Contrast-Enhanced Computed Tomography for Non-Destructive, Quantitative Assessment of the Early Stages of Fracture Healing

2011 ◽  
Author(s):  
C. M. J. De Bakker ◽  
L. N. M. Hayward ◽  
L. C. Gerstenfeld ◽  
M. W. Grinstaff ◽  
E. F. Morgan
Keyword(s):  
Computed Tomography ◽  
Fracture Healing ◽  
Bone Fractures ◽  
The United States ◽  
Fracture Site ◽  
Early Assessment ◽  
Subsequent Formation ◽  
Substantial Impact ◽  
Early Stages ◽  
Enhanced Computed Tomography

Each year in the United States, approximately 600,000 bone fractures show delayed or impaired healing and require subsequent surgical intervention1. Techniques for early identification of these cases are presently lacking but could make substantial impact on reducing the morbidity and costs associated with poor bone healing. A current barrier to early assessment of fracture healing is the difficulty in visualizing the cartilaginous “soft” callus that forms at the fracture site in the early stages of repair. The soft callus serves to partially stabilize the fracture and provides a template for subsequent formation of the bony “hard” callus2. Although measurement or estimation of the size, stiffness, and strength of the hard callus is possible by x-ray or computed tomography (CT)3, no analogous methods have been developed for the soft callus, due to the low radio-opacity of cartilage.

scholarly journals Development and Biocompatibility Characterization of a BioMEMS Sensor for Monitoring the Progression of Fracture Healing

2009 ◽  
Author(s):  
Brandon G. Santoni ◽  
Rohat Melik ◽  
Emre Unal ◽  
Nihan Kosku Perkgoz ◽  
Debra A. Kamstock ◽  
...  
Keyword(s):  
United States ◽  
Fracture Healing ◽  
Bone Fractures ◽  
Financial Burden ◽  
Early Period ◽  
The United States ◽  
Long Bone ◽  
Extremity Injuries ◽  
Manual Manipulation

Orthopaedic extremity injuries present a large medical and financial burden to the United States and world-wide communities [1]. Approximately six million long bone fractures are reported annually in the United States and approximately 10% of these fractures do not heal properly. Though the exact mechanism of impaired healing is poorly understood, many of these non-unions result when there is a communited condition that does not proceed through a stabilized healing pathway [2]. Currently, clinicians may monitor healing visually by radiographs, or via manual manipulation of the bone at the fracture [3]. Unfortunately, the course of aberrant fracture healing is not easily diagnosed in the early period when standard radiographic information of the fracture is not capable of discriminating the healing pathway. Manual assessment of fracture healing is also an inadequate diagnostic tool in the early stages of healing [4].

scholarly journals Gukang Capsule Promotes Fracture Healing by Activating BMP/SMAD and Wnt/β-Catenin Signaling Pathways

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Xue Ma ◽  
Jian Yang ◽  
Ting Liu ◽  
Jing Li ◽  
Yanyu Lan ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Signaling Pathways ◽  
Bone Fractures ◽  
Glycogen Synthase ◽  
Fracture Site ◽  
Bone Morphogenetic Protein 2 ◽  
Radius Fracture ◽  
Smad Signaling ◽  
Alp Activity ◽  
Human Osteosarcoma Cells

Background. Gukang capsule (GKC) is a traditional Chinese medicine formulation which has been used extensively in the clinical treatment of bone fractures. However, the mechanisms underlying its effects on fracture healing remain unclear. Methods. In this study we used a rabbit radius fracture model, and we measured the serum content of bone alkaline phosphatase (ALP), calcium, and phosphorus and examined pathology of the fracture site as indicators of the fracture healing effects of GKC. SaOS-2 human osteosarcoma cells were used to measure (i) ALP activity, (ii) ornithine transcarbamylase (OTC), calcium, and mineralization levels, (iii) the expression of osteogenic-related genes, that is, runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP2), collagen I (COL-I), osteopontin (OPN), OTC, and osterix (Osx), and (iv) the expression of key proteins in the Wnt/β-catenin and BMP/SMAD signaling pathways to study the mechanisms by which GKC promotes fracture healing. Results. We found that GKC effectively promotes radius fracture healing in rabbits and enhances ALP activity, increases OTC and calcium levels, and stimulates the formation of mineralized nodules in SaOS-2 cells. Moreover, COL-I, OTC, Osx, BMP2, and OPN expression levels were higher in SaOS-2 cells treated with GKC than control cells. GKC upregulates glycogen synthase kinase 3β (GSK3β) phosphorylation and Smad1/5 and β-catenin protein levels, thereby activating Wnt/β-catenin and BMP/Smad signaling pathways. Inhibitors of the Wnt/β-catenin and BMP/Smad signaling pathways (DKK1 and Noggin, respectively) suppress the osteogenic effects of GKC. Conclusions. GKC promotes fracture healing by activating the Wnt/β-catenin and BMP/Smad signaling pathways and increasing osteoprotegerin (OPG) secretion by osteoblasts (OBs), which prevents receptor activator of nuclear factor kappa B ligand (RANKL) binding to RANK.

BOSENTAN, A NON-SPECIFIC ENDOTHELIN ANTAGONIST, STIMULATES FRACTURE HEALING

2007 ◽  
Vol 19 (01) ◽  
pp. 37-46 ◽  
Author(s):  
Hasan H. Muratli ◽  
Feza Korkusuz ◽  
Petek Korkusuz ◽  
Ali Bicimoglu ◽  
Z. Sevim Ercan
Keyword(s):  
Fracture Healing ◽  
Bone Fractures ◽  
Fracture Site ◽  
Controlled Study ◽  
Prostaglandin E ◽  
Matrix Mineralization ◽  
Hind Limbs ◽  
Diaphyseal Bone ◽  
Activity Measurements ◽  
Intramedullary Rod

It is assumed that bosentan, a non-selective ET-1 receptor antagonist, will enhance fracture healing. The aim of this prospective randomized controlled study was to investigate the effects of transcutaneous bosentan administration into diaphyseal bone fractures using radiology, histology, prostaglandin E2 (PGE2) and leukotrien C 4 (LTC4) activity measurements. A closed diaphyseal fracture was created in the hind limbs following intramedullary rod fixation of Guinea pigs. Bosentan was administred by repetitive weekly 0.1 μg transcutaneous injections into the fracture site. The effects of bosentan were evaluated by radiology and histology on weeks 1, 2 and 4, whereas prostaglandin E2 (PGE2)-like and leukotrien C 4 (LTC4)-like activity was assessed on weeks 1 and 2. The radiological degree of union (p = 0.001) at the fracture site and cortex-callus ratio (p = 0.02) was significantly better in the bosentan administered site at week 1 when compared to the control. Histology presented an initial stimulation of bone formation on weeks 1 and 2 in the experimental group. PGE2-like activity was significantly higher (p = 0.002) on week 1 and 2 in the bosentan-administered side. LTC4-like activity remained constant on week one and decreased on week two. Transcutaneous repetitive bosentan administration into the fracture site initially stimulated periosteal bone healing that resulted with extracellular matrix mineralization. The inflammatory mediators PGE2/LTC4 played a significant role in this process.

scholarly journals Lithium for Fracture Treatment (LiFT): a double-blind randomised control trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031545 ◽  
Author(s):  
Diane Nam ◽  
Phumeena Balasuberamaniam ◽  
Katrine Milner ◽  
Monica Kunz ◽  
Kathak Vachhani ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Bone Fractures ◽  
Fracture Site ◽  
Long Bone ◽  
Randomised Control Trial ◽  
Secondary Outcome ◽  
Double Blind ◽  
Carbonate Group ◽  
Main Trial ◽  
Radiographic Union

IntroductionFracture healing can fail in up to 10% of cases despite appropriate treatment. While lithium has been the standard treatment for bipolar disorder, it may also have a significant impact to increase bone healing in patients with long bone fractures. To translate this knowledge into clinical practice, a randomised clinical trial (RCT) is proposed.Methods and analysisA multicentre double blind, placebo-controlled RCT is proposed to evaluate the efficacy of lithium to increase the rate and predictability of long bone fracture healing in healthy adults compared to lactose placebo treatment. 160 healthy individuals from 18 to 55 years of age presenting with shaft fractures of the femur, tibia/fibula, humerus or clavicle will be eligible. Fractures will be randomised to placebo (lactose) or treatment (300 mg lithium carbonate) group within 2 weeks of the injury. The primary outcome measure will be radiographic union defined as visible callus bridging on three of the four cortices at the fracture site using a validated radiographic union score. Secondary outcome measures will include functional assessment and pain scoring.Ethics and disseminationParticipant confidentiality will be maintained with publication of results. Research Ethics Board Approval: Sunnybrook Research Institute (REB # 356–2016). Health Canada Approval (HC6-24-C201560). Results of the main trial and secondary endpoints will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration numberNCT02999022.

Effect of Intramedullary Nailing Patterns On Interfragmentary Strain in a Mouse Femur Fracture: a Parametric Finite Element Analysis

2021 ◽  
Author(s):  
Gregory Lowen ◽  
Katherine Garrett ◽  
Moore-Lotridge Stephanie ◽  
Sasidhar Uppuganti ◽  
Scott A. Guelcher ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Fracture Healing ◽  
Bone Repair ◽  
Bone Fractures ◽  
Fracture Site ◽  
Fracture Repair ◽  
Long Bone ◽  
Design Parameters ◽  
Element Analysis

Abstract Delayed long bone fracture healing and nonunion continue to be a significant socioeconomic burden. While mechanical stimulation is known to be an important determinant of the bone repair process, understanding how the magnitude, mode, and commencement of interfragmentary strain (IFS) affect fracture healing can guide new therapeutic strategies to prevent delayed healing or non-union. Mouse models provide a means to investigate the molecular and cellular aspects of fracture repair, yet there is only one commercially available, clinically-relevant, locking intramedullary nail (IMN) currently available for studying long bone fractures in rodents. Having access to alternative IMNs would allow a variety of mechanical environments at the fracture site to be evaluated, and the purpose of this proof-of-concept finite element analysis study is to identify which IMN design parameters have the largest impact on IFS in a murine transverse femoral osteotomy model. Using the dimensions of the clinically relevant IMN as a guide, the nail material, distance between interlocking screws, and clearance between the nail and endosteal surface were varied between simulations. Of these parameters, changing the nail material from stainless steel (SS) to polyetheretherketone (PEEK) had the largest impact on IFS. Reducing the distance between the proximal and distal interlocking screws substantially affected IFS only when nail modulus was low. Therefore, IMNs with low modulus (e.g., PEEK) can be used alongside commercially available SS nails to investigate the effect of initial IFS or stability on fracture healing with respect to different biological conditions of repair in rodents.

scholarly journals Assessment of contrast-enhanced computed tomography for imaging of cartilage during fracture healing

2012 ◽  
Vol 31 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Lauren N.M. Hayward ◽  
Chantal M.J. de Bakker ◽  
Louis C. Gerstenfeld ◽  
Mark W. Grinstaff ◽  
Elise F. Morgan
Keyword(s):  
Computed Tomography ◽  
Fracture Healing ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

scholarly journals Imaging quiz: A child with multiple trauma

2018 ◽  
Vol 26 (1) ◽  
pp. 67-69
Author(s):  
Sercan Özkaçmaz
Keyword(s):  
Computed Tomography ◽  
Bone Fractures ◽  
Fluid Collection ◽  
Splenic Infarction ◽  
Careful Examination ◽  
Renal Infarction ◽  
Contrast Enhanced ◽  
Active Extravasation ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Splenic and renal infarctions are embolic conditions which usually occur secondary to cardiac problems, thromboembolic systemic diseases, and infectious conditions such as sepsis. Trauma is a relatively rare cause of visceral infarctions. Traumatic segmental renal infarction associated with total splenic infarction is extremely rare. For detecting these visceral infarctions, contrast-enhanced computed tomography is essential, and a very careful examination is required for detecting very small infarctions and excluding total visceral infarctions. In isolated splenic or renal infarctions secondary to trauma, the common contrast-enhanced computed tomography findings are wedge-shaped or segmental hypodense areas in kidneys or spleen and rarely total visceral infarctions. Usually, intraperitoneal or retroperitoneal fluid collection which corresponds to bleeding from kidney or spleen is not seen in such cases. Also, the lack of evidence of active extravasation from renal/splenic arteries and pseudoaneurysm or dissection is an important finding of isolated traumatic splenic or renal infarctions. Because total infarctions can be misinterpreted in some cases, differences in density between intra-abdominal organs allowed by computed tomography must be carefully examined. Intestinal infarctions, the other abdominal injuries, pulmonary injuries, and pelvic or thoracic bone fractures usually accompany traumatic renal or splenic infarctions. In this report, we present contrast-enhanced computed tomography findings of a multitrauma pediatric case of traumatic total splenic and bilateral segmental renal infarction by reviewing the literature.

scholarly journals Targeted Delivery of Lovastatin and Tocotrienol to Fracture Site Promotes Fracture Healing in Osteoporosis Model: Micro-Computed Tomography and Biomechanical Evaluation

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e115595 ◽  
Author(s):  
Nurul ‘Izzah Ibrahim ◽  
Mohd Fadhli Khamis ◽  
Mohd Faridz Mod Yunoh ◽  
Shahrum Abdullah ◽  
Norazlina Mohamed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Fracture Healing ◽  
Targeted Delivery ◽  
Fracture Site ◽  
Micro Computed Tomography ◽  
Biomechanical Evaluation

A Giant Coronary Sinus Aneurysm with Secondary Vena Cava Aneurysms

2016 ◽  
Vol 19 (1) ◽  
pp. 028
Author(s):  
Shengjun Wu ◽  
Peng Teng ◽  
Yiming Ni ◽  
Renyuan Li
Keyword(s):  
Computed Tomography ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Unusual Case ◽  
Superior Vena ◽  
Vena Cava ◽  
Final Diagnosis ◽  
Rare Entity ◽  
First Case ◽  
Enhanced Computed Tomography

Coronary sinus aneurysm (CSA) is an extremely rare entity. Herein, we present an unusual case of an 18-year-old symptomatic female patient with a giant CSA. Secondary vena cava aneurysms were also manifested. The final diagnosis was confirmed by enhanced computed tomography (CT) and cardiac catheterization. As far as we know, it is the first case that such a giant CSA coexists with secondary vena cava aneurysms. Considering the complexity of postoperative reconstruction, we believe that heart transplantation may be the optimal way for treatment. The patient received anticoagulant due to the superior vena cava (SVC) thrombosis while waiting for a donor.

Sign in / Sign up

Export Citation Format

Share Document