Forty-eight rats were divided into four groups of 12. For 3 days, each group received the following vitamins in once-daily doses: group 1, vitamin E only; group 2, vitamin C only; group 3, vitamins E and C; and group 4, no treatment (control). The right tibia of each rat was fractured on day 4; the rats then received the same regimen three times a week (once-daily doses) until day 21. Fracture healing was evaluated radiologically by measuring the callus indices, and histologically by a 5-point grading scale. On days 14 and 21, the callus index values in group 2 were statistically higher than those in the other groups. Histological evaluation scores in group 2 were the highest overall, and group 3 scores were higher than those in groups 1 and 4. These findings indicate that vitamin C accelerates fracture healing, vitamin E does not exert a marked effect on this process, and vitamins E and C in combination do not have a synergistic impact on fracture healing.

The present study demonstrated that alpha2-macroglobulin blockade of matrix metalloproteinases can enhance bone-tendon healing. This effect of alpha2-macroglobulin could occur through its effect solely on collagenase or on a subset of matrix metalloproteinases that are present at the healing interface.

Osgood-Schlatter disease (OSD) is a well-described clinical condition, although its origin remains controversial. Mechanical, growth or traumatic factors are suggested as causes of this lesion. Thirty-five patients were included in this study. Twenty of them had OSD (study group) and the remaining 15 adolescents constituted the control group. Magnetic resonance imaging of the knees was performed in all patients. The distance between the distal pole of the patella and the proximal margin of patellar tendon attachment to the tibial apophysis (A), the distance between the distal pole of the patella and the tibial tubercle epiphysis (B), the distance between the proximal margin of the patellar tendon attachment to the tibia and the tibial tubercle epiphysis (C) and the distance between the knee joint level and the tibial tubercle epiphysis (D) were measured. The ratio of the distance between the distal pole of the patella and the proximal margin of the patellar tendon attachment to the tibia to the distance between the distal pole of the patella and the tibial tubercle epiphysis (A : B) was lower in the study group. The ratio of the distance between the proximal margin of the patellar tendon attachment point to the tibia and the tibial tubercle epiphysis to the distance between the knee joint level and the tibial tubercle epiphysis (C : D) was higher in the control group. We conclude that if the patellar tendon attaches more proximally and in a broader area to the tibia, this might probably cause OSD.

No abstract

To investigate the effect of a-tocopherol (vitamin E) on fracture healing in rabbits, two groups of 10 rabbits were either injected with a-tocopherol (treated) or untreated (controls). The right femurs of both groups were fractured, and the treated group were injected intramuscularly with 20 mg/kg a-tocopherol daily for 5 days starting on the day of fracture. After 21 days, histological sections of the fractured region were examined and scored. Fracture healing had progressed further in the a-tocopherol group than in the control group. A statistically significant difference between the histological grading of fracture healing in the two groups was found. This difference may result from an antioxidant (a-tocopherol) effect on free oxygen radicals in the fracture area. We conclude that a-tocopherol may affect fracture healing favourably and might be useful as a therapeutic agent in clinical fracture management.

No abstract

To investigate the effect of modification of biological environmental conditions, one of the factors influencing the healing of anterior cruciate ligament rupture, we performed experimental anterior cruciate ligament ruptures on New Zealand rabbits. After experimental rupture, intra-articular alpha-2 macroglobulin was injected into the knees of the rabbits in the experiment group to prevent structural changes resulting from the enzymatic reactions in the ruptured anterior cruciate ligament. At the end of 10th day of the experiment, we observed that the anterior cruciate ligaments in the experiment group had retained their prerupture brightness and volume when compared with the control group in which intraarticular alpha-2 macroglobulin had not been injected. We also noted that the anterior cruciate ligaments in the experiment group had not retracted or swollen, the incision sites were regular and clean, and they did not show any signs of degeneration. In the histological examination, the anterior cruciate ligaments in the control groups showed disruption of the collagen network and a significant diminution in number of fibroblasts and fibrocytes (p <.001). At the end of this study, we concluded that the necessary conditions for the healing and repair of ruptured anterior cruciate ligament could exist if the enzymatic and biological environments were under control.

Congenital insensitivity to pain with anhidrosis (CIPA) is an autosomal recessive disorder caused by mutations in the neurotrophic tyrosine receptor kinase 1 (NTRK1) gene, which encodes the receptor for nerve growth factor. We report the clinical course of a 7-year-old girl with CIPA and proven NTRK1 mutation. In addition to recurrent dislocation of the left hip joint and avascular necrosis of the left talus, the patient also presented with recurrent infections secondary to hypogammaglobulinemia, a feature not previously known to be associated with CIPA. The patient was treated with regular administration of intravenous immunoglobulins. Conservative treatment of the recurrent left hip dislocation by cast immobilization and bracing was implemented to stabilize the joint. The implication of the immune system of the reported patient broadens the clinical phenotype associated with NTRK1 mutations.