-
Nature Reviews. Rheumatology Jan 2015Fractures are the most common large-organ, traumatic injuries to humans. The repair of bone fractures is a postnatal regenerative process that recapitulates many of the... (Review)
Review
Fractures are the most common large-organ, traumatic injuries to humans. The repair of bone fractures is a postnatal regenerative process that recapitulates many of the ontological events of embryonic skeletal development. Although fracture repair usually restores the damaged skeletal organ to its pre-injury cellular composition, structure and biomechanical function, about 10% of fractures will not heal normally. This article reviews the developmental progression of fracture healing at the tissue, cellular and molecular levels. Innate and adaptive immune processes are discussed as a component of the injury response, as are environmental factors, such as the extent of injury to the bone and surrounding tissue, fixation and the contribution of vascular tissues. We also present strategies for fracture treatment that have been tested in animal models and in clinical trials or case series. The biophysical and biological basis of the molecular actions of various therapeutic approaches, including recombinant human bone morphogenetic proteins and parathyroid hormone therapy, are also discussed.
Topics: Animals; Bone Regeneration; Fracture Healing; Fractures, Bone; Humans
PubMed: 25266456
DOI: 10.1038/nrrheum.2014.164 -
European Cells & Materials Jun 2018Calcium and vitamin D are essential for maintaining bone health. Therefore, deficiencies in calcium and vitamin D are major risk factors for osteoporosis development.... (Review)
Review
Calcium and vitamin D are essential for maintaining bone health. Therefore, deficiencies in calcium and vitamin D are major risk factors for osteoporosis development. Because sufficient amounts of calcium are also required for fracture-callus mineralisation, compromised bone repair that is frequently observed in osteoporotic patients might be attributed to calcium and vitamin D deficiencies. Consequently, calcium and vitamin D supplementation represents a potential strategy for treating compromised fracture healing in osteoporotic patients. Growing clinical evidence suggests that a fracture event may induce post-traumatic bone loss in the non-fractured skeleton, particularly in osteoporotic patients, which might further exacerbate osteoporosis and increase the risk of secondary fractures. Because the skeleton represents the main source of calcium, which is increasingly required during fracture-callus mineralisation, post-traumatic calcium mobilisation might occur under conditions of insufficient calcium and vitamin D status. However, to date, investigations of the roles of calcium and vitamin D in bone repair and post-traumatic bone turnover are very limited. The current review summarises the state of the literature, focusing on the role of calcium and vitamin D in fracture healing and post-traumatic bone turnover, and critically discusses the therapeutic potential of calcium and vitamin D supplementation in this context.
Topics: Animals; Bone Remodeling; Calcium; Fracture Healing; Fractures, Bone; Humans; Vitamin D; Wounds and Injuries
PubMed: 29931664
DOI: 10.22203/eCM.v035a25 -
Journal of Ultrasound in Medicine :... Mar 2022Low-intensity pulsed ultrasound (LIPUS) is a developing technology, which has been proven to improve fracture healing process with minimal thermal effects. This... (Review)
Review
Low-intensity pulsed ultrasound (LIPUS) is a developing technology, which has been proven to improve fracture healing process with minimal thermal effects. This noninvasive treatment accelerates bone formation through various molecular, biological, and biomechanical interactions with tissues and cells. Although LIPUS treatment has shown beneficial effects on different bone fracture locations, only very few studies have examined its effects on deeper bones. This study provides an overview on therapeutic ultrasound for fractured bones, possible mechanisms of action, clinical evidences, current limitations, and its future prospects.
Topics: Bone and Bones; Fracture Healing; Fractures, Bone; Humans; Ultrasonic Therapy; Ultrasonic Waves
PubMed: 33949710
DOI: 10.1002/jum.15738 -
Injury Jun 2021Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of... (Review)
Review
Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of injury severity, comorbidities, patient medication and infection. The majority of nonunions occur after long bone fractures with the tibia, femur, forearm, humerus and clavicle predominating. Despite interest in the biological augmentation of fracture healing, the majority of nonunions can be effectively managed with conventional surgical techniques. In this review we present a review of risk factors for nonunion and the outcome following surgical management.
Topics: Clavicle; Fracture Healing; Fractures, Bone; Fractures, Ununited; Humans; Retrospective Studies; Risk Factors
PubMed: 33221036
DOI: 10.1016/j.injury.2020.11.029 -
Current Osteoporosis Reports Aug 2018This paper describes recent advances in understanding the mechanisms that drive fracture pain and how these findings are helping develop new therapies to treat fracture... (Review)
Review
PURPOSE OF REVIEW
This paper describes recent advances in understanding the mechanisms that drive fracture pain and how these findings are helping develop new therapies to treat fracture pain.
RECENT FINDINGS
Immediately following fracture, mechanosensitive nerve fibers that innervate bone are mechanically distorted. This results in these nerve fibers rapidly discharging and signaling the initial sharp fracture pain to the brain. Within minutes to hours, a host of neurotransmitters, cytokines, and nerve growth factor are released by cells at the fracture site. These factors stimulate, sensitize, and induce ectopic nerve sprouting of the sensory and sympathetic nerve fibers which drive the sharp pain upon movement and the dull aching pain at rest. If rapid and effective healing of the fracture occurs, these factors return to baseline and the pain subsides, but if not, these factors can drive chronic bone pain. New mechanism-based therapies have the potential to fundamentally change the way acute and chronic fracture pain is managed.
Topics: Acute Pain; Analgesics, Opioid; Animals; Bone and Bones; Central Nervous System Sensitization; Chronic Pain; Disease Models, Animal; Fracture Healing; Fractures, Bone; Humans; Neuralgia; Nociceptive Pain; Nociceptors; Pain Management; Peripheral Nerve Injuries; Sensory Receptor Cells
PubMed: 29948820
DOI: 10.1007/s11914-018-0446-8 -
International Orthopaedics Apr 2021The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures. (Review)
Review
PURPOSE
The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures.
METHODS
Review of recent and historical literature.
RESULTS
Acetabular fractures are difficult to treat. The first descriptions of this injury already appeared in ancient Greek history, but intensive development started in the second half of the twentieth century after Judet and Letournel's seminal work. Their classification is still the gold standard today. It is actually a pre-operative planning system and is used to determine the most appropriate surgical approach. The therapy of choice for dislocated fractures is open reduction and internal fixation. Recent modern techniques based on high-tech computerized planning systems and 3D printing have been successfully integrated into orthopaedic trauma practice.
CONCLUSION
There is no ideal surgical approach for acetabulum fracture treatment, so new approaches have been developed in recent decades. The best outcome series have shown good or excellent results, between 70 and 80%.
Topics: Acetabulum; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Printing, Three-Dimensional; Spinal Fractures; Treatment Outcome
PubMed: 32964295
DOI: 10.1007/s00264-020-04806-4 -
Clinics in Orthopedic Surgery Jun 2020Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach... (Review)
Review
Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.
Topics: Clavicle; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators
PubMed: 32489533
DOI: 10.4055/cios20010 -
The Bone & Joint Journal Jul 2016This article presents a unified clinical theory that links established facts about the physiology of bone and homeostasis, with those involved in the healing of...
This article presents a unified clinical theory that links established facts about the physiology of bone and homeostasis, with those involved in the healing of fractures and the development of nonunion. The key to this theory is the concept that the tissue that forms in and around a fracture should be considered a specific functional entity. This 'bone-healing unit' produces a physiological response to its biological and mechanical environment, which leads to the normal healing of bone. This tissue responds to mechanical forces and functions according to Wolff's law, Perren's strain theory and Frost's concept of the "mechanostat". In response to the local mechanical environment, the bone-healing unit normally changes with time, producing different tissues that can tolerate various levels of strain. The normal result is the formation of bone that bridges the fracture - healing by callus. Nonunion occurs when the bone-healing unit fails either due to mechanical or biological problems or a combination of both. In clinical practice, the majority of nonunions are due to mechanical problems with instability, resulting in too much strain at the fracture site. In most nonunions, there is an intact bone-healing unit. We suggest that this maintains its biological potential to heal, but fails to function due to the mechanical conditions. The theory predicts the healing pattern of multifragmentary fractures and the observed morphological characteristics of different nonunions. It suggests that the majority of nonunions will heal if the correct mechanical environment is produced by surgery, without the need for biological adjuncts such as autologous bone graft. Cite this article: Bone Joint J 2016;98-B:884-91.
Topics: Bone and Bones; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Fractures, Ununited; Homeostasis; Humans; Ilizarov Technique; Stress, Mechanical
PubMed: 27365465
DOI: 10.1302/0301-620X.98B7.36061 -
International Journal of Environmental... Dec 2018Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year...
Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years ( = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
Topics: Australia; Female; Fracture Healing; Fractures, Bone; Hospital Costs; Humans; Incidence; Leg Bones; Length of Stay; Male; Outcome Assessment, Health Care; Retrospective Studies; Risk Factors
PubMed: 30551632
DOI: 10.3390/ijerph15122845 -
Lakartidningen Jun 2019This article suggests algorithms for diagnosis and treatment of scaphoid fractures. A clinical suspected scaphoid fracture without signs of fracture on conventional... (Review)
Review
This article suggests algorithms for diagnosis and treatment of scaphoid fractures. A clinical suspected scaphoid fracture without signs of fracture on conventional radiographs should have a supplementary MRI done within 5-7 days. Displaced fractures and all proximal fractures should be classified by CT. Fracture union should be evaluated by CT. 90 procent of non- or minimally displaced waist fractures are healed after 6 weeks of conservative treatment. Non- or minimally displaced fractures with signs of instability can be treated conservatively, but require prolonged immobilisation. Fractures with a displacement ≥1,5 mm as well as the majority of proximal scaphoid fractures should be treated surgically with internal fixation.
Topics: Acute Disease; Algorithms; Fracture Healing; Fractures, Bone; Humans; Magnetic Resonance Imaging; Practice Guidelines as Topic; Radiography; Return to Sport; Return to Work; Scaphoid Bone; Tomography, X-Ray Computed
PubMed: 31211404
DOI: No ID Found