The influence of induced micromovement upon the healing of experimental tibial fractures

Goodship, AE; Kenwright, J

doi:10.1302/0301-620x.67b4.4030869

Cited by 775 publications

(451 citation statements)

References 3 publications

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“…Third, we examined the influence of only two external fixation stiffnesses (one rigid and one flexible) on healing. However, the flexible fixator stiffness we chose was comparable to that reported for ring fixators used clinically [14], and the rigid fixator stiffness was similar to an external fixator also used clinically [18,20].…”

Section: Discussionmentioning

confidence: 93%

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

Willie

Blakytny

Glöckelmann

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Dynamization involves a reduction in fixation construct stiffness during bone healing, allowing increased interfragmentary movement of the fracture through physiologic weightbearing and muscle contraction. Within some optimal range, interfragmentary movement stimulates healing, but this range likely varies across stages of bone healing. Questions/purposes How does the time of dynamization affect the cartilage formation, bony bridging, and bone resorption in a rat fracture-healing model? Methods Unilateral external fixators, stabilizing a 1-mm gap, were dynamized at 1 (D1 group, n = 10), 3 (D3 group, n = 11), or 4 (D4 group, n = 11) weeks postoperatively. Continuously 5 weeks stiff (S group, n = 10) and flexible (F group, n = 11) fixation were included for comparison. After 5 weeks, healing was evaluated by histomorphometric methods.

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Section: Discussionmentioning

confidence: 93%

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

Willie

Blakytny

Glöckelmann

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…While many of the genetic mechanism regulating fetal skeletogenesis also play a role in adult skeletal regeneration (Vortkamp et al, 1998;Ferguson et al, 1999), the mechanical environment is known to play a key role in regulating the outcomes of fracture repair (Goodship and Kenwright 1985;Kenwright and Goodship 1989;Kenwright et al, 1991;Chao et al, 1998;Goodship et al, 1998;Goodship et al, 2009). A number of hypotheses have been proposed for how MSC differentiation is regulated by the mechanical environment during events such as fracture repair.…”

Section: Repairmentioning

confidence: 99%

The role of mechanical signals in regulating chondrogenesis and osteogenesis of mesenchymal stem cells

Kelly

Jacobs

2010

Birth Defects Research Pt C

211

152

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It is becoming increasingly clear that Mesenchymal Stem Cell (MSC) differentiation is regulated by mechanical signals. Mechanical forces generated intrinsically within the cell in response to its extracellular environment, and extrinsic mechanical signals imposed upon the cell by the extracellular environment, play a central role in determining MSC fate. This paper reviews chondrogenesis and osteogenesis during skeletogenesis, and then considers the role of mechanics in regulating limb development and regenerative events such as fracture repair. However, observing skeletal changes under altered loading conditions can only partially explain the role of mechanics in controlling MSC differentiation. Increasingly, understanding how epigenetic factors such as the mechanical environment regulate stem cell fate is undertaken using tightly controlled in vitro models. Factors such as bio-engineered surfaces, substrates and bioreactor systems are used to control the mechanical forces imposed upon, and generated within, MSCs. From these studies, a clearer picture of how osteogenesis and chondrogenesis of MSCs is regulated by mechanical signals is beginning to emerge. Understanding the response of MSCs to such regulatory factors is a key step towards understanding their role in disease and regeneration.3

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“…Studies suggest that ultrasound therapy results in a host of changes, ranging from molecular modifications in ion channel permeability 9 and alterations in gene expression [10][11][12] to more mechanical effects such as increased blood flow 4,10,13 and the generation of strain secondary to acoustic perturbations. 14 The impact of these various changes in skeletally immature bone has not been fully elucidated, and the use of ultrasound therapy as an adjunct for treatment of fracture nonunion is off-label in adolescent patients. No previous studies have described any major complications resulting from the use of ultrasound therapy for fracture healing in adult patients.…”

Section: Discussionmentioning

confidence: 99%

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

et al. 2015

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).Attempts by clinicians to maximize the healing potential of nonunions have led to the use of adjunctive treatment modalities such as low-intensity pulsed ultrasound therapy. The safety and efficacy of low-intensity pulsed ultrasound in the treatment of fracture nonunion has been previously investigated, 1-6 and this technology is approved in the United States by the Food and Drug Administration (FDA) for treatment of fracture nonunion in adults. Several recent studies of this adjunctive treatment modality have included a percentage of scaphoid fractures. Nolte et al reported on 29 cases of established fracture nonunion in a variety of anatomic locations, including five scaphoid fractures. 3 The majority of these cases were treated with prior surgery. Following failure of treatment, the nonunions were subjected to ultrasound therapy; 86% went on to healing in a mean time of 22 weeks. Of the scaphoid nonunions, four out of five demonstrated healing at a mean interval of 143 days. Similarly, Gebauer et al reported on 67 nonunions, including six scaphoid nonunions, treated with ultrasound therapy. 1 Healing occurred in 85% of the patients without additional surgical treatment. Rubin et al analyzed ultrasound prescription registry data to examine the effects of ultrasound on nonunion. 4 The registry subcategorized fracture nonunion by anatomic location, and the reviewing authors found that 101 out of 118, or 86%, of scaphoid fracture nonunions healed following ultrasound therapy. Rubin et al did not assess the registry data for other Keywords ► scaphoid fracture ► scaphoid nonunion ► pulsed ultrasound ► adolescents ► adjunctive therapy AbstractBackground Treatment of scaphoid nonunion is challenging, leading clinicians to pursue innovation in surgical technique and adjunctive therapies to improve union rates. Purpose The purpose of this study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive treatment modality following surgical treatment of scaphoid nonunion in adolescent patients, for whom this therapy has not yet been FDA-approved. Patients and MethodsWe performed a retrospective review of adolescent patients with scaphoid nonunion treated surgically followed by adjunctive low-intensity pulsed ultrasound therapy. All patients underwent 20 minutes of daily ultrasound therapy postoperatively until there was evidence of bony healing, based on both clinical and radiographic criteria. Final healing was confirmed by > 50% bone bridging on CT scan. Results Thirteen of fourteen (93%) patients healed at a mean interval of 113 days (range 61-217 days). There were no surgical or postoperative complications. One patient developed heterotopic bone formation about the scaphoid. Conclusions Our study suggests that low-intensity pulsed ultrasound therapy can safely be utilized as an adjunctive modality in adolescents to augment scaphoid healing following surgical intervention. Level of Evidence Level IV, Case series

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The influence of induced micromovement upon the healing of experimental tibial fractures

Cited by 775 publications

References 3 publications

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

The role of mechanical signals in regulating chondrogenesis and osteogenesis of mesenchymal stem cells

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

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