Introduction VEGF is a well known angiogenic peptide which has been shown to be central to endochondral ossification. Secondary fracture healing involves a combination of intramembranous and endochondral ossification. VEGF has been recently shown to be chemotactic for osteoblasts and chondroclasts. We therefore set out to examine the temporal and spatial expression of VEGF and its receptors in fracture healing. We report here the preliminary findings of our study.

Methods A closed mid-shaft fracture was produced in the right femora of nine 12 week old Sprague Dawley rats, stabilised by an intramedullary K-wire. The rats were sacrificed at one, two and four weeks. Through the use of immunohistochemistry, RT-PCR and in situ hybridisation.

Results We show that at each of the time points, VEGF is expressed in all of the cell types involved in fracture healing; the inflammatory cells, the osteo-progenitor cells,chondroblasts,chondrocytes,osteoblasts and osteoclasts as well as fibroblasts. We further show that there is persistent expression of VEGF in chondrocytes at four weeks.

Conclusions Our findings are consistent with the hypothesis that events in fracture healing reflect the processes that take place at the growth plate during embryonic development.

We investigated clinical features and surgical outcomes for compressive cervical myelopathy in patients over 75 years of age.

Twenty-one patients who underwent surgical decompression for cervical myelopathy were reviewed. The average age at the time of operation was 78.0 years and the mean follow-up period was 5.7 years. Posterior decompression in 19 patients and anterior decompression in 2 patients were performed. Neurologic deficits before and after surgery were assessed using a scoring system by the Japanese Orthopaedic Association (JOA score). Radiological features were examined with radiographs and MRI. The clinical results were compared to those of 24 control patients who were less than 65 years of age at the time of surgery. The average age was 50.2 years and the mean follow-up period was 4.5 years.

In the aged patients, the preoperative mean JOA score was 6.2. Radiological examination revealed that the spinal cord was multisegmentally impinged. The postoperative maximum JOA score averaged 11.1, and the recovery rate was 45.4%. All patients became ambulatory and independent in fundamental daily activities following surgery. Maximum recovery was obtained from 1 to 3 years after the operation and function was maintained for at least 3 years. At the final follow up, the mean JOA score had been reduced to 9.5 and the recovery rate to 27.4%. Only the preoperative duration of symptoms correlated with the outcomes. The pre-operative JOA score in the control patients was 6.5. The postoperative maximum JOA score was 13.8 and the recovery rate was 69.4%. This was not significantly changed at the final follow-up.

Although postoperative recovery of function was significantly inferior to that of the control patients, surgical treatment appears to be beneficial, even in patients over 75 years of age, in improving neurological function and ability of activities in daily living.