A balanced inflammatory response is important for successful fracture healing. The response of osteoporotic fracture healing is deranged and an altered inflammatory response can be one underlying cause. The objectives of this review were to compare the inflammatory responses between normal and osteoporotic fractures and to examine the potential effects on different healing outcomes. A systematic literature search was conducted with relevant keywords in PubMed, Embase, and Web of Science independently. Original preclinical studies and clinical studies involving the investigation of inflammatory response in fracture healing in ovariectomized (OVX) animals or osteoporotic/elderly patients with available full text and written in English were included. In total, 14 articles were selected. Various inflammatory factors were reported; of those tumour necrosis factor-α (TNF-α) and interleukin (IL)-6 are two commonly studied markers. Preclinical studies showed that OVX animals generally demonstrated higher systemic inflammatory response and poorer healing outcomes compared to normal controls (SHAM). However, it is inconclusive if the local inflammatory response is higher or lower in OVX animals. As for clinical studies, they mainly examine the temporal changes of the inflammatory stage or perform comparison between osteoporotic/fragility fracture patients and normal subjects without fracture. Our review of these studies emphasizes the lack of understanding that inflammation plays in the altered fracture healing response of osteoporotic/elderly patients. Taken together, it is clear that additional studies, preclinical and clinical, are required to dissect the regulatory role of inflammatory response in osteoporotic fracture healing. Cite this article:
We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent
Ninety-seven revisions of total hip replacements are reviewed with a median time of observation of 47 months. Satisfactory pain relief was obtained in 86%. There were six complete failures which were reduced to three by further surgery. One hip became infected and was excised. In 12 cases the revisions were complicated by peroperative fractures and in five by dislocations. Radiographic analysis disclosed a high percentage of periarticular
1. Seventy-seven operations on the patella have been reviewed. 2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella. 3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of
Experimental studies indicate that non-steroidal anti-inflammatory drugs (NSAIDs) may have negative effects on fracture healing. This study aimed to assess the effect of immediate and delayed short-term administration of clinically relevant parecoxib doses and timing on fracture healing using an established animal fracture model. A standardized closed tibia shaft fracture was induced and stabilized by reamed intramedullary nailing in 66 Wistar rats. A ‘parecoxib immediate’ (Pi) group received parecoxib (3.2 mg/kg bodyweight twice per day) on days 0, 1, and 2. A ‘parecoxib delayed’ (Pd) group received the same dose of parecoxib on days 3, 4, and 5. A control group received saline only. Fracture healing was evaluated by biomechanical tests, histomorphometry, and dual-energy x-ray absorptiometry (DXA) at four weeks.Objectives
Methods
In 1887, Konig claimed that loose bodies in the knee joints of young persons had three causes: (1) very severe trauma; (2) lesser trauma causing contusion and necrosis; and (3) minimal trauma acting on an underlying lesion-for which he suggested the name osteochondritis dissecans. His thesis has stood the test of time. We still confuse the second and third categories but osteochondritis dissecans has been identified as an
There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of
1. Congenital coxa vara and infantile coxa vara must be separated as distinct entities. 2. Infantile coxa vara is likely to be due to distal movement of the head fragment relative to the shaft and neck. This can result either from severe trauma in normal bone or from shearing stress on an abnormal femoral neck. 3. There is no justification for considering infantile coxa vara as congenital, developmental or due to interruption of
1. Nineteen patients with congenital shortening of the femur without associated coxa vara have been examined and discussed. 2. The diagnosis is made on finding a short, bulky thigh, held in lateral rotation. The radiographs commonly show no abnormality apart from shortening, but delay in
1. Details of clinical, radiological, biochemical and histological investigations of a case of metaphysial dysostosis are presented. 2. The patient was a boy of seven years, and showed widespread lesions (involving long bones of limbs, small bones of hands and feet, pelvis, clavicles, and ribs) characterised by retardation of growth and
To compare complication-related reoperation rates following primary arthroplasty for proximal humerus fractures (PHFs) We identified patients aged 50 years and over, who sustained a PHF between 2004 and 2015, from linkable datasets. We used intervention codes to identify patients treated with initial ORIF or arthroplasty, and those treated with ORIF who returned for revision arthroplasty within two years. We used multilevel logistic regression to compare reoperations between groups.Aims
Patients and Methods
We studied the precise role of the fracture haematoma in healing by the experimental transplantation of the haematoma at two days and four days after fracture of the rat femur to subperiosteal and intramuscular sites. We used bone marrow and peripheral blood haematomas for control experiments. The transplanted two-day fracture haematoma produced new bone by endochondral
The main findings in this experimental work on rats fed on lathyrus odoratus (sweet-pea) meal are as follows:. 1. Growth is retarded. 2. The growth plate is disorganised and normal
Femoroacetabular impingement (FAI) is a potential cause of hip osteoarthritis (OA). The purpose of this study was to investigate the expression profile of matrix metalloproteinases (MMPs) in the labral tissue with FAI pathology. In this study, labral tissues were collected from four FAI patients arthroscopically and from three normal hips of deceased donors. Proteins extracted from the FAI and normal labrums were separately applied for MMP array to screen the expression of seven MMPs and three tissue inhibitors of metalloproteinases (TIMPs). The expression of individual MMPs and TIMPs was quantified by densitometry and compared between the FAI and normal labral groups. The expression of selected MMPs and TIMPs was validated and localized in the labrum with immunohistochemistry.Aims
Methods
1. A patient with macrodactyly of the middle finger of the left hand was followed up from birth until the finger was amputated at the age of three. 2. The affected finger, besides showing gigantism at birth, grew at a faster rate than the normal fingers. The degree of bone maturation (as judged from the appearance and size of the phalangeal
We treated 12 patients with multilevel stenosis of the cervical canal after spondylosis or
Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone. A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.Aims
Patients and Methods
1. The utilisation of radioactive sulphur in vivo has been demonstrated both macroscopically and microscopically during the preosseous stage of bone repair. 2. The labelled mucopolysaccharide complex, chondroitin sulphuric acid, has been studied during the formation of the medullary and periosteal blastemata in the healing of a fracture. 3. The appearance and possible significance of mast cells adjacent to a fracture, and resulting from the stimulus of trauma, are discussed. 4. Cortisone has been seen to affect the formation of the periosteal cartilaginous blastema and subsequent process of endochondral