Interfragmentary movements affect the quality and quantity of callus formation. The mounting plane of monolateral external fixators may give direction to those movements. Therefore, the aim of this study was to determine the influence of the fixator mounting plane on the process of fracture healing.Identically configured fixators were mounted either niedially or anteromedially on the tibiae of sheep. Interfragmentary movements and ground reaction forces were evaluated in vivo during a nine week period. Histomorphological and biomechanical parameters described the bone healing processes.Changing only the mounting plane led to a modification of interfragmentary movements in the initial healing phase. The difference in interfragmentary movements between the groups was only significant during the first post-operative period. However, these initial diferences in mechanical conditions influenced callus tissue formation significantly. The group with the anteromedially mounted fixator. initially showing significantly more interfragmentary movements, ended up with a significantly smaller callus diameter and a significantly higher callus stiffness as a result of advanced fracture healing. This demonstrates that the initial phase of healing is sensitive to mechanical conditions and influences the course of healing. Therefore, initial mechanical stability of an osteosynthesis should be considered an important factor in clinical fracture treatment.

No abstract

Locked intramedullary nailing and external fixation are alternatives for the stabilization of tibial shaft fractures. The goal of this study was to determine to what extent the mechanical conditions at the fracture site influence the healing process after unreamed tibial nailing compared to external fixation. A standardized tibial diastasis was stabilized with either a locked unreamed tibial nail or a monolateral fixator in a sheep model. Interfragmentary movements and ground reaction parameters were monitored in vivo throughout the healing period. After sacrifice, the tibiae were examined mechanically and histologically. Bending angles and axial torsion at the fracture site were larger in the nail group within the first five weeks post-operatively. Unlike the fixator group, the operated limb in the nail group did not return to full weight bearing during the treatment period. Mechanical and histomorphometrical observations showed significantly inferior bone healing in the nail group compared to the fixator group. In this study, unreamed nailing of a tibial diastasis did not provide rotational stability of the osteosynthesis and resulted in a significant delay in bone healing.

The health-promoting effects of lactic acid bacteria (LAB) are well recognised, making them a popular functional food ingredient. Commercially available probiotic products are often promoted as capable of improving immune defences also in healthy subjects. However, while strain-specific differences exist in the effects of LAB, conventional yoghurt bacteria have proved beneficial as well. For comparing the immunological effects of conventional and probiotic LAB, young healthy women received either a commercially available probiotic fermented milk product or a conventional yoghurt for four weeks. Both treatments showed comparable effects resulting in a stronger immunological reaction to stimuli (natural cytotoxicity against cancer cells, mitogen-induced T-lymphocyte activation and stimulated cytokine production). To study the mechanisms behind these effects, conventional (Lactobacillus delbrueckii) and probiotic (Lactobacillus rhamnosus GG), LAB were compared in vitro at the cellular level. Interestingly, L. rhamnosus GG was more potent in inducing maturation of dendritic cells (DC) that play a substantial role in directing the immune response to stimuli. In turn, L. delbrueckii provoked a higher secretion of proinflammatory cytokines as well as IL-10. These effects were, however, observed only after direct incubation of DC and LAB, not when both were separated by a layer of enterocyte-like Caco-2 cells. LAB also induced cytokine secretion in peripheral blood mononuclear cells in a similar manner and this effect was reduced in a Caco-2 cell model, suggesting a modulating influence of gut epithelial cells. While both conventional and probiotic strains modulate the immune response, specific properties may offer therapeutic options in the treatment of certain diseases.