Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1998
ReviewPotential role of bone morphogenetic proteins in fracture healing.
Since their discovery, bone morphogenetic proteins have held the promise for use in various orthopaedic diseases. One of the largest areas of likely application is the area of fracture repair. ⋯ This study examines the preclinical data to support the concept of enhancing bony healing and discusses the preliminary data from clinical trials using bone morphogenetic proteins to augment bony healing. Although the potential clinical uses of bone morphogenetic proteins in fracture healing remain significant, this potential has yet to be realized.
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Clin. Orthop. Relat. Res. · Oct 1998
Randomized Controlled Trial Clinical TrialThe John Charnley Award. Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty.
The efficiency of a new cementing technique developed to prevent the risk of intraoperative pulmonary embolism was assessed. Seventy patients with coxarthrosis entered into a prospective, randomized clinical trial. In the control group of 35 cases the total hip replacement was cemented conventionally. ⋯ The rise of intramedullary pressure in the femur is the most decisive pathogenic factor of pulmonary embolism during total hip arthroplasty. The logical prophylactic measure to prevent intravasation of fat and bone marrow is to create sufficient drainage. The cohorted investigation showed the value of the vacuum cementing technique for a substantial reduction of intraoperative embolism and pulmonary impairment.
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Clin. Orthop. Relat. Res. · Oct 1998
ReviewThe effect of reamed and nonreamed intramedullary nailing on fracture healing.
Intramedullary nailing has revolutionized the treatment of fractures. It is important to be aware of the biological and mechanical effects of reaming and nailing on bone. Most nails are substantially stiffer than bone, but because of their location in the medullary canal do not have nearly as adverse an effect on callus strength as plates. ⋯ This results in a hyperemic reaction that revascularizes the cortex depending on the type of nail used. Preservation of the soft tissue envelope around the fracture enhances this response resulting in fracture healing ratio of 98% when closed nailing techniques are used. The primary advantage of nonreamed nailing is better preservation of the blood supply to the cortex whereas the major advantage of reamed nailing is a more rigid construction, stronger implants, and earlier fracture union.
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Clin. Orthop. Relat. Res. · Oct 1998
Case ReportsBone regeneration and fracture healing. Experience with distraction osteogenesis model.
The relation between physical forces and the processes of bone regeneration and healing remains incompletely understood. Gaps in understanding of these processes stem in part from models that produce inadequate amounts of new bone for study. Bone created through the use of distraction osteogenesis provides an attractive substrate for the study of mechanical forces and their effects on bone formation because this technique produces large volumes of new bone in a controlled fashion. ⋯ Mechanisms responsible for this sensitivity might include vascularity, stem cell supply, and scaffolding architecture. The process of bone formation in distraction osteogenesis appears to be related to bone formation processes associated with more common conditions. The distraction osteogenesis model described suggests a mechanism for bone formation that seems applicable to other more common processes associated with bone formation, including fracture healing and impaired fracture healing.
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Clin. Orthop. Relat. Res. · Oct 1998
Comparative StudyStrain rate and timing of stimulation in mechanical modulation of fracture healing.
Fracture of the long bones results in a repair process that has the potential to restore the anatomic morphology and mechanical integrity of the bone without scar tissue. The repair process can occur in two patterns. In the first, under conditions of rigid stabilization, direct osteonal remodeling of the fracture line can occur with little or no external callus, a process known as direct bone repair. ⋯ The beneficial effect of this particular biophysic stimulus early in the healing period may be related to the viscoelastic nature of the differentiating connective tissues in the early endochondral callus. In the early endochondral callus, high rates of movement induce a greater deformation of the fracture fragments because of the stiffening of the callus. Alternatively, the transduction pathway may involve streaming potentials as a result of the high movement rate.