorly understood. Here, we investigated bone healing in NOD/scid-IL2Rγcnull mice, which exhibit severe defects in innate and adaptive immunity, by biomechanical testing, histomorphometry and micro-computed tomography. We demonstrated that NOD/scid-IL2Rγcnull mice exhibited normal skeletal anatomy and a mild bone phenotype with a slightly reduced bone mass in the trabecular compartment in comparison to immunocompetent Balb/c mice. Fracture healing was impaired in immunodeficient NOD/scid-IL2Rγcnull mice. Callus bone content was unaffected during the early healing stage, whereas it was significantly reduced during the later healing period. Concomitantly, the amount of cartilage was significantly increased, indicating delayed endochondral ossification, most likely due to the decreased osteoclast activity observed in cells isolated from NOD/scid-IL2Rγcnull mice. Our results suggest that--under aseptic, uncomplicated conditions--the immediate immune response after fracture is non-essential for the initiation of bone formation. However, an intact immune system in general is important for successful bone healing, because endochondral ossification is delayed in immunodeficient NOD/scid-IL2Rγcnull mice.

  7. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  8. Effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius

    Directory of Open Access Journals (Sweden)

    Jian-Nian Wang

    2016-10-01

    Full Text Available Objective: To analyze the effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius. Methods: A total of 200 elderly patients with fracture of distal radius treated from September 2010 to September 2015 were randomly divided into observation group and control group (n=100. Control group received routine surgical treatment, and observation group underwent Gukang capsule-assisted surgical treatment. Fracture healing was compared between two groups, serum microcirculation and bone metabolism indexes were detected 1 week after operation, X-ray examination was performed 6 months after operation and imaging parameters were measured. Results: Regression time of postoperative affected-side limb swelling and radiographic healing time of broken ends of fractured bone of observation group were significantly shorter than those of control group; 1 week after operation, serum TXB2, CTX-I, CTX-II, RANK, RANKL and TRACP5b levels as well as TXB-2/6-Keto-PGF1α ratio of observation group were significantly lower than those of control group, and 6-Keto-PGF1α, ALP, OPG, PICP, BGP and 1,25(OH2D3 levels were significantly higher than those of control group. Conclusions: Gukang capsule-assisted surgery helps promote the fracture healing in elderly patients with fracture of distal radius and can improve microcirculation and bone metabolism.

  9. Fracture and healing of elastomers: A phase-transition theory and numerical implementation

    Science.gov (United States)

    Kumar, Aditya; Francfort, Gilles A.; Lopez-Pamies, Oscar

    2018-03-01

    A macroscopic theory is proposed to describe, explain, and predict the nucleation and propagation of fracture and healing in elastomers undergoing arbitrarily large quasistatic deformations. The theory, which can be viewed as a natural generalization of the phase-field approximation of the variational theory of brittle fracture of Francfort and Marigo (1998) to account for physical attributes innate to elastomers that have been recently unveiled by experiments at high spatio-temporal resolution, rests on two central ideas. The first one is to view elastomers as solids capable to undergo finite elastic deformations and capable also to phase transition to another solid of vanishingly small stiffness: the forward phase transition serves to model the nucleation and propagation of fracture while the reverse phase transition models the possible healing. The second central idea is to take the phase transition to be driven by the competition between a combination of strain energy and hydrostatic stress concentration in the bulk and surface energy on the created/healed new surfaces in the elastomer. From an applications point of view, the proposed theory amounts to solving a system of two coupled and nonlinear PDEs for the deformation field and an order parameter, or phase field. A numerical scheme is presented to generate solutions for these PDEs in N = 2 and 3 space dimensions. This is based on an efficient non-conforming finite-element discretization, which remains stable for large deformations and elastomers of any compressibility, together with an implicit gradient flow solver, which is able to deal with the large changes in the deformation field that can ensue locally in space and time from the nucleation of fracture. The last part of this paper is devoted to presenting sample simulations of the so-called Gent-Park experiment. Those are confronted with recent experimental results for various types of silicone elastomers.

  10. An experimental study of mandibular fracture wound healing in the calcium deficient rat

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Wang, Eui Hwan; Lee, Sang Rae

    1997-01-01

    The purpose of this study was to investigate effects of osteoporosis on fracture wound healing in the calcium deficient rat. To research the experiment some ten-week old Wistar strain rats with approximately 300 gms weight were selected. Then, the rats were divided into two groups : Normal diet group (rats given a normal diet before and after bone fracture) and Low calcium diet group (rats given a low calcium diet before and after bone fracture). Both groups had been provided with each diet for three weeks. When the rats became thirteen weeks old, the mandibular angle of rats in both groups was artificially fractured for test. The healing of fracture wounds was reviewed by using soft x-ray radiography and 99m Tc-MDP bone scan and also histopathologic examination. The obtained results were as follows : 1. The radiolucency of the fracture site for the Normal diet group started to decrease from the 14th day since the experiment was made, while the Low calcium diet group began decrease in the radiolucency from the 21st day of the experiment . The radiolucency for the normal diet group disappeared at the 42nd day, but one for the Low calcium diet group disappeared at the 56th day of the experiment. 2. The highest uptake rate of 99m Tc-MDP stood at the 14th day of the experiment in the Normal diet group and the Low calcium diet group's maximum rate was recorded at the 21st day of the experiment. These both groups were gradually experiencing decrease in the uptake rate as the experiment time was going on. However, the uptake rate in the Low calcium diet group was lower than one in the Normal diet group. 3. For the Normal diet group, the newly formed trabecular, which were similar to one of the surrounding bone, were seen at the 42nd day of the experiment. On the other hand, the Low claium diet group showed at the 56th day of the experiment that the osteoporotic findings looked weak, irregular trabecular, and also large bone marrow space were observed clearly. As a result

  11. SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

    Directory of Open Access Journals (Sweden)

    A. N. Erokhin

    2017-01-01

    Full Text Available Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age of patients ranged from 21 to 60 years (median – 37 years, there were 19 male and 22 female patients. The authors worked out the formulas using Weasis software for quantitative characteristics of diaphyseal humerus fractures: distance of the fracture site from proximal metaphysis of the humerus, extension of the fracture line and degree of bone fragments displacement. During statistical analysis of the recorded data the average standard deviation, median, minimum, maximum, 25th percentile and 75th percentile were calculated. The Shapiro-Wilk test was used to check consistency of recorded data with normal distribution of characteristics. Correlation analysis was performed by calculation of Kendall and Pearson coefficients. Statistical processing of reported data was done by means of unpaired criteria: non-parametric Wilcoxon test and parametric Student t-test. When comparing two samples a null hypothesis was rejected at the level of test significance p≤0.05. The authors utilized Microsoft Office Excel 2007 and AtteStat, version 13.1.Results. Statistical analysis of the samples including comminuted and spiral fractures of humeral diaphysis demonstrated that the level of the fracture was within 40.9±19.9% and distributed from 11.6% to 72.4% along the diaphysis. Correlation analysis demonstrated statistically valid moderate negative relation between the level of fracture site and consolidation period (Pearson correlation coefficient r = -0.46; р = 0

  12. Stimulation of bone healing in new fractures of the tibial shaft using interferential currents.

    Science.gov (United States)

    Fourie, J A; Bowerbank, P

    1997-01-01

    The aim of this research was to establish whether interferential currents (IFC) could significantly reduce the healing time for fractures of the tibia and thereby prevent nonunion. Males between the ages of 12 and 86, who had sustained fractures of the tibiae, were entered into this double blind clinical trial. According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomization into two groups; an experimental group (n = 41) and placebo group (n = 35). A further group was entered retrospectively--control group (n = 151). IFCs were applied to the experimental group via suction electrodes for 30 minutes per day for 10 days, using a beat frequency of 10-25 Hz and a swing mode of 6 integral of 6. The placebo group had only suction electrodes applied, the intermittent mode produced a rhythmical massage effect; subjects in this group commented on pain relief which resulted in the addition of the control group as a check on the possible effect of intermittent suction. The control group received no intervention. The data were analysed using analysis of covariance which resulted in a finding of no significant difference in the time taken to union for the three groups. This means that to date there is no reason to believe that IFCs (using the parameters of this trial) can reduce the healing time for new fractures of the tibia or prevent nonunion. However, further investigation is recommended.

  13. Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients.

    Science.gov (United States)

    Metsemakers, W-J; Handojo, K; Reynders, P; Sermon, A; Vanderschot, P; Nijs, S

    2015-04-01

    Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures. Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study. Statistical analysis was performed to determine predictors of deep infection and compromised fracture healing. Compromised fracture healing was subdivided in delayed union and nonunion. The following independent variables were selected for analysis: age, sex, smoking, obesity, diabetes, American Society of Anaesthesiologists (ASA) classification, polytrauma, fracture type, open fractures, Gustilo type, primary external fixation (EF), time to nailing (TTN) and reaming. As primary statistical evaluation we performed a univariate analysis, followed by a multiple logistic regression model. Univariate regression analysis revealed similar risk factors for delayed union and nonunion, including fracture type, open fractures and Gustilo type. Factors affecting the occurrence of deep infection in this model were primary EF, a prolonged TTN, open fractures and Gustilo type. Multiple logistic regression analysis revealed polytrauma as the single risk factor for nonunion. With respect to delayed union, no risk factors could be identified. In the same statistical model, deep infection was correlated with primary EF. The purpose of this study was to evaluate risk factors of poor outcome after IMN of tibial shaft fractures. The univariate regression analysis showed that the nature of complications after tibial shaft nailing could be multifactorial. This was not confirmed in a multiple logistic regression model, which

  14. Computational evaluation of the compositional factors in fracture healing affecting ultrasound axial transmission measurements.

    Science.gov (United States)

    Machado, Christiano Bittencourt; de Albuquerque Pereira, Wagner Coelho; Talmant, Maryline; Padilla, Frédéric; Laugier, Pascal

    2010-08-01

    This work aimed at computationally evaluating the compositional factors in fracture healing affecting ultrasound axial transmission (UAT), using four numerical daily-changing healing models, representing more realistic clinical conditions. Using two-dimensional (2-D) simulations, a 1-MHz source and a receiver were positioned parallel to the bone surface to detect the first arriving signal (FAS). The time-of-flight of the FAS (TOF(FAS)) was found to be sensitive only to superficial modifications in the propagation path. It was also shown that callus mature bone better explained alone the variation in TOF(FAS) (R(2) >or= 0.70, p consolidation delays and nonunions. Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  15. Early prediction of tibial and femoral fracture healing: Are we reliable?

    Science.gov (United States)

    Squyer, Emily R; Dikos, Gregory D; Kaehr, David M; Maar, Dean C; Crichlow, Renn J

    2016-12-01

    To evaluate the ability of orthopaedic trauma subspecialists to predict early bony union in femoral and tibia shaft fractures. Eight orthopaedic trauma subspecialists prospectively predicted the probability of bony union at 6 and 12 weeks post-operatively for an aggregate of 48 femoral and tibial shaft fractures treated at a Level 1 trauma centre. An additional orthopaedic trauma subspecialist was blinded to treating surgeon and adjudicated healing at 18 weeks. The Squared-Error Skill Score (SESS) determined the likelihood of accurate forecasting for bony union. Nine patients were lost follow-up, resulting in 39 fractures (81.25% retention) including 20 femoral and 19 tibial fractures. Fourteen fractures were open, 15 were not-yet united at final follow-up. SESS values were 0.25-0.77. The ability to predict union (sensitivity) was 1.000. The ability to predict nonunions (specificity) was 0.330-0.500. The probability of a correct predicted union was 0.727 and correct predicted nonunion at final follow-up was 1.000. AO/OTA type A fractures pattern predictions were highly accurate. As body mass index increased, predictions trended toward decreased accuracy (p=0.06). Tobacco use, age, gender, associated injuries, open fractures, and surgeons' years in clinical practice were not associated with accuracy of predictions. At 12-weeks post-operatively orthopaedic trauma subspecialists can confidently predict the union state in this patient population. This data is most useful in the nonunion patient, directing early intervention, thereby decreasing patient disability and discomfort. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Rickets or abuse? A histologic comparison of rickets and child abuse-related fractures.

    Science.gov (United States)

    Kepron, Charis; Pollanen, Michael S

    2015-03-01

    The bone changes of vitamin D deficiency rickets have been invoked as an alternate explanation for child-abuse related fractures identified through medical imaging. The lack of modern histopathologic comparisons between these two entities limits the abilities of the forensic pathologist to address this differential diagnosis, both in their autopsy reports and on the witness stand. We report a comparison of the histologic appearance of the bones in a two year old child with vitamin D deficiency rickets with fractures occurring in three young children with child abuse. In the case of rickets, there was marked architectural disorganization of endochondral ossification at the costochondral junctions and growth plates of long bones. The child abuse-related fractures showed osteochondral callus at different stages of healing, either centered on a discrete fracture line or at metaphyses (e.g. classical metaphyseal lesions). In many instances, the healing fractures disrupted the line of endochondral ossification. In none of the child abuse-related fractures was there any similarity to the histologic appearance of rickets. The maturation disturbance in the growth plate that occurs in rickets is a distinctive entity that cannot be confused histologically with healing fractures, including the classical metaphyseal lesion.

  17. Indications for implant removal after fracture healing: a review of the literature.

    Science.gov (United States)

    Vos, D I; Verhofstad, M H J

    2013-08-01

    The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist. A literature search was performed. Though there are several presumed benefits of implant removal, such as functional improvement and pain relief, the surgical procedure can be very challenging and may lead to complications or even worsening of the complaints. Research has focused on the safety of metal implants (e.g., risk of corrosion, allergy, and carcinogenesis). For these reasons, implants have been removed routinely for decades. Along with the introduction of titanium alloy implants, the need for implant removal became a subject of debate in view of potential (dis)advantages since, in general, implants made of titanium alloys are more difficult to remove. Currently, the main indications for removal from both the upper and lower extremity are mostly 'relative' and patient-driven, such as pain, prominent material, or simply the request for removal. True medical indications like infection or intra-articular material are minor reasons. This review illustrates the great variety of view points in the literature, with large differences in opinions and practices about the indications for implant removal after fracture healing. Since some studies have described asymptomatic patients developing complaints after removal, the general advice nowadays is to remove implants after fracture healing only in symptomatic patients and after a proper informed consent. Well-designed prospective studies on this subject are urgently needed in order to form guidelines based on scientific evidence.

  18. Clay club initiative: self-healing of fractures in clay-rich host rocks

    International Nuclear Information System (INIS)

    Horseman, S.T.; Cuss, R.J.; Reeves, H.J.

    2004-01-01

    The capacity of fractures in argillaceous rocks to self-heal (or become, with the passage of time, less conductive to groundwater) is often cited as a primary factor favouring the choice of such materials as host rocks for deep disposal. The underlying processes which contribute to self-healing can be broadly subdivided into: (a) mechanical and hydro-mechanical processes linked to the change in the stress field, movement of pore water, swelling, softening, plastic deformation and creep, and (b) geochemical processes linked to chemical alterations, transport in aqueous solution and the precipitation of minerals. Since chemical alteration can cause profound changes to the mechanical properties of argillaceous rocks, it is often difficult to draw a firm line between these two subdivisions. Based on the deliberations of the recent Cluster Conference in Luxembourg, there would appear to be some support for the use of the term 'self-sealing' for processes affecting fracture conductivity in argillaceous rock that are largely mechanical or hydro-mechanical in their origin. There are four main areas in which the self-healing capacity of the host rock becomes relevant to repository design and performance assessment: - potential for radionuclide transport within the excavation damage zone (EDZ); - design and performance of repository sealing systems; - potential impact of gas migration; - long-term performance considering erosional unloading, seismicity and fault reactivation. The presence of an EDZ is acknowledged to be a particularly important issue in performance assessment. Interconnection of fractures in the EDZ could lead to the development of a preferential flow path extending along the emplacement holes, access tunnels and shafts of a repository towards overlying aquifers and the biosphere. In the preliminary French Safety Analyses, for example, the treatment of scenarios relating to early seal failure have highlighted the hydraulic role of the damaged zone as a

  19. Comparison of effects of LLLT and LIPUS on fracture healing in animal models and patients: A systematic review.

    Science.gov (United States)

    Bayat, Mohammad; Virdi, Amarjit; Jalalifirouzkouhi, Reza; Rezaei, Fatemehalsadat

    2018-01-01

    The aim of this paper is to study the in vivo potency of low-level laser therapy (LLLT) and low intensity pulsed ultrasound (LIPUS) alone, accompanied by bone grafts, or accompanied by other factors on fracture healing in animal models and patients. In this paper, we aim to systematically review the published scientific literature regarding the use of LLLT and LIPUS to accelerate fracture healing in animal models and patients. We searched the PubMed database for the terms LLLT or LIPUS and/or bone, and fracture. Our analysis also suggests that both LIPUS and LLLT may be beneficial to fracture healing in patients, and that LIPUS is more effective. These finding are of considerable importance in those treatments with a LIPUS, as a laser device may reduce healing time. The most clinically relevant impact of the LIPUS treatment could be a significant reduction in the proportion of patients who go on to develop a nonunion. If it is confirmed that the therapeutic influence is true and reliable, patients will obtain benefits from LIPUS and LLLT. Further clinical trials of high methodological quality are needed in order to determine the optimal role of LIPUS and LLLT in fracture healing in patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Histopathological evaluation of the effect of locally administered strontium on healing time in mandibular fractures: An experimental study.

    Science.gov (United States)

    Durmuş, Kasım; Turgut, Nergiz Hacer; Doğan, Mehtap; Tuncer, Ersin; Özer, Hatice; Altuntaş, Emine Elif; Akyol, Melih

    2017-10-01

    Mandibular fractures are the most common facial fractures. They can be treated by conservative techniques or by surgery. The authors hypothesized that the application of a single local dose of strontium chloride would accelerate the healing of subcondylar mandibular fractures, shorten the recovery time and prevent complications. The aim of the present pilot study was to evaluate the effects of a single local dose of strontium chloride on the healing of subcondylar mandibular fractures in rats. This randomized experimental study was carried out on 24 male Wistar albino rats. The rats were randomly divided into 3 groups: experimental group 1, receiving 3% strontium chloride; experimental group 2, receiving 5% strontium chloride; and the control group. A full thickness surgical osteotomy was created in the subcondylar area. A single dose of strontium solution (0.3 cc/site) was administered locally by injection on the bone surfaces of the fracture line created. Nothing was administered to the control group. The mandibles were dissected on postoperative day 21. The fractured hemimandibles were submitted to histopathological examination. The median bone fracture healing score was 9 (range: 7-9) in experimental group 1; 8 (range: 7-10) in experimental group 2; and 7.50 (range: 7-8) in the control group. When the groups were compared in terms of bone healing scores, there was a statistically significant difference between experimental group 1 and the control group (p fractures. In the authors' opinion, 3% strontium was beneficial for accelerating facial skeleton consolidation and bone regeneration in rat subcondylar mandibular fractures. This treatment procedure may be combined with closed fracture treatment or a conservative approach.

  1. Healing patterns of clavicular birth injuries as a guide to fracture dating in cases of possible infant abuse

    International Nuclear Information System (INIS)

    Walters, Michele M.; Forbes, Peter W.; Buonomo, Carlo; Kleinman, Paul K.

    2014-01-01

    Dating fractures is critical in cases of suspected infant abuse. There are little scientific data to guide radiologists, and dating is generally based on personal experience and conventional wisdom. Since birth-related clavicular fractures are not immobilized and their age is known, we propose that an assessment of these injuries may serve as a guide for dating inflicted fractures in young infants, acknowledging that patterns observed in the clavicle may not be entirely generalizable to other bones injured in the setting of abuse. One hundred thirty-one radiographs of presumed birth-related clavicular fractures in infants between 0 and 3 months of age were reviewed by two pediatric radiologists with 30 and 15 years' experience. Readers were asked to evaluate images based on several parameters of fracture healing, with a focus on subperiosteal new bone formation (SPNBF) and callus formation. SPNBF and callus were each evaluated with regard to presence, thickness and character. Responses were correlated with known fracture ages. SPNBF was rarely seen in fractures less than 7 days old and was most often present by 10 days. Callus formation was rarely seen in fractures less than 9 days old and was most often present by 15 days. SPNBF thickness increased with fracture age and the character of SPNBF evolved from single-layered to solid/multilayered. Callus thickness decreased with fracture age and callus matrix evolved from soft to intermediate to hard in character. There is an evolution in clavicular fracture healing in young infants that follows a predictable pattern. These findings afford the prospect that predictable patterns of infant clavicular fracture healing can provide an evidence base that may be applicable in cases of suspected infant abuse. (orig.)

  2. Metaphysical Experience and Constitutive Error in Adorno's "Meditations on Metaphysics"

    NARCIS (Netherlands)

    Skirke, C.

    2012-01-01

    That current ideals of cognition impoverish experience is a classical observation, and complaint, of the early Frankfurt School. Adorno reacts to this phenomenon in several ways, among them his conception of metaphysical experiences. Metaphysical experiences are conventionally understood as

  3. The metaphysics of evolution.

    Science.gov (United States)

    Dupré, John

    2017-10-06

    This paper briefly describes process metaphysics, and argues that it is better suited for describing life than the more standard thing, or substance, metaphysics. It then explores the implications of process metaphysics for conceptualizing evolution. After explaining what it is for an organism to be a process, the paper takes up the Hull/Ghiselin thesis of species as individuals and explores the conditions under which a species or lineage could constitute an individual process. It is argued that only sexual species satisfy these conditions, and that within sexual species the degree of organization varies. This, in turn, has important implications for species' evolvability. One important moral is that evolution will work differently in different biological domains.

  4. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures.

    Science.gov (United States)

    Huang, Kui-Chou; Tong, Kwok-Man; Lin, Yu-Min; Loh, El-Wui; Hsu, Cheng-En

    2012-10-01

    Dynamisation is a simple method for treating femoral shaft fractures (FSFs) in patients with delayed healing after intramedullary nailing. However, only around half of patients with a slow-healing FSF have been successfully treated with this strategy. Although it is thought that dynamisation with a screw preserved in the dynamic locking hole improves treatment outcome in these patients, to date, no studies have demonstrated empirical evidence supporting this technique. In this study, we investigated the effects of dynamisation with and without rotation and length control as well as timing of dynamisation on treatment outcomes in FSF patients with delayed healing. Thirty-nine consecutive acute FSF patients with static locking intramedullary nails who subsequently underwent dynamisation were recruited between January 2000 and June 2011. The indication for dynamisation was the presence of gap caused by bone absorption or over-traction at the fracture site when the locking screws were placed. Age, gender, dynamisation method, fracture classification, duration from nail insertion to dynamisation (i.e., timing of dynamisation) and dynamisation outcome were included in the statistical analysis. Patients whose nail was dynamised with a screw preserved in the dynamic locking hole had a significantly higher successful bone union rate (14/15 vs. 14/24, p=0.028) compared with those with all screws removed from one end of the nail. The patients treated in 10-24 weeks had a significantly increased chance of bone union than those treated after 24 weeks (p=0.027). A significantly higher bone union rate (p=0.036) was observed in 10-24 weeks (83.3%) than after 24 weeks (33.3%) in the group of dynamisation with all screws removed from one end of the nail. No statistical difference in bone union success rate was found between patients at 10-24 weeks and after 24 weeks in the group of dynamisation with a screw preserved in the dynamic locking hole. There were no significant differences

  5. Effect of Diabetes Mellitus Type II on Long Bones Fractures Healing

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2015-07-01

    Full Text Available Introduction: Fracture healing is a complex process where synthesis and activation of a cascade of cells and molecules collaborate and participate in regeneration of the fractured bones. There are several factors involved in nonunion of fractured bones. Endocrine and metabolic diseases are regarded as factors causing nonunion of fractured bones. The present study aims at evaluating effect of diabetes type II, as an important and prevalent metabolic disease, on results of surgical treatment of long bones fractures. Method: This case-control study was conducted on 74 patients with isolated fracture of tibia and femur shafts resulting from low-energy trauma. In this study, 50 patients with definite diagnosis of diabetes were compared with 24 metabolically health persons considering age, gender, type of fracture, and treatment method. The diabetic patients were classified in two groups considering their insulin or oral agent. Level of hs-CRP inflammatory marker was also determined in these patients. Union rate and duration as well as relation between inflammatory marker and union rate were studied. Results: Prevalence of nonunion and delayed union were seen in 8 (32% and 2 (8% patients with orally-treated diabetes, respectively. It was 3 (12% in diabetes patients treated with insulin. However, there was not any case of nonunion in the health group. There was a statistically significant difference between these groups. According to the regression model, hs-CRP level played a significant role considering nonunion prediction (P=0.001, Odd’s Ratio=3.4, CI95%:1.4-4.8. Also, type of diabetes treatment had a significant role in predicting nonunion (P=0.04, Odd’s Ratio=0.6, CI95%:0.3-1.4. Duration of being affected by diabetes did not play any important role in nonunion prediction. Conclusion: Prevalence of nonunion in patients with diabetes suffering from fracture and undergoing orthopedic surgery is higher than healthy people. It seems that increase

  6. Carbon dioxide sequestration induced mineral precipitation healing of fractured reservoir seals

    Science.gov (United States)

    Welch, N.; Crawshaw, J.

    2017-12-01

    Initial experiments and the thermodynaic basis for carbon dioxide sequestration induced mineral precipitation healing of fractures through reservoir seals will be presented. The basis of this work is the potential exists for the dissolution of reservoir host rock formation carbonate minerals in the acidified injection front of CO2 during sequestration or EOR. This enriched brine and the bulk CO2 phase will then flow through the reservoir until contact with the reservoir seal. At this point any fractures present in the reservoir seal will be the preferential flow path for the bulk CO2 phase as well as the acidified brine front. These fractures would currently be filled with non-acidified brine saturated in seal formation brine. When the acidifeid brine from the host formation and the cap rock brine mix there is the potential for minerals to fall out of solution, and for these precipitated minerals to decrease or entirely cut off the fluid flow through the fractures present in a reservoir seal. Initial equilibrium simulations performed using the PHREEQC1 database drived from the PHREEQE2 database are used to show the favorable conditions under which this mineral precipitation can occurs. Bench scale fluid mixing experiments were then performed to determine the kinetics of the mineral precipitation process, and determine the progress of future experiemnts involving fluid flow within fractured anhydrite reservoir seal samples. 1Parkhurst, D.L., and Appelo, C.A.J., 2013, Description of input and examples for PHREEQC version 3—A computer program for speciation, batch-reaction, one-dimensional transport, and inverse geochemical calculations: U.S. Geological Survey Techniques and Methods, book 6, chap. A43, 497 p., available only at https://pubs.usgs.gov/tm/06/a43/. 2Parkhurst, David L., Donald C. Thorstenson, and L. Niel Plummer. PHREEQE: a computer program for geochemical calculations. No. 80-96. US Geological Survey, Water Resources Division,, 1980.

  7. Hedgehog signaling mediates woven bone formation and vascularization during stress fracture healing.

    Science.gov (United States)

    Kazmers, Nikolas H; McKenzie, Jennifer A; Shen, Tony S; Long, Fanxin; Silva, Matthew J

    2015-12-01

    Hedgehog (Hh) signaling is critical in developmental osteogenesis, and recent studies suggest it may also play a role in regulating osteogenic gene expression in the post-natal setting. However, there is a void of studies directly assessing the effect of Hh inhibition on post-natal osteogenesis. This study utilized a cyclic loading-induced ulnar stress fracture model to evaluate the hypothesis that Hh signaling contributes to osteogenesis and angiogenesis during stress fracture healing. Immediately prior to loading, adult rats were given GDC-0449 (Vismodegib - a selective Hh pathway inhibitor; 50mg/kg orally twice daily), or vehicle. Hh signaling was upregulated in response to stress fracture at 3 days (Ptch1, Gli1 expression), and was markedly inhibited by GDC-0449 at 1 day and 3 days in the loaded and non-loaded ulnae. GDC-0449 did not affect Hh ligand expression (Shh, Ihh, Dhh) at 1 day, but decreased Shh expression by 37% at 3 days. GDC-0449 decreased woven bone volume (-37%) and mineral density (-17%) at 7 days. Dynamic histomorphometry revealed that the 7 day callus was composed predominantly of woven bone in both groups. The observed reduction in woven bone occurred concomitantly with decreased expression of Alpl and Ibsp, but was not associated with differences in early cellular proliferation (as determined by callus PCNA staining at 3 days), osteoblastic differentiation (Osx expression at 1 day and 3 days), chondrogenic gene expression (Acan, Sox9, and Col2α1 expression at 1 day and 3 days), or bone resorption metrics (callus TRAP staining at 3 days, Rankl and Opg expression at 1 day and 3 days). To evaluate angiogenesis, vWF immunohistochemistry showed that GDC-0449 reduced fracture callus blood vessel density by 55% at 3 days, which was associated with increased Hif1α gene expression (+30%). Dynamic histomorphometric analysis demonstrated that GDC-0449 also inhibited lamellar bone formation. Lamellar bone analysis of the loaded limb (directly adjacent

  8. A comparison of effi cacy of femoral and tibial fractures healing treated by static and dynamic intramedullary nails

    Directory of Open Access Journals (Sweden)

    Đemil Omerović

    2012-12-01

    Full Text Available Introduction: Intramedullary nailing is synthesis and  consolidation of fracture fragments with the main goalto gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.Methods: The study was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B. Patients were divided into two groups, based on the applied operating method, static or dynamic intramedullary osteosynthesis.Results: The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382. The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978.Conclusion: We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Static intramedullary ostesinthesys resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

  9. Lack of endogenous parathyroid hormone delays fracture healing by inhibiting vascular endothelial growth factor‑mediated angiogenesis.

    Science.gov (United States)

    Ding, Qingfeng; Sun, Peng; Zhou, Hao; Wan, Bowen; Yin, Jian; Huang, Yao; Li, Qingqing; Yin, Guoyong; Fan, Jin

    2018-04-03

    Intermittent low‑dose injections of parathyroid hormone (PTH) have been reported to exert bone anabolic effects and to promote fracture healing. As an important proangiogenic cytokine, vascular endothelial growth factor (VEGF) is secreted by bone marrow mesenchymal stem cells (BMSCs) and osteoblasts, and serves a crucial regulatory role in the process of vascular development and regeneration. To investigate whether lack of endogenous PTH causes reduced angiogenic capacity and thereby delays the process of fracture healing by downregulating the VEGF signaling pathway, a PTH knockout (PTHKO) mouse fracture model was generated. Fracture healing was observed using X‑ray and micro‑computerized tomography. Bone anabolic and angiogenic markers were analyzed by immunohistochemistry and western blot analysis. The expression levels of VEGF and associated signaling pathways in murine BMSC‑derived osteoblasts were measured by quantitative polymerase chain reaction and western blot analysis. The expression levels of protein kinase A (PKA), phosphorylated‑serine/threonine protein kinase (pAKT), hypoxia‑inducible factor‑1α (HIF1α) and VEGF were significantly decreased in BMSC‑derived osteoblasts from PTHKO mice. In addition, positive platelet endothelial cell adhesion molecule staining was reduced in PTHKO mice, as determined by immunohistochemistry. The expression levels of HIF1α, VEGF, runt‑related transcription factor 2, osteocalcin and alkaline phosphatase were also decreased in PTHKO mice, and fracture healing was delayed. In conclusion, lack of endogenous PTH may reduce VEGF expression in BMSC‑derived osteoblasts by downregulating the activity of the PKA/pAKT/HIF1α/VEGF pathway, thus affecting endochondral bone formation by causing a reduction in angiogenesis and osteogenesis, ultimately leading to delayed fracture healing.

  10. Effect of amino acids lysine and arginine on fracture healing in rabbits: A radiological and histomorphological analysis

    Directory of Open Access Journals (Sweden)

    Sinha Shivam

    2009-01-01

    Full Text Available Background: Amino acids like arginine and lysine have been suggested to hasten the process of fracture healing by improving the local blood supply, supplementing growth factors, and improving collagen synthesis. We studied the role of lysine and arginine in the fracture repair process with regard to the rate of healing, probable mechanisms involved in the process, and mutual synergism between these agents. Materials and Methods: In an experimental study, 40 rabbits were subjected to ulnar osteotomy. They were distributed in control (14 and test groups (26. Twenty-six animals in the test group were fed with a diet rich in lysine and arginine. Both the groups were followed radiologically and histologically till union. Results: There was better healing of osteotomy in terms of better vascularization, callus formation, and mineralization in the test group. The time of healing in the test group was reduced by a period of 2 weeks. Conclusion: We conclude that amino acids like arginine and lysine may hasten fracture healing.

  11. Studying the effect of photodynamic therapy (PDT) to enhance healing of femur fractures using polarimetric second-harmonic generation microscopy

    Science.gov (United States)

    Golaraei, Ahmad; Raja, Vaishnavi; Akens, Margarete K.; Wilson, Brian C.; Barzda, Virginijus

    2017-07-01

    Linear polarization-in, polarization-out second-harmonic generation microscopy was used to study the effect of Photodynamic therapy treatment on enhancing the healing of femur fracture by investigating the ultrastructure of collagen as a major component of bone matrix.

  12. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Lou, Shenghan; Lv, Houchen; Wang, Guoqi; Zhang, Licheng; Li, Ming; Li, Zhirui; Zhang, Lihai; Tang, Peifu

    2016-01-01

    Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] -4.54 days, 95% confidence interval [CI] -8.80 to -0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD -6.24 days, 95% CI -7.20 to -5.29), but upper limb group did not (MD -1 days, 95% CI -2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] -1.02, 95% CI -1.81 to -0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD -1.68, 95% CI -2.07 to -1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.

  13. Effect of bone marrow and low power lasers on fracture healing with destruction of both periosteum and endosteum in rabbits

    Directory of Open Access Journals (Sweden)

    M. G. Thanoon

    2010-01-01

    Full Text Available Ten mature rabbits of local breed were used in this study; weighing between 1.5 to 1.75 kg and aged about 1–2 years. These animals were divided into two equal groups; in group A destruction of both periosteum and endosteum was done one centimeter from each side of mid-shaft femoral bone fracture, then sufficient amount of autogenously bone marrow was injected directly at the fracture site after immobilization by intramedullary pin. In group B a similar procedure was achieved as in group A, but in additional to that He-Ne infrared laser therapy was used for several sessions. The result of radiological findings indicated that, the fracture healing occurred within group B at fifteen weeks, whereas in group A the healing occurred at eighteen weeks after operation. The implantation of autologous bone marrow enhanced the fracture healing, whereas using of combinations of autologous bone marrow and He-Ne infrared laser therapy hastened the healing.

  14. Radiographic configuration and healing of 121 fractures of the proximal phalanx in 120 Thoroughbred racehorses (2007-2011).

    Science.gov (United States)

    Smith, M R W; Wright, I M

    2014-01-01

    Although fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred horses in training, limited details on variations in morphology and radiological progression have been published. To describe in detail the configuration of parasagittal fractures of the proximal phalanx in a group of Thoroughbred racehorses, to report fracture distribution within this group of horses and to document radiological progression of fracture healing in cases treated by internal fixation. Restrospective case series. Case records and radiographs of Thoroughbred racehorses with parasagittal fractures of the proximal phalanx admitted to Newmarket Equine Hospital between 2007 and 2011 were analysed. One hundred and twenty-one fractures were identified in 120 Thoroughbred racehorses. Fractures were frequently more complex than was appreciated immediately following injury; a feature that has not been reported previously. There was seasonality of fractures in 2- and 3-year-old horses, but not in older horses. Fractures of the proximal phalanx may be more complex than recognised previously, although often their complexity cannot be identified radiographically immediately following injury. The seasonality observed in 2- and 3-year-old horses is most likely to be a consequence of the timing of the turf-racing season in the UK. The Summary is available in Chinese - see Supporting information. © 2013 EVJ Ltd.

  15. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study

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    Mohamed Abdalla Estai

    2011-01-01

    fracture healing, as assessed by the reduced callus volumes and reduced callus scores. This extract is beneficial for fractures in osteoporotic states.

  16. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-01-01

    Background: Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. Objectives: This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. Materials and Methods: This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Results: Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Conclusions: Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group. PMID:26756019

  17. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation.

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-12-01

    Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group.

  18. Osteoblast-specific Krm2 overexpression and Lrp5 deficiency have different effects on fracture healing in mice.

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    Astrid Liedert

    Full Text Available The canonical Wnt/β-catenin pathway plays a key role in the regulation of bone remodeling in mice and humans. Two transmembrane proteins that are involved in decreasing the activity of this pathway by binding to extracellular antagonists, such as Dickkopf 1 (Dkk1, are the low-density lipoprotein receptor related protein 5 (Lrp5 and Kremen 2 (Krm2. Lrp 5 deficiency (Lrp5-/- as well as osteoblast-specific overexpression of Krm2 in mice (Col1a1-Krm2 result in severe osteoporosis occurring at young age. In this study, we analyzed the influence of Lrp5 deficiency and osteoblast-specific overexpression of Krm2 on fracture healing in mice using flexible and semi-rigid fracture fixation. We demonstrated that fracture healing was highly impaired in both mouse genotypes, but that impairment was more severe in Col1a1-Krm2 than in Lrp5-/- mice and particularly evident in mice in which the more flexible fixation was used. Bone formation was more reduced in Col1a1-Krm2 than in Lrp5-/- mice, whereas osteoclast number was similarly increased in both genotypes in comparison with wild-type mice. Using microarray analysis we identified reduced expression of genes mainly involved in osteogenesis that seemed to be responsible for the observed stronger impairment of healing in Col1a1-Krm2 mice. In line with these findings, we detected decreased expression of sphingomyelin phosphodiesterase 3 (Smpd3 and less active β-catenin in the calli of Col1a1-Krm2 mice. Since Krm2 seems to play a significant role in regulating bone formation during fracture healing, antagonizing KRM2 might be a therapeutic option to improve fracture healing under compromised conditions, such as osteoporosis.

  19. Osteoblast-specific Krm2 overexpression and Lrp5 deficiency have different effects on fracture healing in mice.

    Science.gov (United States)

    Liedert, Astrid; Röntgen, Viktoria; Schinke, Thorsten; Benisch, Peggy; Ebert, Regina; Jakob, Franz; Klein-Hitpass, Ludger; Lennerz, Jochen K; Amling, Michael; Ignatius, Anita

    2014-01-01

    The canonical Wnt/β-catenin pathway plays a key role in the regulation of bone remodeling in mice and humans. Two transmembrane proteins that are involved in decreasing the activity of this pathway by binding to extracellular antagonists, such as Dickkopf 1 (Dkk1), are the low-density lipoprotein receptor related protein 5 (Lrp5) and Kremen 2 (Krm2). Lrp 5 deficiency (Lrp5-/-) as well as osteoblast-specific overexpression of Krm2 in mice (Col1a1-Krm2) result in severe osteoporosis occurring at young age. In this study, we analyzed the influence of Lrp5 deficiency and osteoblast-specific overexpression of Krm2 on fracture healing in mice using flexible and semi-rigid fracture fixation. We demonstrated that fracture healing was highly impaired in both mouse genotypes, but that impairment was more severe in Col1a1-Krm2 than in Lrp5-/- mice and particularly evident in mice in which the more flexible fixation was used. Bone formation was more reduced in Col1a1-Krm2 than in Lrp5-/- mice, whereas osteoclast number was similarly increased in both genotypes in comparison with wild-type mice. Using microarray analysis we identified reduced expression of genes mainly involved in osteogenesis that seemed to be responsible for the observed stronger impairment of healing in Col1a1-Krm2 mice. In line with these findings, we detected decreased expression of sphingomyelin phosphodiesterase 3 (Smpd3) and less active β-catenin in the calli of Col1a1-Krm2 mice. Since Krm2 seems to play a significant role in regulating bone formation during fracture healing, antagonizing KRM2 might be a therapeutic option to improve fracture healing under compromised conditions, such as osteoporosis.

  20. Low intensity pulsed ultrasound enhanced mesenchymal stem cell recruitment through stromal derived factor-1 signaling in fracture healing.

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    Fang-Yuan Wei

    Full Text Available Low intensity pulsed ultrasound (LIPUS has been proven effective in promoting fracture healing but the underlying mechanisms are not fully depicted. We examined the effect of LIPUS on the recruitment of mesenchymal stem cells (MSCs and the pivotal role of stromal cell-derived factor-1/C-X-C chemokine receptor type 4 (SDF-1/CXCR4 pathway in response to LIPUS stimulation, which are essential factors in bone fracture healing. For in vitro study, isolated rat MSCs were divided into control or LIPUS group. LIPUS treatment was given 20 minutes/day at 37 °C for 3 days. Control group received sham LIPUS treatment. After treatment, intracellular CXCR4 mRNA, SDF-1 mRNA and secreted SDF-1 protein levels were quantified, and MSCs migration was evaluated with or without blocking SDF-1/CXCR4 pathway by AMD3100. For in vivo study, fractured 8-week-old young rats received intracardiac administration of MSCs were assigned to LIPUS treatment, LIPUS+AMD3100 treatment or vehicle control group. The migration of transplanted MSC to the fracture site was investigated by ex vivo fluorescent imaging. SDF-1 protein levels at fracture site and in serum were examined. Fracture healing parameters, including callus morphology, micro-architecture of the callus and biomechanical properties of the healing bone were investigated. The in vitro results showed that LIPUS upregulated SDF-1 and CXCR4 expressions in MSCs, and elevated SDF-1 protein level in the conditioned medium. MSCs migration was promoted by LIPUS and partially inhibited by AMD3100. In vivo study demonstrated that LIPUS promoted MSCs migration to the fracture site, which was associated with an increase of local and serum SDF-1 level, the changes in callus formation, and the improvement of callus microarchitecture and mechanical properties; whereas the blockade of SDF-1/CXCR4 signaling attenuated the LIPUS effects on the fractured bones. These results suggested SDF-1 mediated MSCs migration might be one of the

  1. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach

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    Yatinder Kharbanda

    2016-11-01

    Full Text Available Abstract Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  2. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach.

    Science.gov (United States)

    Kharbanda, Yatinder; Tanwar, Yashwant Singh; Srivastava, Vishal; Birla, Vikas; Rajput, Ashok; Pandit, Ramsagar

    2017-04-01

    Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  3. On neuropsychoanalytic metaphysics.

    Science.gov (United States)

    Talvitie, Vesa; Ihanus, Juhani

    2011-12-01

    Neuropsychoanalysis focuses on the neural counterparts of psychoanalytically interesting phenomena and has left the difference in the metaphysical presuppositions between neuroscience and psychoanalysis unexamined. The authors analyse the logical possibilities concerning the relation between the brain and the mental unconscious in terms of the serial, parallel, epiphenomenalist and Kantian conceptions, and conclude that none of them provides a satisfactory ground for neuropsychoanalysis. As far as psychoanalytic explanations refer to the mental unconscious, they cannot be verified with the help of neuroscience. Neither is it possible to form a picture of how a neuro-viewpoint might be of help for psychoanalytic theorizing. Neuropsychoanalysis has occasionally been seen as a reductionist affair, but the authors suggest that neuropsychoanalysts themselves lean on the hybrid conception, which combines neuroscientific and psychoanalytic viewpoints. The authors state arguments in favour of the interfield conception of neuropsychoanalysis that takes seriously the metaphysical tensions between neuroscience and psychoanalysis. Copyright © 2011 Institute of Psychoanalysis.

  4. Osteoporotic Fracture Care: Are We Closer to Gold Standards?

    Science.gov (United States)

    Marmor, Meir; Alt, Volker; Latta, Loren; Lane, Joseph; Rebolledo, Brian; Egol, Kenneth A; Miclau, Theodore

    2015-12-01

    This review summarizes symposium presentations from the OTA's Basic Science Focus Forum on care for osteoporotic fractures. The limitations of diaphyseal osteoporotic animal bone models are discussed, together with the potential benefits of using metaphyseal models to study osteoporotic fracture fixation constructs. Metaphyseal bone repair models provide better simulation of the most common osteoporotic fractures. Selection of an osteoporotic model for mechanical testing is also challenging. One should always thoroughly define the clinical problem to be addressed. The selected model should then be validated for behavior matched to known clinical behavior with known fixation configurations. The medical management of osteoporosis is directed at enhancing bone mass, improving bone quality, and lowering fracture risk. Medical strategies to achieve these goals are discussed. The medical strategy should include provision of an adequate calcium and vitamin D environment to facilitate well-mineralized bone and improve bone quality, prevent excessive bone resorption, and provide an anabolic stimulus to enhance bone formation. Atypical femur fractures continue to be a serious issue for the orthopaedic community. Risk factors, treatment modalities, and prevention strategies are discussed. A comprehensive strategy for the improved treatment of osteoporotic fractures must address both biological and mechanical issues and includes 4 specific approaches: (1) removal of inhibitors to bone healing; (2) introduction of bone healing stimulants; (3) modification of fracture fixation constructs; and (4) application of bone augmentation or substitutes. There is currently no optimal bone substitute. Substitutes should be chosen based on the most critical need when treating a particular fracture.

  5. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur.

    Science.gov (United States)

    Singh, Roop; Rohilla, Rajesh; Gawande, Jeetesh; Kumar Sehgal, Paramjit

    2017-02-01

    New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation, tissue repair, and the process of bone mineralization. The present study aims to evaluate the role of platelet-rich plasma (PRP) in healing of acute femoral shaft fractures radiologically. We hypothesize that it provides artificial hematoma and releases various growth factors. This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails (closed or open). Patients were divided into two groups: study group A (n = 33) treated with intramedullary nailing & PRP injection/gel application in the same setting; and control group B (n = 39) treated with intramedullary nailing without PRP application. Both groups were further divided into two subgroups. Study group included subgroup A1 (n = 14) operated with closed intramedullary nailing and PRP injection at the fracture site under radiological control, and subgroup A2 (n = 19) operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site; while control group included subgroup B1 (n = 16) operated with closed intramedullary nailing, and subgroup B2 (n = 23) operated with open intramedullary nailing. Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months. Measurements of mean cortex to callus ratio revealed significant difference between the groups A & B at third and fourth months. Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months. A statistically significant difference was observed between subgroups A1 & B2 and B1 & B2 at the

  6. Stimulation of fracture healing by local application of humoral factors integrated in biodegradable implants.

    Science.gov (United States)

    Illi, O E; Feldmann, C P

    1998-08-01

    Growth stimulation by growth hormones or by IGF-1 is well known whereas publications about stimulation of fracture healing with these substances are rare. One of the main effects of IGF-1 is angiopoiesis which consequently may be expected to induce and accelerate the soft tissue callus formation. BMP-2 is a stimulator for osteoclasts and osteoblasts and prepares the osseous reparation. RhBMPs, mostly BMP-2, are already used in the reconstruction of the cranial vault. The main disadvantage of these proteins is the quick inactivation after about 20-30 minutes. Local stimulation without systemic effects might be avoided by releasing a low but constant dose of IGF-1 or BMP. We speculate that the combination of a reasonable implant with an integrated drug release system may enlarge the field of application of biodegradable implants in the treatment of fractures. Such an implant might remarkably reduce the time for fracture healing and also lower the costs of postoperative treatment. In this paper we report our animal models in which we have tested constructive principles of biodegradable implants, we present the first clinical experiences with polyactates (PLLA) in the osteosynthesis of children, and we describe our inventions concerning drug releasing implants. 1) PLLA-implants a) The animal models We performed on oblique osteotomy of the right metacarpal bone in 48 juvenile calves and osteoplastic reconstructions of the cranial vault in 28 juvenile Göttinger minipigs. Biodegradable osteosynthesis with PLLA implants led to results as good as with conventional materials in both animal models, so that we proceeded to clinical evaluation in children. b) The clinical application in children 35 children, aged 6 weeks to 17 years, had resorbable osteosynthesis of their cranioplasties for correction of congenital malformations and posttraumatic reconstructions. The follow-up ranged from 5-15 years. 2) Invention of a drug-releasing system IGF-1 or BMP-2 is planned to be

  7. Bone morphogenetic protein-7: Review of signalling and efficacy in fracture healing

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    Steven Cecchi

    2016-01-01

    Full Text Available Bone morphogenetic proteins (BMPs are a group of signalling molecules that belong to the transforming growth factor-β superfamily of proteins. Initially identified for their ability to induce bone formation, recent advances in the understanding of cellular and molecular mechanisms regarding BMPs have led to the use of the growth factor to accelerate bone healing. Recent clinical trials have demonstrated that BMPs, BMP-7 in particular, may present an alternative line of treatment other than the gold standard, autogenous bone grafting, in the treatment of fracture nonunion. We performed a literature search in September 2014 of PubMed and Embase using search terms, including “bone morphogenetic proteins”, “BMP-7”, “non-union”, “fracture healing” and “cost-effectiveness”, reviewing the efficacy, safety, and cost of treatment of nonunions with BMP-7. The authors further canvassed the reference lists of selected articles and used online search tools, such as Google Scholar. BMP-7 uses both the canonical and noncanonical signalling pathways. The treatment of fracture nonunion with recombinant human BMP-7 (rhBMP-7 has a comparable efficacy with that of autogenous bone grafting with an average union rate of 87% compared with 93% for bone grafting. Furthermore, fewer complications have been described with the use of rhBMP-7 compared with traditional bone grafting. We describe the signalling pathways that BMP-7 uses to exert its effect on bone. In nonunions, rhBMP-7 has been shown to have a similar efficacy to bone grafting with fewer complications.

  8. A study of radiological features of healing in long bone fractures among infants less than a year

    Energy Technology Data Exchange (ETDEWEB)

    Warner, Christopher; Miller, Angie; Weinman, Jason; Fadell, Michael [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Maguire, Sabine; Trefan, Laszlo [Cardiff University, Institute of Primary Care and Child Health, Cardiff (United Kingdom)

    2017-03-15

    To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing. A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted. The level of agreement among the three radiologists was high (0.64-0.85). The sequence in which the features were seen was: periosteal reaction range 7-130 (present in the majority of cases between 9 and 49 days); callus range 9-130 (present in the majority of cases between days 9-26); bridging range 15-130 (seen in the majority of cases between 15 and 67 days); remodeling range 51-247 days. This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures. (orig.)

  9. A study of radiological features of healing in long bone fractures among infants less than a year

    International Nuclear Information System (INIS)

    Warner, Christopher; Miller, Angie; Weinman, Jason; Fadell, Michael; Maguire, Sabine; Trefan, Laszlo

    2017-01-01

    To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing. A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted. The level of agreement among the three radiologists was high (0.64-0.85). The sequence in which the features were seen was: periosteal reaction range 7-130 (present in the majority of cases between 9 and 49 days); callus range 9-130 (present in the majority of cases between days 9-26); bridging range 15-130 (seen in the majority of cases between 15 and 67 days); remodeling range 51-247 days. This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures. (orig.)

  10. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture.

    Science.gov (United States)

    Jiang-Jun, Zhou; Min, Zhao; Ya-Bo, Yan; Wei, Lei; Ren-Fa, Lv; Zhi-Yu, Zhu; Rong-Jian, Chen; Wei-Tao, Yu; Cheng-Fei, Du

    2014-03-01

    Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not.

  11. Temporal Experience and Metaphysics

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    Graham Peebles

    Full Text Available ABSTRACT The well-known phenomenological argument draws metaphysical conclusions about time, specifically about change through time and the resulting passage or flow of time, from our temporal experience. The argument begins with the phenomenological premise that there is a class of properties which underlies our experience of time and change through time, and its conclusion is that these properties are not merely experienced but exemplified. I argue that the phenomenological argument is best served by the adoption of a representational theory of perception. I then present a representational theory of temporal experience.

  12. Histological evaluation of frakture healing after unreamed nail versus fixateur intern osteosynthesis of simple mid-shaft tibia fractures in sheep

    OpenAIRE

    Teschner, Steffi

    2010-01-01

    Introduction: Complication of conventional open reduction and internal fixation of fraktures are believed to be in part due to disruption of perfusion by the surgical approach and/or implant. Recently, an internal fixator has been developed wtch has only punctual contact to the periosteum and does not further damage the fracture healing process. Furthermore, the internal fixator can be applied through minimal invasive approach. This study compares the ease of fracture healing ater internal fi...

  13. Effect of nicotine and tobacco administration method on the mechanical properties of healing bone following closed fracture.

    Science.gov (United States)

    Hastrup, Sidsel Gaarn; Chen, Xinqian; Bechtold, Joan E; Kyle, Richard F; Rahbek, Ole; Keyler, Daniel E; Skoett, Martin; Soeballe, Kjeld

    2010-09-01

    We previously showed different effects of tobacco and nicotine on fracture healing, but due to pump reservoir limits, maximum exposure period was 4 weeks. To allow flexibility in pre- and post-fracture exposure periods, the objective of this study was to compare a new oral administration route for nicotine to the established pump method. Four groups were studied: (1) pump saline, (2) pump saline + oral tobacco, (3) pump saline/nicotine + oral tobacco, and (4) pump saline + oral nicotine/tobacco. Sprague-Dawley rats (n = 84) received a transverse femoral fracture stabilized with an intramedullary pin 1 week after initiating dosing. After 3 weeks, no difference was found in torsional strength or stiffness between oral nicotine/tobacco or pump nicotine + tobacco, while energy absorption with oral nicotine/tobacco was greater than pump nicotine + tobacco (p < 0.05). Compared to saline control, strength for oral nicotine/tobacco was higher than control (p < 0.05), and stiffnesses for pump nicotine + tobacco and oral nicotine/tobacco were higher than control (p < 0.05). No differences in energy were found for either nicotine-tobacco group compared to saline control. Mean serum cotinine (stable nicotine metabolite) was different between pump and oral nicotine at 1 and 4 weeks, but all groups were in the range of 1-2 pack/day smokers. In summary, relevant serum cotinine levels can be reached in rats with oral nicotine, and, in the presence of tobacco, nicotine can influence mechanical aspects of fracture healing, dependent on administration method. Caution should be exercised when comparing results of fracture healing studies using different methods of nicotine administration. (c) 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing

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    Yokoyama Kazuhiko

    2008-01-01

    Full Text Available Background: The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN by multivariate analysis. Materials and Methods: We examined 99 open tibial fractures (98 patients treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (≤6 h or> 6 h, method of soft-tissue management, skin closure time (≤1 week or> 1 week, existence of polytrauma (ISS< 18 or ISS≥18, existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Results: Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5 of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection ( P < 0.0001. In the immediate nailing group alone, the deep infection rate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA ( P = 0.016. Nonunion occurred in 17 fractures (20.3%, 17/84. Multivariate analysis revealed that Gustilo type, skin closure time, and

  15. Experimental osteoporosis induced by ovariectomy and vitamin D deficiency does not markedly affect fracture healing in rats.

    Science.gov (United States)

    Melhus, Gunhild; Solberg, Lene B; Dimmen, Sigbjoern; Madsen, Jan E; Nordsletten, Lars; Reinholt, Finn P

    2007-06-01

    The question of whether fracture healing and mechanical properties of the callus are influenced by osteoporosis (OP) is still not settled. We therefore studied this issue in vitamin D-depleted ovariectomized (OVX) rats, an OP model previously shown to induce weakening of the femoral neck, and thus thought to be closer to the human condition than the classic OVX rat model. 72 female Wistar rats were randomized into two groups: ovariectomy and vitamin D-deficient diet (Ovx-D group) or sham operation and normal rat chow (Sham group). After 12 weeks, a closed tibial midshaft fracture was performed on the right side and fixed with an intramedullary nail. Bone loss and callus formation were monitored with DXA; serum levels of estradiol and vitamin D3 were measured and histomorphometric analyses were performed. Mechanical properties of callus, tibia, femoral shaft, and femoral neck were examined in 3-point cantilever bending 6 weeks after fracture. The Ovx-D group showed reduced BMD in the spine and femoral neck, and reduced trabecular bone volume in the femoral head. There were no differences in BMD and mechanical properties of callus between the groups. Except for reduced stiffness of the right femoral neck in the Ovx-D group (p = 0.02), no differences in the mechanical strength of long bones were detected. Our results suggest that the systemic effects of estrogen and vitamin D deficiency are not crucial for fracture healing or mechanical properties of the callus.

  16. A cohesive elements based model to describe fracture and cohesive healing in elastomers

    NARCIS (Netherlands)

    Baldi, A.; Grande, A.M.; Bose, R.K.; Airoldi, A.; Garcia Espallargas, S.J.; Di Landro, L.; Van der Zwaag, S.

    2013-01-01

    Several polymeric systems with intrinsic Self-Healing (SH) capabilities have been reported in literature. Many of them showed healing upon contact across the crack interface. Different parameters such as contact time, temperature, pressure or chemical activity determine the degree of healing

  17. Upregulation of inflammatory genes and downregulation of sclerostin gene expression are key elements in the early phase of fragility fracture healing.

    Directory of Open Access Journals (Sweden)

    Joana Caetano-Lopes

    Full Text Available BACKGROUND: Fracture healing is orchestrated by a specific set of events that culminates in the repair of bone and reachievement of its biomechanical properties. The aim of our work was to study the sequence of gene expression events involved in inflammation and bone remodeling occurring in the early phases of callus formation in osteoporotic patients. METHODOLOGY/PRINCIPAL FINDINGS: Fifty-six patients submitted to hip replacement surgery after a low-energy hip fracture were enrolled in this study. The patients were grouped according to the time interval between fracture and surgery: bone collected within 3 days after fracture (n = 13; between the 4(th and 7(th day (n = 33; and after one week from the fracture (n = 10. Inflammation- and bone metabolism-related genes were assessed at the fracture site. The expression of pro-inflammatory cytokines was increased in the first days after fracture. The genes responsible for bone formation and resorption were upregulated one week after fracture. The increase in RANKL expression occurred just before that, between the 4(th-7(th days after fracture. Sclerostin expression diminished during the first days after fracture. CONCLUSIONS: The expression of inflammation-related genes, especially IL-6, is highest at the very first days after fracture but from day 4 onwards there is a shift towards bone remodeling genes, suggesting that the inflammatory phase triggers bone healing. We propose that an initial inflammatory stimulus and a decrease in sclerostin-related effects are the key components in fracture healing. In osteoporotic patients, cellular machinery seems to adequately react to the inflammatory stimulus, therefore local promotion of these events might constitute a promising medical intervention to accelerate fracture healing.

  18. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts.

    Science.gov (United States)

    Kogan, Natalya M; Melamed, Eitan; Wasserman, Elad; Raphael, Bitya; Breuer, Aviva; Stok, Kathryn S; Sondergaard, Rachel; Escudero, Ana V Villarreal; Baraghithy, Saja; Attar-Namdar, Malka; Friedlander-Barenboim, Silvina; Mathavan, Neashan; Isaksson, Hanna; Mechoulam, Raphael; Müller, Ralph; Bajayo, Alon; Gabet, Yankel; Bab, Itai

    2015-10-01

    Cannabinoid ligands regulate bone mass, but skeletal effects of cannabis (marijuana and hashish) have not been reported. Bone fractures are highly prevalent, involving prolonged immobilization and discomfort. Here we report that the major non-psychoactive cannabis constituent, cannabidiol (CBD), enhances the biomechanical properties of healing rat mid-femoral fractures. The maximal load and work-to-failure, but not the stiffness, of femurs from rats given a mixture of CBD and Δ(9) -tetrahydrocannabinol (THC) for 8 weeks were markedly increased by CBD. This effect is not shared by THC (the psychoactive component of cannabis), but THC potentiates the CBD stimulated work-to-failure at 6 weeks postfracture followed by attenuation of the CBD effect at 8 weeks. Using micro-computed tomography (μCT), the fracture callus size was transiently reduced by either CBD or THC 4 weeks after fracture but reached control level after 6 and 8 weeks. The callus material density was unaffected by CBD and/or THC. By contrast, CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures, encoding an enzyme that catalyzes lysine hydroxylation, which is in turn involved in collagen crosslinking and stabilization. Using Fourier transform infrared (FTIR) spectroscopy we confirmed the increase in collagen crosslink ratio by CBD, which is likely to contribute to the improved biomechanical properties of the fracture callus. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes. © 2015 American Society for Bone and Mineral Research.

  19. Ontological engineering versus metaphysics

    Science.gov (United States)

    Tataj, Emanuel; Tomanek, Roman; Mulawka, Jan

    2011-10-01

    It has been recognized that ontologies are a semantic version of world wide web and can be found in knowledge-based systems. A recent time survey of this field also suggest that practical artificial intelligence systems may be motivated by this research. Especially strong artificial intelligence as well as concept of homo computer can also benefit from their use. The main objective of this contribution is to present and review already created ontologies and identify the main advantages which derive such approach for knowledge management systems. We would like to present what ontological engineering borrows from metaphysics and what a feedback it can provide to natural language processing, simulations and modelling. The potential topics of further development from philosophical point of view is also underlined.

  20. Effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture

    Directory of Open Access Journals (Sweden)

    Yan-Kui Bai

    2016-11-01

    Full Text Available Objective: To analyze the effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture. Methods: A total of 70 elderly patients with femoral intertrochanteric fracture were randomly divided into observation group and control group (n=35, control group received minimally invasive surgery alone and observation group received minimally invasive surgery combined with postoperative placenta polypeptide injection therapy. The differences in postoperative bone mineral density as well as serum inflammatory indexes, bone metabolism indexes, hemorheology parameters, femoral neck length, neck-shaft angle value and so on were compared between two groups of patients. Results: Serum TNF-α, IL-6, PCT and MCP-1 content of observation group 2 weeks after treatment were lower than those of control group while IL-10 and TGF-β content were higher than those of control group; serum PINP and 25(OHD3 content were higher than those of control group while CTX and PCT content were lower than those of control group; whole blood high shear, middle shear and low shear viscosity, plasma viscosity as well as ESR and Fib content were lower than those of control group; the femoral neck length and neck-shaft angle levels 3 months after treatment were higher than those of control group. Conclusions: Minimally invasive surgery combined with postoperative placenta polypeptide injection therapy has advantages in promoting fracture healing, restoring physiological function of lower limbs and other aspects in elderly patients with femoral intertrochanteric fracture.

  1. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    Energy Technology Data Exchange (ETDEWEB)

    O' Connell, AnnaMarie [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); Donoghue, Veronica B. [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); National Maternity Hospital, Radiology Department, Dublin (Ireland)

    2007-05-15

    Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury. To demonstrate that the CML may occur following simple lower segment caesarean section (LSCS). A review of 22 years of an obstetric practice that delivers 8,500 babies per year. We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML. We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed. (orig.)

  2. Estrogen receptor α- (ERα), but not ERβ-signaling, is crucially involved in mechanostimulation of bone fracture healing by whole-body vibration.

    Science.gov (United States)

    Haffner-Luntzer, Melanie; Kovtun, Anna; Lackner, Ina; Mödinger, Yvonne; Hacker, Steffen; Liedert, Astrid; Tuckermann, Jan; Ignatius, Anita

    2018-05-01

    Mechanostimulation by low-magnitude high frequency vibration (LMHFV) has been shown to provoke anabolic effects on the intact skeleton in both mice and humans. However, experimental studies revealed that, during bone fracture healing, the effect of whole-body vibration is profoundly influenced by the estrogen status. LMHFV significantly improved fracture healing in ovariectomized (OVX) mice being estrogen deficient, whereas bone regeneration was significantly reduced in non-OVX, estrogen-competent mice. Furthermore, estrogen receptors α (ERα) and β (ERβ) were differentially expressed in the fracture callus after whole-body vibration, depending on the estrogen status. Based on these data, we hypothesized that ERs may mediate vibration-induced effects on fracture healing. To prove this hypothesis, we investigated the effects of LMHFV on bone healing in mice lacking ERα or ERβ. To study the influence of the ER ligand estrogen, both non-OVX and OVX mice were used. All mice received a femur osteotomy stabilized by an external fixator. Half of the mice were sham-operated or subjected to OVX 4 weeks before osteotomy. Half of each group received LMHFV with 0.3 g and 45 Hz for 20 min per day, 5 days per week. After 21 days, fracture healing was evaluated by biomechanical testing, μCT analysis, histomorphometry and immunohistochemistry. Absence of ERα or ERβ did not affect fracture healing in sham-treated mice. Wildtype (WT) and ERβ-knockout mice similarly displayed impaired bone regeneration after OVX, whereas ERα-knockout mice did not. Confirming previous data, in WT mice, LMHFV negatively affected bone repair in non-OVX mice, whereas OVX-induced compromised healing was significantly improved by vibration. In contrast, vibrated ERα-knockout mice did not display significant differences in fracture healing compared to non-vibrated animals, both in non-OVX and OVX mice. Fracture healing in ERβ-knockout mice was similarly affected by LMHFV as in WT

  3. The Effects of Targeted Deliveries of Lovastatin and Tocotrienol on Ossification-Related Gene Expressions in Fracture Healing in an Osteoporosis Rat Model

    Directory of Open Access Journals (Sweden)

    Nurul ‘Izzah Ibrahim

    2015-10-01

    Full Text Available Osteoporotic drugs are used to prevent fragility fractures, but their role in fracture healing still remains unknown. Thus, alternative agents with suitable mode of delivery are needed to promote fracture healing. This study was performed to investigate the effects of direct deliveries of lovastatin and tocotrienol to fracture sites on ossification-related gene expression in fracture healing in a postmenopausal osteoporosis model. Forty-eight Sprague Dawley female rats were divided into six groups. Group I comprised the sham-operated rats, while Groups II–VI were ovariectomized rats. After 8 weeks, the right tibiae of all rats were fractured and stabilized. Group I and Group II were given two single injections of lovastatin and tocotrienol carriers. Group III was given an estrogen preparation at 64.5 µg/kg daily via oral gavages. Group IV was injected with lovastatin particles (750 µg/kg, while Group V was injected with tocotrienol particles (60 mg/kg. Group VI received two single injections of 750 µg/kg lovastatin particles and 60 mg/kg tocotrienol particles. After 4 weeks, the gene expressions were measured. Group VI showed significantly higher gene expressions of osteocalcin, BMP-2, VEGF-α, and RUNX-2 compared to Group II. In conclusion, combined treatment of lovastatin and tocotrienol upregulated the expression of genes related to fracture healing.

  4. Metaphyseal cupping: a case report.

    Science.gov (United States)

    Wiss, D A

    1981-06-01

    A case of metaphyseal cupping of bone that probably occurred as the result of an impaired blood supply to the leg of an infant is reported. Avascularity and premature closure of the central segment of the growth plate is the proposed pathogenesis. The blood supply, growth and development of the ends of growing bones are discussed and the radiographie features of metaphyseal cupping are described. Copyright 2013, SLACK Incorporated.

  5. The Everyday Condition of Metaphysics

    Directory of Open Access Journals (Sweden)

    Ştefan Afloroaei

    2010-12-01

    Full Text Available The question I intend to answer is whether one can speak of a tacit metaphysics, not expressed conceptually, but nevertheless common. If the answer is positive and providing that it is specific to day-to-day life, such metaphysics may be called everyday metaphysics. To this end, I review the meaning of everyday life and its ambivalent character. Next, I present several milestones in the debate on the subject, from authors who have focused on a kind of usual, common or ‘natural’ metaphysics. Lastly, I formulate the idea under consideration, namely that everyday life implies or underlies a certain metaphysics. I note that it is an implicit metaphysics – not expressed formally – and rather free. Embraced in experience with a certain degree of freedom, it is recognisable by means of certain representations active in our mind, by the manner of speaking or of understanding and by the common forms of expression. Its vibrancy, concrete and relaxed character makes it highly evocative of the mental life of an era. It ensures a truly essential difference in our everyday mode of being.

  6. Time-Dependent Changes in T1 during Fracture Healing in Juvenile Rats: A Quantitative MR Approach.

    Directory of Open Access Journals (Sweden)

    Katharina Baron

    Full Text Available Quantitative magnetic resonance imaging (qMRI offers several advantages in imaging and determination of soft tissue alterations when compared to qualitative imaging techniques. Although applications in brain and muscle tissues are well studied, its suitability to quantify relaxation times of intact and injured bone tissue, especially in children, is widely unknown. The objective observation of a fracture including its age determination can become of legal interest in cases of child abuse or maltreatment. Therefore, the aim of this study is the determination of time dependent changes in intact and corresponding injured bones in immature rats via qMRI, to provide the basis for an objective and radiation-free approach for fracture dating. Thirty-five MR scans of 7 Sprague-Dawley rats (male, 4 weeks old, 100 ± 5 g were acquired on a 3T MRI scanner (TimTrio, Siemens AG, Erlangen, Germany after the surgical infliction of an epiphyseal fracture in the tibia. The images were taken at days 1, 3, 7, 14, 28, 42 and 82 post-surgery. A proton density-weighted and a T1-weighted 3D FLASH sequence were acquired to calculate the longitudinal relaxation time T1 of the fractured region and the surrounding tissues. The calculation of T1 in intact and injured bone resulted in a quantitative observation of bone development in intact juvenile tibiae as well as the bone healing process in the injured tibiae. In both areas, T1 decreased over time. To evaluate the differences in T1 behaviour between the intact and injured bone, the relative T1 values (bone-fracture were calculated, showing clear detectable alterations of T1 after fracture occurrence. These results indicate that qMRI has a high potential not only for clinically relevant applications to detect growth defects or developmental alterations in juvenile bones, but also for forensically relevant applications such as the dating of fractures in cases of child abuse or maltreatment.

  7. Potent anti-inflammatory agent escin does not affect the healing of tibia fracture and abdominal wound in an animal model.

    Science.gov (United States)

    Zhang, Leiming; Wang, Hongsheng; Wang, Tian; Jiang, Na; Yu, Pengfei; Liu, Feiyan; Chong, Yating; Fu, Fenghua

    2012-04-01

    Escin, a potent anti-inflammatory and anti-edematous agent, has been widely used clinically in preventing inflammatory edema after trauma, such as fracture and surgery. The aim of this study was to investigate whether escin has an inhibitory effect on fracture healing, and whether escin has an inhibitory effect on wound healing after surgery. Male New Zealand white rabbits underwent tibial mid-diaphyseal osteotomy, and were administered escin once per day for 10 days. At weeks 2, 4 and 6, bone fracture healing and bone mineral density were measured. The histologic examination of callus, osteocalcin, alkaline phosphatase, calcium and phosphate in the serum were also assayed. In another experiment, the rats underwent midline laparotomy, and received escin once prior to or after the operation. Six days later, the abdominal incision wounds were excised for measuring hydroxyproline levels. The results showed that there were no significant differences in fracture healing between the model and rabbits administered escin, and escin did not affect the hydroxyproline levels in the abdominal incision wounds of the rats. These findings suggest that escin has no inhibitory effect on fracture and wound healing in animal models.

  8. Local application of a gentamicin-loaded thermo-responsive hydrogel allows for fracture healing upon clearance of a high Staphylococcus aureus load in a rabbit model.

    Science.gov (United States)

    Ter Boo, G J; Schmid, T; Zderic, I; Nehrbass, D; Camenisch, K; Richards, R G; Grijpma, D W; Moriarty, T F; Eglin, D

    2018-03-02

    Antibiotic-loaded biomaterials (ALBs) have emerged as a potential useful adjunctive antimicrobial measure for the prevention of infection in open fracture care. A biodegradable thermo-responsive poly(N-isopropylacrylamide) grafted hyaluronic acid (HApN) hydrogel loaded with gentamicin has recently been shown to prevent implant-related infection in a rabbit osteosynthesis model. The primary aim of this study was to determine the influence of this HApN hydrogel on bone healing at an early stage (4 weeks). A rabbit humeral osteotomy model with plating osteosynthesis was used to compare fracture healing in rabbits receiving the hydrogel as compared with control animals. The secondary aim was to observe fracture healing in groups treated with and without antibiotic-loaded hydrogel in the presence of bacterial contamination. In all groups, outcome measures were mechanical stability and histological score, with additional quantitative bacteriology in the inoculated groups. Application of the HApN hydrogel in non-inoculated rabbits did not significantly influence humeral stiffness or histological scores for fracture healing in comparison to controls. In the inoculated groups, animals receiving the bacterial inoculum without hydrogel were culture-positive at euthanasia and found to display lower humeral stiffness values and higher histopathological scores for bacterial presence in comparison with equivalents receiving the gentamicin-loaded HApN hydrogel, which were also infection-free. In summary, our data showed that HApN was an effective antibiotic carrier that did not affect fracture healing. This data supported its suitability for application in fracture care. Addition of osteopromotive compounds could provide further support for accelerating fracture healing in addition to successful infection prophylaxis.

  9. The use of 18F-fluoride and 18F-FDG PET scans to assess fracture healing in a rat femur model

    Science.gov (United States)

    Hsu, W. K.; Feeley, B. T.; Krenek, L.; Stout, D. B.; Chatziioannou, A. F.; Lieberman, J. R.

    2011-01-01

    Purpose Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with 18F-fluoride ion, which localizes in regions of high osteoblastic activity, and 18F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Methods Fractures were created in the femurs of immuno-competent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, 18F-fluoride, and 18F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. Results All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. 18F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using 18F-FDG PET imaging at any time point. Conclusion This study suggests that 18F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time point

  10. The interplay of transcriptional and post-transcriptional regulation of migration of mesenchymal stem cells during early stages of bone fracture healing.

    Science.gov (United States)

    Dong, C-H; Deng, Y-S; Yang, X-J; Liu, J; Liu, R; Hou, F-Y; Li, S-S; Zhen, P

    2017-12-01

    Bone fractures are a medical condition where the continuity of the bone is broken due to a fall or accident. The fracture may also be the result of medical conditions such as osteoporosis, cancers of bone or osteogenesis imperfect. During the bone fracture healing process, the mesenchymal stem cells (undifferentiated connective tissue cells) are recruited from local and systemic sources. The modulation of mesenchymal cell migration to the fractured site is the desired goal. Still, there are many processes that are still required to be studied and analyzed. We aimed to consolidate and review the available information on this topic.

  11. Low-magnitude high-frequency vibration enhances gene expression related to callus formation, mineralization and remodeling during osteoporotic fracture healing in rats.

    Science.gov (United States)

    Chung, Shu-Lu; Leung, Kwok-Sui; Cheung, Wing-Hoi

    2014-12-01

    Low magnitude high frequency vibration (LMHFV) has been shown to improve anabolic and osteogenic responses in osteoporotic intact bones and during osteoporotic fracture healing; however, the molecular response of LMHFV during osteoporotic fracture healing has not been investigated. It was hypothesized that LMHFV could enhance osteoporotic fracture healing by regulating the expression of genes related to chondrogenesis (Col-2), osteogenesis (Col-1) and remodeling (receptor activator for nuclear factor- κ B ligand (RANKL) and osteoproteger (OPG)). In this study, the effects of LMHFV on both osteoporotic and normal bone fracture healing were assessed by endpoint gene expressions, weekly radiographs, and histomorphometry at weeks 2, 4 and 8 post-treatment. LMHFV enhanced osteoporotic fracture healing by up-regulating the expression of chondrogenesis-, osteogenesis- and remodeling-related genes (Col-2 at week 4 (p=0.008), Col-1 at week 2 and 8 (p<0.001 and p=0.008) and RANKL/OPG at week 8 (p=0.045)). Osteoporotic bone had a higher response to LMHFV than normal bone and showed significantly better results as reflected by increased expression of Col-2 and Col-1 at week 2 (p<0.001 for all), larger callus width at week 2 (p=0.001), callus area at week 1 and 5(p<0.05 for all) and greater relative area of osseous tissue (p=0.002) at week 8. This study helps to understand how LMHFV regulates gene expression of callus formation, mineralization and remodeling during osteoporotic fracture healing. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Fictional metaphysics of fiction: Metaphysics and imagination in the humanities

    OpenAIRE

    Johann-Albrecht Meylahn

    2017-01-01

    A very simplified description of physics could be, according to Wikipedia, natural science that involves the study of matter and its motion and behaviour through space and time. In relation to this simplified description of physics, metaphysics would then be that which gives matter, or metaphysics would be the reflection on the space and time in which matter is given. Yet, how are space and time connected? It is in language, or more specifically narrative (fiction), that space and time are co...

  13. Potent anti-inflammatory agent escin does not affect the healing of tibia fracture and abdominal wound in an animal model

    OpenAIRE

    ZHANG, LEIMING; WANG, HONGSHENG; WANG, TIAN; JIANG, NA; YU, PENGFEI; LIU, FEIYAN; CHONG, YATING; FU, FENGHUA

    2012-01-01

    Escin, a potent anti-inflammatory and anti-edematous agent, has been widely used clinically in preventing inflammatory edema after trauma, such as fracture and surgery. The aim of this study was to investigate whether escin has an inhibitory effect on fracture healing, and whether escin has an inhibitory effect on wound healing after surgery. Male New Zealand white rabbits underwent tibial mid-diaphyseal osteotomy, and were administered escin once per day for 10 days. At weeks 2, 4 and 6, bon...

  14. A biomechanical, micro-computertomographic and histological analysis of the influence of diclofenac and prednisolone on fracture healing in vivo.

    Science.gov (United States)

    Bissinger, Oliver; Kreutzer, Kilian; Götz, Carolin; Hapfelmeier, Alexander; Pautke, Christoph; Vogt, Stephan; Wexel, Gabriele; Wolff, Klaus-Dietrich; Tischer, Thomas; Prodinger, Peter Michael

    2016-09-05

    Non-steroidal anti-inflammatory drugs (NSAIDs) have long been suspected of negatively affecting fracture healing, although numerous disputes still exist and little data are available regarding diclofenac. Glucocorticoids interfere in this process over a similar and even broader mechanism of action. As many previously conducted studies evaluated either morphological changes or biomechanical properties of treated bones, the conjunction of both structural measures is completely missing. Therefore, it was our aim to evaluate the effects of diclofenac and prednisolone on the fracture callus biomechanically, morphologically and by 3-dimensional (3D) microstructural analysis. Femura of diclofenac-, prednisolone- or placebo-treated rats were pinned and a closed transverse fracture was generated. After 21 days, biomechanics, micro-CT (μCT) and histology were examined. The diclofenac group showed significantly impaired fracture healing compared with the control group by biomechanics and μCT (e.g. stiffness: 57.31 ± 31.11 N/mm vs. 122.44 ± 81.16 N/mm, p = 0.030; callus volume: 47.05 ± 15.67 mm3 vs. 67.19 ± 14.90 mm3, p = 0.037, trabecular thickness: 0.0937 mm ± 0.003 vs. 0.0983 mm ± 0.003, p = 0.023), as confirmed by histology. Biomechanics of the prednisolone group showed obviously lower absolute values than the control group. These alterations were confirmed in conjunction with μCT and histology. The inhibiting effects of both substances were not only mediated by absolute parameters (e.g. breaking load, BV), but we have shown, for the first time, that additional changes occurred in the microstructural bony network. Especially in patients at risk for delayed bone healing (arteriosclerosis, diabetes mellitus, smoking), the administration of these drugs should be weighed carefully.

  15. Identification of novel genes associated with fracture healing in osteoporosis induced by Krm2 overexpression or Lrp5 deficiency.

    Science.gov (United States)

    Gao, Feng; Xu, Feng; Wu, Dankai; Cheng, Jieping; Xia, Peng

    2017-06-01

    The aim of the present study was to screen potential key genes associated with osteoporotic fracture healing. The microarray data from the Gene Expression Omnibus database accession number GSE51686, were downloaded and used to identify differentially expressed genes (DEGs) in fracture callus tissue samples obtained from the femora of type I collagen (Col1a1)‑kringle containing transmembrane protein 2 (Krm2) mice and low density lipoprotein receptor‑related protein 5‑/‑ (Lrp5‑/‑) transgenic mice of osteoporosis compared with those in wild‑type (WT) mice. Enrichment analysis was performed to reveal the DEG function. In addition, protein‑protein interactions (PPIs) of DEGs were analyzed using the Search Tool for the Retrieval of Interacting Genes database. The coexpression associations between hub genes in the PPI network were investigated, and a coexpression network was constructed. A total of 841 DEGs (335 upregulated and 506 downregulated) were identified in the Col1a1‑Krm2 vs. the WT group, and 50 DEGs (16 upregulated and 34 downregulated) were identified in the Lrp5‑/‑ vs. the WT group. The DEGs in Col1a1‑Krm2 mice were primarily associated with immunity and cell adhesion (GO: 0007155) functions. By contrast, the DEGs in Lrp5‑/‑ mice were significantly associated with muscle system process (GO: 0003012) and regulation of transcription (GO: 0006355). In addition, a series of DEGs demonstrated a higher score in the PPI network, and were observed to be coexpressed in the coexpression network, and included thrombospondin 2 (Thbs2), syndecan 2 (Sdc2), FK506 binding protein 10 (Fkbp10), 2'‑5'-oligoadneylate synthase‑like protein 2 (Oasl2), interferon induced protein with tetratricopeptide repeats (Ifit) 1 and Ifit2. Thbs2 and Sdc2 were significantly correlated with extracellular matrix‑receptor interactions. The results suggest that Thbs2, Sdc2, Fkbp10, Oasl2, Ifit1 and Ifit2 may serve important roles during the fracture

  16. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study

    DEFF Research Database (Denmark)

    Doetsch, A M; Faber, J; Lynnerup, N

    2004-01-01

    density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements...... that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period...... demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other...

  17. Effects of " vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Eftekhari

    2014-01-01

    Full Text Available Background: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. Material and Methods: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1 one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus plus 250 mg magnesium oxide (VAC + Mg group (n = 10, 2 one Agnugol tablet plus placebo (VAC group (n = 15, 3 placebo plus 250 mg magnesium oxide (Mg group (n = 12, or 4 placebo plus placebo (placebo group (n = 14 per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF were measured together with radiological bone assessment. Results: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05, administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05. Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39. No relevant side effect was observed in patients in each group. Conclusion : Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

  18. Effects of "vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture.

    Science.gov (United States)

    Eftekhari, Mohammad Hassan; Rostami, Zahra Hassanzadeh; Emami, Mohammad Jafar; Tabatabaee, Hamid Reza

    2014-01-01

    The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

  19. [Our first experiences with autologous transplantation of bone marrow stem cells to treat pseudarthrosis, delayed fracture healing and long bone defects fracture].

    Science.gov (United States)

    Sír, M; Procházka, V; Gumulec, J; Pleva, L

    2009-03-01

    Traumatology and orthopaedics have undergone substantial progress in the use of new, sophisticated techniques, implants and navigation methods. Nevertheless, these new methods continue to fail in some instances. Regenerative medicine using the growth potential of stem cells that posses the ability to regenerate damaged tissues represent one of the possible ways forward. There is a potential for more comprehensive utilization of bone marrow stem cells that had for many years been used in transplant medicine. Traumatology and orthopaedics could utilise stem cells in the treatment of bone defects, i.e. in the treatment of pseudarthrosis, delayed fracture healing, defect fractures and aseptic bone necroses. Bone formation and growth is a complex, predominantly anabolic, process with a range of feedbacks. Nevertheless, it is the bone marrow where the necessary progenitors of bone growth are located. These are mesenchymal stem cells (MSCs), haematopoietic stem cells (HSCs) as well as thrombocytes containing a range of necessary growth factors. A number of studies showed positive results for stem cells treatment of pseudarthrosis, with only a fraction, however, being statistically significant in human medicine. This method was used in 11 patients of the Traumatology Centre of the Faculty Hospital in Ostrava, Czech Republic in 2008. The researched patients were treated for pseudarthrosis of long bones, delayed multifragmentary fracture haling and defect fractures of long bones. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect in a patient lightly anaesthetised with propofol. The results from this small sample of patients are not yet available. However, we are sharing our first experiences with this treatment option.

  20. Conceptual Realism. The Structure of Metaphysical Thought

    NARCIS (Netherlands)

    Mulder, J.M.

    2014-01-01

    Metaphysics is now a respectable discipline within analytic philosophy: metaphysical realists are proposing their various theories as to the ultimate structure of reality. However, their project is also being fundamentally questioned, by metaphysical anti-realists. This ambivalent situation is due

  1. The Scientific Metaphysics of Charles S. Peirce

    DEFF Research Database (Denmark)

    Sørensen, Bent; Thellefsen, Torkild Leo

    scientific results and conceptions of his time, but also, like Immanuel Kant, to set metaphysics on the path of a science. This collection of articles investigates central themes and difficulties in the metaphysics of Peirce - some of the articles clarify aspects of his metaphysics, others also show...

  2. In Vivo Evaluation of Fracture Callus Development During Bone Healing in Mice Using an MRI-compatible Osteosynthesis Device for the Mouse Femur.

    Science.gov (United States)

    Haffner-Luntzer, Melanie; Müller-Graf, Fabian; Matthys, Romano; Abaei, Alireza; Jonas, René; Gebhard, Florian; Rasche, Volker; Ignatius, Anita

    2017-11-14

    Endochondral fracture healing is a complex process involving the development of fibrous, cartilaginous, and osseous tissue in the fracture callus. The amount of the different tissues in the callus provides important information on the fracture healing progress. Available in vivo techniques to longitudinally monitor the callus tissue development in preclinical fracture-healing studies using small animals include digital radiography and µCT imaging. However, both techniques are only able to distinguish between mineralized and non-mineralized tissue. Consequently, it is impossible to discriminate cartilage from fibrous tissue. In contrast, magnetic resonance imaging (MRI) visualizes anatomical structures based on their water content and might therefore be able to noninvasively identify soft tissue and cartilage in the fracture callus. Here, we report the use of an MRI-compatible external fixator for the mouse femur to allow MRI scans during bone regeneration in mice. The experiments demonstrated that the fixator and a custom-made mounting device allow repetitive MRI scans, thus enabling longitudinal analysis of fracture-callus tissue development.

  3. Effects of radiation and surgery on healing of femoral fractures in a rat model.

    Science.gov (United States)

    Nicholls, Fred; Janic, Katarina; Filomeno, Paola; Willett, Thomas; Grynpas, Marc; Ferguson, Peter

    2013-08-01

    Management of soft tissue sarcoma involves multimodality treatment, including surgery and radiotherapy. Pathologic fracture of the femur after such treatment in the thigh is one serious, late complication and nonunion rates of 80-90% are reported. We hypothesize that the combination of radiotherapy and periosteal stripping (during tumor resection) leads to greater impairment of the fracture repair process than either intervention alone. Female Wistar retired breeder rats were randomized into four treatment groups (control, radiotherapy, surgery, and combination of radiotherapy and surgery) and three end-points (21, 28, and 35 days post-fracture). Designated animals first underwent radiotherapy, followed by surgical stripping of the periosteum 3 weeks later and femoral fracture with fixation after another 3 weeks. Animals were sacrificed and fractures examined using microCT and histomorphometry. Simple transverse or short oblique femoral fractures were produced. By 35 days, control animals formed unions, periosteum-stripped animals formed hypertrophic non-unions and irradiated animals formed atrophic non-unions. Histomorphometry revealed an absence of chondroid and osteoid production in animals undergoing radiotherapy. The relative contribution of periosteal stripping to occurrence of non-union was statistically insignificant. Radiation prior to fracture reliably resulted in atrophic non-union in our model. The contribution of periosteal stripping was negligible. Copyright © 2013 Orthopaedic Research Society.

  4. Fatalism as a Metaphysical Thesis

    Directory of Open Access Journals (Sweden)

    Ulrich Meyer

    Full Text Available ABSTRACT Even though fatalism has been an intermittent topic of philosophy since Greek antiquity, this paper argues that fate ought to be of little concern to metaphysicians. Fatalism is neither an interesting metaphysical thesis in its own right, nor can it be identified with theses that are, such as realism about the future or determinism.

  5. String theory : physics or metaphysics?

    CERN Document Server

    Veneziano, Gabriele

    2010-01-01

    I will give arguments for why the enormous progress made during the last century on understanding elementary particles and their fundamental interactions suggests strings as the truly elementary constituents of Nature. I will then address the issue of whether the string paradigm can in principle be falsified or whether it should be considered as mere metaphysics.

  6. Interzones of Law and Metaphysics

    DEFF Research Database (Denmark)

    Mossin, Christiane

    and sources of authority. On the basis of a historical-conceptual understanding of law according to which law, social structure and metaphysical presumptions are inescapably intertwined, the dissertation derives from the binding provisions of law certain essential features of social order. More precisely...

  7. Towards a Metaphysics of Complexity

    Science.gov (United States)

    Robinson, Keith

    2005-01-01

    In this paper, I combine aspects of process philosophy and elements from philosophies of difference in order to give some indication of how we might begin to construct a metaphysics of contemporary science. I will focus on the work of Whitehead and Deleuze as representatives of each respective tradition and try to show how their work can be…

  8. Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study.

    Science.gov (United States)

    Bojan, Alicja J; Jönsson, Anders; Granhed, Hans; Ekholm, Carl; Kärrholm, Johan

    2018-03-01

    Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice

    Directory of Open Access Journals (Sweden)

    Esther Wehrle

    2015-01-01

    Full Text Available Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV. We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96 were either ovariectomised (OVX or sham operated (non-OVX at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day with 0.3 g peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine were evaluated using bending-testing, micro-computed tomography (μCT, histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (−81% and bone formation (−80% in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2 and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+1398% and bone formation (+637%, which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet. On a molecular level, we found an upregulation of ERα in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERα might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and

  10. Comparison of the effects of dexketoprofen trometamol, meloxicam and diclofenac sodium on fibular fracture healing, kidney and liver: an experimental rat model.

    Science.gov (United States)

    Inal, Sermet; Kabay, Sahin; Cayci, M Kasim; Kuru, H Isa; Altikat, Sayit; Akkas, Gizem; Deger, Aysenur

    2014-03-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly used in patients with bone fractures, but there are limited studies on whether one NSAID is superior to another. In this study, we used histopathological and biochemical parameters to determine whether there are differences between the effects of the administration of clinical doses of dexketoprofen trometamol (DEXT), meloxicam (MEL) and diclofenac sodium (DIC) on the healing of closed fibular fractures and the toxicity of both the liver and kidney. Twenty-eight male Sprague-Dawley rats were randomly divided into four groups of seven each. Closed diaphyseal fractures were formed in the left fibulas of all of the rats. The NSAIDs dexketoprofen trometamol (DEXT) (Arveles(®)), meloxicam (MEL) (Melox(®)) and diclofenac sodium (DIC) (Voltaren(®)) were intramuscularly administered to Groups I, II, and III, respectively, for a period of 10 days after the fibular fractures were performed. No pharmacological agents were administered to Group IV (Control group). Blood samples were collected from all of the rats after the fractures were performed, and the rats were sacrificed on day 28. The histopathological findings were compared, and the blood samples were evaluated to determine any differences between the levels of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). Our results suggest that DEXT and MEL impair the healing of bone fractures and that DIC does not histopathologically affect the healing process of bone fractures. We also found that DEXT, MEL, and DIC impaired the renal histopathology compared with the control group. However, the liver histopathological analysis showed that DEXT and MEL caused a higher degree of parenchymal necrosis compared with DIC. Based on our results, DIC can be considered a relatively safe medication in patients with fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Delayed healing of a navicular stress fracture, following limited weight-bearing activity.

    Science.gov (United States)

    Robinson, Matthew; Fulcher, Mark

    2014-03-11

    This report describes a 21-year-old man, a semiprofessional football (soccer) player, with a navicular stress fracture. It highlights the difficulty in diagnosing the condition and the complications arising from inadequate management. The case discusses the optimal management of these stress fractures and the detrimental role of weight-bearing recovery. The diagnosis of navicular stress fractures is challenging, and a high index of suspicion is required. The available literature indicates that limited weightbearing is not an appropriate treatment for navicular stress injuries. Non-weight-bearing (NWB) cast immobilisation for 6-8 weeks appears to be the gold standard treatment; however, open reduction with internal fixation (ORIF) has similar success rates and an equal return-to-play time but should also be followed by a period of NWB. NWB cast immobilisation for 6 weeks remains a good second option at any time following failed limited weight-bearing activity.

  12. Mechanical stimulation enhanced estrogen receptor expression and callus formation in diaphyseal long bone fracture healing in ovariectomy-induced osteoporotic rats.

    Science.gov (United States)

    Chow, S K H; Leung, K S; Qin, J; Guo, A; Sun, M; Qin, L; Cheung, W H

    2016-10-01

    Estrogen receptor (ER) in ovariectomy-induced osteoporotic fracture was reported to exhibit delayed expression. Mechanical stimulation enhanced ER-α expression in osteoporotic fracture callus at the tissue level. ER was also found to be required for the effectiveness of vibrational mechanical stimulation treatment in osteoporotic fracture healing. Estrogen receptor(ER) is involved in mechanical signal transduction in bone metabolism. Its expression was reported to be delayed in osteoporotic fracture healing. The purpose of this study was to investigate the roles played by ER during osteoporotic fracture healing enhanced with mechanical stimulation. Ovariectomy-induced osteoporotic SD rats that received closed femoral fractures were divided into five groups, (i) SHAM, (ii) SHAM-VT, (iii) OVX, (iv) OVX-VT, and (v) OVX-VT-ICI, where VT stands for whole-body vibration treatment and ICI for ER antagonization by ICI 182,780. Callus formation and gene expression were assessed at 2, 4, and 8 weeks postfracture. In vitro osteoblastic differentiation, mineralization, and ER-α expression were assessed. The delayed ER expression was found to be enhanced by vibration treatment. Callus formation enhancement was shown by callus morphometry and micro-CT analysis. Enhancement effects by vibration were partially abolished when ER was modulated by ICI 182,780, in terms of callus formation capacity at 2-4 weeks and ER gene and protein expression at all time points. In vitro, ER expression in osteoblasts was not enhanced by VT treatment, but osteoblastic differentiation and mineralization were enhanced under estrogen-deprived condition. When osteoblastic cells were modulated by ICI 182,780, enhancement effects of VT were eliminated. Vibration was able to enhance ER expression in ovariectomy-induced osteoporotic fracture healing. ER was essential in mechanical signal transduction and enhancement in callus formation effects during osteoporotic fracture healing enhanced by vibration

  13. Development of a Novel Synthetic Drug for Osteoporosis and Fracture Healing

    Science.gov (United States)

    2014-09-01

    exclusively in electronic tonn (no paper notiJications will be sent). --------------~-~~::~-~~-~-~:::~-~-~---~-~-~~-~-~@-~_:;-~~!!~~~-~X::’.:!::~~2...expression. Thus, the result here is consistent with the previously reported role of salubrinal 30 that stimulates new bone fom1ation in the healing...17] Sudo H, KodamaHA, Amagai Y, Yamamoto S, Kasai S (1983) In vitro differentiation and calcification in a new donal osteogenic cell 1ine derived from

  14. Forces associated with launch into space do not impact bone fracture healing

    Science.gov (United States)

    Childress, Paul; Brinker, Alexander; Gong, Cynthia-May S.; Harris, Jonathan; Olivos, David J.; Rytlewski, Jeffrey D.; Scofield, David C.; Choi, Sungshin Y.; Shirazi-Fard, Yasaman; McKinley, Todd O.; Chu, Tien-Min G.; Conley, Carolynn L.; Chakraborty, Nabarun; Hammamieh, Rasha; Kacena, Melissa A.

    2018-02-01

    Segmental bone defects (SBDs) secondary to trauma invariably result in a prolonged recovery with an extended period of limited weight bearing on the affected limb. Soldiers sustaining blast injuries and civilians sustaining high energy trauma typify such a clinical scenario. These patients frequently sustain composite injuries with SBDs in concert with extensive soft tissue damage. For soft tissue injury resolution and skeletal reconstruction a patient may experience limited weight bearing for upwards of 6 months. Many small animal investigations have evaluated interventions for SBDs. While providing foundational information regarding the treatment of bone defects, these models do not simulate limited weight bearing conditions after injury. For example, mice ambulate immediately following anesthetic recovery, and in most cases are normally ambulating within 1-3 days post-surgery. Thus, investigations that combine disuse with bone healing may better test novel bone healing strategies. To remove weight bearing, we have designed a SBD rodent healing study in microgravity (μG) on the International Space Station (ISS) for the Rodent Research-4 (RR-4) Mission, which launched February 19, 2017 on SpaceX CRS-10 (Commercial Resupply Services). In preparation for this mission, we conducted an end-to-end mission simulation consisting of surgical infliction of SBD followed by launch simulation and hindlimb unloading (HLU) studies. In brief, a 2 mm defect was created in the femur of 10 week-old C57BL6/J male mice (n = 9-10/group). Three days after surgery, 6 groups of mice were treated as follows: 1) Vivarium Control (maintained continuously in standard cages); 2) Launch Negative Control (placed in the same spaceflight-like hardware as the Launch Positive Control group but were not subjected to launch simulation conditions); 3) Launch Positive Control (placed in spaceflight-like hardware and also subjected to vibration followed by centrifugation); 4) Launch Positive

  15. Means of enhancing bone fracture healing : Optimal cell source, isolation methods and acoustic stimulation

    NARCIS (Netherlands)

    Ghebes, Corina Adriana; Braham, Maaike Vera Jasmijn; Zeegers, Adelgunde Veronica Clemens Maria; Renard, Auke Jan Sijbe; Fernandes, Hugo; Saris, Daniel B F

    2016-01-01

    Background: The human body has an extensive capacity to regenerate bone tissue after trauma. However large defects such as long bone fractures of the lower limbs cannot be restored without intervention and often lead to nonunion. Therefore, the aim of the present study was to assess the pool and

  16. Effects of intramedullary nails composed of a new β-type Ti-Nb-Sn alloy with low Young's modulus on fracture healing in mouse tibiae.

    Science.gov (United States)

    Fujisawa, Hirokazu; Mori, Yu; Kogure, Atsushi; Tanaka, Hidetatsu; Kamimura, Masayuki; Masahashi, Naoya; Hanada, Shuji; Itoi, Eiji

    2018-01-23

    The influence of Young's moduli of materials on the fracture healing process remains unclear. This study aimed to assess the effects of intramedullary nails composed of materials with low Young's moduli on fracture repair. We previously developed a β-type Ti-Nb-Sn alloy with low Young's modulus close to that of human cortical bone. Here, we prepared two Ti-Nb-Sn alloys with Young's moduli of 45 and 78 GPa by heat treatment, and compared their effects on fracture healing. Fracture and nailing were performed in the right tibiae of C57BL/6 mice. The bone healing process was evaluated by microcomputed tomography (micro-CT), histomorphometry, and RT-PCR. We found larger bone volumes of fracture callus in the mice treated with the 45-GPa Ti-Nb-Sn alloy as compared with the 78-GPa Ti-Nb-Sn alloy in micro-CT analyses. This was confirmed with histology at day 14, with accelerated new bone formation and cartilage absorption in the 45-GPa Ti-Nb-Sn group compared with the 78-GPa Ti-Nb-Sn group. Acp5 expression was lower in the 45-GPa Ti-Nb-Sn group than in the 78-GPa Ti-Nb-Sn group at day 10. These findings indicate that intramedullary fixation with nails with a lower Young's modulus offer a greater capacity for fracture repair. Our 45-GPa Ti-Nb-Sn alloy is a promising material for fracture treatment implants. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

  17. Musical Ontology: Critical, not Metaphysical

    Directory of Open Access Journals (Sweden)

    Jonathan A. Neufeld

    2014-01-01

    Full Text Available The ontology of musical works often sets the boundaries within which evaluation of musical works and performances takes place. Questions of ontology are therefore often taken to be prior to and apart from the evaluative questions considered by either performers as they present works to audiences or an audience’s critical reflection on a performance. In this paper I argue that, while the ontology of musical works may well set the boundaries of legitimate evaluation, ontological questions should not be considered as prior to or apart from critical evaluation. Rather, ontological claims are a type of critical evaluation made within musical practices. I argue that philosophers of music might learn from the debate in political philosophy about the difficulty of setting the limits of public reason in a way that remains open to a plurality of legitimate evaluative perspectives. Just as pre-political or metaphysical identification of the boundaries of public reason fail to accommodate the fact of pluralism in contemporary democratic politics, so too does a metaphysical identification of the boundaries of legitimate evaluation of musical works and performances fail to accommodate the fact of pluralism in contemporary musical practices. I apply John Rawls’s formulation of political liberalism, arguing that musical ontology should be critical, not metaphysical.

  18. [Healing of spiral fractures in the sheep tibia comparing different methods--osteosynthesis with internal fixation, interlocking nailing and dynamic compression plate].

    Science.gov (United States)

    Seibold, R; Schlegel, U; Kessler, S B; Cordey, J; Perren, S M; Schweiberer, L

    1995-12-01

    The healing process of spiral fractures of the sheep tibia was investigated in an experiment with simulated clinical conditions. The effects of conventional internal fixation techniques with the DCP and the intramedullary nail are compared with those of internal fixation with the spine fixator. The internal fixation techniques are described in terms of their bending stiffness when mounted on the fractured bone. The in vivo investigation was documented clinically and radiographically and the post mortem specimens were evaluated histologically. The bending stiffness of the healed bone was assessed in relation to the contralateral side. After application of the DCP, primary healing took place and extensive transcortical necrosis occurred in the implant bed. Intramedullary nailing led to secondary healing and to necrosis of the inner cortex close to the endosteum. After internal fixation with the spine fixator, gap healing took place and no cortical necrosis was observed. The clinical course was generally good after all procedures. The histological evaluation shows that damage to the vascularity of the bone can only be avoided by using the spine fixator. This principle seems to be appropriate for the purposes of biological internal fixation.

  19. Healing of shear strength and its time dependency in a single rock fracture

    International Nuclear Information System (INIS)

    Kawaguchi, Yuta; Nakashima, Shinichiro; Yasuhara, Hideaki; Kishida, Kiyoshi

    2011-01-01

    Evolution of the long-term mechanical, hydraulic, and transport characteristics of rock fractures should be, in advance, predicted in considering an issue on entombment of energy byproducts of high level radioactive wastes. Under stressed and temperature conditions, those behaviors of the rock fractures of interest may be evolved in time and space likely due to the change in topographical aperture distributions. This irreversible process may be induced by pure mechanical and/or chemo-mechanical creeps such as water-rock reactions like stress corrosion and pressure solution, and chemical effects including mineral dissolution and reprecipitation in the free-walls of fractures. Specifically, the chemo-mechanical processes active at the contacting asperities within rock fractures may exert a significant influence on the mechanical, hydraulic, and transport behaviors throughout a long period, and thus, should be vigorously examined theoretically and experimentally. This paper presents the slide-hold-slide shear test results for fully saturated, single-jointed mortar specimens so as to investigate the effects of load holding on mechanical properties of rock joints. From the test results, it was confirmed that shear strength increased for mortar specimens in both short and long time holding cases. However, the evolution of shear strength recovery in two cases is different. This is because a dominant factor of shear strength recovery during the short time holding may be attributed to a pure mechanical process like creep deformation at contacting asperities, while the one during long time holding is affected by both mechanical and chemical processes like pressure solution. Moreover, to reproduce the shear strength recovery during short time holding we develop a direct shear model by including temporal variation of dilation during holding. The model predictions are in relatively good agreement with the test measurements. (author)

  20. Transhumanism, metaphysics, and the posthuman god.

    Science.gov (United States)

    Bishop, Jeffrey P

    2010-12-01

    After describing Heidegger's critique of metaphysics as ontotheology, I unpack the metaphysical assumptions of several transhumanist philosophers. I claim that they deploy an ontology of power and that they also deploy a kind of theology, as Heidegger meant it. I also describe the way in which this metaphysics begets its own politics and ethics. In order to transcend the human condition, they must transgress the human.

  1. Metaphysics after Metaphysics: The Limitative Conception of First Philosophy in Kant

    OpenAIRE

    Günter Zöller

    2003-01-01

    The essay examines Kant’s Enlightenment conception of metaphysics as a science (Wissenschaft) to be kept free of ideological prejudice and extrarational cognitive resources and to be established under the conditions of public, intersubjectively valid discourse. I analyze Kant’s self-interpretation of his transcendental philosophy as “metaphysics of metaphysics” and argue for the extensional partial identity of the critique of metaphysics and the metaphysics so rendered possible. In particular...

  2. On Darwin's 'metaphysical notebooks'. II: "Metaphysics" and final cause.

    Science.gov (United States)

    Calabi, L

    2001-01-01

    The first part of this paper was published in Rivista di Biologia/Biology Forum 94 (2001). In the second part below an examination is made of the meaning of the term Metaphysics in some passages of the Darwinian Notebooks for the years 1836-1844. Metaphysics no longer defines a field of philosophical enquiries mainly concerning the being and the essence after the manner of Aristotle; it now refers to a kind of philosophy of mind after the manner of J. Locke's criticism of the Hypokeimenon. However Aristotle's Metaphysics also encompasses a treatment of the idea of causes, and of final cause particularly, in the explanation of events, and in the explanation of natural phenomena especially. The criticism of the idea of final cause in the interpretation of the world of life is one of Darwin's foundational acts in his early years. When conceiving his Système du monde, in the last years of the XVIII Century, Laplace could think that God is a hypothesis not really needed by science, as we are told. For the knowledge of organic nature to attain the status of science, it remained to be shown that since--certain of the exemplariness of Newton's Principles as much as cautious before the mystery of life--did not need the hypothesis of final ends in order to understand and explain the productions of the living nature: not only in the form of that final cause (the First Cause, the Vera Causa) in which Natural Theology still rested, but also in the form of nature's inner finality which still moulded Whewell's Kantian philosophy. Such demonstration is a very important subject in Darwin's early enquiries, where he criticises finalism as a projection of self-conceiving Man, likely inherited from a knowing of causality in nuce to be found also in animals.

  3. Effects of Low-Dose Microwave on Healing of Fractures with Titanium Alloy Internal Fixation: An Experimental Study in a Rabbit Model

    Science.gov (United States)

    Zhang, Han; Fu, Tengfei; Jiang, Lan; Bai, Yuehong

    2013-01-01

    Background Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. Methods Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day) to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. Findings The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. Conclusion Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method. PMID:24086626

  4. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  5. Fracture Toughness of Carbon Fiber Composites Containing Various Fiber Sizings and a Puncture Self-Healing Thermoplastic Matrix

    Science.gov (United States)

    Cano, Roberto J.; Grimsley, Brian W.; Ratcliffe, James G.; Gordon, Keith L.; Smith, Joseph G.; Siochi, Emilie J.

    2015-01-01

    Ongoing efforts at NASA Langley Research Center (LaRC) have resulted in the identification of several commercially available thermoplastic resin systems which self-heal after ballistic impact and through penetration. One of these resins, polybutylene graft copolymer (PBg), was selected as a matrix for processing with unsized carbon fibers to fabricate reinforced composites for further evaluation. During process development, data from thermo-physical analyses was utilized to determine a processing cycle to fabricate laminate panels, which were analyzed by photo microscopy and acid digestion. The process cycle was further optimized based on these results to fabricate panels for mechanical property characterization. The results of the processing development effort of this composite material, as well as the results of the mechanical property characterization, indicated that bonding between the fiber and PBg was not adequate. Therefore, three sizings were investigated in this work to assess their potential to improve fiber/matrix bonding compared to previously tested unsized IM7 fiber. Unidirectional prepreg was made at NASA LaRC from three sized carbon fibers and utilized to fabricate test coupons that were tested in double cantilever beam configurations to determine GIc fracture toughness.

  6. Low-intensity pulsed ultrasound increases bone volume, osteoid thickness and mineral apposition rate in the area of fracture healing in patients with a delayed union of the osteotomized fibula

    NARCIS (Netherlands)

    Rutten, S.; Nolte, P.A.; Korstjens, C.M.; van Duin, M.A.; Klein-Nulend, J.

    2008-01-01

    Introduction Low-intensity pulsed ultrasound (LIPUS) accelerates impaired fracture healing, but the exact mechanism is unknown. The aim of this study was to investigate how LIPUS affects bone healing at the tissue level in patients with a delayed union of the osteotomized fibula, by using histology

  7. Delayed fracture healing and increased callus adiposity in a C57BL/6J murine model of obesity-associated type 2 diabetes mellitus.

    Directory of Open Access Journals (Sweden)

    Matthew L Brown

    Full Text Available INTRODUCTION: Impaired healing and non-union of skeletal fractures is a major public health problem, with morbidity exacerbated in patients with diabetes mellitus (DM. DM is prevalent worldwide and affects approximately 25.8 million US adults, with >90% having obesity-related type 2 DM (T2DM. While fracture healing in type 1 DM (T1DM has been studied using animal models, an investigation into delayed healing in an animal model of T2DM has not yet been performed. METHODS: Male C57BL/6J mice at 5 weeks of age were placed on either a control lean diet or an experimental high-fat diet (HFD for 12 weeks. A mid-diaphyseal open tibia fracture was induced at 17 weeks of age and a spinal needle was used for intra-medullary fixation. Mice were sacrificed at days 7, 10, 14, 21, 28, and 35 for micro-computed tomography (μCT, histology-based histomorphometry and molecular analyses, and biomechanical testing. RESULTS: HFD-fed mice displayed increased body weight and impaired glucose tolerance, both characteristic of T2DM. Compared to control mice, HFD-fed mice with tibia fractures showed significantly (p<0.001 decreased woven bone at day 28 by histomorphometry and significantly (p<0.01 decreased callus bone volume at day 21 by μCT. Interestingly, fracture calluses contained markedly increased adiposity in HFD-fed mice at days 21, 28, and 35. HFD-fed mice also showed increased PPARγ immunohistochemical staining at day 14. Finally, calluses from HFD-fed mice at day 35 showed significantly (p<0.01 reduced torsional rigidity compared to controls. DISCUSSION: Our murine model of T2DM demonstrated delayed fracture healing and weakened biomechanical properties, and was distinctly characterized by increased callus adiposity. This suggests altered mesenchymal stem cell fate determination with a shift to the adipocyte lineage at the expense of the osteoblast lineage. The up-regulation of PPARγ in fracture calluses of HFD-fed mice is likely involved in the proposed

  8. Dewey's Naturalistic Metaphysics: Expostulations and Replies

    Science.gov (United States)

    Friedman, Randy L.

    2011-01-01

    Critics of Dewey's metaphysics point to his dismissal of any philosophy which locates ideals in a realm beyond experience. However, Dewey's sustained critique of dualistic philosophies is but a first step in his reconstruction and recovery of the function of the metaphysical. Detaching the discussion of values from inquiry, whether scientific,…

  9. The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice.

    Science.gov (United States)

    Wehrle, Esther; Liedert, Astrid; Heilmann, Aline; Wehner, Tim; Bindl, Ronny; Fischer, Lena; Haffner-Luntzer, Melanie; Jakob, Franz; Schinke, Thorsten; Amling, Michael; Ignatius, Anita

    2015-01-01

    Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV). We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96) were either ovariectomised (OVX) or sham operated (non-OVX) at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day) with 0.3 G: peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine) were evaluated using bending-testing, micro-computed tomography (μCT), histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (-81%) and bone formation (-80%) in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2) and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+1398%) and bone formation (+637%), which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet). On a molecular level, we found an upregulation of ERα in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERα might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and effective in

  10. Dual modulation of bone formation and resorption with zoledronic acid-loaded biodegradable magnesium alloy implants improves osteoporotic fracture healing: An in vitro and in vivo study.

    Science.gov (United States)

    Li, Guoyuan; Zhang, Lei; Wang, Lei; Yuan, Guangyin; Dai, Kerong; Pei, Jia; Hao, Yongqiang

    2018-01-01

    Osteoporotic fracture (OPF) remains a major clinical challenge for skeletal regeneration. Impaired osteogenesis and excessive remodeling result in prolonged and poor quality of fracture healing. To augment bone formation and inhibit excessive resorption simultaneously, we constructed a biodegradable magnesium-based implant integrated with the anti-catabolic drug zoledronic acid (ZA); this implant exhibits controllable, sustained release of magnesium degradation products and ZA in vitro. The extracts greatly stimulate the osteogenic differentiation of rat-bone marrow-derived mesenchymal stem cells (rBMSCs), while osteoclastogenesis is inhibited by ZA. Implantation of intramedullary nails to fix femur fracture in ovariectomy-induced osteoporotic rats for up to 12 weeks demonstrates magnesium implants alone can enhance OPF repair through promoting callus formation compared to conventional stainless steel, while the combinatory treatment with local ZA release from implant coating further increases bone regeneration rate and callus size, remarkably improves bone quality and mechanical strength and suppresses osteoclasts and bone remodeling, due to the synergistic effect of both agents. The slow and uniform degradation of the implant ensures a steady decrease in bending force, which meets clinical requirements. In summary, biodegradable magnesium-based implants can locally co-deliver magnesium degradation products and zoledronic acid in a controlled manner, and can be superior alternatives for the reconstruction of osteoporosis-related fracture. Management of osteoporotic fracture has posed a major challenge in orthopedics, as the imbalance between diminished osteogenesis and excessive bone remodeling often leads to delayed and compromised fracture repair. Among various efforts expended on augmenting osteoporotic fracture healing, herein we reported a new strategy by engineering and utilizing a biodegradable magnesium-based implant integrated with local drug delivery

  11. Pyle metaphyseal dysplasia in an African child: Case report and review of the literature.

    Science.gov (United States)

    Wonkam, A; Makubalo, N; Roberts, T; Chetty, M

    2016-05-25

    Pyle disease (OMIM 265900), also known as metaphyseal dysplasia, is a rare autosomal recessive disorder with no known gene mutation. We report a case of Pyle disease in a 7-year-old African boy of mixed ancestry who presented with finger and wrist fractures following minor trauma. The radiological findings revealed abnormally broad metaphyses of the tubular bones, known as Erlenmeyer-flask bone deformity, and mild cranial sclerosis, both hallmarks of the condition. We report the first case in a patient with African ancestry, which could help in the gene discovery of this rare autosomal recessive skeletal dysplasia with unknown mutations.

  12. [Value of intramedullary locked nailing in distal fractures of the tibia].

    Science.gov (United States)

    Bonnevialle, P; Savorit, L; Combes, J M; Rongières, M; Bellumore, Y; Mansat, M

    1996-01-01

    This study is a retrospective analysis of 38 extra-articular distal tibial fractures treated by intramedullary locked nailing. 38 patients with a distal metaphyseal extra-articular fracture (43 A AO type) or with minimal ankle joint extension were managed. There was 26 men and 12 women with a mean age of 32.3 years, 10 fractures were open. The fractures were transverse or oblique in 13 cases, with torsional or flexion wedge in 12 cases and spiroïd in 13 cases. In only 2 cases was the fibula intact. AO classification was not useful because many fractures began more proximally than the limit described by Müller. All the fractures were fixed by closed locked intramedullary nailing : the nail was cut just after the distal hole and impacted close to the subchondral plate. In 7 cases the fibula was fixed too. There was no postoperative complication in 27 cases. Three patients had a transient nerve palsy (one tibial nerve and two common fibular nerve). In ten cases the nail was dynamized. One patient had a non union but healed with a new dynamic nail. Two patients had a delayed union and healed after dynamization and osteotomy of the fibula. The mean time to union was 5 months (2 to 8). 8 patients had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suffered from anterior knee pain and in 5 patients the fracture site was painful. In 18 patients a CT scan was performed : 6 had a rotational deformity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy of 7 and 9 mm). Closed intramedullary nailing is a safe and effective method for the treatment of distal metaphyseal tibial fractures. The authors propose a new classification.

  13. Endogenous Parathyroid Hormone Promotes Fracture Healing by Increasing Expression of BMPR2 through cAMP/PKA/CREB Pathway in Mice

    Directory of Open Access Journals (Sweden)

    Wei Zhou

    2017-06-01

    Full Text Available Background/Aims: Endogenous parathyroid hormone (PTH plays an important role in fracture healing. This study investigated whether endogenous PTH regulates fracture healing by bone morphogenetic protein (BMP and/or the transforming growth factor-β (TGF-β signaling pathway. Methods: Eight-week-old wild-type (WT and PTH-knockout (PTH KO male mice were selected, and models of open right-femoral fracture were constructed. Fracture healing and callus characteristics of mice in the two groups were compared by X-ray, micro-computed tomography, histological, and immunohistochemical examinations. Bone marrow mesenchymal stem cells (BMMSCs of 8-week-old WT and PTHKO male mice were obtained and induced into osteoblasts and chondrocytes. Results: We found that expression levels of Runt-related transcription factor (RUNX2, bone morphogenetic protein-receptor-type Ⅱ (BMPR2, phosphorylated Smad 1/5/8, and phosphorylated cyclic adenosine monophosphate-responsive element binding protein (CREB in the callus of PTHKO mice were significantly decreased, whereas no significant difference in expression of SOX9, TGF-βR2,or pSMAD2/3 was observed between PTHKO and WT mice. Additionally, the activity of osteoblast alkaline phosphatase was low at 7 days post-induction, and was upregulated by addition of PTH or dibutyryl cyclic adenosine monophosphate (dbcAMP to the cell culture. Furthermore, H89 (protein kinase A inhibitoreliminated the simulating effects of PTH and dbcAMP, and a low concentration of cyclic adenosine monophosphate (cAMP was observed in PTHKO mouse BMMSCs. Conclusion: These results suggested that endogenous PTH enhanced BMPR2 expression by a cAMP/PKA/CREB pathway in osteoblasts, and increased RUNX2 expression through transduction of the BMP/pSMAD1/5/8 signaling pathway.

  14. Interzones of Law and Metaphysics

    DEFF Research Database (Denmark)

    Mossin, Christiane

    The dissertation analyzes a contemporary battlefield of law, the field of EU social rights, from a political-philosophical point of view. It is the conviction of the dissertation that law is deeply and inescapably conceptually connected with fundamental features of social order. The interrelations...... between the two do not merely concern the rights and obligations explicitly laid down in the law, but fundamental presumptions regarding the nature of human beings, overall purposes of social order, hierarchical and dynamic features of society and the possibility at all of regulation, its logics...... and sources of authority. On the basis of a historical-conceptual understanding of law according to which law, social structure and metaphysical presumptions are inescapably intertwined, the dissertation derives from the binding provisions of law certain essential features of social order. More precisely...

  15. The Value Question in Metaphysics.

    Science.gov (United States)

    Kahane, Guy

    2012-07-01

    Much seems to be at stake in metaphysical questions about, for example, God, free will or morality. One thing that could be at stake is the value of the universe we inhabit-how good or bad it is. We can think of competing philosophical positions as describing possibilities, ways the world might turn out to be, and to which value can be assigned. When, for example, people hope that God exists, or fear that we do not possess free will, they express attitudes towards these possibilities, attitudes that presuppose answers to questions about their comparative value. My aim in this paper is to distinguish these evaluative questions from related questions with which they can be confused, to identify structural constraints on their proper pursuit, and to address objections to their very coherence. Answers to such evaluative questions offer one measure of the importance of philosophical disputes.

  16. The Value Question in Metaphysics

    Science.gov (United States)

    Kahane, Guy

    2012-01-01

    Much seems to be at stake in metaphysical questions about, for example, God, free will or morality. One thing that could be at stake is the value of the universe we inhabit—how good or bad it is. We can think of competing philosophical positions as describing possibilities, ways the world might turn out to be, and to which value can be assigned. When, for example, people hope that God exists, or fear that we do not possess free will, they express attitudes towards these possibilities, attitudes that presuppose answers to questions about their comparative value. My aim in this paper is to distinguish these evaluative questions from related questions with which they can be confused, to identify structural constraints on their proper pursuit, and to address objections to their very coherence. Answers to such evaluative questions offer one measure of the importance of philosophical disputes. PMID:23024399

  17. Transforming Growth Factor Beta Family: Insight into the Role of Growth Factors in Regulation of Fracture Healing Biology and Potential Clinical Applications

    Directory of Open Access Journals (Sweden)

    Łukasz A. Poniatowski

    2015-01-01

    Full Text Available The transforming growth factor beta (TGF-β family forms a group of three isoforms, TGF-β1, TGF-β2, and TGF-β3, with their structure formed by interrelated dimeric polypeptide chains. Pleiotropic and redundant functions of the TGF-β family concern control of numerous aspects and effects of cell functions, including proliferation, differentiation, and migration, in all tissues of the human body. Amongst many cytokines and growth factors, the TGF-β family is considered a group playing one of numerous key roles in control of physiological phenomena concerning maintenance of metabolic homeostasis in the bone tissue. By breaking the continuity of bone tissue, a spread-over-time and complex bone healing process is initiated, considered a recapitulation of embryonic intracartilaginous ossification. This process is a cascade of local and systemic phenomena spread over time, involving whole cell lineages and various cytokines and growth factors. Numerous in vivo and in vitro studies in various models analysing cytokines and growth factors’ involvement have shown that TGF-β has a leading role in the fracture healing process. This paper sums up current knowledge on the basis of available literature concerning the role of the TGF-β family in the fracture healing process.

  18. Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws.

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    Full Text Available There is a high incidence of vertebral burst fractures following low velocity trauma in the elderly. Treatment of unstable vertebral burst fractures using the same principles like in stable vertebral burst fractures may show less favourable results in terms of fracture reduction, maintenance of reduction and cement leakage. In order to address these shortcomings this study introduces cementless fixation of unstable vertebral burst fractures using internal fixators and expandable intravertebral titanium mesh cages in a one-stage procedure via minimum-invasive techniques.A total of 16 consecutive patients (median age 76 years, range 58-94 with unstable thoracolumbar burst fractures and concomitant osteoporosis were treated by an internal fixator inserted via minimum invasive technique one level above and below the fractured vertebra. Fracture reduction was achieved and maintained by transpedicular placement of two titanium mesh cages into the fractured vertebral body during the same procedure. Intra- and postoperative safety of the procedure as well as analysis of reduction quality was analysed by 3D C-arm imaging or CT, respectively. Clinical and radiographic follow-up averaged 10.4 months (range 4.5-24.5.Stabilization of the collapsed vertebral body was achieved in all 16 cases without any intraoperative complication. Surgical time averaged 102 ± 6.6 minutes (71-194. The postoperative kyphotic angle (KA and Cobb angle revealed significant improvements (KA 13.7° to 7.4°, p < 0.001; Cobb 9.6° to 6.0°, p < 0.002 with partial loss of reduction at final follow-up (KA 8.3°, Cobb 8.7°. VAS (Visual Analogue Scale improved from 7.6 to 2.6 (p < 0.001. Adjacent fractures were not observed. One minor (malposition of pedicle screw complication was encountered.Cementless fixation of osteoporotic burst fractures revealed substantial pain relief, adequate maintenance of reduction and a low complication rate. Bony healing after unstable osteoporotic burst

  19. Should orthopedic surgeons consider the effects of gabapentin administration on bone healing while treating a long bone fracture: experimental study in a rat model

    Directory of Open Access Journals (Sweden)

    Sofu Hakan

    2016-01-01

    Full Text Available Objective: The main purpose of the present study was to assess the radiographic, histological, and mechanical effects of gabapentin on fracture healing in a rat model of femur fracture. Materials and methods: A standard transverse fracture of the mid-diaphysis was created. A total of 60 female Wistar-Albino rats with the mean age of 13.5 ± 1.2 weeks were used for this experimental trial. The rats were randomized into four groups with 15 animals included in each group. Group A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage twice a day with the daily dosage calculated according to body surface area conversion to the human equivalent dosing regimen of 1200 mg/day. Radiographic, histological, and biomechanical evaluation was performed. Results: We could not detect any statistically significant difference between the control and gabapentin treatment groups according to the comparative assessment of radiographic scores on the 15th and 30th days. Although no significant differences were found between the groups on the 15th day, histological scores were better in the control group on the 30th day. According to the results of biomechanical testing, the fractured femurs resected from the control group exhibited significantly more strength on the 30th day. Conclusions: According to the data we acquired during the present study, administration of gabapentin negatively affects the fracture healing process especially in the aspects of histological progression as well as the biomechanical strength of the callus in a rat model.

  20. Fixation principles in metaphyseal bone--a patent based review.

    Science.gov (United States)

    Curtis, R; Goldhahn, J; Schwyn, R; Regazzoni, P; Suhm, N

    2005-03-01

    Osteoporotic changes start in cancellous bone due to the underlying pathophysiology. Consequently, the metaphyses are at a higher risk of "osteoporotic" fracture than the diaphysis. Furthermore, implant purchase to fix these fractures is also affected by the poor bone quality. In general, researchers and developers have worked on three different approaches to address the problem of fractures to osteoporotic bone: adapted anchoring techniques, improved load distribution as well as transfer with angular stable screws, and augmentation techniques using bone substitutes. A patent-based review was performed to evaluate which ideas were utilized to improve fixation in osteoporotic, metaphyseal bone, especially in the proximal femur, and to analyze whether the concept had entered clinical use. Anchoring devices that are either extramedullary or intramedullary have a long clinical history. However, demanding surgical techniques and complications, especially in poor quality bone, are justification that such implants and their corresponding surgical techniques need to be improved upon. Expanding elements have been evaluated in the laboratory. The results are promising and the potential of this approach has yet to be fully exploited in the clinics. Internal fixators with angular stable screws open the door for many new anchorage ideas and have great potential for further optimization of load distribution and transfer. Augmentation techniques may improve anchorage in osteoporotic bone. However, the properties of bone substitute materials will need to be modified and improved upon in order to meet the demanding requirements. If we summarise the development process and the clinical use of implants to date, we have to clearly state that more factors than simply biomechanical advantage will determine the clinical success of a new fixation principle or a new implant. Instead, fracture treatment of patients with osteoporosis really needs an interdisciplinary approach!

  1. Parathyroid hormone and bone healing

    DEFF Research Database (Denmark)

    Ellegaard, M; Jørgensen, N R; Schwarz, P

    2010-01-01

    , no pharmacological treatments are available. There is therefore an unmet need for medications that can stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis, and intriguingly a number of animal studies suggest that PTH could be beneficial...... in the treatment of fractures and could thus be a potentially new treatment option for induction of fracture healing in humans. Furthermore, fractures in animals with experimental conditions of impaired healing such as aging, estrogen withdrawal, and malnutrition can heal in an expedited manner after PTH treatment....... Interestingly, fractures occurring at both cancellous and cortical sites can be treated successfully, indicating that both osteoporotic and nonosteoporotic fractures can be the target of PTH-induced healing. Finally, the data suggest that PTH partly prevents the delay in fracture healing caused by aging...

  2. The classic metaphyseal lesion and traumatic injury

    International Nuclear Information System (INIS)

    Thackeray, Jonathan D.; Wannemacher, Jacob; Adler, Brent H.; Lindberg, Daniel M.

    2016-01-01

    It is widely accepted that the classic metaphyseal lesion (CML) is a traumatic lesion, strongly associated with abuse in infants. Nevertheless, various non-traumatic origins for CMLs continue to be suggested in medical and legal settings. No studies to date systematically describe the association of CMLs with other traumatic injuries. The primary objective of this study is to examine the association of CMLs with other traumatic injuries in a large data set of children evaluated for physical abuse. This was a retrospectively planned secondary analysis of data from a prospective, observational study of children <120 months of age who underwent evaluation by a child abuse physician. For this secondary analysis, we identified all children ≤12 months of age with an identified CML and determined the number and type of additional injuries identified. Descriptive analysis was used to report frequency of additional traumatic injuries. Among 2,890 subjects, 119 (4.1%) were identified as having a CML. Of these, 100 (84.0%) had at least one additional (non-CML) fracture. Thirty-three (27.7%) had traumatic brain injury. Nearly half (43.7%) of children had cutaneous injuries. Oropharyngeal injuries were found in 12 (10.1%) children. Abdominal/thoracic injuries were also found in 12 (10.1%) children. In all, 95.8% of children with a CML had at least one additional injury; one in four children had three or more categories of injury. CMLs identified in young children are strongly associated with traumatic injuries. Identification of a CML in a young child should prompt a thorough evaluation for physical abuse. (orig.)

  3. A proper metaphysics for cognitive performance.

    Science.gov (United States)

    Van Orden, Guy C; Moreno, Miguel A; Holden, John G

    2003-01-01

    The general failure to individuate component causes in cognitive performance suggests the need for an alternative metaphysics. The metaphysics of control hierarchy theory accommodates the fact of self-organization in nature and the possibility that intentional actions are self-organized. One key assumption is that interactions among processes dominate their intrinsic dynamics. Scaling relations in response time variability motivate this assumption in cognitive performance.

  4. Socialcultural background of formation of classical metaphysics

    OpenAIRE

    I. Z. Derzhko

    2014-01-01

    The classical model of philosophy has shaped ideas about its nature and aims that were laid in ancient metaphysics, but have been substantially amended by civilizational change. Socialcultural background of philosophy became trends that began to emerge in late medieval culture has particularly flourished there during modern times. Sphere of existence is important for the development of any spiritual phenomenon. For metaphysics it is the idea of humanity, acting as a kind of cultural protest a...

  5. Metaphysics and medical ethics: a reply.

    Science.gov (United States)

    Gillett, G

    1994-01-01

    The total longitudinal form view of human beings is a metaphysical view which aims to locate our moral judgements about human embryos in a broader set of attitudes and characterisations. On this basis it has explanatory power and a real function in that it grounds our ethical discussion of embryos in other discourses. Contra Leavitt, this grounding suggests a broader criterion of relevance for metaphysical discussion than asking 'what comes out of' such a discussion for a particular ethical dilemma. PMID:8035442

  6. On the metaphysics of experimental physics

    CERN Document Server

    Rogers, K

    2005-01-01

    This provocative and critical work addresses the question of why scientific realists and positivists consider experimental physics to be a natural and empirical science. Taking insights from contemporary science studies, continental philosophy, and the history of physics, this book describes and analyses the metaphysical presuppositions that underwrite the technological use of experimental apparatus and instruments to explore, model, and understand nature. By revealing this metaphysical foundation, the author questions whether experimental physics is a natural and empirical science at all.

  7. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis – A prospective series of 50 patients

    Science.gov (United States)

    Paluvadi, Siddhartha Venkata; Lal, Hitesh; Mittal, Deepak; Vidyarthi, Kandarp

    2014-01-01

    Background Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series. Methods From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years. Results The mean fracture healing time was 21.4 weeks (range 16–32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%). Conclusion MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension. PMID:25983486

  8. Internal Realism: Putnam's Alternative to Metaphysical Realism

    Directory of Open Access Journals (Sweden)

    J Akbari Takhtameshlou

    2014-02-01

    Full Text Available Hilary Putnam, who was once one of the representatives and proponents of scientific and metaphysical realism, became an unrelenting opponent of metaphysical realism during the mid-70s. Having argued against alethic and ontological dimensions of metaphysical realism, he proposed “internal realism” as an alternative to it. Putnam's major objection to the alethic dimension of metaphysical realism was that this philosophy brings about an unbridgeable gap between the truth of a proposition and our epistemic justifications for it. As to the ontological dimension of metaphysical realism, he proposed the criticism to the effect that according to this philosophical position the world consists of “ready-made” objects. Putnam poses these criticisms because, as he argues, firstly, truth cannot be considered anything but the ideal justification and secondly, the world is not made of ready-made objects, but rather it is we that cut up the world into different objects when we take a conceptual scheme. Indeed, according to Putnam assuming any "external perspective", whether about truth or about ontology, is meaningless. Having introduced and reviewed Putnam's arguments in rejecting metaphysical realism, this article explains and examines the basic elements of internal realism. The results of this article show that Putnam's objections against metaphysical realism lack the necessary credibility and strength and at the same time his proposed alternative (internal realism has serious problems that made to be addressed. By his chosen conception of truth, internal realism, cannot touch its stated purpose i.e. the removal of a huge gap between the truth of a statement and our knowledge of it. The ontological claims of internal realism are not, indeed, the reliable and true consequences of the thesis of conceptual relativity, which is considered as Putnam’s main base in this regard, but rather it is more a consequence of mistaking the

  9. Role of Fas and Treg Cells in Fracture Healing as Characterized in the Fas-Deficient (lpr) Mouse Model of Lupus†

    Science.gov (United States)

    Al-Sebaei, Maisa O; Daukss, Dana M; Belkina, Anna C; Kakar, Sanjeev; Wigner, Nathan A; Cusher, Daniel; Graves, Dana; Einhorn, Thomas; Morgan, Elise; Gerstenfeld, Louis C

    2014-01-01

    Previous studies showed that loss of tumor necrosis factor α (TNFα) signaling delayed fracture healing by delaying chondrocyte apoptosis and cartilage resorption. Mechanistic studies showed that TNFα induced Fas expression within chondrocytes; however, the degree to which chondrocyte apoptosis is mediated by TNFα alone or dependent on the induction of Fas is unclear. This question was addressed by assessing fracture healing in Fas-deficient B6.MRL/Faslpr/J mice. Loss of Fas delayed cartilage resorption but also lowered bone fraction in the calluses. The reduced bone fraction was related to elevated rates of coupled bone turnover in the B6.MRL/Faslpr/J calluses, as evidenced by higher osteoclast numbers and increased osteogenesis. Analysis of the apoptotic marker caspase 3 showed fewer positive chondrocytes and osteoclasts in calluses of B6.MRL/Faslpr/J mice. To determine if an active autoimmune state contributed to increased bone turnover, the levels of activated T cells and Treg cells were assessed. B6.MRL/Faslpr/J mice had elevated Treg cells in both spleens and bones of B6.MRL/Faslpr/J but decreased percentage of activated T cells in bone tissues. Fracture led to ∼30% to 60% systemic increase in Treg cells in both wild-type and B6.MRL/Faslpr/J bone tissues during the period of cartilage formation and resorption but either decreased (wild type) or left unchanged (B6.MRL/Faslpr/J) the numbers of activated T cells in bone. These results show that an active autoimmune state is inhibited during the period of cartilage resorption and suggest that iTreg cells play a functional role in this process. These data show that loss of Fas activity specifically in chondrocytes prolonged the life span of chondrocytes and that Fas synergized with TNFα signaling to mediate chondrocyte apoptosis. Conversely, loss of Fas systemically led to increased osteoclast numbers during later periods of fracture healing and increased osteogenesis. These findings suggest that retention

  10. Role of Fas and Treg cells in fracture healing as characterized in the fas-deficient (lpr) mouse model of lupus.

    Science.gov (United States)

    Al-Sebaei, Maisa O; Daukss, Dana M; Belkina, Anna C; Kakar, Sanjeev; Wigner, Nathan A; Cusher, Daniel; Graves, Dana; Einhorn, Thomas; Morgan, Elise; Gerstenfeld, Louis C

    2014-06-01

    Previous studies showed that loss of tumor necrosis factor α (TNFα) signaling delayed fracture healing by delaying chondrocyte apoptosis and cartilage resorption. Mechanistic studies showed that TNFα induced Fas expression within chondrocytes; however, the degree to which chondrocyte apoptosis is mediated by TNFα alone or dependent on the induction of Fas is unclear. This question was addressed by assessing fracture healing in Fas-deficient B6.MRL/Fas(lpr) /J mice. Loss of Fas delayed cartilage resorption but also lowered bone fraction in the calluses. The reduced bone fraction was related to elevated rates of coupled bone turnover in the B6.MRL/Fas(lpr) /J calluses, as evidenced by higher osteoclast numbers and increased osteogenesis. Analysis of the apoptotic marker caspase 3 showed fewer positive chondrocytes and osteoclasts in calluses of B6.MRL/Fas(lpr) /J mice. To determine if an active autoimmune state contributed to increased bone turnover, the levels of activated T cells and Treg cells were assessed. B6.MRL/Fas(lpr) /J mice had elevated Treg cells in both spleens and bones of B6.MRL/Fas(lpr) /J but decreased percentage of activated T cells in bone tissues. Fracture led to ∼30% to 60% systemic increase in Treg cells in both wild-type and B6.MRL/Fas(lpr) /J bone tissues during the period of cartilage formation and resorption but either decreased (wild type) or left unchanged (B6.MRL/Fas(lpr) /J) the numbers of activated T cells in bone. These results show that an active autoimmune state is inhibited during the period of cartilage resorption and suggest that iTreg cells play a functional role in this process. These data show that loss of Fas activity specifically in chondrocytes prolonged the life span of chondrocytes and that Fas synergized with TNFα signaling to mediate chondrocyte apoptosis. Conversely, loss of Fas systemically led to increased osteoclast numbers during later periods of fracture healing and increased osteogenesis. These findings

  11. Preliminary experience with biodegradable implants for fracture fixation

    Directory of Open Access Journals (Sweden)

    Dhillon Mandeep

    2008-01-01

    Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

  12. Mechanisms, determination and the metaphysics of neuroscience.

    Science.gov (United States)

    Soom, Patrice

    2012-09-01

    In this paper, I evaluate recently defended mechanistic accounts of the unity of neuroscience from a metaphysical point of view. Considering the mechanistic framework in general (Sections 2 and 3), I argue that explanations of this kind are essentially reductive (Section 4). The reductive character of mechanistic explanations provides a sufficiency criterion, according to which the mechanism underlying a certain phenomenon is sufficient for the latter. Thus, the concept of supervenience can be used in order to describe the relation between mechanisms and phenomena (Section 5). Against this background, I show that the mechanistic framework is subject to the causal exclusion problem and faces the classical metaphysical options when it comes to the relations obtaining between different levels of mechanisms (Section 6). Finally, an attempt to improve the metaphysics of mechanisms is made (Section 7) and further difficulties are pointed out (Section 8). Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study.

    Science.gov (United States)

    Iwata, Akira; Kanayama, Masahiro; Oha, Fumihiro; Hashimoto, Tomoyuki; Iwasaki, Norimasa

    2017-04-07

    Teriparatide (recombinant human parathyroid hormone 1-34) is increasingly used for the treatment of severe osteoporosis because it stimulates bone formation and may potentially enhance fracture healing. The objective of this study was to investigate the effects of teriparatide versus a bisphosphonate on radiographic outcomes in the treatment of osteoporotic vertebral compression fractures (OVCF). A total of 98 patients undergoing non-operative treatment for recent single-level OVCF were reviewed retrospectively. Thirty-eight patients were treated by a once-daily subcutaneous injection of 20 micrograms of teriparatide (TPD group), whereas 60 patients received 35 mg of alendronate weekly (BP group). Except for these medications, the same treatment protocol was applied to both groups. The radiographic assessments included union status, vertebral kyphosis, and mid-vertebral body height. The rates of fracture site surgical intervention were also compared between the two groups. The mean follow-up period was 27 months (median 22.5, range 2 - 75 months). Cox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 - 2.83). The union rate at six months after treatment was 89% in the TPD group and 68% in the BP group; the surgical intervention rate was significantly higher in the TPD group (p = 0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 - 43.33). The change in local kyphosis was 4.6° in the TPD group and 3.8° in the BP group (p = 0.495, paired t-test). The change of mid-vertebral body height was 4.4 mm in the TPD group and 3.4 mm in the BP group (p = 0.228, paired t-test). Fracture site surgical interventions were not required in the TPD group; however, two patients in the BP group eventually underwent surgical treatment for symptomatic non-union or vertebral collapse. This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

  14. Ronacaleret, a calcium-sensing receptor antagonist, has no significant effect on radial fracture healing time: results of a randomized, double-blinded, placebo-controlled Phase II clinical trial.

    Science.gov (United States)

    Fitzpatrick, Lorraine A; Smith, Phillipa L; McBride, Trish A; Fries, Michael A; Hossain, Mohammad; Dabrowski, Christine E; Gordon, David N

    2011-10-01

    Fractures cause significant morbidity, mortality, and use of health care resources. An oral agent that enhances fracture healing could reduce costs and prevent future disabilities. In Phase I studies, ronacaleret, a novel calcium-sensing receptor antagonist, stimulated parathyroid hormone (PTH) release and increased bone formation markers, suggesting that it may act as an effective oral anabolic agent to enhance fracture healing. This was a randomized, double-blind, placebo-controlled, parallel-group, clinical trial in 85 male and female subjects who had sustained a closed, unilateral, extra-articular fracture of the distal radius and were receiving conservative treatment. Subjects were randomly assigned in a double-blind manner to ronacaleret 200 mg twice daily, ronacaleret 400 mg once daily or matching placebo and followed for 12 weeks. Fracture healing was assessed by radiographs and quantitative computed tomography (CT), and bone turnover markers were measured. The study was terminated early for futility based on the results of an unplanned interim analysis. There were no significant differences between treatment groups in time to radiographic fracture healing (74, 65 and 68 days for placebo, 200 mg twice daily and 400 mg once daily dose groups, respectively), cortical bridging, grip strength, pain and swelling, time to cast removal, or range of motion. Markers of bone formation and levels of whole PTH, intact PTH and serum calcium increased following treatment with ronacaleret. Ronacaleret had no significant effect on duration of healing by radiograph or CT scan, time to cast removal, clinical symptoms, grip strength, or range of motion. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-01-01

    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify.......3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear...

  16. Metaphysical Realism: A Conceptual Analysis | Emedolu | Sophia ...

    African Journals Online (AJOL)

    Metaphysical realism is a common sense disposition that maintains that there exist objects in the world with their structure-defining properties, and that scientific theories try to explain reality exactly the way it is. The crucial question for this paper is whether the human mind does not make any contribution in the very art of ...

  17. Improving the Metaphysical Argument against Free Will ...

    African Journals Online (AJOL)

    Galen Strawson and Saul Smilansky have offered a well-known argument that free will does not exist because the control involved is so robust that it would require influence over an infinite series of prior decisions. (Strawson 1986, 1994, 2002, Smilansky 2000, 2002) Unfortunately, while this metaphysical argument has ...

  18. Quine, Putnam, and the Naturalization of Metaphysics

    NARCIS (Netherlands)

    Verhaegh, Sander; Baumgartner, S.; Heisenberg, T.; Krebs, S.

    2014-01-01

    Naturalists argue that metaphysics ought to be in some sense continuous with science. Putnam has claimed that if we push naturalism to its limits, we have to conclude with Quine that reference is indeterminate. Since Putnam believes Quine’s thesis to be extremely counterintuitive, he regards

  19. What is Metaphysical Equivalence? | Miller | Philosophical Papers

    African Journals Online (AJOL)

    Theories are metaphysically equivalent just if there is no fact of the matter that could render one theory true and the other false. In this paper I argue that if we are judiciously to resolve disputes about whether theories are equivalent or not, we need to develop testable criteria that will give us epistemic access to the obtaining ...

  20. Metaphysical Beliefs as Predictors of Death Anxiety.

    Science.gov (United States)

    Naidu, R. K.; Sinha, Ambalika

    1992-01-01

    Investigated impact of four metaphysical beliefs (existence of God, attributes of God, afterlife, consequences of suffering) on death anxiety. Householders (n=120), one-half of whom lived in high exposure to death sight areas, responded to pictures depicting death and nondeath scenes to measure death anxiety. Subjects from low exposure areas…

  1. The Role of Metaphysical Naturalism in Science

    Science.gov (United States)

    Mahner, Martin

    2012-01-01

    This paper defends the view that metaphysical naturalism is a constitutive ontological principle of science in that the general empirical methods of science, such as observation, measurement and experiment, and thus the very production of empirical evidence, presuppose a no-supernature principle. It examines the consequences of metaphysical…

  2. Rectal prolapse associated with a healed pelvic fracture in a pregnant free-ranging African black rhinoceros (Diceros bicornis. Part 2 : surgery and necropsy : case report

    Directory of Open Access Journals (Sweden)

    A. Olivier

    2001-07-01

    Full Text Available The oedematous and traumatised protruding section of the rectal tissue of an adult free-ranging female African black rhinoceros (Diceros bicornis was surgically amputated. Immediately before completion of surgery, the rhinoceros died of anaesthetic-related cardiac arrest. At necropsy a deformed pelvis and sacrum associated with a healed fracture of the left ileal wing were noted. New bone formation in and around the left ventral sacral foramina may have resulted in neuropathy of particularly the 3rd and 4th left ventral sacral nerves, which (in the horse supply the majority of the nerve fibres innervating the caudal rectum and anus. The cause of the injury is not known, although back injuries, presumably sustained during mating by bulls, have been recorded in white rhinoceros. An encounter with elephants could also have been responsible for the injury in this case.

  3. The discourse of Jurgen Habermas: metaphysics after Kant

    OpenAIRE

    D. O. Shyshkin

    2014-01-01

    The purpose of the article is to implement the explication of one of the sub-sections of the work of Jurgen Habermas «Postmetaphysical thinking», which is called «Metaphysics after Kant». This work of the German philosopher is a milestone to mark the location of metaphysics, problems of metaphysics and differences in the position of metaphysics for Kant and after him. Some abstracts demonstrate how the discourse of Habermas and proves protective provisions postkantian metaphysics that violate...

  4. The place of metaphysics in the historiography of science

    Science.gov (United States)

    Agassi, Joseph

    1996-04-01

    Legitimating the use of metaphysics in scientific research constituted a farreaching methodological revolution, invalidating the inductivist demands that science be guided by empirical information alone. Thus, science became tentative. The revolution was established when pioneering historians of science, Max Jammer among them, exhibited the working of metaphysics in scientific research. This raises many problems, since most metaphysical ideas are poor as compared with scientific ones. Yet taking science to be the effort to explain facts in a comprehensive manner, makes some metaphysics unavoidable, and presents the better metaphysics as the possible frameworks within which older scientific theories may be reinterpreted and improved and newer ones may be developed.

  5. Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children

    Science.gov (United States)

    Shen, Kaiying; Cai, Haiqing; Wang, Zhigang; Xu, Yunlan

    2016-01-01

    Abstract Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically. Complications were assessed: the patients were evaluated with regard to nonunion, malunion, infection, growth arrest, leg length discrepancy, implant irritation, and joint function. Mean age at the time of surgery was 7.8 years (range between 5.3 and 14.8 years), mean body weight 34.1 kg, all fractures were transverse or mild oblique type, including 3 open fractures, 5 multifragmented fractures, and 4 fractures associated with polytrauma; 6 cases were treated with antegrade ESIN of tibia while 15 cases need combined retrograde fibula and antegrade tibia fixation treatments. Follow-ups were ranging from 11 to 36 months, 19 fractures showed both clinical and radiographic evidence of healing within 5 months; all cases had full range motion of knee and ankle with symmetrical foot progress angle. Nail removal was at a mean 7.1 months, at final follow-up, no growth arrest or disturbances occurred. Five patients had complications; leg length discrepancy had decreased yet affected 2 patients, 2 cases showed delayed union, and 1 case developed restricted dorsal extension at the metatarsophalangeal joint of the hallux. ESIN is the treatment of choice for pediatric severely displaced DTDMJ fractures that cannot be reduced by closed reduction or ones that cannot be casted. The advantages include faster fracture healing, excellent functional and cosmetic results, safe and reliable surgical technique, and lower severe complication rate. PMID

  6. Determination of death: Metaphysical and biomedical discourse

    Directory of Open Access Journals (Sweden)

    Irayda Jakušovaitė

    2016-01-01

    Full Text Available The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational–logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question “Does a brain death mean death of a human being?” two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death.

  7. Bone Morphogenetic Protein for the Healing of Tibial Fracture: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Jiezhi Dai

    Full Text Available To review the evidence from RCTs on clinical outcomes and benefit of acute tibial fracture and nonunion treated with and without BMPs.We searched multiple databases (MEDLINE, EMABSE, BIOSIS and Cochrane central as well as reference lists of articles and contacted authors. Evaluated outcomes included union rate, revision rate, hardware failure and infection. The weighted and standard mean difference (WMD and SMD or the relative risk (RR was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration's REVMAN 5.0 software.Eight RCTs involving 1113 patients were included. For acute tibial fracture, BMP group was associated with a higher rate of union (RR, 1.16; 95% CI, 1.04 to 1.30 and a lower rate of revision (RR, 0.68; 95% CI, 0.54 to 0.85 compared with control group. No significant differences were found in rate of hardware failure and infection. The pooled RR for achieving union for tibial fracture nonunion was 0.98 (95% CI, 0.86 to 1.13. There was no significant difference between the two groups in the rate of revision (RR, 0.48; 95% CI, 0.13 to 1.85 and infection (RR, 0.61; 95% CI, 0.37 to 1.02.Study on acute tibial fractures suggests that BMP is more effective that controls, for bone union and for decreasing the rate of surgical revision to achieve union. For the treatment of tibial fracture nonunion, BMP leads to similar results to as autogenous bone grafting. Finally, well-designed RCTs of BMP for tibial fracture treatment are also needed.

  8. Effects of “vitex agnus castus” extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture

    Science.gov (United States)

    Eftekhari, Mohammad Hassan; Rostami, Zahra Hassanzadeh; Emami, Mohammad Jafar; Tabatabaee, Hamid Reza

    2014-01-01

    Background: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. Material and Methods: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. Results: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes. PMID:24672557

  9. Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Cao

    2017-04-01

    Full Text Available Objective: To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods: A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP. Results: 1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group; the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients; 36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group. Conclusion: The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

  10. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.

    Science.gov (United States)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-04-01

    To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors. A total of 91 patients with 223 traumatized teeth. The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P = 0.01), displacement in the horizontal part of the fracture >2 mm (HR: 1.8; 95% CI: 1.1-3.2, P = 0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Traumatic Fracture in a patient of Osteopoikilosis with review of literature

    Directory of Open Access Journals (Sweden)

    Rohan Bansal

    2013-04-01

    Full Text Available Introduction: Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. Case Report: A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach , showed complete union and was followed up for eight months. Conclusion: Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays ( for type ,extent and site of lesions, bones affected, clinical features of patient , histopathology and other systemic or pre-existing conditions. Keywords: Fracture , Osteopoikilosis , union, Pilon, Osteoblastic metastasis

  12. Effect of Pulsed Wave Low-Level Laser Therapy on Tibial Complete Osteotomy Model of Fracture Healing With an Intramedullary Fixation

    Science.gov (United States)

    Mostafavinia, Atarodalsadat; Masteri Farahani, Reza; Abbasian, Mohammadreza; Vasheghani Farahani, Mohammadmehdi; Fridoni, Mohammadjavad; Zandpazandi, Sara; Ghoreishi, Seyed Kamran; Abdollahifar, Mohammad Amin; Pouriran, Ramin; Bayat, Mohammad

    2015-01-01

    Background: Fractures pose a major worldwide challenge to public health, causing tremendous disability for the society and families. According to recent studies, many in vivo and in vitro experiments have shown the positive effects of PW LLLT on osseous tissue. Objectives: The aim of this study was to evaluate the outcome of infrared pulsed wave low-level laser therapy (PW LLLT) on the fracture healing process in a complete tibial osteotomy in a rat model, which was stabilized by an intramedullary pin. Materials and Methods: This experimental study was conducted at Shahid Beheshti University of Medical Sciences in Tehran, Iran. We performed complete tibial osteotomies in the right tibias for the population of 15 female rats. The rats were divided randomly into three different groups: I) Control rats with untreated bone defects; II) Rats irradiated by a 0.972 J/cm2 PW LLLT; and III) Rats irradiated by a 1.5 J/cm2 PW LLLT. The right tibias were collected six weeks following the surgery and a three-point bending test was performed to gather results. Immediately after biomechanical examination, the fractured bones were prepared for histological examinations. Slides were examined using stereological method. Results: PW LLLT significantly caused an increase in maximum force (N) of biomechanical repair properties for osteotomized tibias in the first and second laser groups (30.0 ± 15.9 and 32.4 ± 13.8 respectively) compared to the control group (8.6 ± 4.5) LSD test, P = 0.019, P = 0.011 respectively). There was a significant increase in the osteoblast count of the first and second laser groups (0.53 ± 0.06, 0.41 ± 0.06 respectively) compared to control group (0.31 ± 0.04) (LSD test, P = 0001, P = 0.007 respectively). Conclusions: This study confirmed the efficacy of PW LLLT on biomechanical strength, trabecular bone volume, callus volume, and osteoblast number of repairing callus in a complete tibial osteotomy animal model at a relatively late stage of the bone

  13. Development of an Injectable Salmon Fibrinogen-Thrombin Matrix to Enhance Healing of Compound Fractures of Extremities

    Science.gov (United States)

    2012-09-01

    growth reoccurring (Figure 3C). Bone healing measured by radiography showed fibrous deposition and some calcification in all treatments Radiography ...and fiber cast (Figure 4). With plane radiography , we could follow the deposition of a fibrous callous and the beginning of the calcification...diagnosis of venous thrombosis and impedance  plethysmography measured on the  thorax  is a special diagnostic application and is usually called

  14. Stress fracture healing: fatigue loading of the rat ulna induces upregulation in expression of osteogenic and angiogenic genes that mimic the intramembranous portion of fracture repair.

    Science.gov (United States)

    Wohl, Gregory R; Towler, Dwight A; Silva, Matthew J

    2009-02-01

    Woven bone is formed in response to fatigue-induced stress fractures and is associated with increased local angiogenesis. The molecular mechanisms that regulate this woven bone formation are unknown. Our objective was to measure the temporal and spatial expression of osteo- and angiogenic genes in woven bone formation in response to increasing levels of fatigue-induced damage. We used the rat forelimb compression model to produce four discrete levels of fatigue damage in the right ulna of 115 male Fischer rats. Rats were killed at 0 (1 h), 1, 3 and 7 days after loading. Using qRT-PCR, we quantified gene expression associated with osteogenesis (BMP2, Msx2, Runx2, Osx, BSP, Osc), cell proliferation (Hist4), and angiogenesis (VEGF, PECAM-1) from the central half of the ulna. The spatial distribution of BMP2, BSP and PCNA was assessed by immunohistochemistry or in situ hybridization in transverse histological sections 1, 4, and 7 mm distal to the ulnar mid-diaphysis. One hour after loading, BMP2 was significantly upregulated in neurovascular structures in the medial ulnar periosteum. Expression of angiogenic markers (VEGF, PECAM-1) increased significantly between Day 0 and 1 and, as with BMP2 expression, remained upregulated through Day 7. While Osx and BSP were upregulated on Day 1, the other osteogenic genes (Msx2, Runx2, Osx, BSP and Osc) were induced on Day 3 in association with the initiation of periosteal woven bone formation and continued through Day 7. The magnitude of osteogenic gene expression, particularly matrix genes (BSP, Osc) was significantly proportional the level of fatigue damage. The woven bone response to fatigue injury is remarkably similar to the "intramembranous" portion of fracture repair - rapid formation of periosteal woven bone characterized by early BMP2 expression, cell proliferation, and upregulation of osteogenic genes. We speculate that woven bone repair of fatigue damage may be an abbreviated fracture response without the requirement

  15. Optimal Treatment of Malignant Long Bone Fracture: Influence of Method of Repair and External Beam Irradiation on the Pathway and Efficacy of Fracture Healing

    Science.gov (United States)

    2015-10-01

    Year 3 SOW animal procedures in Group V for histological testing will begin on schedule in the ninth quarter of the award. 15. SUBJECT TERMS Fracture...Figure 1. a) Lateral X-ray of IM nail (right femur). b) Anterior-Posterior xray of both femurs. c) Lateral X-ray of plate (left femur). (a) (b...Posterior xray of both femurs. c) Lateral X-ray of plate (left femur). (a) (b) Figure 2. Typical 3D µCT images of external and internal callus

  16. The many Metaphysics within Physics. Essay review of 'The Metaphysics within Physics' by Tim Maudlin

    Science.gov (United States)

    Suárez, Mauricio

    Tim Maudlin's new book The Metaphysics within Physics (Oxford University Press, 2007) collects six essays by one of the most thoughtful and original minds working in the philosophy of physics nowadays. Some had previously circulated informally for years. For example, Chapter 1 ('A Modest Proposal Concerning Laws, Counterfactuals and Explanations') is as old as my own philosophical career-I recall reading a draft in the early 1990s. The mere publication of such a long-awaited collection is therefore already good news. In addition, the degree of coherence and the lack of redundancy are greater than one would expect from a collection of disparate essays written at diverse times and with a range of different targets. The whole book can be understood coherently as an extended argument in favor of a particular 'physics-based' methodology for inquiry in metaphysics. This methodology recommends a detailed and thorough analysis of current physics as a benchmark for any thesis, dispute or argument in metaphysics. It follows that proper metaphysical inquiry must be suitably informed not just about the current state of play in analytical metaphysics but also about the current state of development of the relevant part of present day physics.

  17. Abstract Objects in a Metaphysical Perspective

    Directory of Open Access Journals (Sweden)

    Aleksandr Kulieshov

    2018-02-01

    Full Text Available The article presents an unconventional although not absolutely unprecedented view on abstract objects defending the position of metaphysical realism. It is argued that abstract objects taken in purely ontological sense are the forms of objects. The forms possess some common characteristics of abstract objects, they can exist not in physical space and time and play a grounding role in their relation to concrete objects. It is stated that commonly discussed abstract objects – properties, kinds, mathematical objects – are forms.

  18. Metaphysics and medical education: taking holism seriously.

    Science.gov (United States)

    Wilson, Bruce

    2013-06-01

    Medical education is now suffused with concepts that have their source outside the traditional scientific and medical disciplines: concepts such as holism, connectedness and reflective practice. Teaching of these, and other problematic concepts such as medical uncertainty and error, has been defined more by the challenge they pose to the standard model rather than being informed by a strong positive understanding. This challenge typically involves a critical engagement with the idea of objectivity, which is rarely acknowledged as an inherently metaphysical critique. Consequently, these ideas prove to be difficult to teach well. I suggest that the lack of an integrating, positive narrative is the reason for teaching difficulty, and propose that what is needed is an explicit commitment to teach the metaphysics of medicine, with the concept of holism being the fulcrum on which the remaining concepts turn. An acknowledged metaphysical narrative will encompass the scientific realism that medical students typically bring to their tertiary education, and at the same time enable a bigger picture to be drawn that puts the newer and more problematic concepts into context. © 2013 John Wiley & Sons Ltd.

  19. A prospective randomized study of operative treatment for noncomminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis.

    Science.gov (United States)

    Kim, Ji Wan; Oh, Chang-Wug; Byun, Young-Soo; Kim, Jung Jae; Park, Ki Chul

    2015-04-01

    To compare the clinical and radiologic results of conventional open plating (COP) and minimally invasive plate osteosynthesis (MIPO) in the treatment of noncomminuted humeral shaft fractures. Randomized prospective study. Five level 1 trauma centers. Sixty-eight consecutive patients were randomized into 2 study groups: those treated by COP (COP group; n = 32) and those treated by MIPO (MIPO group; n = 36). Simple humeral shaft fractures (AO/OTA classification types A and B) were reduced by open reduction or closed reduction and fixed with a narrow 4.5/5.0 locking compression plate, metaphyseal locking compression plate, or proximal humeral internal locking system plate to the anterior lateral aspect of the humerus. Fracture healing time, operative time, radiation exposure time, and intraoperative nerve injury. To assess shoulder and elbow function, we used the University of California, Los Angeles (UCLA) scoring system and the Mayo elbow performance index, including the range of motion and pain. Radiographic measurements included fracture alignment, delayed union, and nonunion. Thirty-one fractures (97%) healed in the COP group within 16 weeks, whereas 36 fractures (100%) were healed in the MIPO group by 15 weeks. No significant difference was observed in the operative time or complication rates. In both groups, all fractures achieved union without malunion and with excellent functional outcomes by definition of the Mayo elbow performance index and UCLA scoring system. This study confirmed a high overall rate of union and excellent functional outcomes in both MIPO and COP groups. MIPO is equivalent to COP as a safe and effective method for simple types of humeral shaft fractures when surgery is indicated, and the surgeon is experienced in the technique. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  20. Does the Fibula Need to be Fixed in Complex Pilon Fractures?

    Science.gov (United States)

    Kurylo, John C; Datta, Neil; Iskander, Kendra N; Tornetta, Paul

    2015-09-01

    To review a series of patients with complex plafond injuries with a metadiaphyseal dissociation who did not have the fibula fixed and compare with patients who had their fibula fixed using patients without a fibula fracture as a control group. Retrospective case-control study. Level 1 Trauma center at a university hospital. Skeletally mature patients with a complete metadiaphyseal plafond fracture, and adequate presentation, postreduction, and healed radiographs to measure varus and valgus alignment. Surgical treatment [external fixator or open reduction internal fixation (ORIF)] of high energy pilon fractures. Metaphyseal alignment at the time of presentation, after fixation, and at union, surgical procedures performed, and complications. From 364 patients with plafond fractures, 111 had high energy injuries with metadiaphyseal dissociation and form the basis of the study. Radiographs and charts were reviewed for fracture characteristics, metaphyseal alignment at the time of presentation, after fixation, and at union, surgical procedures performed, and complications. Of the 111 study patients, 93 patients were treated definitively with ORIF of the tibia and 18 patients were treated definitively in an external fixator. Within the 93 patients treated definitively with ORIF of the tibia, we identified 3 groups of patients those with a fibula fracture that was fixed (26 patients), those with a fibula fracture that was not fixed (37 patients), and those without a fibula fracture acting as the control group (30 patients). Between the 2 groups having a fibula fracture treated with ORIF of the tibia, there was no difference in fibula fracture pattern or location. For the 26 patients who had fibular fixation, it was performed in 11 patients at an average of 17 days for inability to hold length and alignment and in 15 patients to augment fixation in poor bone stock or to aid in the reduction. Patients with initial valgus deformity were more likely to have their fibula fixed

  1. Clinical study on the effect of simvastatin on the bone healing in elderly patients with femoral intertrochanteric fracture merged with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Long Zhang

    2017-05-01

    Full Text Available Objective: To explore the effect of simvastatin on the bone mineral density (BMD and bone metabolism in elderly patients with femoral intertrochanteric fracture merged with type 2 diabetes mellitus (T2DM. Methods: A total of 120 patients with femoral intertrochanteric fracture merged with T2DM who were admitted in our hospital from June, 2014 to October, 2016 were included in the study and randomized into the observation group and the control group (n=60. The patients in the two groups were given minimally invasive PFNA, and blood sugar and blood pressure reducing. The patients in the control group were given alendronate sodium, 70 mg/time, 1 time/week. On this basis, the patients in the observation group were given simvastatin, 40 mg/time,1 time/every night. After 6-month treatment, the efficacy was evaluated. The morning fasting peripheral venous blood before and after treatment in the two groups was collected. The full automatic biochemical analyzer was used to detect the serum Ca, P, and GHb. ECLI was used to detect the serum OC and BAP. ELISA was used to detect the serum TRACP-5b and s-CTX. The dual energy X-ray absorptiomery was used to detect BMD level of the forearm, femoral neck, and anterial position of lumbar spine. Results: Ca, P, and GHb levels after treatment in the two groups were not significantly changed (P>0.05. BMD level of the forearm, femoral neck, and anterial position of lumbar spine after treatment in the observation group was significantly higher than that in the control group (P<0.05. OC and BAP levels after treatment in the observation group were significantly higher than those in the control group (P<0.05, while s-CTX and TRACP-5b levels were significantly lower than those in the control group (P<0.05. Conclusions: Simvastatin can significantly improve the bone metabolism abnormality in elderly patients with femoral intertrochanteric fracture merged with T2DM, enhance BMD, and promote the bone formation and fracture

  2. Intra-articular fractures of the distal tibia: Current concepts of management.

    Science.gov (United States)

    Sitnik, Alexandre; Beletsky, Aleksander; Schelkun, Steven

    2017-08-01

    Results of the treatment of intra-articular fractures of the distal tibia have improved significantly during the last two decades.Recognition of the role of soft tissues has led to the development of a staged treatment strategy. At the first stage, joint-bridging external fixation and fibular fixation are performed. This leads to partial reduction of the distal tibial fracture and allows time for the healing of soft tissues and detailed surgical planning.Definitive open reduction and internal fixation of the tibial fracture is performed at a second stage, when the condition of the soft tissues is safe. The preferred surgical approach(es) is chosen based on the fracture morphology as determined from standard radiographic views and computed tomography.Meticulous atraumatic soft-tissue handling and the use of modern fixation techniques for the metaphyseal component such as minimally invasive plate osteosynthesis further facilitate healing. Cite this article: EFORT Open Rev 2017;2:352-361. DOI: 10.1302/2058-5241.2.150047.

  3. The history of the walls of the Acropolis of Athens and the natural history of secondary fracture healing process.

    Science.gov (United States)

    Lyritis, G P

    2000-09-01

    During its long and adventurous history, the Acropolis of Athens has been a site of many dramatic events. It suffered its most disastrous destruction during the Persian wars. Under the command of King Xerxes, the Persians invaded Athens and ruined the Temple of the Parthenon and the walls of the Acropolis. After their victorious sea battle at Salamis, the Athenians, led by Themistocles, returned home and tried to repair the damage. Their priority still was to defend their city by restoring the walls of the Acropolis. Materials of all kinds were salvaged from the ruins of the Acropolis and used for an immediate reconstruction of the walls. Later, when the Athenians became the leaders of the Greek world, it was decided that the walls should be rebuilt in a proper artistic way. Themistocles suggested that a small section of the walls, which had formerly been a part of the urgent restoration, should remain in place so as to remind the citizens of this historical event. This is a characteristic example of the biological and mechanical adaptation of fracture callus to musculoskeletal function. After a period of urgency with the fixation of a fracture by means of a primitive secondary callus formation, the broken limb gradually returns to its usual function. Increased mechanical loading enhances the remodelling of the callus and the replacement of woven bone with lamellar bone.

  4. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Storgård Jensen, Simon; Kofod, Thomas

    2008-01-01

    The clinical outcome of closed vs open reduction and rigid fixation was compared based on a systematic review of the literature. Ten non-randomized retrospective studies were found. In six of these ten studies, the complication rate was significantly increased when open reduction and plating...... or wires. Nerve injuries were slightly increased when open reduction was found (although not significant). With regard to occlusal disturbances, no difference was found in the open and closed reduction group. Concerning overall complication problems, six of seven studies showed more problems after open...... in case of more complicated fractures cannot be excluded, which might explain the differences found between the two procedures. Prospective, randomized clinical trials are needed to illuminate this problem....

  5. Comparison between different methods for biomechanical assessment of ex vivo fracture callus stiffness in small animal bone healing studies.

    Directory of Open Access Journals (Sweden)

    Malte Steiner

    Full Text Available For ex vivo measurements of fracture callus stiffness in small animals, different test methods, such as torsion or bending tests, are established. Each method provides advantages and disadvantages, and it is still debated which of those is most sensitive to experimental conditions (i.e. specimen alignment, directional dependency, asymmetric behavior. The aim of this study was to experimentally compare six different testing methods regarding their robustness against experimental errors. Therefore, standardized specimens were created by selective laser sintering (SLS, mimicking size, directional behavior, and embedding variations of respective rat long bone specimens. For the latter, five different geometries were created which show shifted or tilted specimen alignments. The mechanical tests included three-point bending, four-point bending, cantilever bending, axial compression, constrained torsion, and unconstrained torsion. All three different bending tests showed the same principal behavior. They were highly dependent on the rotational direction of the maximum fracture callus expansion relative to the loading direction (creating experimental errors of more than 60%, however small angular deviations (<15° were negligible. Differences in the experimental results between the bending tests originate in their respective location of maximal bending moment induction. Compared to four-point bending, three-point bending is easier to apply on small rat and mouse bones under realistic testing conditions and yields robust measurements, provided low variation of the callus shape among the tested specimens. Axial compressive testing was highly sensitive to embedding variations, and therefore cannot be recommended. Although it is experimentally difficult to realize, unconstrained torsion testing was found to be the most robust method, since it was independent of both rotational alignment and embedding uncertainties. Constrained torsional testing showed small

  6. Stress and human spirituality 2000: at the cross roads of physics and metaphysics.

    Science.gov (United States)

    Seaward, B L

    2000-12-01

    Although stress is defined as a perceived threat, the implications of stress go well beyond physical well-being. In the words of Carl Jung, "Every crisis is a spiritual crisis." Western science, so strongly influenced by the Cartesian Principle of Reductionism, has ignored the essence and significance of human spirituality in the health and healing process. Holistic healing honors the integration, balance, and harmony of mind, body, spirit, and emotions, where the whole is greater than the sum of the parts. Stress (unresolved issues of anger and fear) chokes the human spirit, the life force of human energy, which ultimately affects the physical body. From the perspectives of both physics and metaphysics, stress is a disruption in the state of coherence between the layers of consciousness in the human energy field. The emerging paradigm of health reunites mind, body, and spirit, and considers health as a function of coherence among the energy levels of these components.

  7. Mendelssohn and Kant on Mathematics and Metaphysics

    OpenAIRE

    Callanan, John Joseph

    2014-01-01

    The difference between the method of metaphysics and the method of mathematics was an issue of central concern for Kant in both the Pre-Critical and Critical periods. I will argue that when Kant speaks of the ‘philosophical method’ in the Doctrine of Method in the Critique of Pure Reason (CPR), he frequently has in mind not his own methodology but rather the method of conceptual analysis associated with rationalism. The particular target is Moses Mendelssohn’s picture of analysis contained in...

  8. Complex Tibial Fractures: Tips and Tricks for Intramedullary Nail Fixation

    Directory of Open Access Journals (Sweden)

    Michael Githens

    2014-01-01

    Full Text Available Intramedullary nailing of metaphyseal and segmental tibia fractures can be technically challenging for a variety of reasons. Restoring length, alignment and rotation of the injured limb requires careful preoperative planning and meticulous attention to surgical technique, while avoiding common pitfalls. Understanding the deforming forces on the fracture segments and normal tibial osteology provides a background for recognizing the most common pitfalls when nailing these fractures. Many adjuncts for obtaining and maintaining fracture reduction while nailing have been described, including extended positioning, use of the femoral distractor, blocking screws, and provisional plating. We discuss these techniques as well as the role of intramedullary fixation for treating metaphyseal fractures with articular extension. The purpose of this paper is to describe the background and technique for a variety of operative tips and tricks to facilitate intramedullary nailing of metaphyseal and segmental tibia fractures.

  9. Metaphysical outlooks in physics and the anthropic principle.

    Science.gov (United States)

    Dallaporta, N.

    In order to justify the various assumptions current in present day cosmology, it is necessary for each of them to build a frame of metaphysical postulates much more involved and artificial than the opposite straightforwardly metaphysical view of a universe built according to an a priori plan, requiring a planning intelligence adequate to have conceived it.

  10. Naturalizing the Metaphysics of Species: A Perspective on the ...

    African Journals Online (AJOL)

    The idea of naturalizing metaphysics stretches back to Locke and Newton. Recently it has been revived by Ross and Ladyman et al (2007) in 'Every Thing Must Go'. At the heart of the doctrine is the idea that metaphysics should be constrained by actual science (science which is current and institutionally valid). It is my ...

  11. The Problem of Being in Metaphysics | Kanu | African Research ...

    African Journals Online (AJOL)

    What is being? This was and still is one of the fundamental questions within the area of metaphysics. The researcher in this piece studies the dynamics of the problem of being in metaphysics. A historical approach is adopted to this study. The researcher goes through the Ancient, Medieval, Modern and Contemporary ...

  12. Hylozoism as an Interpretive Principle in African Metaphysics ...

    African Journals Online (AJOL)

    Hylozoism as an Interpretive Principle in African Metaphysics. ... is only used as an interpretive principle in African Metaphysics; unlike the widely held assumption by some popular proponents that inanimate beings have elein vitale, that is, life-force. ... LWATI: A Journal of Contemporary Research, 8(1), 319-327, 2011 ...

  13. The metaphysics market - pushing language as platonic (not to ...

    African Journals Online (AJOL)

    This is the fourth of a series of studies in which prototypical conceptions of language are subversively turned inside out. It has to be read together with the first three, The Metaphysics Market: 1 Merchandizing Language as Matter (= SPIL PLUS li, 1989), The Metaphysics Market: 2 Billing Language as Behavioural (= SPIL ...

  14. The metaphysics market - selling language as soul | Botha ...

    African Journals Online (AJOL)

    This is the third of a series of studies in which prototypical conceptions of language are subversively turned inside out. It has to be read together with the first two, The Metaphysics Market: 1 Merchandizing Language as Matter (= SPIL 20, 1989) and The Metaphysics Market: 2 Billing Language as Behavioural (= SPIL 21, ...

  15. The Functionality of Being in Pantaleon's Operative Metaphysics vis ...

    African Journals Online (AJOL)

    The area of operative metaphysics speaks of a metaphysical system that does not just exist as an ivory tower apart from people's experience, but one that could be applied to a concrete historical circumstance. This piece studies the concept of being as understood by Pantaleon Iroegbu, as being qua belongingness.

  16. The metaphysics market - stocking language as something social ...

    African Journals Online (AJOL)

    This is the fifth of a series of studies in which prototypical conceptions of language are turned inside out. It has to be read together with the first four, The Metaphysics Market: 1 Merchandizing Language as Matter C= SPIL 20, 1989), The Metaphysics Market: 2 Billing Language as Behavioural (= SPIL 21, 1990), The ...

  17. Wound healing.

    Science.gov (United States)

    Wang, Peng-Hui; Huang, Ben-Shian; Horng, Huann-Cheng; Yeh, Chang-Ching; Chen, Yi-Jen

    2018-02-01

    Wound healing is an important physiological process to maintain the integrity of skin after trauma, either by accident or by intent procedure. The normal wound healing involves three successive but overlapping phases, including hemostasis/inflammatory phase, proliferative phase, and remodeling phase. Aberration of wound healing, such as excessive wound healing (hypertrophic scar and keloid) or chronic wound (ulcer) impairs the normal physical function. A large number of sophisticated experimental studies have provided insights into wound healing. This article highlights the information after 2010, and the main text includes (i) wound healing; (ii) wound healing in fetus and adult; (iii) prostaglandins and wound healing; (iv) the pathogenesis of excessive wound healing; (v) the epidemiology of excessive wound healing; (vi) in vitro and in vivo studies for excessive wound healing; (vii) stem cell therapy for excessive wound healing; and (viii) the prevention strategy for excessive wound healing. Copyright © 2017. Published by Elsevier Taiwan LLC.

  18. Wound healing

    Directory of Open Access Journals (Sweden)

    Peng-Hui Wang

    2018-02-01

    Full Text Available Wound healing is an important physiological process to maintain the integrity of skin after trauma, either by accident or by intent procedure. The normal wound healing involves three successive but overlapping phases, including hemostasis/inflammatory phase, proliferative phase, and remodeling phase. Aberration of wound healing, such as excessive wound healing (hypertrophic scar and keloid or chronic wound (ulcer impairs the normal physical function. A large number of sophisticated experimental studies have provided insights into wound healing. This article highlights the information after 2010, and the main text includes (i wound healing; (ii wound healing in fetus and adult; (iii prostaglandins and wound healing; (iv the pathogenesis of excessive wound healing; (v the epidemiology of excessive wound healing; (vi in vitro and in vivo studies for excessive wound healing; (vii stem cell therapy for excessive wound healing; and (viii the prevention strategy for excessive wound healing.

  19. Minimally invasive treatment of distal tibial fractures with locking and non-locking plates.

    Science.gov (United States)

    Ozkaya, Ufuk; Parmaksizoglu, Atilla S; Gul, Murat; Sokucu, Sami; Kabukcuoglu, Yavuz

    2009-12-01

    The purpose of this study was to evaluate the clinical performances of stainless steel nonlocking plates and titanium locking plates in minimally invasive medial plating of extra-articular metaphyseal fractures of the distal tibia. Between 2004 and 2006, 43 patients who sustained closed fractures of the distal tibia metaphysis were managed with either a stainless steel nonlocking plate (Group 1, n = 21) or a titanium locking plate (Group 2, n = 22). Clinical and radiographic data were retrospectively reviewed. Function was assessed with use of the American Orthopaedic Foot and Ankle Society ankle-hindfoot instrument. The average followup period was 25 months. The average AOFAS foot and ankle scores in Group 1 and Group 2 at final followup were 85 and 81, respectively. Fracture reduction was anatomical or nearly anatomical without angular displacement in all cases except one patient in Group 2. (p > 0.05) The average time to full, unprotected weightbearing in Group 1 and Group 2 were 15 weeks and 18 weeks, respectively (p plating with titanium locking plates resulted in prolonged secondary healing both in comminuted and simple fracture patterns compared to conventional stainless steel nonlocking plates. We believe that in biological fixation of distal tibial fractures, similarly good results may be obtained with both materials as the locking technology had a greater effect on stability.

  20. Ultrasound stimulation of maxillofacial bone healing

    NARCIS (Netherlands)

    Schortinghuis, J; Stegenga, B; Raghoebar, GM; de Bont, LGM

    A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%,

  1. Effects of Bone Marrow Mesenchymal Stem Cells-Conditioned Medium on Tibial Partial Osteotomy Model of Fracture Healing in Hypothyroidism Rats

    Science.gov (United States)

    Sefati, Niloofar; Norouzian, Mohsen; Abbaszadeh, Hojjat-Allah; Abdollahifar, Mohammad-Amin; Amini, Abdollah; Bagheri, Mohammad; Aryan, Arefeh; Fadaei Fathabady, Fatemeh

    2018-03-01

    Hypothyroidism is associated with dysfunction of the bone turnover with reduced osteoblastic bone formation and osteoclastic bone resorption. Mesenchyme stem cells (MSCs) secrete various factors and cytokines that may stimulate bone regeneration. The aim of this study was to determine the effects of MSCs-conditioned medium (CM) in hypothyroidism male rats after inducing bone defect. : In this study, 24 male rats were randomly assigned to three groups: (I) hypothyroidism+bone defect (HYPO), (II) hypothyroidism+bone defect+CM (HYPO+CM), and (III) no hypothyroidism+bone defect (control). Four weeks after surgery, the right tibia was removed, and immediately, biomechanical and histological examinations were performed. The results showed a significant reduction in bending stiffness (32.64±3.99), maximum force (14.63±1.89), high stress load (7.59±2.31), and energy absorption (12.68±2.12) at the osteotomy site in hypothyroidism rats in comparison to the control and hypothyroidism+condition medium groups (P<0.05). There was also a significant decrease in the trabecular bone volume (3.86±3.88) and the number of osteocytes (5800±859.8) at the osteotomy site in hypothyroidism rats compared to the control and hypothyroidism+condition medium groups (P<0.01 and P<0.02, respectively). The present study suggests that the use of the CM can improve the fracture regeneration and accelerates bone healing at the osteotomy site in hypothyroidism rats.

  2. Diderot’s ontology and Hollywood metaphysics

    Directory of Open Access Journals (Sweden)

    Božovič Miran

    2013-01-01

    Full Text Available Diderot’s universe is somewhat weird, often dreamlike and hallucinatory, and his ontology fluid and elusive. It comprises the existing, the non-existent and even contradictory entities, the boundaries between which cannot always be clearly delimited. This universe in which nothing is of the essence of a particular being and everything is more or less something or other, resembles the amorphous and oneiric world of Zhuangzi in which nothing is clearly defined, while essenceless things, floating in uncertainty and indeterminacy, literally blend into one another. The author examines what the early Hollywood comedies of Preston Sturges and the Marx brothers can teach us about the metaphysics and the principles at work in this complex and intricate world.

  3. Audism: exploring the metaphysics of oppression.

    Science.gov (United States)

    Bauman, H-Dirksen L

    2004-01-01

    This article traces the development of the concept of "audism" from its inception in the mid-1970s by exploring three distinct dimensions of oppression: individual, institutional, and metaphysical. Although the first two aspects of audism have been identified, there is a deeply rooted belief system regarding language and human identity that is yet to be explored within the context of audism. This article attempts to expose how our particular historical and philosophical constructions of language and being have created what French philosopher Jacques Derrida calls phonocentrism. Although Derrida does not discuss audism, his deconstruction of the Western notion of language provides a lens through which we can better see the orientation that has provided fertile ground out of which individual and institutional audism has flourished.

  4. The Metaphysics of Chinese Information Philosophy

    DEFF Research Database (Denmark)

    Liqian, Zhou; Brier, Søren

    2015-01-01

    Compared with other transdisciplinary frames of information Wu Kun’s philosophy of information differs in its metaphysical framework in that it has a background in a conception of Dialectics of Nature coming from the old Stalin textbook system but also a part of the renewal of thinking in China...... appearing through the thought liberty movement in the 1980s, which among other things also added a modern view of information to Chinese thinking. Still it is a philosophy in a distinctive Chinese style. Wu’s philosophical system begins by re-dividing the field of existence and founding a new ontological...... area or aspect of being, which he called the world of information and named it objective unreality. This, ontological framework, different from that in the West, made the concept of information in his system different from the information concept in Shannon’s and even Wiener’s sense. Wu’s philosophy...

  5. Transition from Critical Ontology To Metaphysical Foundations of Natural Science

    Directory of Open Access Journals (Sweden)

    Juan Csno De Pablo

    2015-03-01

    Full Text Available The Critique of Pure Reason out lines an a priori ontology of nature. We find in the Critique the category of substance, which is totally a priori. However, the metaphysical principles of natural science come from the notion of matter, which is empirical. This article shows the transition carried out by Kant between two areas of knowledge. For this purpose, we will relate two Kantian texts: Prologomena to Any Future Metaphysics Which Shall Lay Claim to Being a Science and Metaphysical Foundations of Natural Science.

  6. [Hip fractures].

    Science.gov (United States)

    Weisová, Drahomíra; Salášek, Martin; Pavelka, Tomáš

    2013-01-01

    Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH - proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails - PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP - locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.

  7. OUT-OF-BODY EXPERIENCE, PURE BEING AND METAPHYSICS

    Directory of Open Access Journals (Sweden)

    I. V. Karivets

    2016-12-01

    Full Text Available Purpose. The author will show that metaphysical concepts and the concepts of empirical sciences derive from experience. The only difference is that metaphysical concepts derive from unusual experience, i.e. out-of-body experience, while empirical sciences – from usual one. The example set metaphysical concept of pure being. Methodology. In order to obtain this goal the author uses two methods. The first one is comparative method. With the help of this method the stories of men who experienced clinical death and returned to life are compared with the famous philosophers’ metaphysical statements (Plato, Descartes, and Bonaventura. The second one is transpersonal method. It helps to study the peculiarities of the extraordinary experience in the state of clinical death or mystical ecstasy. Such experience lies in experience of transcendence, pure being as light, ultimate awareness of truth, which are identical to the metaphysical statements of philosophers and mystics. These ultimate experiences belong to different people, who lived and grown in different cultures, but nevertheless metaphysical statements of philosophers or mystics and statements of the ordinary people who experienced clinical death are the same. Therefore we can say that out-of-body experience is transpersonal. Originality. Metaphysics is neither speculative nor withdrawn from experience of a human being sphere. It arises from out-of-body experience while empirical sciences – from usual experience. Therefore, metaphysical concepts, in particular, pure being, are empirical, because they are based also on (extraordinary experience. In general, metaphysics becomes possible on the basis of out-of-body experience. Conclusions. In this article the author argues that the concepts of metaphysics are not a priori because they originate from out-of-body experience that is from the experience of the distinction between body and soul or body and mind. As a result of such experience

  8. The tragic and the metaphysical in philosophy and psychoanalysis.

    Science.gov (United States)

    Stolorow, Robert D; Atwood, George E

    2013-06-01

    This article elaborates a claim, first introduced by Wilhelm Dilthey, that metaphysics represents an illusory flight from the tragedy of human finitude. Metaphysics, of which psychoanalytic metapsychologies are a form, transforms the unbearable fragility and transience of all things human into an enduring, permanent, changeless reality, an illusory world of eternal truths. Three "clinical cases" illustrate this thesis in the work and lives of a philosopher and two psychoanalytic theorists: Friedrich Nietzsche and his metaphysical doctrine of the eternal return of the same, Sigmund Freud and his dual instinct theory, and Heinz Kohut and his theoretical language of the self. It is contended that the best safeguard against the pitfalls of metaphysical illusion lies in a shared commitment to reflection on the constitutive contexts of all our theoretical ideas.

  9. The abundant world: Paul Feyerabend's metaphysics of science.

    Science.gov (United States)

    Brown, Matthew J

    2016-06-01

    The goal of this paper is to provide an interpretation of Feyerabend's metaphysics of science as found in late works like Conquest of Abundance and Tyranny of Science. Feyerabend's late metaphysics consists of an attempt to criticize and provide a systematic alternative to traditional scientific realism, a package of views he sometimes referred to as "scientific materialism." Scientific materialism is objectionable not only on metaphysical grounds, nor because it provides a poor ground for understanding science, but because it implies problematic claims about the epistemic and cultural authority of science, claims incompatible with situating science properly in democratic societies. I show how Feyerabend's metaphysical view, which I call "the abundant world" or "abundant realism," constitute a sophisticated and challenging form of ontological pluralism that makes interesting connections with contemporary philosophy of science and issues of the political and policy role of science in a democratic society. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

    LENUS (Irish Health Repository)

    Ong, J C Y

    2012-06-01

    The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.

  11. Management of metaphyseal bone loss in revision knee arthroplasty.

    Science.gov (United States)

    Mancuso, Francesco; Beltrame, Arianna; Colombo, Elia; Miani, Enrick; Bassini, Fabrizio

    2017-06-07

    Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.

  12. Relativistic Constraints for a Naturalistic Metaphysics of Time

    OpenAIRE

    Evans, Peter W.

    2010-01-01

    The traditional metaphysical debate between static and dynamic views in the philosophy of time is examined in light of considerations concerning the nature of time in physical theory. Adapting the formalism of Rovelli (1995, 2004), I set out a precise framework in which to characterise the formal structure of time that we find in physical theory. This framework is used to provide a new perspective on the relationship between the metaphysics of time and the special theory of relativity by emph...

  13. Gould on species, metaphysics and macroevolution: A critical appraisal.

    Science.gov (United States)

    Boucher, Sandy C

    2017-04-01

    Stephen Jay Gould's views on the ontology of species were an important plank of his revisionist program in evolutionary theory. In this paper I cast a critical eye over those views. I focus on three central aspects of Gould's views on species: the relation between the Darwinian and the metaphysical notions of individuality, the relation between the ontology of species and macroevolution, and the issue of contextualism and conventionalism about the metaphysics of species. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Classic metaphyseal lesion following external cephalic version and cesarean section

    Energy Technology Data Exchange (ETDEWEB)

    Lysack, John T.; Soboleski, Don [Department of Diagnostic Radiology, Queen' s University, Kingston General Hospital, 76 Stuart Street, K7L 2V7, Kingston, Ont. (Canada)

    2003-06-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. (orig.)

  15. Classic metaphyseal lesion following external cephalic version and cesarean section

    International Nuclear Information System (INIS)

    Lysack, John T.; Soboleski, Don

    2003-01-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. (orig.)

  16. Beyond the realism debate: The metaphysics of 'racial' distinctions.

    Science.gov (United States)

    Lemeire, Olivier

    2016-10-01

    The current metaphysical race debate is very much focused on the realism question whether races exist. In this paper I argue against the importance of this question. Philosophers, biologists and anthropologists expect that answering this question will tell them something substantive about the metaphysics of racial classifications, and will help them to decide whether it is justified to use racial categories in scientific research and public policy. I argue that there are two reasons why these expectations are not fulfilled. First of all, the realism question about race leads to a very broad philosophical debate about the semantics of general terms and the criteria for real kinds, rather than to a debate about the metaphysics of racial categories specifically. Secondly, there is a type of race realism that is so toothless that it is almost completely uninformative about the metaphysics of race. In response to these worries, I argue that the metaphysical race debate should rather be focused on the question in what way and to what extent 'racial' distinctions can ground the epistemic practices of various scientific disciplines. I spell out what I mean by this, and go on to demonstrate that trying to answer this question leads to a more fruitful metaphysical debate. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Socialcultural background of formation of classical metaphysics

    Directory of Open Access Journals (Sweden)

    I. Z. Derzhko

    2014-09-01

    Full Text Available The classical model of philosophy has shaped ideas about its nature and aims that were laid in ancient metaphysics, but have been substantially amended by civilizational change. Socialcultural background of philosophy became trends that began to emerge in late medieval culture has particularly flourished there during modern times. Sphere of existence is important for the development of any spiritual phenomenon. For metaphysics it is the idea of humanity, acting as a kind of cultural protest against the domination of religion. This caused criticism of the medieval way of life and thinking. The idea of human revival based on spirit of antiquity has grounded. Disclaimer theological philosophy medieval variant type is as opposed to free philosophizing, coupled with poetry and literature, University dogmatic philosophy. There were a «rediscovery» of Plato, Aristotle reinterpretation. Philosophers explored a problem of human emotions and relationships, considering the person as a whole being, which is inherent in the mind, which cannot be considered without bodily desires and emotions. Change of the values awakened activity of the human person, led its transformation settings concerning himself and the surrounding world. Thus objectively obtained expression and ideological embodiment of civilization in a need of a new type of man - to a much greater extent compared to medieval activity, initiative, freedom, rationality, responsibility. Under the influence of such attitudes changes within religion gradually took place. Through the efforts of thinkers like Luther, Calvin, Munzer there were laid ideas of the Reformation that go far beyond its borders, gaining general cultural nature. The Church was increasingly losing control over everyday human existence. Gradually standards of a free, relaxed life became conventional; requirements of the body, «earthly» spirit demands fulfilling played a huge role. Thought and Culture of the Renaissance reflects

  18. Stress fractures at the base of the second metatarsal in ballet dancers.

    Science.gov (United States)

    O'Malley, M J; Hamilton, W G; Munyak, J; DeFranco, M J

    1996-02-01

    Stress fractures are a frequent injury in ballet companies and the most common location is at the base of the second metatarsal. While previous reports have focused on risk factors for this injury (overtraining, delayed menarche, poor nutrition), there is no published series describing the natural history and outcome following this fracture. We reviewed the office records of the senior author and identified 51 professional dancers (64 fractures) who sustained a stress fracture at the base of the second metatarsal. History of a previous stress fracture in the lower extremity was seen in 19 patients and delayed menarche in the women was common. The clinical presentation was insidious onset of midfoot pain an average of 2.5 weeks prior to seeking medical care. The initial radiographs of the foot were positive in 19 patients, questionable in 3 patients, and negative in 42 patients. The usual location of the fracture was at the proximal metaphyseal-diaphyseal junction (three fractures extended into the tarsometatarsal joint). Treatment consisted of a short leg walking cast for 6 patients, and a wooden shoe and symptomatic treatment for the remainder. At follow-up, 14% of patients still had occasional pain or stiffness in the midfoot with dancing. The patients returned to performance at an average of 6.2 weeks following diagnosis. No patients required bone grafting for persistent symptoms. There were eight refractures (at the same site) occurring an average of 4.3 years, all of which healed with conservative care. Stress fractures at the base of the second metatarsal are common in ballet dancers and can usually be treated with symptomatically. The results of this study are discussed in terms of risk factors, the use of a posterior-anterior view of the foot to eliminate overlap at Lisfranc's joint, and our present treatment regimen.

  19. Fracture of the Distal Ulna Metaphysis in the Setting of Distal Radius Fractures.

    Science.gov (United States)

    Paksima, Nader; Khurana, Sonya; Soojian, Michael; Patel, Vipul; Egol, Kenneth

    2017-04-01

    Fracture of the metaphyseal region of the distal ulna is an uncommon injury that has been reported to occur concomitantly with distal radius fracture. We aimed to report the incidence and types of distal ulnar head and neck fractures associated with distal radius fractures and compare outcomes in operatively versus non-operatively treated patients. Over a 5-year period a distal radius fracture registry was maintained at our institution. Eleven of 512 consecutive patients had metaphyseal distal ulna fractures in association with distal radius fractures and at least 1-year follow-up. Baseline radiographs and functional data were obtained, and patients were followed at 1-week, 2-week, 3-week, 6-week, 3-month, 6-month, 1-year, and 2-year intervals. Patients were split into two treatment groups: Group 1 consisted of five non-operatively treated patients, and Group 2 consisted of six operatively treated patients. Four separate fracture patterns were observed: simple transverse or oblique fracture of the ulnar neck just proximal to the ulnar head, fracture of the neck region with concomitant fracture of the tip of the ulnar styloid, simple fracture of the ulnar head, and comminuted fracture of the ulnar head. There were no statistical differences between the two groups with regard to flexion, extension, supination, pronation, and functional outcomes. Ulnar fracture patterns observed did not easily fall into previously described categories, and we have proposed a new classification system. Simple fractures of the ulnar neck or head often do not require operative fixation.

  20. Assessment of bone healing on tibial fractures treated with wire osteosynthesis associated or not with infrared laser light and biphasic ceramic bone graft (HATCP) and guided bone regeneration (GBR): Raman spectroscopy study

    Science.gov (United States)

    Bastos de Carvalho, Fabíola; Aciole, Gilberth Tadeu S.; Aciole, Jouber Mateus S.; Silveira, Landulfo, Jr.; Nunes dos Santos, Jean; Pinheiro, Antônio L. B.

    2011-03-01

    The aim of this study was to evaluate, through Raman spectroscopy, the repair of complete tibial fracture in rabbits fixed with wire osteosynthesis - WO, treated or not with infrared laser light (λ 780nm, 50mW, CW) associated or not to the use of HATCP and GBR. Surgical fractures were created under general anesthesia (Ketamine 0.4ml/Kg IP and Xilazine 0.2ml/Kg IP), on the tibia of 15 rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with WO. Animals of groups III and V were grafted with hydroxyapatite + GBR technique. Animals of groups IV and V were irradiated at every other day during two weeks (16J/cm2, 4 x 4J/cm2). Observation time was that of 30 days. After animal death the specimens were kept in liquid nitrogen for further analysis by Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p<0.001). It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of calcium hydroxyapatite.

  1. Podoplanin immunopositive lymphatic vessels at the implant interface in a rat model of osteoporotic fractures.

    Directory of Open Access Journals (Sweden)

    Katrin Susanne Lips

    Full Text Available Insertion of bone substitution materials accelerates healing of osteoporotic fractures. Biodegradable materials are preferred for application in osteoporotic patients to avoid a second surgery for implant replacement. Degraded implant fragments are often absorbed by macrophages that are removed from the fracture side via passage through veins or lymphatic vessels. We investigated if lymphatic vessels occur in osteoporotic bone defects and whether they are regulated by the use of different materials. To address this issue osteoporosis was induced in rats using the classical method of bilateral ovariectomy and additional calcium and vitamin deficient diet. In addition, wedge-shaped defects of 3, 4, or 5 mm were generated in the distal metaphyseal area of femur via osteotomy. The 4 mm defects were subsequently used for implantation studies where bone substitution materials of calcium phosphate cement, composites of collagen and silica, and iron foams with interconnecting pores were inserted. Different materials were partly additionally functionalized by strontium or bisphosphonate whose positive effects in osteoporosis treatment are well known. The lymphatic vessels were identified by immunohistochemistry using an antibody against podoplanin. Podoplanin immunopositive lymphatic vessels were detected in the granulation tissue filling the fracture gap, surrounding the implant and growing into the iron foam through its interconnected pores. Significant more lymphatic capillaries were counted at the implant interface of composite, strontium and bisphosphonate functionalized iron foam. A significant increase was also observed in the number of lymphatics situated in the pores of strontium coated iron foam. In conclusion, our results indicate the occurrence of lymphatic vessels in osteoporotic bone. Our results show that lymphatic vessels are localized at the implant interface and in the fracture gap where they might be involved in the removal of

  2. A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol

    Directory of Open Access Journals (Sweden)

    Enrique Gómez-Barrena

    2018-01-01

    Full Text Available ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32 to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC treatments versus iliac crest autograft (ICA to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments. The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n=108 will be randomly assigned to either the experimental low dose (n=36, the experimental high dose (n=36, or the comparator arm (n=36 using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

  3. A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol.

    Science.gov (United States)

    Gómez-Barrena, Enrique; Padilla-Eguiluz, Norma G; Avendaño-Solá, Cristina; Payares-Herrera, Concepción; Velasco-Iglesias, Ana; Torres, Ferran; Rosset, Philippe; Gebhard, Florian; Baldini, Nicola; Rubio-Suarez, Juan C; García-Rey, Eduardo; Cordero-Ampuero, José; Vaquero-Martin, Javier; Chana, Francisco; Marco, Fernando; García-Coiradas, Javier; Caba-Dessoux, Pedro; de la Cuadra, Pablo; Hernigou, Philippe; Flouzat-Lachaniette, Charles-Henri; Gouin, François; Mainard, Didier; Laffosse, Jean Michel; Kalbitz, Miriam; Marzi, Ingo; Südkamp, Norbert; Stöckle, Ulrich; Ciapetti, Gabriela; Donati, Davide Maria; Zagra, Luigi; Pazzaglia, Ugo; Zarattini, Guido; Capanna, Rodolfo; Catani, Fabio

    2018-01-01

    ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 10 6 hBM-MSCs is noninferior to that of 200 × 10 6 hBM-MSCs. The participants ( n = 108) will be randomly assigned to either the experimental low dose ( n = 36), the experimental high dose ( n = 36), or the comparator arm ( n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

  4. Augmentation of bone healing in delayed and atrophic nonunion of fractures of long bones by partially decalcified bone allograft (decal bone

    Directory of Open Access Journals (Sweden)

    Anuj Jain

    2015-01-01

    Conclusion: The partially decalcified bone allograft is an effective modality for augmentation of bone healing without complication associated with autograft like donor site morbidity, increased blood loss and increase in the surgical time.

  5. Calcium phosphate cement augmentation after volar locking plating of distal radius fracture significantly increases stability.

    Science.gov (United States)

    Kainz, Hans; Dall'Ara, Enrico; Antoni, Anna; Redl, Heinz; Zysset, Philippe; Weninger, Patrick

    2014-08-01

    Distal radius fractures represent the most common fractures in adults. Volar locking plating to correct unstable fractures has become increasingly popular. Although reasonable primary reduction is possible in most cases, maintenance of reduction until the fracture is healed is often problematic in osteoporotic bone. To our knowledge, no biomechanical studies have compared the effect of enhancement with biomaterial on two different volar fixed-angle plates. Human fresh-frozen cadaver pairs of radii were used to simulate an AO/OTA 23-A3 fracture. In a total of four groups (n = 7 for each group), two volar fixed-angle plates (Aptus 2.5 mm locking fracture plate, Medartis, Switzerland and VA-LCP two-column distal radius plate 2.4, volar, Synthes, Switzerland) with or without an additional injection of a biomaterial (Hydroset Injectable HA Bone Substitute, Stryker, Switzerland) into the dorsal comminution zone were used to fix the distal metaphyseal fragment. Each specimen was tested load-controlled under cyclic loading with a servo-hydraulic material testing machine. Displacement, stiffness, dissipated work and failure mode were recorded. Improved mechanical properties (decreased displacement, increased stiffness, decreased dissipated work) were found in both plates if the biomaterial was additionally injected. Improvement of mechanical parameters after biomaterial injection was more evident in the Synthes plate compared to the Aptus plate. Pushing out of the screws was noticed as a failure mode only in samples lacking supplementary biomaterial. Injection of a biomaterial into the dorsal comminution zone increases stability after volar locking plating of distal radius fractures in vitro.

  6. The wave function essays on the metaphysics of quantum mechanics

    CERN Document Server

    Albert, David Z

    2013-01-01

    This is a new volume of original essays on the metaphysics of quantum mechanics. The essays address questions such as: What fundamental metaphysics is best motivated by quantum mechanics? What is the ontological status of the wave function? Does quantum mechanics support the existence of any other fundamental entities, e.g. particles? What is the nature of the fundamental space (or space-time manifold) of quantum mechanics? What is the relationship between the fundamental ontology of quantum mechanics and ordinary, macroscopic objects like tables, chairs, and persons? This collection includes a comprehensive introduction with a history of quantum mechanics and the debate over its metaphysical interpretation focusing especially on the main realist alternatives.

  7. The Metaphysical Instincts & Spiritual Bypassing in Integral Psychology

    Directory of Open Access Journals (Sweden)

    Bahman A.K. Shirazi

    2013-09-01

    Full Text Available Instincts are innate, unconscious means by which Nature operates in all forms of life including animals and human beings. In humans however, with progressive evolution of consciousness, instincts become increasingly conscious and regulated by egoic functions. Biological instincts associated with the lower-unconscious such as survival, aggressive, and reproductive instincts are well known in general psychology. The higher-unconscious, which is unique to human beings, may be said to have its own instinctual processes referred to here as the ‘metaphysical instincts’. In traditional spiritual practices awakening the metaphysical instincts has often been done at the expense of suppressing the biological instincts—a process referred to as spiritual bypassing. This essay discusses how the metaphysical instincts initially expressed as the religious impulse with associated beliefs and behaviors may be transformed and made fully conscious, and integrated with the biological instincts in integral yoga and psychology in order to achieve wholeness of personality.

  8. A critical introduction to the metaphysics of time

    CERN Document Server

    Curtis, Benjamin

    2016-01-01

    What is the nature of time? Does it flow? Do the past and future exist? Drawing connections between historical and present-day questions, A Critical Introduction to the Metaphysics of Time provides an up-to-date guide to one of the most central and debated topics in contemporary metaphysics. Introducing the views and arguments of Parmenides, Plato, Aristotle, Descartes, Newton and Leibniz, this accessible introduction covers the history of the philosophy of time from the Pre-Socratics to the beginning of the 20th Century. The historical survey presents the necessary background to understanding more recent developments, including McTaggart's 1908 argument for the unreality of time, the open future, the perdurance/endurance debate, the possibility of time travel, and the relevance of current physics to the philosophy of time. Informed by cutting-edge philosophical research, A Critical Introduction to the Metaphysics of Time evaluates influential historical arguments in the context of contemporary developments. ...

  9. Metaphysics as the Science of Essence: E. J. Lowe and Thomas Aquinas

    Directory of Open Access Journals (Sweden)

    Alejandro Pérez

    2013-12-01

    Full Text Available Metaphysics after being ignored for years has returned to the center of the stage in contemporary philosophy. Thomas Aquinas has lived a very similar story, which gave birth to analytical Thomism. Despite the work done in this line of research, the metaphysics of Aquinas has been heavily ignored. However, the metaphysics of Thomas Aquinas has an advantage, little discussed among Thomists and “Tomasinos”, and it is the fact that it is essentialist metaphysics. So, in keeping with the work of metaphysical E. J. Lowe, who presents his metaphysics as “serious essentialist” it is shown here that the metaphysics of Aquinas has the same virtues of “serious essentialism”, which allows to postulate it as a valid and plausible position for contemporary metaphysics.

  10. Information in Reality: Logic and Metaphysics

    Directory of Open Access Journals (Sweden)

    Joseph E. Brenner

    2011-10-01

    Full Text Available The recent history of information theory and science shows a trend in emphasis from quantitative measures to qualitative characterizations. In parallel, aspects of information are being developed, for example by Pedro Marijuan, Wolfgang Hofkirchner and others that are extending the notion of qualitative, non-computational information in the biological and cognitive domain to include meaning and function. However, there is as yet no consensus on whether a single acceptable definition or theory of the concept of information is possible, leading to many attempts to view it as a complex, a notion with varied meanings or a group of different entities. In my opinion, the difficulties in developing a Unified Theory of Information (UTI that would include its qualitative and quantita-tive aspects and their relation to meaning are a consequence of implicit or explicit reliance on the principles of standard, truth-functional bivalent or multivalent logics. In reality, information processes, like those of time, change and human con-sciousness, are contradictory: they are regular and irregular; consistent and inconsistent; continuous and discontinuous. Since the indicated logics cannot accept real contradictions, they have been incapable of describing the multiple but interre-lated characteristics of information. The framework for the discussion of information in this paper will be the new extension of logic to real complex processes that I have made, Logic in Reality (LIR, which is grounded in the dualities and self-dualities of quantum physics and cos-mology. LIR provides, among other things, new interpretations of the most fundamental metaphysical questions present in discussions of information at physical, biological and cognitive levels of reality including, especially, those of time, continuity vs. discontinuity, and change, both physical and epistemological. I show that LIR can constitute a novel and general ap-proach to the non-binary properties of

  11. Biomechanics of the classic metaphyseal lesion: finite element analysis

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Harvard Medical School, Boston, MA (United States); Coats, Brittany [University of Utah, Department of Mechanical Engineering, Salt Lake City, UT (United States)

    2017-11-15

    The classic metaphyseal lesion (CML) is strongly associated with infant abuse, but the biomechanics responsible for this injury have not been rigorously studied. Radiologic and CT-pathological correlates show that the distal tibial CML always involves the cortex near the subperiosteal bone collar, with variable extension of the fracture into the medullary cavity. Therefore, it is reasonable to assume that the primary site of bone failure is cortical, rather than intramedullary. This study focuses on the strain patterns generated from finite element modeling to identify loading scenarios and regions of the cortex that are susceptible to bone failure. A geometric model was constructed from a normal 3-month-old infant's distal tibia and fibula. The model's boundary conditions were set to mimic forceful manipulation of the ankle with eight load modalities (tension, compression, internal rotation, external rotation, dorsiflexion, plantar flexion, valgus bending and varus bending). For all modalities except internal and external rotation, simulations showed increased cortical strains near the subperiosteal bone collar. Tension generated the largest magnitude of cortical strain (24%) that was uniformly distributed near the subperiosteal bone collar. Compression generated the same distribution of strain but to a lesser magnitude overall (15%). Dorsiflexion and plantar flexion generated high (22%) and moderate (14%) localized cortical strains, respectively, near the subperiosteal bone collar. Lower cortical strains resulted from valgus bending, varus bending, internal rotation and external rotation (8-10%). The highest valgus and varus bending cortical strains occurred medially. These simulations suggest that the likelihood of the initial cortical bone failure of the CML is higher along the margin of the subperiosteal bone collar when the ankle is under tension, compression, valgus bending, varus bending, dorsiflexion and plantar flexion, but not under internal

  12. METAPHYSICAL REVOLUTION OF DESCARTES AND TRANSFORMATION OF THE ANTHROPOLOGICAL PROJECT

    Directory of Open Access Journals (Sweden)

    Anatolii M. Malivskyi

    2015-05-01

    Full Text Available The purpose is to reveal and comprehend forms of influence metaphysical' revolution for a way of interpretation of the anthropological project by Descartes on the basis of investigations of modern dekartes's researchers, that is the recognition of a fundamental role of metaphysics. Methodology. As methodological base modern investigations of dekartes's researchers accenting a fundamental role of metaphysics and expediency of unbiassed judgment of heritage of the great thinker are used. The scientific novelty. The transformation of the anthropological project is outlined as manifestation of metaphysical revolution. It is about a transcendencecy of naive anthropology (as an embodiment of reductive mindset, that is interpretations of human nature as its corporality and transition to metaphysical anthropology which consists in upholding of unconditional priority of human thinking as associated with God. As result of transition concentration of attention on intense human nature, that is at tension between sensuality and intelligence, aspiration to truth and tendency to delusion, between Life and Nothing, etc. Conclusions. The appeal to the incomplete anthropological project of Descartes on the basis of innovative researches allows proving the thesis about influence of metaphysical revolution on a way of its interpretation. The main forms of oriented to science ideals of naive anthropology, trust in evidence of the senses, atheism, interpretation of science as the main form of detection rationality of human nature, which Descartes tends constructively to overcome in the text of "meditation", are highlighted. During creation of metaphysical anthropology the attention of the thinker is drawn by the fact of impossibility of comprehension of human nature by means of natural-science rationality and expediency of the appeal to metaphysics. The subject of attention of the thinker is the tension between sensuality and intelligence, need

  13. [The mark of envy: metaphysics and embryology according to Descartes].

    Science.gov (United States)

    Gaudemard, Lynda

    2012-01-01

    This paper explores the interaction between medicine and metaphysics in modern natural philosophy and especially in Descartes' philosophy. I argue that Descartes hypothetical account of birthmarks in connection with his embryology provides an argumentative proof of the metaphysical necessity of a substantial union between mind and body, which however does not threaten his doctrine of the real distinction between these two substances. It would appear that his argument relies on a temporal conception of alethic modalities and provides a new answer to Henricus Regius who in 1641 claimed that, for Descartes, the human being is an ensper accidens.

  14. Fall and Rise of Aristotelian Metaphysics in the Philosophy of Science

    Science.gov (United States)

    Lamont, John

    2009-01-01

    The paper examines the fortunes of Aristotelian metaphysics in science and the philosophy of science. It considers the Enlightenment claim that such a metaphysics is fundamentally unscientific, and that its abandonment was essential to the scientific revolution. The history of the scientific revolution and the metaphysical debates involved in it…

  15. The Futility of Any Anti-Metaphysical Position | Okoro | Lagos Notes ...

    African Journals Online (AJOL)

    This essay explains why it is difficult or even impossible to reject metaphysics. By this we do not mean that metaphysical theories cannot be refuted; what we rather mean to say is that it is absolutely futile to deny the existence of metaphysics and its importance to human life. To do so would amount to the denial of the human ...

  16. Metaphysical Concept of Secularization versus Islamic Concept of Secularization

    Directory of Open Access Journals (Sweden)

    Volkan ERTİT

    2017-12-01

    Full Text Available In early 21st century, the question “Is Turkey becoming secularized contrary to popular belief?” was one of the discussions occupying Turkish public opinion. These discussions led to the encounter of two different concepts of secularization, “theological (Islamic” and "metaphysical", and to put forward different claims using the same concept. Hence, it became evidentwas understood that a discussion was necessary to understand what secularization is and what it is not before starting any debate on Turkey's secularization. That is because the metaphysical discussion that defines secularization as the decline in the social influence of metaphysical realm (religion, religion-like mechanisms, folk religions, superstitious beliefs, etc. is overshadowed by the Islamic definition describing secularization as "irreligiousness" or "non-Islamism". Therefore, discussingTo understand the social transformation in Turkey, this article attempts to explain that metaphysical rather than theological definition of secularization is necessary for understanding the social implications of the process of modernization.

  17. Modes of Learning: Whitehead's Metaphysics and the Stages of Education

    Science.gov (United States)

    Allan, George

    2012-01-01

    Educators are familiar with Alfred North Whitehead's three stages of education: romance, precision, and generalization. Philosophers are familiar with his metaphysical theories about the primacy of temporal processes. In "Modes of Learning," George Allan brings these two sides of Whitehead's thought together for the first time in a book…

  18. Metaphysical Modality, Modality of Predicate and the Theory of

    Directory of Open Access Journals (Sweden)

    l nabavi

    2010-05-01

    This paper discusses the historical overview of the metaphysical modality firstly and then shows that the theory of "Decisive Necessity” is true and justified in a model of modal logic with equivalent accessibility relation and homogeneous possible world view (fixed domain.

  19. The Metaphysics and Epistemology of Singular Terms | Borg ...

    African Journals Online (AJOL)

    Can we draw apart questions of what it is to be a singular term (a metaphysical issue) from questions about how we tell when some expression is a singular term (an epistemological matter)? Prima facie, it might seem we can't: language, as a man-made edifice, might seem to prohibit such a distinction, and, indeed, some ...

  20. Peirce’s Scientific and Spiritual Process Metaphysics

    DEFF Research Database (Denmark)

    Brier, Søren

    Peirce saw as his primary task to develop a comprehensive metaphysical and epistemological system in which a new theory of categories, developed after Kant and Hegel, was defined in a completely new way. His triadic category theory was connected to a dynamic triadic web of semiotics viewed as the...

  1. The metaphysics market - billing language as behavioural | Botha ...

    African Journals Online (AJOL)

    This is the second of a series of studies in which prototypical conceptions of language are subversively turned inside out. It has to be read in tandem with the first. The Metaphysics Market: 1 Merchandizing Language as Matter (= SPIL and SPIL PLUS 14, 1989). I would like to thank Walter Winckler for contributing generously ...

  2. The Problem of Personal Identity in Metaphysics | Kanu | AFRREV ...

    African Journals Online (AJOL)

    Although Western Philosophical tradition ascribes the invention of the problem of identity to John Locke, it has remained one of the fundamental questions within the parameters of enquiry in Metaphysics, Epistemology and Philosophy of Mind. It is one that has remained evergreen right from the Pre-Socratic Epoch to the ...

  3. Conceptual and Metaphysical Origins and Relevance of Temporal Logic

    DEFF Research Database (Denmark)

    Jakobsen, David; Øhrstrøm, Peter

    2016-01-01

    Logic has sometimes been seen as an alternative to metaphysics and to speculation. In this paper it is argued that a different story should be told when it comes to temporal logic and tense-logic in particular. A.N. Prior’s first formulation of tense logic was mainly established in order to quali...

  4. Metaphysics as praxis : Rereading Dōgen's Metaphysics through Deleuzian pragmatism and Pratītyasamutpāda

    NARCIS (Netherlands)

    Hiramoto, S.

    2017-01-01

    This thesis interprets the Japanese Buddhist master, Dōgen's metaphysical ideas concerning Buddha-nature, Total-function, and temporality, with the help of Deleuze's pragmatism, in a manner congruent with the central Buddhist doctrine of pratītyasamutpāda. In doing so, the research attempts to

  5. Effects of long-term immobilization and recovery on human triceps surae and collagen turnover in the Achilles tendon in patients with healing ankle fracture

    DEFF Research Database (Denmark)

    Christensen, Britt; Dyrberg, Eva; Aagaard, Per

    2008-01-01

    The aim of the present study was to analyze how human tendon connective tissue responds to an approximately 7-wk period of immobilization and a remobilization period of a similar length, in patients with unilateral ankle fracture, which is currently unknown. Calf muscle cross-sectional area (CSA)...

  6. Self-healing polymers

    Science.gov (United States)

    Klein, Daniel J. (Inventor)

    2011-01-01

    A three dimensional structure fabricated from a self-healing polymeric material, comprising poly(ester amides) obtained from ethylene glycol, azelaic acid and 1,1-aminoundecanoic acid, wherein polymeric material has a melt index above 2.5 g/10 min. as determined by ASTM D1238 at 190.degree. C. and 2.16kg, impact resistance and ductility sufficient to resist cracking and brittle fracture upon impact by a 9 mm bullet fired at a temperature of about 29.degree. C. at subsonic speed in a range from about 800 feet/sec to about 1000 feet/sec. It has been determined that the important factors necessary for self-healing behavior of polymers include sufficient impact strength, control of the degree of crystallinity, low melting point and the ability to instantly melt at impacted area.

  7. Mechanical Failure of Revision Knee Prosthesis at both Femoral and Tibial Modular Metaphyseal Stem Junctions.

    Science.gov (United States)

    Woodgate, Ian G; Rooney, John; Mulford, Johnathan S; Gillies, R Mark

    2016-01-01

    This is a report of a mechanical failure of an S-ROM revision total knee prosthesis. The prosthesis was used as a revision implant following deep peri-prosthetic infection in a morbidly obese male. The prosthesis failed on both the femoral and tibial sides at the modular metaphyseal stem junctions and required a further revision using the same type of implant after infection was excluded. A 57 year old male had previously undergone a left total knee arthroplasty in 1999 for osteoarthritis. He acquired a late deep peri-prosthetic infection with a multi-resistant Staphylococcus epidermidis. The organism was sensitive to vancomycin and rifampicin. A two stage revision was undertaken after clinical signs of infection had resolved and blood parameters had normalized. Intra-operative gram stain was negative for micro-organisms and frozen section of deep tissue was less than five polymorphs per high power field. A cemented S-ROM prosthesis was implanted using a coronal tibial osteotomy and a lateral release for exposure. After three years of the second stage of revision, the patient again presented to the orthopaedic department after reportedly falling on a wet floor six weeks ago. Radiographically, there was a broken tibial wire, osteolysis and pedestal formation around both the femoral and distal tibial stem extensions. The prosthesis was bent at the proximal tibial sleeve and stem junction. The prosthesis was considered loose with mechanical failure. At implant removal, it was noted that the femoral and tibial components at the modular metaphyseal sleeve-stem junction were fractured. Surgeons should be cautious in the use of these implants in morbidly obese patients where the stresses generated maybe above the yield stress of the material and the frictional forces that may overcome the modular taper junction's locking mechanism.

  8. The systemic angiogenic response during bone healing.

    Science.gov (United States)

    Weiss, Stefan; Zimmermann, Gerald; Pufe, Thomas; Varoga, Deike; Henle, Philipp

    2009-07-01

    Angiogenesis is known to be a critical and closely regulated step during bone formation and fracture healing driven by a complex interaction of various cytokines. Delays in bone healing or even nonunion might therefore be associated with altered concentrations of specific angiogenic factors. These alterations might in turn be reflected by changes in serum concentrations. To determine physiological time courses of angiogenic cytokines during fracture healing as well as possible changes associated with failed consolidation, we prospectively collected serum samples from patients who had sustained surgical treatment for a long bone fracture. Fifteen patients without fracture healing 4 months after surgery (nonunion group) were matched to a collective of 15 patients with successful healing (union group). Serum concentrations of angiogenin (ANG), angiopoietin 2 (Ang-2), basic fibroblast growth factor (bFGF), platelet derived growth factor AB (PDGF-AB), pleiotrophin (PTN) and vascular endothelial growth factor (VEGF) were measured using enzyme linked immunosorbent assays over a period of 24 weeks. Compared to reference values of healthy uninjured controls serum concentrations of VEGF, bFGF and PDGF were increased in both groups. Peak concentrations of these cytokines were reached during early fracture healing. Serum concentrations of bFGF and PDGF-AB were significantly higher in the union group at 2 and 4 weeks after the injury when compared to the nonunion group. Serum concentrations of ANG and Ang-2 declined steadily from the first measurement in normal healing fractures, while no significant changes over time could be detected for serum concentrations of these factures in nonunion patients. PTN serum levels increased asymptotically over the entire investigation in timely fracture healing while no such increase could be detected during delayed healing. We conclude that fracture healing in human subjects is accompanied by distinct changes in systemic levels of specific

  9. Occult fracture of the calcaneus - another Toddler's fracture

    International Nuclear Information System (INIS)

    Starshak, R.J.; Simons, G.W.; Sty, J.R.

    1984-01-01

    Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 to 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized. (orig.)

  10. Les fractures de l'extremite proximale de l'humerus chez l'enfant au ...

    African Journals Online (AJOL)

    The fracture was associated with concussion in one case. The shoulder x-ray showed that the fracture was metaphyseal 6 times, and epiphyseal 4 times. In any case, orthopedic treatment led to very good results. Conclusion: Even though the orthopedic treatment leads to very good results in the majority of cases, an early ...

  11. Foucauldian diagnostics: space, time, and the metaphysics of medicine.

    Science.gov (United States)

    Bishop, Jeffrey P

    2009-08-01

    This essay places Foucault's work into a philosophical context, recognizing that Foucault is difficult to place and demonstrates that Foucault remains in the Kantian tradition of philosophy, even if he sits at the margins of that tradition. For Kant, the forms of intuition-space and time-are the a priori conditions of the possibility of human experience and knowledge. For Foucault, the a priori conditions are political space and historical time. Foucault sees political space as central to understanding both the subject and objects of medicine, psychiatry, and the social sciences. Through this analysis one can see that medicine's metaphysics is a metaphysics of efficient causation, where medicine's objects are subjected to mechanisms of efficient control.

  12. Internal Realism: Putnam\\'s Alternative to Metaphysical Realism

    Directory of Open Access Journals (Sweden)

    J Akbari Takhtameshlou

    2014-03-01

    Having introduced and reviewed Putnam's arguments in rejecting metaphysical realism, this article explains and examines the basic elements of internal realism. The results of this article show that Putnam's objections against metaphysical realism lack the necessary credibility and strength and at the same time his proposed alternative (internal realism has serious problems that made to be addressed. By his chosen conception of truth, internal realism, cannot touch its stated purpose i.e. the removal of a huge gap between the truth of a statement and our knowledge of it. The ontological claims of internal realism are not, indeed, the reliable and true consequences of the thesis of conceptual relativity, which is considered as Putnam’s main base in this regard, but rather it is more a consequence of mistaking the linguistic issues with ontological ones.

  13. The metaphysical lessons of synthetic biology and neuroscience.

    Science.gov (United States)

    Baertschi, Bernard

    2015-01-01

    In this paper, I examine some important metaphysical lessons that are often presented as derived from two new scientific disciplines: synthetic biology and neuroscience. I analyse four of them: the nature of life, the existence of a soul (the mind-body problem), personhood, and free will. Many caveats are in order, and each 'advance' or each case should be assessed for itself. I conclude that a main lesson can nevertheless be learned: in conjunction with modern science, neuroscience and synthetic biology allow us to enrich old metaphysical debates, to deepen and even renew them. In particular, it becomes less and less plausible to consider life, mind, person, and agency as non-natural or non-physical entities. Copyright © 2015 Académie des sciences. Published by Elsevier SAS. All rights reserved.

  14. Monteggia Type 1 Fracture Equivalent with Concomitant Ipsilateral Distal Radius and Ulna Fracture in an Adult: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Shankarlinga S Sajjan

    2017-10-01

    Full Text Available Monteggia fracture comprises of 5% to 10% of all forearm fractures. It represents severe forearm injuries which require operative intervention. We report a unique case of Monteggia variant in female patient aged 67-year-old presenting a fracture of proximal ulna and radial neck along with ipsilateral fracture of distal ulna and radius at its metaphyseal end, which cannot be classified under Monteggia fracture and its equivalents occurring in adults. We managed this case using dorsal approach surgically and patient had good functional result at the end of six months.

  15. Spectroscopic Biomarkers for Monitoring Wound Healing and Infection in Combat Wounds

    Science.gov (United States)

    2011-10-01

    the distal part of the femur of a patient with fractures of the femoral shaft and tibial plateau, above a transtibial amputation. The ...showing a femoral shaft fracture . Fracture - healing was complicated by hetero- topic ossification, which caused symptomatic entrapment of the sciatic...in vivo, i.e. monitor wound healing during surgical debridements. - Is it the best time to close the wound?

  16. Probing the limits of reality: the metaphysics in science fiction

    Science.gov (United States)

    Taylor, John L.

    2003-01-01

    Science fiction provides a genre in which metaphysical questions concerning the ultimate structure of reality regularly arise. In addressing these questions, contemporary scientists tend to assume that the questions are of a scientific nature and should be handled solely by reference to our best theories. In this paper, it is argued that we cannot afford to neglect the role of conceptual analysis - a distinctively philosophical task - in thinking critically about the possibilities that science fiction claims to describe.

  17. Beware of mereologists bearing gifts: prolegomena to a medical metaphysics.

    Science.gov (United States)

    Khushf, George

    2013-10-01

    This essay considers implications of formal mereologies and ontologies for medical metaphysics. Edward Fried's extensional mereological account of the human body is taken as representative of a prominent strand in analytic metaphysics that has close affinities with medical positivism. I show why such accounts fail. First, I consider how Fried attempts to make sense of the medical case of Barney Clark, the first recipient of an artificial heart, and show that his analytic metaphysical categories do not have the right kind of fit with the case. A proper medical metaphysic should involve a richer two way dialogue with medicine, and it should not just "apply" formal accounts worked out in other settings. Second, I argue that any effort to account for real wholes with extensional mereological sums requires all sorts of ad hoc, supplementary mechanisms that do the real work, and the full repertoire of these mechanisms involves inconsistencies and semantic shifts. Finally, I consider an alternative strand of work on non-extensional whole/part relations that is closer to medicine and that can deepen reflection on some core problems in bioethics, for example, associated with the determination of death when an organism ceases to function as a whole. In addition to the utility such formal ontologies have for addressing traditional problems such as the determination of death, philosophers of medicine should appreciate the increasingly influential role such formal tools are playing in the development of data system ontologies. Assumptions integral to these ontologies have far reaching implications for the way future research and practice in medicine will be conducted, and much greater critical reflection is needed on the full range of issues associated with the development and use of such medical ontologies.

  18. Semantics and metaphysics in informatics: toward an ontology of tasks.

    Science.gov (United States)

    Figdor, Carrie

    2011-04-01

    This article clarifies three principles that should guide the development of any cognitive ontology. First, that an adequate cognitive ontology depends essentially on an adequate task ontology; second, that the goal of developing a cognitive ontology is independent of the goal of finding neural implementations of the processes referred to in the ontology; and third, that cognitive ontologies are neutral regarding the metaphysical relationship between cognitive and neural processes. Copyright © 2011 Cognitive Science Society, Inc.

  19. Defining human death: an intersection of bioethics and metaphysics.

    Science.gov (United States)

    Manninen, Bertha Alvarez

    2009-01-01

    For many years now, bioethicists, physicians, and others in the medical field have disagreed concerning how to best define human death. Different theories range from the Harvard Criteria of Brain Death, which defines death as the cessation of all brain activity, to the Cognitive Criteria, which is based on the loss of almost all core mental properties, e.g., memory, self-consciousness, moral agency, and the capacity for reason. A middle ground is the Irreversibility Standard, which defines death as occurring when the capacity for consciousness is forever lost. Given all these different theories, how can we begin to approach solving the issue of how to define death? I propose that a necessary starting point is discussing an even more fundamental question that properly belongs in the philosophical field of metaphysics: we must first address the issue of diachronic identity over time, and the persistence conditions of personal identity. In this paper, I illustrate the interdependent relationship between this metaphysical question and questions concerning the definition of death. I also illustrate how it is necessary to antecedently attend to the metaphysical issue of defining death before addressing certain issues in medical ethics, e.g., whether it is morally permissible to euthanize patients in persistent vegetative states or procure organs from anencephalic infants.

  20. Conscience claims, metaphysics, and avoiding an LGBT eugenic.

    Science.gov (United States)

    Brummett, Abram

    2018-04-23

    Novel assisted reproductive technologies (ART) are poised to present our society with strange new ethical questions, such as whether lesbian, gay, bisexual, and transgender (LGBT) couples should be allowed to produce children biologically related to both parents, or whether trans-women who want to experience childbirth should be allowed to receive uterine transplants. Clinicians opposed to offering such technologies to LGBT couples on moral grounds are likely to seek legal shelter through the conscience clauses enshrined in U.S. law. This paper begins by briefly discussing some novel ART on the horizon and noting that it is unclear whether current conscience clauses will permit fertility clinics to deny such services to LGBT individuals. A compromise approach to conscience is any view that sees the value of respecting conscience claims within limits. I describe and critique the constraints proposed in the recent work of Wicclair, NeJaime and Siegel as ultimately begging the question. My purpose is to strengthen their arguments by suggesting that in the controversial situations that elicit claims of conscience, bioethicists should engage with the metaphysical claims in play. I argue that conscience claims against LGBT individuals ought to be constrained because the underlying metaphysic-that God has decreed the LGBT lifestyle to be sinful-is highly implausible from the perspective of a naturalized metaphysic, which ought to be the lens through which we evaluate conscience claims. © 2018 John Wiley & Sons Ltd.

  1. Gene Therapy for Fracture Repair

    Science.gov (United States)

    2007-05-01

    the periosteal tissues of healing fractures in small animals , and allow more accurate evaluation of the effects of the fracture therapy (Rundle et...X-ray fluoroscopy (Figure 7). Individual animals receiving the MLV-BMP-2/4 gene therapy by either the percutaneous injection or the intramedullary... animal subjects to understand gene expression in the healing response to bone injury and identify novel genes that might accelerate or delay the

  2. Nose fracture

    Science.gov (United States)

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...

  3. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  4. Feng Youlan’s Interpretation of Western Philosophy:A Critical Examination from the Perspective of Metaphysical Methodology

    Directory of Open Access Journals (Sweden)

    Derong Chen

    2015-04-01

    Full Text Available The paper aims to display a limited observation of Feng’s interpretation of Western philosophy through the window of metaphysical methodology. This paper concentrates on Feng’s interpretation of Western philosophy from the perspective of metaphysical methodology and aims to display a limited observation of Feng’s interpretation of Western philosophy through the window of metaphysical methodology. Based on a brief review the recent studies of Feng Youlan and Western philosophy, this paper analyzes the progress and insufficient aspects in current studies on this issue and particularly clarifies what are the metaphysics and metaphysical methods in the context of Feng Youlan’s philosophy. In clarifying Feng’s interpretation of Western philosophy from the perspective of methodology, this paper further critically analyzes the Feng’s positive metaphysical methods and negative metaphysical methods, and assumes that Feng’s negative metaphysical methods essentially is a kind of attitudes towards metaphysics but neither a kind of metaphysics nor a kind of metaphysical methods. Instead of characterizing metaphysical methods as positive and negative as Feng did, this paper suggests an alternative division of metaphysical methods: direct and indirect methods of dealing with metaphysical issues.

  5. Johann Christoph Sturm's universal mathematics and metaphysics (German Title: Universalmathematik und Metaphysik bei Johann Christoph Sturm)

    Science.gov (United States)

    Leinsle, Ulrich G.

    In order to understand Sturm's concept of a universal mathematics as a replacement or complement of metaphysics, one first has to examine the evolution of the idea of a mathesis universalis up to Sturm, and his concept of metaphysics. According to the understanding of those times, natural theology belongs to metaphysics. The last section is concerned with Sturm's statements on the existence of God and his assessments for a physico-theology.

  6. Fall and Rise of Aristotelian Metaphysics in the Philosophy of Science

    Science.gov (United States)

    Lamont, John

    2009-06-01

    The paper examines the fortunes of Aristotelian metaphysics in science and the philosophy of science. It considers the Enlightenment claim that such a metaphysics is fundamentally unscientific, and that its abandonment was essential to the scientific revolution. The history of the scientific revolution and the metaphysical debates involved in it is examined, and it is argued that the eclipse of Aristotelian views was neither complete, nor merited. The evolution of Humeian and positivist accounts of science is described, and it is shown how the severe problems with these accounts, together with a revival of Aristotelian concepts in philosophy, have led to the rebirth of broadly Aristotelian accounts of the metaphysics underlying science.

  7. Healing Architecture

    DEFF Research Database (Denmark)

    Folmer, Mette Blicher; Mullins, Michael; Frandsen, Anne Kathrine

    2012-01-01

    The project examines how architecture and design of space in the intensive unit promotes or hinders interaction between relatives and patients. The primary starting point is the relatives. Relatives’ support and interaction with their loved ones is important in order to promote the patients healing...... process. Therefore knowledge on how space can support interaction is fundamental for the architect, in order to make the best design solutions. Several scientific studies document that the hospital's architecture and design are important for human healing processes, including how the physical environment...... architectural and design solutions in order to improve quality of interaction between relative and patient in the hospital's intensive unit....

  8. Displaced patella fractures.

    Science.gov (United States)

    Della Rocca, Gregory J

    2013-10-01

    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus.

    Science.gov (United States)

    Burnei, G; Gavriliu, Ş; Nepaliuc, I; Vlad, C; Drăgoescu, M; Georgescu, I; Ghita, R A; Muntean, L; Pârvan, A A; Dughilă, C; Ţiripa, I; Hamei, Ş; Klinaku, I

    2014-01-01

    Supracondylar fractures of the humerus represent a current concern in the child's and adolescent's osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in "Prof. Dr. Alexandru Pesamosca" Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation. The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications--28 out of 96 (29.1%)--were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure. The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow's mobility was completely recovered, the thoracic member's axis was appropriate and

  10. Patients' substantialization of disease, the hybrid symptom and metaphysical care.

    Science.gov (United States)

    Pârvan, Alexandra

    2015-06-01

    In the context of current scholarship concerned with facilitating integration between the biomedical and the patient-centred models of care, the article suggests that disease brings about an ontological disruption in patients, which is not directly addressed in either model, and may interfere with treatment and therapy outcomes if not met with a type of care termed here as 'metaphysical'. The receipt of diagnosis and medical care can give patients the sense that they are ontologically diminished, or less of a human, and along with physicians' approaches to and discourses about disease, may prompt them to seek ontological restoration or security in the same way as psychologically traumatized patients sometimes do: by treating the disease and/or the experience of harm associated with it as a thing that exists per se. I call this 'substantialization' of disease (or harm) and draw on Augustine's theory of non-substantial deficiencies (physiological and moral) and on Plato's and Plotinus's different takes on such defects in order to discuss what substantialization can do for patients. Based on literature that examines patients' ways of talking about and living with their disease, I speculate that substantialization can generate a 'hybrid symptom', consisting in patterns of exercising agency which may predispose to non-adherence. Ways in which physicians could provide metaphysical care are proposed, along with an understanding of chronic patients as hybrid ontological and agentic units, which draws on theories of enactive cognition. I opine that metaphysical care may facilitate integration between the depersonalized and personalized models of care. © 2014 John Wiley & Sons, Ltd.

  11. Basic structures of reality essays in meta-physics

    CERN Document Server

    McGinn, Colin

    2011-01-01

    In Basic Structures of Reality, Colin McGinn deals with questions of metaphysics, epistemology, and philosophy of mind from the vantage point of physics. Combining general philosophy with physics, he covers such topics as the definition of matter, the nature of space, motion, gravity, electromagnetic fields, the character of physical knowledge, and consciousness and meaning. Throughout, McGinn maintains an historical perspective and seeks to determine how much we really know of the world described by physics. He defends a version of "structuralism": the thesis that our knowledge is p

  12. Like an Image: Sensibility and Reflexivity in Descartes’ Metaphysics

    Directory of Open Access Journals (Sweden)

    Augustin Dumont

    2014-06-01

    Full Text Available This paper aims at questioning the role of image and imagination in Descartes’ Metaphysics, especially in the Meditations on First Philosophy, by holding both a certain doctrinal or theoretical discourse on image/imagination and the Cartesian use of images/imagination. Besides the fact that this rarely considered perspective prevents from freezing the original text, this strategy allows to highlight the ambiguity of theses notions, revealed through what is doing by the act of imagining compared to the act of conceiving with the understanding.

  13. Infanticide for handicapped infants: sometimes it's a metaphysical dispute.

    Science.gov (United States)

    Long, T A

    1988-01-01

    Since 1973 the practice of infanticide for some severely handicapped newborns has been receiving more open discussion and defence in the literature on medical ethics. A recent and important argument for the permissibility of infanticide relies crucially on a particular concept of personhood that excludes the theological. This paper attempts to show that the dispute between the proponents of infanticide and their religious opponents cannot be resolved because one side's perspective on the infant is shaped by a metaphysics that is emphatically rejected by the other. In such a situation philosophical argument is powerless to bring about a resolution because there can be no refutation of one side by the other. PMID:2969052

  14. Rejecting medical humanism: medical humanities and the metaphysics of medicine.

    Science.gov (United States)

    Bishop, Jeffrey P

    2008-03-01

    The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day.

  15. Science and Metaphysics in the Three Religions of the Book

    Directory of Open Access Journals (Sweden)

    Toby E. Huff

    2000-12-01

    Full Text Available The three religions of the Book trace their origins back to the same Abrahamic experience, but only one, Christianity, developed a metaphysical framework consistent with that of modern science. Both Judaism and Islam during their formative years, and continuously up to modern times, considered Greek philosophy and science alien wisdom, jeopardizing their sacred scriptures. The different path followed by Christianity is due to the influence of Hellenistic thought during Christianity's early formative period. Both Judaism and Islam were spared the direct mediation of Greek culture and ideas because both Judaism and Islam developed geographically and linguistically isolated from the Greek influences during the reception of their scriptures.

  16. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)

    2010-07-15

    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)

  17. Fracture Mechanics

    International Nuclear Information System (INIS)

    Jang, Dong Il; Jeong, Gyeong Seop; Han, Min Gu

    1992-08-01

    This book introduces basic theory and analytical solution of fracture mechanics, linear fracture mechanics, non-linear fracture mechanics, dynamic fracture mechanics, environmental fracture and fatigue fracture, application on design fracture mechanics, application on analysis of structural safety, engineering approach method on fracture mechanics, stochastic fracture mechanics, numerical analysis code and fracture toughness test and fracture toughness data. It gives descriptions of fracture mechanics to theory and analysis from application of engineering.

  18. Golfer's fracture of the ribs

    International Nuclear Information System (INIS)

    Lim, J. H.

    1980-01-01

    Golfer's fracture is stress fracture of the posterior portion of left 3, 4, 5, 6 or 7th ribs of golfer's, usually beginners,and it is considered due to exposure to unaccustomed severe exercise of this fascinating sport. Healing is usually uneventful, but possible complication may occur, because symptom is mild and golfers continue the exercise with physical therapy such as massage. Author report 4 cases of golfer's fracture, including 1 case complicated by platelike at electasis of lung.

  19. The disclosure of a metaphysical horizon, or how to escape dialectics

    African Journals Online (AJOL)

    In a footnote to The Inoperative Community French philosopher Jean-Luc Nancy wonders how to escape Hegelian dialectics. Because Nancy in his later work often returns to this attempt of a 'disclosure of our metaphysical horizon', we not only consider this note as a crucial one in his attempt to 'disclose' our metaphysical ...

  20. Carbon Dots as Fillers Inducing Healing/Self-Healing and Anticorrosion Properties in Polymers.

    Science.gov (United States)

    Zhu, Cheng; Fu, Yijun; Liu, Changan; Liu, Yang; Hu, Lulu; Liu, Juan; Bello, Igor; Li, Hao; Liu, Naiyun; Guo, Sijie; Huang, Hui; Lifshitz, Yeshayahu; Lee, Shuit-Tong; Kang, Zhenhui

    2017-08-01

    Self-healing is the way by which nature repairs damage and prolongs the life of bio entities. A variety of practical applications require self-healing materials in general and self-healing polymers in particular. Different (complex) methods provide the rebonding of broken bonds, suppressing crack, or local damage propagation. Here, a simple, versatile, and cost-effective methodology is reported for initiating healing in bulk polymers and self-healing and anticorrosion properties in polymer coatings: introduction of carbon dots (CDs), 5 nm sized carbon nanocrystallites, into the polymer matrix forming a composite. The CDs are blended into polymethacrylate, polyurethane, and other common polymers. The healing/self-healing process is initiated by interfacial bonding (covalent, hydrogen, and van der Waals bonding) between the CDs and the polymer matrix and can be optimized by modifying the functional groups which terminate the CDs. The healing properties of the bulk polymer-CD composites are evaluated by comparing the tensile strength of pristine (bulk and coatings) composites to those of fractured composites that are healed and by following the self-healing of scratches intentionally introduced to polymer-CD composite coatings. The composite coatings not only possess self-healing properties but also have superior anticorrosion properties compared to those of the pure polymer coatings. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. LEIBNIZ AND THE POLYP, OR THE METAPHYSICAL PUZZLE OF LIFE

    Directory of Open Access Journals (Sweden)

    Arthur Dony

    2017-06-01

    Full Text Available LEIBNIZ AND THE POLYP, OR THE METAPHYSICAL PUZZLE OF LIFE   In this paper, I propose to explore the link between experience and reason in the problem of the apprehension of life. My general claim is that philosophical issues are necessarily involved in a theory of living organisms, since identifying a certain entity as a living being is to go beyond its manifestations. In part I, I argue that the empirical approach of the natural sciences cannot fully account for the peculiarity of life, showing that the different criteria used to distinguish the living from the non‐living, as those proposed in biology, may turn out to be inadequate. In the second part, I elaborate on these issues by focusing on the Leibnizian theory of living beings. In particular, I will emphasize how Leibniz’s theory exemplifies the problematic relationship between the observable properties of organized matter and the inner (or metaphysical properties of the living as such. Finally, I will propose to consider the discovery of the polyp in the eighteenth century as a case of particular interest and a challenge to the classical conceptions of the living, insofar as it raises the crucial questions of unity and individuality, which are of utmost importance with regard to the ontological status of life. 

  2. "Bewitching" or confusing methaphysics? The demarcation between science and metaphysics according to Karl Popper

    Directory of Open Access Journals (Sweden)

    M. Elaine Botha

    1986-03-01

    Full Text Available The problems of both classical and modern theory of knowledge, according to Popper, reside in the problem of demarcation: a problem closely re­ lated to the problem of induction. The paper argues the view that Popper's view of metaphysics is ambiguous, requiring another criterion to distinguish between "good " and "bad " metaphysics. The sources of the problem are pinpointed, and Popper's distinction between three types of theory outlined. The article then explores the distinction between types of theories and the issues of falsification, testability and refutation, before going on to a consideration of the relationship between science and metaphysics, and w eighing up the issue of good ancid metaphysics. From this emerges clearly that the second "criterionot demarcation" is needed to make precisely this distinction; also in view of Popper's u n ­ clear, even ambiguous, view of metaphysics.

  3. Influência da ciprofloxacina na consolidação óssea de fraturas de fêmur em ratos Influence of ciprofloxacin on femoral fractures healing in rats

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2009-01-01

    Full Text Available OBJETIVO: Apresentar um estudo experimental sobre o efeito da ciprofloxacina na resistência do calo ósseo de fraturas padronizadas de fêmures de ratos. MÉTODOS: Os ratos foram separados em dois grupos de oito animais: o grupo estudo (cipro e o grupo controle. Os animais foram submetidos à fixação dos fêmures esquerdos com fio metálico intramedular e à confecção de fraturas padronizadas no mesmo osso. O grupo estudo recebeu ciprofloxacina e o grupo controle soro fisiológico durante seis semanas. Após este período, realizou-se estudo radiográfico controle e ensaio biomecânico de três pontos para obtenção da força de flexão mensurada em Newtons. RESULTADOS: As radiografias e a análise macroscópica demonstraram consolidação óssea em todas as fraturas. Foram comparados os resultados encontrados no estudo biomecânico entre os dois grupos, sendo que o grupo cipro apresentou resistência à força de flexão média 71,11 e o grupo controle, força de flexão média 74,78, não apresentando significância estatística (p = 0,601, test t. CONCLUSÃO: Não houve diferença estatística significante na resistência do calo ósseo de fraturas padronizadas de fêmur de ratos após o uso de ciprofloxacina em relação ao grupo controle.OBJECTIVE: To present an experimental study about the effects of ciprofloxacin on the bone callus strength on femoral fractures in rats. METHODS: The animals were divided in two groups of 8 rats each: the group study (cipro and the control group. The animals were fixed with an intramedullary nail and submitted to a standardized femoral fracture. The group study was treated with ciprofloxacin and the control group with saline solution for six weeks. After that period, the femurs were analyzed using X-ray images and biomechanical three-point test, which measured the flexion strength in Newtons. RESULTS: The X-ray images and the macroscopic analysis showed that all fractures healed. The results found in

  4. Intramedullary nailing in segmental tibial fractures.

    Science.gov (United States)

    Melis, G C; Sotgiu, F; Lepori, M; Guido, P

    1981-10-01

    Thirty-eight consecutive segmental fractures of the tibia were treated by intramedullary nailing with the Küntscher-Herzog nail. Twenty-two fractures were closed and sixteen were open. Reaming of the medullary cavity was performed and adequate fixation was ensured by use of a plaster cast. Weight-bearing was allowed after thirty-days for closed fractures and sixty days for open fractures. All of the closed fractures healed without malunion or infection. Of the patients with open fractures, one had an infection; one, non-union; and one, malunion. In all cases but one, union was slower at the distal fracture.

  5. Interfacial self-healing of nanocomposite hydrogels: Theory and experiment

    Science.gov (United States)

    Wang, Qiming; Gao, Zheming; Yu, Kunhao

    2017-12-01

    Polymers with dynamic bonds are able to self-heal their fractured interfaces and restore the mechanical strengths. It is largely elusive how to analytically model this self-healing behavior to construct the mechanistic relationship between the self-healing properties (e.g., healed interfacial strength and equilibrium healing time) and the material compositions and healing conditions. Here, we take a self-healable nanocomposite hydrogel as an example to illustrate an interfacial self-healing theory for hydrogels with dynamic bonds. In the theory, we consider the free polymer chains diffuse across the interface and reform crosslinks to bridge the interface. We analytically reveal that the healed strengths of nanocomposite hydrogels increase with the healing time in an error-function-like form. The equilibrium self-healing time of the full-strength recovery decreases with the temperature and increases with the nanoparticle concentration. We further analytically reveal that the healed interfacial strength decreases with increasing delaying time before the healing process. The theoretical results quantitatively match with our experiments on nanosilica hydrogels, and also agree well with other researchers' experiments on nanoclay hydrogels. We expect that this theory would open promising avenues for quantitative understanding of the self-healing mechanics of various polymers with dynamic bonds, and offer insights for designing high-performance self-healing polymers.

  6. What more in the name of god? Theologies and theodicies of faith healing.

    Science.gov (United States)

    Campbell, Courtney S

    2010-03-01

    The recent deaths of two children from parental decisions to rely on faith healing rather than medical treatment raises fundamental questions about the extent and limits of religious liberty in a liberal democratic society. This essay seeks to identify and critically examine three central issues internal to the ethics of religious communities that engage in faith healing regarding children: (1) the various forms of religious and nonreligious justification for faith healing; (2) the moral, institutional, or metaphysical wrong of medical practice from the perspectives of faith-healing communities; (3) the explanation or "theodicy" articulated by the religious community when faith healing does not occur and a child dies. The essay finds that the holding in Prince v. Massachusetts that parents with religious convictions cannot enforce martyrdom on their children presents a guiding principle for medicine and public policy.

  7. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: kath.halliday@nuh.nhs.uk [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N.J.; Somers, J.M. [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R. [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)

    2011-11-15

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  8. Critics to Metaphysics by Modern Philosophers: A Discourse on Human Beings in Reality

    Directory of Open Access Journals (Sweden)

    Frederikus Fios

    2016-01-01

    Full Text Available We have entered the 21st century that is popularly known as the era of the development of modern science and technology. Philosophy provides naming for contemporary era as postmodern era. But do we suddenly come to this day and age? No! Because humans are homo viator, persona that does pilgrimage in history, space and time. Philosophy has expanded periodically in the long course of history. Since the days of classical antiquity, philosophy comes with a patterned metaphysical paradigm. This paradigm survives very long in the stage history of philosophy as maintained by many philosophers who hold fast to the philosophical-epistemic claim that philosophy should be (das sollen metaphysical. Classical Greek philosopher, Aristotle was a philosopher who claims metaphysics as the initial philosophy. Then, Immanuel Kant, Hegel, Heidegger, Marx even Habermas offer appropriate shades of metaphysical philosophy versus spirit of the age. Modern philosophers offer a new paradigm in the way of doing philosophy. The new spirit of modern philosophers declared as if giving criticism on traditional western metaphysics (since Aristotle that are considered irrelevant. This paper intends to show the argument between traditional metaphysical and modern philosophers who criticize metaphysics. The author will make a philosophical synthesis to obtain enlightenment to the position of human beings in the space of time. Using the method of Hegelian dialectic (thesis-antiteses-synthesis, this topic will be developed and assessed in accordance with the interests of this paper. 

  9. MR evaluation of 'Metaphyseal' change in Legg-Calve-Perthes disease

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Haeng Jin; Na, Jae Boem; Shin, Chang Min; You, Jin Jong; Chung, Sung Hoon [Gyeongsang National Univ. College of Medicine, Chinju (Korea, Republic of)

    2001-06-01

    To determine the metaphyseal changes occurring in Legg-Calve-Perthes(LCP) disease using MRI. Between 1992 to 1999, 80 LCP patients (87 hips) underwent MR imaging and plain radiography. All MR images were reviewed, bone marrow signal intensity, the size and locatiion of the metaphyseal cyst and its epiphyseal necrosis grade determined. Metaphyses were abnormal in 43hips (49%), while bone marrow edema was present in 28 (32%) and a metaphyseal cyst in 30 (34%). Metaphyseal cysts were classified as either 'true' (n=9) or 'false' (n=21) according to the enhancement pattern. The maximum diameters of true and false cysts were 1.1{+-}0.3 cm and 1.1{+-}0.4 cm, respectively. Their most commom location was the anterior column; a true cyst occurred there in 7cases (78%), and false cyst in 16 (76%). Using the Waldenstrom classification, seven of the nine hips wih a true cyst (78%), were found to be at the avascular stage and 15 of the 21 with a false cyst (71%) were at the fragmentation stage. Seven of these nine (78%) and 19 of these 21 (90%) were Catterall grade IV. According to the findings of MR imaging, the metaphyseal changes occurring in LCP disease were bone marrow edema and metaphyseal cyst. This latter was visualized mainly in the anterior column and severely affected hip, and was classified as 'true' or 'false'.

  10. Fractures in childhood; Frakturen beim Kind

    Energy Technology Data Exchange (ETDEWEB)

    Moritz, Joerg D. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Klinik fuer diagnostische Radiologie, Paediatrische Radiologie und Sonografie

    2014-09-15

    Clinical diagnosis of fractures in childhood can be very difficult. Therefore imaging, not only x-rays but also ultrasound, computed tomography and magnetic resonance imaging are of special importance. There are typical pediatric types of fractures due to epiphyseal plates and high flexibility of the bone. Fractures heal faster and dislocations can be spontaneously corrected better but also growth disturbance can occur. The second part of the article describes the special types of fractures with special attention to the characteristics in childhood.

  11. Pedicular stress fracture in the lumbar spine

    International Nuclear Information System (INIS)

    Chong, V.F.H.; Htoo, M.M.

    1997-01-01

    Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle ('pediculolysis') is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors)

  12. Pedicular stress fracture in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Chong, V.F.H.; Htoo, M.M. [Singapore General Hospital, Singapore, (Singapore). Department of Diagnostic Radiology

    1997-08-01

    Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle (`pediculolysis`) is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors). 10 refs., 2 figs.

  13. Particles, particle labels, and quanta: The toll of unacknowledged metaphysics

    Energy Technology Data Exchange (ETDEWEB)

    Redhead, M. (Cambridge Univ. (United Kingdom)); Teller, P. (Univ. of California, Davis (United States))

    1991-01-01

    The practice of describing multiparticle quantum systems in terms of labeled particles indicates that the authors think of quantum entities as individuatable. The labels, together with particle indistinguishability, create the need for symmetrization or antisymmetrization (or, in principle, higher-order symmetries), which in turn results in surplus formal structure' in the formalism, formal structure which corresponds to nothing in the real world. The authors argue that these facts show quanta to be unindividuatable entities, things in principle incapable of supporting labels, and so things which support no factual difference if two of them are thought of as being switched. When thinking of the metaphysics of quanta, one should eschew the misleading labels of the tensor product Hilbert space formalism and prefer the ontologically more faithful description of the Fock space formalism. This conception eliminates puzzles about the quantum statistics of bosons.

  14. Pragmatism, metaphysics, and bioethics: beyond a theory of moral deliberation.

    Science.gov (United States)

    Pamental, Matthew

    2013-12-01

    Pragmatism has been understood by bioethicists as yet another rival in the "methods wars," as yet another theory of moral deliberation. This has led to criticism of pragmatic bioethics as both theoretically and practically inadequate. Pragmatists' responses to these objections have focused mainly on misunderstandings of pragmatism's epistemology. These responses are insufficient. Pragmatism's commitment to radical empiricism gives it theoretical resources unappreciated by critics and defenders alike. Radical empiricism, unlike its more traditional ancestors, undercuts the gaps between theory and practice, and subjective and objective accounts of experience, and in so doing provides the metaphysical and epistemological basis for a thoroughgoing empirical naturalism in ethics. Pragmatism's strength as an approach to moral problems thus emerges as a result of a much wider array of resources than contemporary interpreters have acknowledged, which makes it a richer, deeper framework for understanding moral deliberation in general and bioethical decision making in particular.

  15. Spreading disease: a controversy concerning the metaphysics of disease.

    Science.gov (United States)

    D'Amico, R

    1998-01-01

    This article concerns the metaphysics of disease. Is disease a fixed feature of the world or a social value or preference? I argue that disease is not a value-laden concept and thus debates concerning it differ fundamentally from debates concerning health, harm, or suffering where evaluative judgements are central. I show how the so-called social constructionist view of disease has been motivated both by ethical concerns with medical practices and general theoretical doubts about scientific naturalism. If I can show that ethical concerns about medical treatment can be answered without adopting social constructionism, that leaves only the broader theoretical question of naturalism. I cannot completely answer those theoretical doubts, but I show that the theoretical motivation is less convincing when it is separated from the moral challenge often accompanying it. I conclude that a convincing defense of the non-naturalistic conception of disease is rarely attempted and proves more difficult and counter-intuitive than its proponents assume.

  16. Distal leg fractures: How critical is the fibular fracture and its fixation?

    Science.gov (United States)

    Bonnevialle, P; Lafosse, J-M; Pidhorz, L; Poichotte, A; Asencio, G; Dujardin, F

    2010-10-01

    Extra-articular distal tibia fractures include a tibial fracture line located partially or totally in the metaphyseal bone and a fibular fracture in variable areas or sometimes absent. There is no consensus in the literature on the conduct to address the fibula fracture. The main objective of this study was to assess its impact on tibial reduction and union. Fibular fixation plays a positive role in reducing tibial displacement and improving mechanical stability of the entire lesion. This study was based on the multicenter observational group of the 2009 SOFCOT symposium, i.e., 142 metaphyseal fractures of the tibia. The fibula was intact in 10 cases and fractured in 132. In the three main categories of surgical treatment for the tibia (nailing, plating, external fixation) (126 fractures), the fibular lesion was not treated in 79 cases (61%) in this series, nine were treated with intramedullary pinning, and 38 with plate and screw fixation. There was no statistical relation between the anatomic situation of the diaphysis and the anatomic type of the fibular fracture or between the anatomic type of the fibular fracture and its situation compared to the tibial fracture line. The intertubercular and neck fractures were type A1 or B1 (Pfracture with a torsional component; the medial-diaphyseal and subtubercular fractures were associated with tibial fracture lines with a simple transversal or comminution or metaphyseal-diaphyseal component (Pfracture was 4.7% at 1 year; in all these cases, fibular treatment had been conservative. All treatments combined, the tibial axes were statistically better corrected when the fibula was treated with fixation. In four of the 11 cases of axial tibial malunion, the primary fibular fixation caused or worsened them. The present clinical series provides results similar to the biomechanical studies. The consequences of fibular fixation perpetuating a tibia reduction abnormality or on the contrary the absence of fibular fixation appeared

  17. Paranormal healing and hypertension

    OpenAIRE

    Beutler, Jaap J; Attevelt, Johannes T M; Schouten, Sybo A; Faber, Joop A J; Mees, Evert J Dorhout; Geijskes, Gijsbert G

    1988-01-01

    A prospective randomised trial was carried out to see whether paranormal healing by laying on of hands might reduce blood pressure in essential hypertension and whether such an effect might be due to a paranormal, psychological, or placebo factor. Patients were randomised to three treatment groups: paranormal healing by laying on of hands (n=40), paranormal healing at a distance (n=37), and no paranormal healing (controls; n=38). Healing at a distance and no paranormal healing were investigat...

  18. Les fractures de l'extrémité proximale de l'humérus chez l'enfant au ...

    African Journals Online (AJOL)

    The fracture was associated with concussion in one case. The shoulder x-ray showed that the fracture was metaphyseal 6 times, and epiphyseal 4 times. In any case, orthopedic treatment led to very good results. Conclusion: Even though the orthopedic treatment leads to very good results in the majority of cases, an early ...

  19. Femoral shaft fractures

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C. II

    1985-01-01

    The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

  20. Antibacterial and antifungal activity and Bone healing Potency of ...

    African Journals Online (AJOL)

    EDEMA

    proliferative physiological process in which the body facilitates the repair of bone fracture. The phases of fracture healing include; the reactive phase, reparative and remodeling. 1 . Cissus arguta a creeping plant found in the rain forest of southern Nigeria, is been extensively utilized locally in the treatment of certain.

  1. Treating Simple Tibia Fractures with Poly-DL-Lactic Acid Screw as a ...

    African Journals Online (AJOL)

    blood loss, postoperative complications, fracture-healing time, and Johner-Wruh grade at the last follow- up time point of the two treatment ... Keywords: Simple tibia fracture, Fracture healing time Poly-DL-lactic acid, Poly-DL-Lactic Acid,. Absorbable screw, Dynamic ... The gender, age, wound, time of operation, position of ...

  2. The nature of Suárez's Metaphysics. Disputationes Metaphysicae and Their Main Systematic Strains

    Czech Academy of Sciences Publication Activity Database

    Heider, Daniel

    2009-01-01

    Roč. 6, č. 1 (2009), s. 99-110 ISSN 1214-8407 Institutional research plan: CEZ:AV0Z90090514 Keywords : Suárez * metaphysics * being * unity * concept * Scotus * Aquinas Subject RIV: AA - Philosophy ; Religion

  3. High-resolution CT with histopathological correlates of the classic metaphyseal lesion of infant abuse

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); McDonald, Anna G. [Office of the Chief Medical Examiner, Boston, MA (United States); Rosenberg, Andrew E. [University of Miami Hospital, Department of Pathology, Miami, FL (United States); Gupta, Rajiv [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2014-02-15

    The classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse and its imaging features have been correlated histopathologically in infant fatalities. High-resolution CT imaging and histologic correlates were employed to (1) characterize the normal infant anatomy surrounding the chondro-osseous junction, and (2) confirm the 3-D model of the CML previously inferred from planar radiography and histopathology. Long bone specimens from 5 fatally abused infants, whose skeletal survey showed definite or suspected CMLs, were studied postmortem. After skeletal survey, selected specimens were resected and imaged with high-resolution digital radiography. They were then scanned with micro-CT (isotropic resolution of 45 μm{sup 3}) or with high-resolution flat-panel CT (isotropic resolutions of 200 μm{sup 3}). Visualization of the bony structures was carried out using image enhancement, segmentation and isosurface extraction, together with volume rendering and multiplanar reformatting. These findings were then correlated with histopathology. Study of normal infant bone clarifies the 3-D morphology of the subperiosteal bone collar (SPBC) and the radiographic zone of provisional calcification (ZPC). Studies on specimens with CML confirm that this lesion is a fracture extending in a planar fashion through the metaphysis, separating a mineralized fragment. This disk-like mineralized fragment has two components: (1) a thick peripheral component encompassing the SPBC; and (2) a thin central component comprised predominantly of the radiologic ZPC. By manipulating the 3-D model, the varying appearances of the CML are displayed. High-resolution CT coupled with histopathology provides elucidation of the morphology of the CML, a strong indicator of infant abuse. This new information may prove useful in assessing the biomechanical factors that produce this strong indicator of abusive assaults in infants. (orig.)

  4. High-resolution CT with histopathological correlates of the classic metaphyseal lesion of infant abuse

    International Nuclear Information System (INIS)

    Tsai, Andy; Kleinman, Paul K.; McDonald, Anna G.; Rosenberg, Andrew E.; Gupta, Rajiv

    2014-01-01

    The classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse and its imaging features have been correlated histopathologically in infant fatalities. High-resolution CT imaging and histologic correlates were employed to (1) characterize the normal infant anatomy surrounding the chondro-osseous junction, and (2) confirm the 3-D model of the CML previously inferred from planar radiography and histopathology. Long bone specimens from 5 fatally abused infants, whose skeletal survey showed definite or suspected CMLs, were studied postmortem. After skeletal survey, selected specimens were resected and imaged with high-resolution digital radiography. They were then scanned with micro-CT (isotropic resolution of 45 μm 3 ) or with high-resolution flat-panel CT (isotropic resolutions of 200 μm 3 ). Visualization of the bony structures was carried out using image enhancement, segmentation and isosurface extraction, together with volume rendering and multiplanar reformatting. These findings were then correlated with histopathology. Study of normal infant bone clarifies the 3-D morphology of the subperiosteal bone collar (SPBC) and the radiographic zone of provisional calcification (ZPC). Studies on specimens with CML confirm that this lesion is a fracture extending in a planar fashion through the metaphysis, separating a mineralized fragment. This disk-like mineralized fragment has two components: (1) a thick peripheral component encompassing the SPBC; and (2) a thin central component comprised predominantly of the radiologic ZPC. By manipulating the 3-D model, the varying appearances of the CML are displayed. High-resolution CT coupled with histopathology provides elucidation of the morphology of the CML, a strong indicator of infant abuse. This new information may prove useful in assessing the biomechanical factors that produce this strong indicator of abusive assaults in infants. (orig.)

  5. Murk Jansen's metaphyseal chondrodysplasia with long-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Silverthorn, K.G.; Houston, C.S.; Duncan, B.P.

    1987-02-01

    The fourteenth reported patient with Murk Jansen's metaphyseal chondrodysplasia is presented, with a remarkable followup from birth to the age of 15 years. Numerous invasive procedures were performed in pursuit of erroneous provisional diagnoses. Five of these patients presented in infancy with radiographic metaphyseal changes similar to rickets, but with preservation of the provisional zone of calcification. Following infancy, these patients reveal the more typical short-limbed dwarfism, with fusiform joints and bowed extremities.

  6. On How physics Could impact on the Metaphysics of Space and Time

    OpenAIRE

    Alireza Mansouri

    2015-01-01

    This paper aims to illustrate the mutual inter-relation of physics and metaphysics in the context of the philosophy of space and time. We especially emphasize, in this paper, that scientific development could impact on our position regarding the reality of space and time. To illustrate this point, we investigate the mutual inter-relation of physics and metaphysics in the modern developments of physics, i.e. neo-Newtonian structure, special and general relativity (GR). This paper ends up antic...

  7. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture.

    Science.gov (United States)

    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji

    2015-09-01

    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

  8. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  9. Tibial shaft fractures treated with functional braces. Experience with 780 fractures.

    Science.gov (United States)

    Sarmiento, A; Gersten, L M; Sobol, P A; Shankwiler, J A; Vangsness, C T

    1989-08-01

    We have reviewed our recent results with functional bracing of tibial shaft fractures in adults in order to define its role in management. We also analysed several parameters of these fractures to discover those which influence healing. A total of 780 tibial fractures treated in prefabricated functional braces were followed to union; shortening of less than 10 mm and angulation of less than 5 degrees in any plane were our parameters for successful treatment. The average time before applying a brace was 3.8 weeks for closed fractures and 5.2 weeks for open ones. Closed fractures healed in an average of 17.4 weeks and open fractures in an average of 21.7 weeks, 90% of them with 10 mm of shortening or less. Varus angulation and posterior angulation were the most common deformities encountered at union. There were 20 nonunions (2.5%) and 46 braces were discontinued during treatment. We found no association between fracture healing and the patient's age, the mechanism of injury or the fracture location. The degree of soft tissue injury appeared to have most influence on the speed of fracture healing. Fracture comminution and initial displacement, the condition of the fibula and the time from injury to bracing also appeared to affect the speed of union.

  10. Possible benefits of strontium ranelate in complicated long bone fractures.

    Science.gov (United States)

    Alegre, Duarte Nuno; Ribeiro, Costa; Sousa, Carlos; Correia, João; Silva, Luís; de Almeida, Luís

    2012-02-01

    Osteoporosis drugs are prescribed to prevent fragility fractures, which is the principal aim of the management of osteoporosis. However, if fracture does occur, then it is also important to promote a fast and uneventful healing process. Despite this, little is known about the effect of osteoporosis drugs on bone healing in humans. Strontium ranelate is an osteoporosis agent that increases bone formation and reduces bone resorption and may therefore be beneficial in fracture healing. We report four cases of fracture non-union for up to 20 months. Treatment with strontium ranelate (2 g/day) for between 6 weeks and 6 months appeared to contribute to bone consolidation in the four cases. Animal studies support beneficial effects of strontium ranelate on bone healing via improvement of bone material properties and microarchitecture in the vicinity of the fracture. The clinical cases described herein provide new information on these effects, in the absence of randomized controlled studies on the clinical efficacy of pharmacological treatments in osteoporosis in fracture repair. Further studies are necessary. Fracture healing is an important topic in orthopedic research and is also a concern for patients with postmenopausal osteoporosis. Evidence from case reports and animal studies suggests that strontium ranelate improves bone microarchitecture and accelerates fracture healing. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research.

  11. Overcoming O: Dewey and the Problem of Bion's Metaphysics.

    Science.gov (United States)

    Soffer-Dudek, Nir

    2015-10-01

    Bion guides us to eschew memory, desire, and understanding in order to become one with O-the ultimate reality of the analytic moment. However, his directions are valid only to the extent that such a meta-reality actually exists. Otherwise there is nothing to unite with and no reason to shun memory or desire. The present work inquires whether we may provide Bion's technique with a less speculative philosophy, specifically Dewey's pragmatist theory of aesthetics. It begins with reviewing the similarities between the two writers' methods, highlighting their shared emphasis on openness to the unknown. Yet listening to their intonations reveals that they actually convey opposite ideas as to what this "unknown" may be. Whereas Dewey sanguinely portrays the possibilities of the "yet-unknown," Bion emphasizes the dread of our inescapable encounter with the unknowable. This dread is embodied in his concept of O. Thus, rather than being merely a metaphysical speculation, O communicates Bion's conviction that fear forms the core of our existence. Banishing O from the counseling room may indeed aid his method in becoming accessible to a wider audience; at the same time, however, doing so might also deprive it of the very context that gives it meaning. © 2015 by the American Psychoanalytic Association.

  12. Fundamental awareness: A framework for integrating science, philosophy and metaphysics.

    Science.gov (United States)

    Theise, Neil D; Kafatos, Menas C

    2016-01-01

    The ontologic framework of Fundamental Awareness proposed here assumes that non-dual Awareness is foundational to the universe, not arising from the interactions or structures of higher level phenomena. The framework allows comparison and integration of views from the three investigative domains concerned with understanding the nature of consciousness: science, philosophy, and metaphysics. In this framework, Awareness is the underlying reality, not reducible to anything else. Awareness and existence are the same. As such, the universe is non-material, self-organizing throughout, a holarchy of complementary, process driven, recursive interactions. The universe is both its own first observer and subject. Considering the world to be non-material and comprised, a priori, of Awareness is to privilege information over materiality, action over agency and to understand that qualia are not a "hard problem," but the foundational elements of all existence. These views fully reflect main stream Western philosophical traditions, insights from culturally diverse contemplative and mystical traditions, and are in keeping with current scientific thinking, expressible mathematically.

  13. Method and metaphysics in Clements's and Gleason's ecological explanations.

    Science.gov (United States)

    Eliot, Christopher

    2007-03-01

    To generate explanatory theory, ecologists must wrestle with how to represent the extremely many, diverse causes behind phenomena in their domain. Early twentieth-century plant ecologists Frederic E. Clements and Henry A. Gleason provide a textbook example of different approaches to explaining vegetation, with Clements allegedly committed, despite abundant exceptions, to a law of vegetation, and Gleason denying the law in favor of less organized phenomena. However, examining Clements's approach to explanation reveals him not to be expressing a law, and instead to be developing an explanatory structure without laws, capable of progressively integrating causal complexity. Moreover, Clements and Gleason largely agree on the causes of vegetation; but, since causal understanding here underdetermines representation, they differ on how to integrate recognized causes into general theory--that is, in their methodologies. Observers of the case may have mistakenly assumed that scientific representation across the disciplines typically aims at laws like Newton's, and that representations always reveal scientists' metaphysical commitments. Ironically, in the present case, this assumption seems to have been made even by observers who regard Clements as nai ve for his alleged commitment to an ecological law.

  14. Four queries concerning the metaphysics of early human embryogenesis.

    Science.gov (United States)

    Howsepian, A A

    2008-04-01

    In this essay, I attempt to provide answers to the following four queries concerning the metaphysics of early human embryogenesis. (1) Following its first cellular fission, is it coherent to claim that one and only one of two "blastomeric" twins of a human zygote is identical with that zygote? (2) Following the fusion of two human pre-embryos, is it coherent to claim that one and only one pre-fusion pre-embryo is identical with that postfusion pre-embryo? (3) Does a live human being come into existence only when its brain comes into existence? (4) At implantation, does a pre-embryo become a mere part of its mother? I argue that either if things have quidditative properties or if criterialism is false, then queries (1) and (2) can be answered in the affirmative; that in light of recent developments in theories of human death and in light of a more "functional" theory of brains, query (3) can be answered in the negative; and that plausible mereological principles require a negative answer to query (4).

  15. Philosophical Creationism: Thomas Aquinas’ Metaphysics of Creatio ex Nihilo

    Directory of Open Access Journals (Sweden)

    Andrzej Maryniarczyk

    2016-03-01

    Full Text Available All philosophers, beginning with the pre-Socratics, through Plato and Aristotle, and up to Thomas Aquinas, accepted as a certain that the world as a whole existed eternally. The foundation for the eternity of the world was the indestructible and eternal primal building material of the world, a material that existed in the form of primordial material elements (the Ionians, in the form of ideas (Plato, or in the form of matter, eternal motion, and the first heavens (Aristotle. The article outlines the main structure of the philosophical theory of creation ex nihilo developed by St. Thomas Aquinas and indebted to his metaphysical thought. It shows the wisdom-based and ratiocinative foundation of the rational cognition of reality—reality that comes from the personal creative act of God. It concludes that the perception that the beings called to existence by the personal act of God the Creator are intelligible is the ultimate rational justification for the fact that our human cognition, love, and spiritual creativity are rational.

  16. Beyond positivism: a metaphysical basis for clinical practice?

    Science.gov (United States)

    Herman, J

    1992-09-01

    Medicine does not have its own unified body of scientific knowledge. Instead, physicians who are oriented to research make sporadic incursions into the basic sciences such as genetics, biochemistry, immunology, epidemiology, physiology, pharmacology and so on. These latter, taken together, comprise biomedicine which is said to have adopted the positivist epistemology or the Cartesian/Newtonian one that regards the scientist as an uninvolved observer of nature. In effect, medical science has come to rest on a theory of knowledge which links meaning to probability and considers prediction as the scientist's chief task. Like its predecessor, the probability theory of meaning rejects metaphysical speculation and remains connected to observations made, directly or indirectly, by means of the five senses. Despite some brilliant successes touching on relatively uncommon disorders, biomedicine cannot explain most day-to-day clinical activity. An understanding of what transpires between patient and doctor, of its diagnostic potential and therapeutic weight requires hermeneutic, or phenomenological, inquiry which brings about changes in both parties to it. Such a science, as ontological speculation has been called, cannot be deciphered by an epistemology couched in the imagery of physics and chemistry.

  17. Biomimetic Self-Healing

    Science.gov (United States)

    2015-07-21

    interface. A chemical healing process in which the adhesion strength is higher than the inherent material strength would provide a solution; however...Encapsulation of Healing Substances 4.1.1. Self-Healing Based on Biological Capsules Of the different methods for self-healing, the use of capsules is the least...common approach in nature, which encapsulates chemicals for numerous reasons other than self- healing. Cells can be seen as capsules with numerous

  18. Lap shear strength and healing capability of self-healing adhesive containing epoxy/mercaptan microcapsules

    International Nuclear Information System (INIS)

    Ghazali, Habibah; Ye, Lin; Zhang, Ming-Qiu

    2016-01-01

    The aim of this work is to develop a self-healing polymeric adhesive formulation with epoxy/mercaptan microcapsules. Epoxy/mercaptan microcapsules were dispersed into a commercialize two-part epoxy adhesive for developing self-healing epoxy adhesive. The influence of different content of microcapsules on the shear strength and healing capability of epoxy adhesive were investigated using single-lap-joints with average thickness of adhesive layer of about 180 µm. This self-healing adhesive was used in bonding of 5000 series aluminum alloys adherents after mechanical and alkaline cleaning surface treatment. The adhesion strength was measured and presented as function of microcapsules loading. The results indicated that the virgin lap shear strength was increased by about 26% with addition of 3 wt% of self-healing microcapsules. 12% to 28% recovery of the shear strength is achieved after self-healing depending on the microcapsules content. Scanning electron microscopy was used to study fracture surface of the joints. The self-healing adhesives exhibit recovery of both cohesion and adhesion properties with room temperature healing.

  19. Lap shear strength and healing capability of self-healing adhesive containing epoxy/mercaptan microcapsules

    Energy Technology Data Exchange (ETDEWEB)

    Ghazali, Habibah; Ye, Lin [Centre for Advanced Materials Technology (CAMT), School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006 (Australia); Zhang, Ming-Qiu [Key Laboratory of Polymeric Composite and Functional Materials of Ministry of Education, Zhongshan University, Guangzhou 510275 (China)

    2016-03-09

    The aim of this work is to develop a self-healing polymeric adhesive formulation with epoxy/mercaptan microcapsules. Epoxy/mercaptan microcapsules were dispersed into a commercialize two-part epoxy adhesive for developing self-healing epoxy adhesive. The influence of different content of microcapsules on the shear strength and healing capability of epoxy adhesive were investigated using single-lap-joints with average thickness of adhesive layer of about 180 µm. This self-healing adhesive was used in bonding of 5000 series aluminum alloys adherents after mechanical and alkaline cleaning surface treatment. The adhesion strength was measured and presented as function of microcapsules loading. The results indicated that the virgin lap shear strength was increased by about 26% with addition of 3 wt% of self-healing microcapsules. 12% to 28% recovery of the shear strength is achieved after self-healing depending on the microcapsules content. Scanning electron microscopy was used to study fracture surface of the joints. The self-healing adhesives exhibit recovery of both cohesion and adhesion properties with room temperature healing.

  20. Open tibia fractures in HIV positive patients

    African Journals Online (AJOL)

    focus of debate is on wound sepsis and healing, with note also of fracture union. Final functional result has not been specifically assessed, but is largely consequent upon these two entities. Wound and pin-track sepsis. In the first of our studies2 we looked at 27 cases of open tibia fracture (Gustilo5 grades 2 and 3) treated by ...

  1. Occult fracture of the calcaneus - another toddler's fracture

    Energy Technology Data Exchange (ETDEWEB)

    Starshak, R.J.; Simons, G.W.; Sty, J.R.

    1984-01-01

    Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 to 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized.

  2. Solid state self-healing system: Effects of using PDGEBA, PVC and PVA as linear healing agents

    Science.gov (United States)

    Muhamad, Noor Nabilah; Jamil, Mohd. Suzeren Md.; Abdullah, Shahrum

    2014-09-01

    The solid state self-healing system was obtained by employing a thermosetting epoxy resin, into which a thermoplastic is dissolved. In this study, the effect of healing efficiency was investigated by using different thermoplastic polymers which are poly(bisphenol-A-co-epichlorohydrin), polyvinyl chloride and polyvinyl alcohol as healing agents. Healing was achieved by heating the fractured resins to a specific temperature i.e. above their glass transition temperature (Tg) which obtained from dynamic mechanical analysis (DMA) to mobilize the polymeric chains of the healing agent. The curing reaction in the epoxy resins were characterized by means of Fourier transform infrared spectroscopy (FTIR). Izod impact test was been performed to demonstrate self-healing of the different specimens. Under test, it was found that healable resin with PDGEBA has highest healing efficiency followed by PVC and PVA, with 63%, 35% and 18% of average percentage healing efficiencies respectively. These results are due to the different solubility parameters of the thermoset/network and thermoplastic polymer which led to the phase separation. Morphological studies prove the fracture-healing process and morphological properties of the resins.

  3. Effects of water-aging on self-healing dental composite containing microcapsules

    Science.gov (United States)

    Wu, Junling; Weir, Michael D.; Melo, Mary Anne S.; Strassler, Howard E.; Xu, Hockin H. K.

    2016-01-01

    Objectives The objectives of this study were to develop a self-healing dental composite containing poly(urea-formaldehyde) (PUF) shells with triethylene glycol dimethacrylate (TEGDMA) and N,N-dihydroxyethyl-p-toluidine (DHEPT) as healing liquid, and to investigate the mechanical properties of the composite and its self-healing efficacy after water-aging for 6 months. Methods PUF microspheres were synthesized encapsulating a TEGDMA-DHEPT healing liquid. Composite containing 30% of a resin matrix and 70% of glass fillers by mass was incorporated with 0%, 2.5%, 5%, 7.5% and 10% of microcapsules. A flexural test was used to measure flexural strength and elastic modulus. A single edge V-notched beam method was used to measure fracture toughness (KIC) and self-healing efficacy. Specimens were water-aged at 37 °C for 1 d to 6 months and then tested for self-healing. Fractured specimens were healed while being immersed in water to examine self-healing efficacy, in comparison with that in air. Results Incorporation of up to 7.5% of microcapsules into the resin composite achieved effective self-healing, without adverse effects on the virgin mechanical properties of the composite (p > 0.1). An excellent self-healing efficacy of 64%–77% recovery was obtained (mean ± sd; n = 6). Six months of water-aging did not decrease the self-healing efficacy compared to 1 d (p > 0.1). Exposure to water did not decrease the healing efficacy, compared to that healed in air (p > 0.1). Conclusions A composite was developed with excellent self-healing efficacy even while being immersed in water. The self-healing efficacy did not decrease with increasing water-aging time for 6 months. Clinical significance The novel self-healing composite may be promising for dental applications to heal cracks, resist fracture, and increase the durability and longevity. PMID:26808158

  4. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...

  5. Tooth mobility changes subsequent to root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth mobility changes in root-fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because...... of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root-fractured permanent incisors. Mobility changes were measured...... with a Mühlemanns periodontometer and noninjured incisors served as controls. The mobility values represented the labial-lingual excursion of the root measured in μm when the tooth received a frontal and a palatal impact of 100 g force. In 18 cases of hard tissue healing (HT), a slightly increased mobility was seen...

  6. Early mechanical stimulation only permits timely bone healing in sheep.

    Science.gov (United States)

    Tufekci, Pelin; Tavakoli, Aramesh; Dlaska, Constantin; Neumann, Mirjam; Shanker, Mihir; Saifzadeh, Siamak; Steck, Roland; Schuetz, Michael; Epari, Devakar

    2017-11-21

    Bone fracture healing is sensitive to the fixation stability. However, it is unclear which phases of healing are mechano-sensitive and if mechanical stimulation is required throughout repair. In this study, a novel bone defect model, which isolates an experimental fracture from functional loading, was applied in sheep to investigate if stimulation limited to the early proliferative phase is sufficient for bone healing. An active fixator controlled motion in the fracture. Animals of the control group were unstimulated. In the physiological-like group, 1 mm axial compressive movements were applied between day 5 and 21, thereafter the movements were decreased in weekly increments and stopped after 6 weeks. In the early stimulatory group, the movements were stopped after 3 weeks. The experimental fractures were evaluated with mechanical and micro-computed tomography methods after 9 weeks healing. The callus strength of the stimulated fractures (physiological-like and early stimulatory) was greater than the unstimulated control group. The control group was characterized by minimal external callus formation and a lack of bone bridging at 9 weeks. In contrast, the stimulated groups exhibited advanced healing with solid bone formation across the defect. This was confirmed quantitatively by a lower bone volume in the control group compared to the stimulated groups.The novel experimental model permits the application of a well-defined load history to an experimental bone fracture. The poor healing observed in the control group is consistent with under-stimulation. This study has shown early mechanical stimulation only is sufficient for a timely healing outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. MR of physeal fractures of the adolescent knee.

    Science.gov (United States)

    Close, B J; Strouse, P J

    2000-11-01

    The aim of this study was to assess physeal fractures of the pediatric knee identified by MR imaging and to describe the MR findings of such fractures. The authors reviewed 315 consecutive pediatric knee MR examinations done to assess for traumatic injury. The MR images were reviewed for evidence of physeal fracture. Fractures were classified by the Salter-Harris system, and associated findings and injuries were noted. Plain radiographs and medical records were reviewed. Seven distal femoral physeal fractures (Salter II, n = 6; Salter III, n = 1) and two proximal tibia physeal fractures (Salter III, n = 1; complex Salter IV, n = 1) were identified. Magnetic resonance demonstrated widening of a portion of the physis with visualization of a metaphyseal/epiphyseal fracture line. Periosteal elevation was observed in six cases. Four patients had associated ligamentous or meniscal injuries. Plain radiographs were available for review in eight patients. Bone abnormalities suggesting fracture were evident in six of eight patients; however, the fracture was fully delineated in only one patient. The diagnosis or confirmation of fracture by MR changed clinical management in seven of eight patients in whom follow-up was available. Physeal fractures of the pediatric knee are occasionally diagnosed by MR. Magnetic resonance provides improved delineation of non-displaced physeal fractures of the knee, while simultaneously allowing for evaluation of soft tissue structures.

  8. Functional treatment of closed humeral shaft fractures

    OpenAIRE

    Toivanen, J. A. K.; Nieminen, J.; Laine, H.-J.; Honkonen, S. E.; Järvinen, M. J.

    2004-01-01

    We treated 93 consecutive patients, average age 53 (16–90) years, with closed humeral shaft fractures applying a functional brace immediately after injury. Seventy-two (77%) fractures healed without problems. There were significantly more consolidation problems in fractures in the proximal third (46% consolidated) compared to those at the middle (81% consolidated) and distal third (86% consolidated) of the shaft. Logistic regression analysis revealed the only predictive factor in respect to s...

  9. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?

    NARCIS (Netherlands)

    E.M.M. van Lieshout (Esther); V. Alt (Volker)

    2016-01-01

    textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft

  10. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers

    National Research Council Canada - National Science Library

    Jones, D

    1995-01-01

    .... Pulsing electromagnetic fields (PEMFs)have been shown to speed the healing of non-union fractures and we have used them successfully to treat stress fractures in the lower limbs. All women at Ft...

  11. Biomechanical assessment and clinical analysis of different intramedullary nailing systems for oblique fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; Seral, B; García-Aznar, J M

    2016-09-01

    The aim of this study is to evaluate the fracture union or non-union for a specific patient that presented oblique fractures in tibia and fibula, using a mechanistic-based bone healing model. Normally, this kind of fractures can be treated through an intramedullary nail using two possible configurations that depends on the mechanical stabilisation: static and dynamic. Both cases are simulated under different fracture geometries in order to understand the effect of the mechanical stabilisation on the fracture healing outcome. The results of both simulations are in good agreement with previous clinical experience. From the results, it is demonstrated that the dynamization of the fracture improves healing in comparison with a static or rigid fixation of the fracture. This work shows the versatility and potential of a mechanistic-based bone healing model to predict the final outcome (union, non-union, delayed union) of realistic 3D fractures where even more than one bone is involved.

  12. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

    Science.gov (United States)

    Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

    2017-04-01

    Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the lower extremities of a representative population of children classified according to the PCCF. Patients and methods - We included patients up to the age of 17 who were diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at either of 2 tertiary care university hospitals in Switzerland. Patient charts were retrospectively reviewed. Results - More lower extremity fractures occurred in boys (62%, n = 341). Of 548 fractured long bones in the lower extremity, 25% involved the femur and 75% the lower leg. The older the patients, the more combined fractures of the tibia and fibula were sustained (adolescents: 50%, 61 of 123). Salter-Harris (SH) fracture patterns represented 66% of single epiphyseal fractures (83 of 126). Overall, 74 of the 83 SH patterns occurred in the distal epiphysis. Of all the metaphyseal fractures, 74 of 79 were classified as incomplete or complete. Complete oblique spiral fractures accounted for 57% of diaphyseal fractures (120 of 211). Of all fractures, 7% (40 of 548) were classified in the category "other", including 29 fractures that were identified as toddler's fractures. 5 combined lower leg fractures were reported in the proximal metaphysis, 40 in the diaphysis, 26 in the distal metaphysis, and 8 in the distal epiphysis. Interpretation - The PCCF allows classification of lower extremity fracture patterns in the clinical setting. Re-introduction of a specific code for toddler's fractures in the PCCF should be considered.

  13. Ipsilateral humeral neck and shaft fractures

    Directory of Open Access Journals (Sweden)

    Zhu Bin

    2017-01-01

    Full Text Available Background/Aim. Fractures of the proximal humerus or shaft are common, however, ipsilateral neck and shaft humerus fracture is a rare phenomenon. This combination injury is challenging for orthopaedic surgeons because of its complex treatment options at present. The purpose of this study was to review a series of ipsilateral humeral neck and shaft fractures to study the fracture pattern, complications and treatment outcomes of each treatment options used. Methods. A total of six patients (four female and two male with the average age of 42.8 years (range: 36–49 years was collected and reviewed retrospectively. Two of them were treated with double plates and four with antegrade intramedullary nail. According to the Neer’s classification, all proximal fractures were two-part surgical neck fractures. All humeral shaft fractures were located at the middle of one third. Five fractures were simple transverse (A3, one fragmented wedge fracture (B3. One patient had associated radial nerve palsy. Results. All surgical neck fractures except one united uneventfully in the average time span of 8.7 weeks. Four humeral shaft fractures healed in near anatomic alignment. The remaining two patients had the nonunion with no radiological signs of fracture healing. The average University of California, Los Angeles End-Results (UCLA score was 23.1. On the contrary, the average American Shoulder and Elbow Surgeon's (ASES score was 73.3. The patients treated with antegrade intramedullary nails presented 70.5 points. The ASES scores were 79 in the double plates group. Conclusions. Ipsilateral humeral shaft and neck fracture is extremely rare. Both antegrade intramedullar nailing and double plates result in healing of fractures. However the risk of complication is lower in the double plating group.

  14. Interfragmental fixation of rostral mandibular fracture with cerclage wire in a thoroughbred English horse

    OpenAIRE

    ÇETİNKAYA, Mehmet Alper; DEMİRUTKU, Alper

    2014-01-01

    The patient in this study was a 20-year-old thoroughbred gelding. After clinical and radiographical assessments, a bilateral rostral mandibular body fracture was determined. Fracture stabilization was achieved via a bilateral interfragmentary cerclage wire application. The horse started to use its jaw within 24 h of surgery. Postoperative radiographs were taken until month 6, at different periods, and fracture healing was evaluated. Fixation materials were left in place. Fracture healing occu...

  15. Unusual presentation of a radial neck fracture in a child

    Directory of Open Access Journals (Sweden)

    Murali Poduval

    2013-01-01

    Full Text Available Fracture of the radial neck are uncommon injuries. In children, they may present as radial neck fractures, a components of forearm fracture dislocations, or as isolated fracture dislocations. Here, we present an unusual and previously undescribed variant of radial neck fracture with dislocation of the radial head to the medial side and ulnar nerve injury. The fracture dislocation was openly reduced and fixed with a small fragment plate. The fracture healed with some loss of rotational movements. At short followup of 6 months patient had useful elbow function but ulnar nerve did not recover.

  16. Prescription for herbal healing

    National Research Council Canada - National Science Library

    Balch, Phyllis A; Bell, Stacey J

    2012-01-01

    .... From the most trusted name in natural healing, Phyllis A. Balch's new edition of Prescription for Herbal Healing provides the most current research and comprehensive facts in an easy-to-read A- to-Z format, including...

  17. investigating electromagnetic waves to enhance bone healing

    International Nuclear Information System (INIS)

    Agayan, Ali.

    1996-09-01

    Bone formation of fractured tibia stimulated by pulsed electromagnetic fields were studied and results assessed by roentgenography. A total of 89 male New Zealand rabbits was osteotomized by creating a 1.5-2 mm gap at right and left tibia, one for control and another for treatment by PEMF. The radiography of bone imaging with X-ray (60 k vp) was performs to observe the course of fracture healing and to establish criteria for distinguishing PEMF from normal healing. This paper also gives a theoretical model to calculate the field produced in bone for simple geometry. The induced electrical field need not have complex wave forms to be osteogenic and frequency suggested to be very low frequency

  18. A Study of Relation Between Physics and Metaphysics in the Field of Space and Time's Reality

    Directory of Open Access Journals (Sweden)

    Alireza Mansouri

    2015-02-01

    Full Text Available In this article it is aimed to explain the manner of science and metaphysics' interaction in space and time discussion. We will emphasize on this point that unlike the current perception, the changes in scientific and physics theories can be effective for us in taking philosophical and metaphysical position for space and time. For this purpose, in addition to surveying traditional arguments of essentialists and relationship-oriented about space and time, which are especially mentioned in Leibniz's  and Clarke's letters, interaction between science and metaphysics will be shown, according to new theoretical backgrounds, such as adoption of new Newtonian structure or field theory and general and special relativity theory. In the end, we will be close to this viewpoint that considering new scientific theories, such as general relativity theory of Einstein, essentialists' viewpoint about space and time, in current situation, seems more defendable.

  19. Mind, medicine, and metaphysics: reflections on the reclamation of the human spirit.

    Science.gov (United States)

    Penn, Michael L; Wilson, Lindsay

    2003-01-01

    Following the publication of such works as Auguste Comte's Cour de Philosophie Positive (1830-1842), in which he argued the inherent immaturity of metaphysical discourse, metaphysics, for Western intellectuals--and especially for Western intellectuals committed to science--has largely been abandoned. In recent years, however, we have seen renewed interest in metaphysics among some researchers and clinicians, due, in part, to increasing attempts to integrate diverse fields of study into some unified and coherent understanding of human life. For many psychologists and psychiatrists, this renewed interest is accompanied by an implicit, and sometimes explicit, re-embrace of the notion of the "human spirit." In this paper we explore some of the processes animating this movement and some of the clinical implications that flow from it.

  20. Wound Healing and Care

    Science.gov (United States)

    ... mouth, or sunken eyes. There's good news about wound healing when you're a teen: Age is on your side because young bodies heal faster. It may be frustrating having to hold back on activities like sports while a wound heals. But if you take good care of ...

  1. Bilateral avulsion fractures of the anterior superior iliac spines in sprinters

    Energy Technology Data Exchange (ETDEWEB)

    Khoury, M.B.; Kirks, D.R.; Martinez, S.; Apple, J.

    1985-01-01

    Three cases of bilateral pelvic avulsion fractures in adolescent sprinters are reviewed. An acute avulsion fracture of the anterior superior iliac spine (ASIS) occurred during active running in three teenaged sprinters. Radiography confirmed a healed fracture of the contralateral ASIS. The clinical features and radiologic appearances are characteristic. The pathophysiology of this type of unique pediatric fracture is discussed. Conservative treatment is successful.

  2. The old with the die. A contribution to metaphysics of quantum mechanics

    International Nuclear Information System (INIS)

    Ijjas, Anna

    2011-01-01

    Since the rise of quantum mechanics also their ideological implications and consequences were discussed. Meanwhile still scarcely a metaphysical problem exists, which was not supposedly solved under calling on quantum theory. Anna Ijjas inquires the usual practice and developes a new model of the assignment of quantum mechanics and metaphysics. She discusses both the physical foundations and the classical philosophical controversies, before she draws consequencies for the relation determination of brain and consciousness, the problem of freedom of will, as well as for the question of the influence of God in the world.

  3. On How physics Could impact on the Metaphysics of Space and Time

    Directory of Open Access Journals (Sweden)

    Alireza Mansouri

    2015-03-01

    Full Text Available This paper aims to illustrate the mutual inter-relation of physics and metaphysics in the context of the philosophy of space and time. We especially emphasize, in this paper, that scientific development could impact on our position regarding the reality of space and time. To illustrate this point, we investigate the mutual inter-relation of physics and metaphysics in the modern developments of physics, i.e. neo-Newtonian structure, special and general relativity (GR. This paper ends up anticipating that it is likely, by considering modern physics, especially GR, that substantivalism to be a more defensible position.

  4. Fractures in the growing foal. Part 1: Epiphyseal fractures

    International Nuclear Information System (INIS)

    Auer, J.A.

    1986-01-01

    This paper discusses general considerations for epiphyseal fractures and the anatomical differences which led to the Salter-Harris-classification are explained. The various locations and fracture configurations in the different bones are mentioned, and suggestions for their treatment are made. Epiphyseal fractures in growing foals have generally a favourable prognosis for healing, if treated properly. However, the prognosis for future use as an athlete has to be judged as guarded. The limb with an epiphyseal fracture should under any circumstances be splinted or cast for the transport to hospital. Epiphyseal fractures of the distal portions of the limb may be treated by cast application in some cases. More frequently, however, surgical reduction followed by some form of internal fixation is preferred. It is important to follow the basic principles of internal fixation. The implants should be removed at the earliest convenience, to prevent undue growth disturbances. Epiphyseal fractures should be treated as soon as possible to avoid further destruction of the growth plate through continuous movement at the fracture site. Growth disturbances are the most frequently encountered complications with epiphyseal fractures. Other complications include infection, osteomyelitis, degenerative joint disease and breakdown of the fracture fixation

  5. Fault Permeability and Strength Evolution Related to Fracturing and Healing Episodic Processes (Years to Millennia: the Role of Pressure Solution Évolution de la perméabilité et de la résistance des failles associée à des processus épisodiques de fracturation et colmatage (années - millénaires : le rôle de la dissolution cristallisation sous contrainte

    Directory of Open Access Journals (Sweden)

    Gratier J.-P.

    2011-02-01

    Full Text Available It is well known that fluids flow through faults and fractures but it is also demonstrated that fault zones act as impermeable barriers. Consequently, one must consider that faults are successively open and closed paths for fluids. On the human-activity time scale (years to millennia, studies of the seismic cycle offer the possibility of making a model of such evolution. According to this model, seismic (or hydraulic fracturing opens fluid paths almost instantaneously through the faults with associated weakening and post-fracturing creep processes. Fault healing processes then progressively close such fluid paths, associated with fault strengthening and fluid pressure recovery. Such transient behaviors have major consequences in the studies of: the evolution of permeability along faults with application tooil-field reservoir exploitation and fluid and waste storage; the evolution of fluid fluxes along faults with application to mass balance and climate evolution on the scale of the earth; the timing of earthquakes and the probability of their occurrence. The aim is to understand and evaluate the kinetics of the processes and the specific characteristic times of the fracturing and healing cycles. Results from laboratory experiments and natural fault studies are presented that show how pressure solution processes can explain both creep and sealing processes and the way they are associated in nature. The various fault-healing processes are discussed with their various characteristics in times from weeks to millennia. It is shown how they can be integrated into creep and sealing laws. Laboratory experiments give the values of some parameters of the laws (kinetics, thermodynamic. Other parameters must always be evaluated from the study of natural structures (geometry of path transfer, pressure and temperature conditions, nature of minerals and fluids. Consequently, the duration of the fracturing and sealing cycle is related to some extent to the

  6. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  7. Current concepts in pediatric femur fracture treatment.

    Science.gov (United States)

    Kanlic, Enes; Cruz, Miguel

    2007-12-01

    Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or fractures are treated operatively. Transverse or short oblique shaft fractures in patients fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures