Occurance of atrophic nonunion is a complex process. Previous studies suggested that atrophic nonunion was mainly due to lack of blood supply of fracture fragments, but recent studies found that blood supply was not deficiency in middle and late stages, indicating that decreased osteogenic factors and blood supply in early stages might play an important role in morbidity. Current effective treatment measures for atrophic nonunion mainly include bone graft and fixation,physical therapy, local injection therapy. All-round preventive could reduce incidence of atrophic nonunion. Atrophic nonunion is still a troublesome complication of fractures in orthopaedics, and more attention should be paid for its effective prevention and treatment. The paper summarized recent original articles about atrophic nonunion and reviewed the occurrence mechanisms, diagnosis, prevention and treatment measures of this disease.
Atrophy ; diagnosis ; etiology ; prevention & control ; therapy ; Fracture Healing ; drug effects ; Fractures, Bone ; pathology ; Humans

BACKGROUNDPrevious studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone. However, the effect of prostaglandin I2 (PGI2) on fracture healing remains unclear. To investigate the effect of PGI2, a study on fracture healing process in closed tibia fractures was designed.

METHODSThirty-six Sprague-Dawley male rats were randomized into two groups. On the first day, their right tibias were fractured by three-point bending technique. The study group (n = 18) received a single injection of 10 µg/kg iloprost for 5 days, while the control group (n = 18) received saline solution in the same way. On the 7th, 14th and 28th days following the fracture, six rats were sacrificed and their right legs were harvested in each group. The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al).

RESULTSOn the 7th day, the radiographic and histologic scores were equal. On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group, whereas radiographic total score was 11 and histologic total score was 33 in the control group. On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P < 0.05). On the 28th day radiographic total score was 12 and histologic total score was 37 in the iloprost group, whereas radiographic total score was 15 and histologic total score was 40 in the control group. On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group, it was not statistically significant (P > 0.05).

CONCLUSIONIloprost delays fracture healing in early stage in rats.

Animals ; Epoprostenol ; pharmacology ; Fracture Healing ; drug effects ; Fractures, Bone ; pathology ; Iloprost ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Tibial Fractures ; pathology ; Wound Healing ; drug effects

OBJECTIVETo investigate the effect of recombinant human basic fibroblast growth factor (rhbFGF) on angiogenesis during mandible fracture healing in rabbit.

METHODSFifty adult white rabbits were used for animal model and randomly divided into a control group (25 rabbits) and an experimental group (25 rabbits). The membranous complex of rhbFGF and bovine type I collagen was prepared and implanted into the rabbit mandible fracture site under periosteum. The animals were sacrificed on 7, 14, 28, 56 and 84 days respectively after operation and the whole mandibles were harvested. The expression of factor VIII related antigen (F8-RA) in callus was examined with immunohistochemical staining.

RESULTSThe amounts of microvascular formation in calluses in the rhbFGF-treating group on days 7, 14, 28 and 56 were more than those of the control group (P<0.01).

CONCLUSIONSThe results indicated that rhbFGF could stimulate microvascular formation during mandible fracture healing in rabbits.

Animals ; Fibroblast Growth Factor 2 ; pharmacology ; Fracture Healing ; physiology ; Mandibular Fractures ; physiopathology ; Neovascularization, Physiologic ; drug effects ; Rabbits ; Recombinant Proteins ; pharmacology

OBJECTIVETo assess the effect of intermittent subcutaneous injections of signal-selective parathyroid hormone (PTH) peptide analog on fracture healing in orchiectomized mouse models.

METHODSThirty-six 7-week-old C57/BL male mice were orchiectomized and injected with hPTH(1-34), the signal-selective PTH peptide analog [Gly(1), Arg(19)]hPTH (1-34), or an identical volume of vehicle 1 week after induction of femoral fracture. At 14 and 28 days after the operation, the mice were sacrificed for measurement of bone mineral density (BMD) and bone mineral content (BMC) of the callus using by dual energy X-ray absorptiometry. The bone healing was evaluated by radiography, biomechanical testing, micro-computed tomography (Micro-CT) and histological examination.

RESULTSAt 14 days after the operation, BMD in PTH peptide analog group was significantly increased (P<0.05). The mouse models treated with the PTH peptide analog showed significantly lower ultimate bending force and bending rigidity than those with hPTH(1-34) treatment. X-ray and Micro-CT scanning showed that callus transformation and remodeling was better in PTH peptide analog group than in the vehicle control group but poorer than in hPTH(1-34) group.

CONCLUSIONThe signaling-selective PTH peptide analog G1, R19 (1-28) can accelerate fracture healing in orchiectomized mouse models, in which process cAMP/PKA pathway plays an important role.

Animals ; Bone Density ; Fracture Healing ; drug effects ; Male ; Mice ; Mice, Inbred C57BL ; Orchiectomy ; Parathyroid Hormone ; analogs & derivatives ; pharmacology ; Signal Transduction

To investigate the influence of high molecular weight polyethylene (HMWP) on the viability of osteoblasts and new bone formation in the process of fracture healing, the osteoblasts derived from adult human bone marrow were cultured in HMWP maceration extract and normal culture medium. The viability of the osteoblasts was measured by MTT assay, and the function of the osteoblasts was detected by use of alkaline phosphatase test kit. The locked double-plating (steel plate and HMWP plate) was implanted and fixed at the artificial fracture of distal femur of dogs. Specimens were gained at 3, 6, 9 and 12 weeks postoperatively, examined with macroscopy, microscope and scanning electron microscope (SEM). The results showed that HMWP did no harm to osteoblasts. There is no significant difference in activities of proliferation and alkaline phosphatase between HMWP maceration extract and normal culture medium at each observation time of at 2,4,8, and 14 dyas (P>0. 05). Bone tissue under the implanted HMWP plate manifested no absorption; the new bones formed under the HMWP plate and gradually matured as time went on. It is demonstrated in this study that HMWP has no adverse influence on the viability of osteoblasts and new bone formation and it can be used as internal fixation implant in treating fractures.
Animals ; Biocompatible Materials ; chemistry ; pharmacology ; Cells, Cultured ; Dogs ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; Fracture Healing ; physiology ; Humans ; Implants, Experimental ; Internal Fixators ; Male ; Osteoblasts ; cytology ; drug effects ; Osteogenesis ; drug effects ; Polyethylene ; chemistry ; pharmacology

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Fracture Healing ; drug effects ; Humans ; Male ; Middle Aged ; Phytotherapy ; Tibial Fractures ; drug therapy

OBJECTIVETo explore the effects of qianggu capsules (QGC) on the fracture healing and the bone mineral density (BMD) in radius distal osteoporosis fracture (RDOF) patients.

METHODSBone mineral density (BMD) of femoral neck in 65 patients with RDOF was detected after the fracture was fixed manually. They were then randomly divided into two groups. Thirty-three patients in the treated group took QC, 1 capsule (180 mg) each time, three times a day, while 32 patients in the control group took D-Cal Biocal 2 tablets (1500 mg) each time, once daily. The therapeutic course for both groups was three months. X-ray examination on the broken end of the fractured bone was taken every month to observe the bony callus formation for comparing the curative effect, and BMD of femoral neck were detected again after patients were treated for 3 months. The bony callus appeared earlier, more in volume with thicker cortex in the treated group after 2 months of treatment versus that in the control group. The fracture healing time in the treated group was 9.4 +/- 2.5 weeks and that in the control group was 12.5 +/- 2.9 weeks, showing significant difference between them (P < 0.05). BMD in the treated group before treatment was 0.621 +/- 0.085 g/cm2, which was lower than that after treatment (0.646 +/- 0.090 g/cm2) with significant difference showing between them (P < 0.05), while no significant change of BMD was found in the control group between before and after treatment, and significant difference was found in BMD between the two groups after treatment (P < 0.05).

CONCLUSIONQGC can promote the formation of bony callus ahead of time, increase the volume of bony callus and BMD, improve the bone structure, and thus the time of external fixation in treating RDOF could be reduced.

Aged ; Bone Density ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Fracture Healing ; drug effects ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Phytotherapy ; Radius Fractures ; complications ; drug therapy

This study was designed to investigate the effects of some Traditional Chinese Medicine (TCM) agents on bone resorption and morphometric features of osteoclasts as well as their relationships. TCM ShengGuZaiZaoSan and XianLingGuBao, were used to treat the experimental fracture. Thirty 6-month-old Chinchilla rabbits were used for the establishment of animal models each with a 3 mm bone defect in the middle of left radius as well as of right radius. These models were divided randomly into 3 groups : ShengGuZaiZaoSan Group (Group A), XianLingGuBao groups (Group B) and control-group (Group C). Every group was further divided into 2 subgroups: a former sacrificed group (14 days after operation) and a latter sacrificed group (31 days after operation). After the rabbits being killed, the samples of their undecalcified calli were subjected to the morphometry study of bone resorption and osteoclasts. Group A had more bone resorption, compared with Group B and C. Both Groups A and B exhibited some changed morphometric features of osteoclasts as compared with Group C (P < 0.05). Simple correlation analysis indicated that bone resorption is mainly correlated with osteoclast numbers, and that in individual group, bone resorption is correlated with osteoclast form factor, area and mean photodensity (P < 0.05). These allow us to conclude that ShengGuZaiZaoSan can increase bone resorption and accelerate bone remodeling by increasing osteoclast numbers at the former stage and can enhance osteoclast function at the latter stage. These changes are beneficial to fracture healing.
Animals ; Bone Remodeling ; drug effects ; Bone Resorption ; physiopathology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Fracture Healing ; drug effects ; physiology ; Male ; Osteoclasts ; drug effects ; pathology ; Phytotherapy ; Rabbits ; Radius Fractures ; drug therapy ; pathology ; physiopathology ; Random Allocation

PURPOSE: Bisphosphonates have been used to treat osteoporosis for more than ten years. However, complications associated with long-term administration of bisphosphonates, such as nonunion after pelvic insufficiency fracture or osteonecrosis of the jaw, have been recently reported in the literature. We investigated the relationships among the mechanical properties of the intact rat femur as well as healing fracture calluses and the intraosseous concentration of pamidronate (ICP), after long-term administration of pamidronate in a rat osteoporosis model. MATERIALS AND METHODS: We performed bilateral ovariectomy in 25 3-month-old female Sprague-Dawley rats. Beginning three months after ovariectomy, disodium pamidronate (0.5mg/kg) was injected every month. After the six-month administration period, the left femoral shaft was fractured using the closed fracture technique. Five weeks after fracture, 23 rats were euthanized and both femora were removed. We checked the mechanical properties of the intact (right) and fractured (left) femora using a three-point bending technique. Intraosseous concentration of pamidronate was checked by high-performance liquid chromatography. RESULTS: The mean ICP was 61.8+/-15.7ng/mg of bone. High ICP decreased the ultimate load to failure, stiffness, and ultimate stress of the intact femora (p=0.015, 0.027, 0.039, respectively). There was a tendency to decrease the ultimate load to failure in the healing callus when the ICP increased (p= 0.183). High ICP decreased the bone mineral density of the femoral head (p=0.005). CONCLUSION: High concentrations of pamidronate in intact bone decreased the bone mineral density and weakened the mechanical strength of the rat femora. The mechanical strength of the early healing callus was not correlated with concentration of pamidronate in the bone.
Animals ; Bone Density Conservation Agents/*pharmacology ; Diphosphonates/*pharmacology ; Disease Models, Animal ; Female ; Femur/*drug effects/physiology ; Fracture Healing/physiology ; Osteoporosis/*metabolism ; Rats ; Rats, Sprague-Dawley ; Stress, Mechanical

Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues.
Animals ; Bone Regeneration/*drug effects ; Bone Substitutes/*therapeutic use ; Bone and Bones/*drug effects/pathology/physiopathology ; Ceramics/therapeutic use ; Diffusion of Innovation ; Fracture Healing/drug effects ; Humans ; Hydrogels ; Polymers/therapeutic use ; Regenerative Medicine/*trends ; Tissue Engineering/*trends ; Treatment Outcome