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Acta cir. bras ; 34(7): e201900702, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038116


Abstract Purpose: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. Methods: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. Results: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. Conclusions: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.

Animals , Vibration/therapeutic use , Metatarsal Bones/injuries , Fracture Healing/physiology , Fractures, Bone/diagnostic imaging , Sheep , Metatarsal Bones/surgery , Metatarsal Bones/diagnostic imaging , Random Allocation , Finite Element Analysis , Fractures, Bone/surgery , Fractures, Bone/therapy , X-Ray Microtomography , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/standards
Acta cir. bras ; 34(1): e20190010000002, 2019. graf
Article in English | LILACS | ID: biblio-983685


Abstract Purpose: To evaluate the effects of food restriction on fracture healing in growing rats. Methods: Sixty-eight male Wistar rats were assigned to two groups: (1) Control and (2) Dietary restriction. After weaning the dietary restricted animals were fed ad libitum for 42 days with 50% of the standard chow ingested by the control group. Subsequently, the animals underwent bone fracture at the diaphysis of the right femur, followed by surgical stabilization of bone fragments. On days 14 and 28 post-fracture, the rats were euthanized, and the fractured femurs were dissected, the callus was analyzed by dual-energy X-ray absorptiometry, micro-computed tomography, histomorphometry, mechanical tests, and gene expression. Results: Dietary restriction decreased body mass gain and resulted in several phenotypic changes at the bone callus (a delay in cell proliferation and differentiation, lower rate of newly formed bone and collagen deposition, reductions in bone callus density and size, decrease in tridimensional callus volume, deterioration in microstructure, and reduction in bone callus strength), together with the downregulated expression of osteoblast-related genes. Conclusion: Dietary restriction had detrimental effects on osseous healing, with a healing delay and a lower quality of bone callus formation.

Animals , Male , Rats , Bony Callus/physiology , Bone Density/physiology , Fracture Healing/physiology , Malnutrition , Femoral Fractures/physiopathology , Fractures, Closed/physiopathology , Osteoporosis/prevention & control , Rats, Wistar , Femoral Fractures/diagnostic imaging , Fracture Fixation, Intramedullary , Fractures, Closed/diagnostic imaging
Rev. chil. ortop. traumatol ; 59(3): 117-126, dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-1095715


El abordaje de Smith Petersen modificado (SPM), permite la reducción de fracturas del cuello femoral desde anterior, manteniendo la fijación a través de un abordaje lateral. Realizar la reducción bajo visión directa mejoraría la calidad de la reducción y los resultados en fracturas complejas de cuello femoral. MÉTODOS: Estudio retrospectivo de ocho pacientes con fracturas de cuello femoral Pauwels III/Garden IV secundarias a un accidente de alta energía operadas con abordaje SPM. Registramos el tiempo de evolución desde el accidente hasta la cirugía. Se realizó radiografía y tomografía axial computada postoperatoria. Seguimos los pacientes con radiografías mensuales hasta evidenciar consolidación de la fractura y casos de necrosis avascular. RESULTADOS: En promedio, los pacientes fueron operados 2,1 días tras el accidente y fueron seguidos con una mediana de 24,5 meses tras su cirugía. Siete de los ocho pacientes consolidaron. Sólo un caso presentó una no-unión que requirió de una prótesis total de cadera. No hubo casos de necrosis avascular. CONCLUSIÓN: Las fracturas de cuello femoral de alta energía en pacientes jóvenes son lesiones poco frecuentes. Aunque esta serie es pequeña, llama la atención que tratándose de lesiones desplazadas y con rasgos verticales no observamos casos de necrosis avascular, a pesar de algunos casos con prolongado tiempo de evolución desde el accidente hasta la cirugía. Creemos que esas fracturas deben operarse lo antes posible, pero que es más importante lograr una reducción anatómica en vez de retrasar algunas horas la cirugía. En nuestra experiencia, el abordaje de SPM facilita la reducción adecuada en fracturas complejas de cuello femoral.

Modified Smith Petersen Approach (MSP) allows an anterior reduction for femoral neck fractures, keeping the fixation through a lateral approach to the hip. Performing the reduction under direct visualization would improve the quality of the reduction and the outcomes in complex fractures of femoral neck. METHODS: Retrospective study including eight patients with femoral neck fracture classified as Pauwels III / Garden IV, in which MSP was performed. We kept record of the time from the accident until the final surgery. Post-operative studies included plain radiograph and CT scan. Monthly radiographic controls were obtained until fracture healing was achieved or radiological signs of avascular necrosis were found. RESULTS: Surgery was performed in an average of 2.1 days after the accident. Postoperative follow-up was an average of 24.5 month. Consolidation was achieved in seven of the eight patients, only one patient evolved into a nonunion of femoral neck which required a total hip arthroplasty. CONCLUSION: High energy femoral neck fractures in young patients are infrequent injuries. Even though this is a small series of patients it comes to our attention that being displaced fractures with vertical fracture lines we didn't find any case of avascular necrosis despite some of the cases the prolonged timing since the accident to surgery. We believe that this type of fracture should be treated as soon as possible but is more important to achieve an anatomical reduction than pass over the 12 hours threshold. In our experience MSP approach facilitates the achievement of an adequate reduction and complex femoral neck fractures.

Humans , Male , Adult , Middle Aged , Young Adult , Femoral Neck Fractures/surgery , Fracture Fixation/methods , Clinical Evolution , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Fracture Healing/physiology , Orthopedic Procedures/methods
Acta cir. bras ; 32(11): 924-934, Nov. 2017. graf
Article in English | LILACS | ID: biblio-886184


Abstract Purpose: To evaluate the influence of nandrolone decanoate on fracture healing and bone quality in normal rats. Methods: Male rats were assigned to four groups (n=28/group): Control group consisting of animals without any intervention, Nandrolone decanoate (DN) group consisting of animals that received intramuscular injection of nandrolone decanoate, Fracture group consisting of animals with a fracture at the mid-diaphysis of the femur, and Fracture and nandrolone decanoate group consisting of animals with a femur fracture and treatment with nandrolone decanoate. Fractures were created at the mid-diaphysis of the right femur by a blunt trauma and internally fixed using an intramedullary steel wire. The DN was injected intramuscularly twice per week (10 mg/kg of body mass). The femurs were measured and evaluated by densitometry and mechanical resistance after animal euthanasia. The newly formed bone and collagen type I levels were quantified in the callus. Results: The treated animals had longer femurs after 28 days. The quality of the intact bone was not significantly different between groups. The bone callus did show a larger mass in the treated rats. Conclusion: The administration of nandrolone decanoate did not affect the quality of the intact bone, but might have enhanced the bone callus formation.

Animals , Male , Rats , Bony Callus/physiology , Fracture Healing/drug effects , Femoral Fractures/drug therapy , Anabolic Agents/pharmacology , Nandrolone/analogs & derivatives , Bone Density/physiology , Rats, Wistar , Fracture Healing/physiology , Nandrolone/pharmacology
An. acad. bras. ciênc ; 89(1): 231-245, Jan,-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-886627


ABSTRACT Bone turnover markers (BTMs) are product of bone cell activity and are generally divided in bone formation and bone resorption markers. The purpose of this review was to structure the available information on the use of BTMs in studies on small ruminants, especially for monitoring their variations related to diet, exercise, gestation and metabolic lactation state, circadian and seasonal variations, and also during skeletal growth. Pre-clinical and translational studies using BTMs with sheep and goats as animal models in orthopaedic research studies to help in the evaluation of the fracture healing process and osteoporosis research are also described in this review. The available information from the reviewed studies was systematically organized in order to highlight the most promising BTMs in small ruminant research, as well as provide a wide view of the use of sheep and goat as animal models in orthopaedic research, type of markers and commercial assay kits with cross-reactivity in sheep and goat, method of sample and storage of serum and urine for bone turnover markers determination and the usefulness and limitations of bone turnover markers in the different studies, therefore an effective tool for researchers that seek answers to different questions while using BTMs in small ruminants.

Animals , Goats/physiology , Sheep/physiology , Bone Remodeling/physiology , Models, Animal , Bone Resorption/physiopathology , Bone Resorption/metabolism , Biomarkers/urine , Biomarkers/blood , Fracture Healing/physiology
Braz. j. med. biol. res ; 49(3): e5076, Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-771937


Osteoporosis has become a serious global public health issue. Hence, osteoporotic fracture healing has been investigated in several previous studies because there is still controversy over the effect osteoporosis has on the healing process. The current study aimed to analyze two different periods of bone healing in normal and osteopenic rats. Sixty, 7-week-old female Wistar rats were randomly divided into four groups: unrestricted and immobilized for 2 weeks after osteotomy (OU2), suspended and immobilized for 2 weeks after osteotomy (OS2), unrestricted and immobilized for 6 weeks after osteotomy (OU6), and suspended and immobilized for 6 weeks after osteotomy (OS6). Osteotomy was performed in the middle third of the right tibia 21 days after tail suspension, when the osteopenic condition was already set. The fractured limb was then immobilized by orthosis. Tibias were collected 2 and 6 weeks after osteotomy, and were analyzed by bone densitometry, mechanical testing, and histomorphometry. Bone mineral density values from bony calluses were significantly lower in the 2-week post-osteotomy groups compared with the 6-week post-osteotomy groups (multivariate general linear model analysis, P<0.000). Similarly, the mechanical properties showed that animals had stronger bones 6 weeks after osteotomy compared with 2 weeks after osteotomy (multivariate general linear model analysis, P<0.000). Histomorphometry indicated gradual bone healing. Results showed that osteopenia did not influence the bone healing process, and that time was an independent determinant factor regardless of whether the fracture was osteopenic. This suggests that the body is able to compensate for the negative effects of suspension.

Animals , Female , Bone Diseases, Metabolic/physiopathology , Fracture Healing/physiology , Tibial Fractures/physiopathology , Bone Density/physiology , Bony Callus/physiopathology , Collagen/analysis , Hindlimb Suspension/adverse effects , Hindlimb Suspension/physiology , Models, Animal , Osteotomy/adverse effects , Random Allocation , Rats, Wistar , Time Factors , Torsion, Mechanical
Braz. j. med. biol. res ; 49(1): e4736, 2016. tab, graf
Article in English | LILACS | ID: biblio-951645


Transforming growth factor beta 1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2) are important regulators of bone repair and regeneration. In this study, we examined whether TGF-β1 and BMP-2 expressions were delayed during bone healing in type 1 diabetes mellitus. Tibial fractures were created in 95 diabetic and 95 control adult male Wistar rats of 10 weeks of age. At 1, 2, 3, 4, and 5 weeks after fracture induction, five rats were sacrificed from each group. The expressions of TGF-β1 and BMP2 in the fractured tibias were measured by immunohistochemistry and quantitative reverse-transcription polymerase chain reaction, weekly for the first 5 weeks post-fracture. Mechanical parameters (bending rigidity, torsional rigidity, destruction torque) of the healing bones were also assessed at 3, 4, and 5 weeks post-fracture, after the rats were sacrificed. The bending rigidity, torsional rigidity and destruction torque of the two groups increased continuously during the healing process. The diabetes group had lower mean values for bending rigidity, torsional rigidity and destruction torque compared with the control group (P<0.05). TGF-β1 and BMP-2 expression were significantly lower (P<0.05) in the control group than in the diabetes group at postoperative weeks 1, 2, and 3. Peak levels of TGF-β1 and BMP-2 expression were delayed by 1 week in the diabetes group compared with the control group. Our results demonstrate that there was a delayed recovery in the biomechanical function of the fractured bones in diabetic rats. This delay may be associated with a delayed expression of the growth factors TGF-β1 and BMP-2.

Animals , Male , Tibial Fractures/physiopathology , Bony Callus/physiopathology , Fracture Healing/physiology , Diabetes Mellitus, Type 1/physiopathology , Transforming Growth Factor beta1/metabolism , Bone Morphogenetic Protein 2/metabolism , Tibial Fractures/metabolism , Time Factors , Biomechanical Phenomena , Immunohistochemistry , Rats, Wistar , Torque , Diabetes Mellitus, Experimental/physiopathology , Diabetes Mellitus, Type 1/metabolism , Fractures, Bone/physiopathology , Real-Time Polymerase Chain Reaction
Acta cir. bras ; 30(11): 727-735, Nov. 2015. tab, graf
Article in English | LILACS | ID: lil-767596


PURPOSE: To investigate the effect of vibration therapy on the bone callus of fractured femurs and the bone quality of intact femurs in ovariectomized rats. METHODS: Fifty-six rats aged seven weeks were divided into four groups: control with femoral fracture (CON, n=14), ovariectomized with femoral fracture (OVX, n=14), control with femoral fracture plus vibration therapy (CON+VT, n=14), and ovariectomized with femoral fracture plus vibration therapy (OVX+VT, n=14). Three months after ovariectomy or sham surgery, a complete fracture was produced at the femoral mid-diaphysis and stabilized with a 1-mm-diameter intramedullary Kirschner wire. X-rays confirmed the fracture alignment and fixation. Three days later, the VT groups underwent vibration therapy (1 mm, 60 Hz for 20 minutes, three times per week for 14 or 28 days). The bone and callus quality were assessed by densitometry, three-dimensional microstructure, and mechanical test. RESULTS : Ovariectomized rats exhibited a substantial loss of bone mass and severe impairment in bone microarchitecture, both in the non-fractured femur and the bone callus. Whole-body vibration therapy exerted an important role in ameliorating the bone and fracture callus parameters in the osteoporotic bone. CONCLUSION: Vibration therapy improved bone quality and the quality of the fracture bone callus in ovariectomized rats.

Animals , Female , Bony Callus/physiology , Femoral Fractures/therapy , Fracture Healing/physiology , Osteoporosis/physiopathology , Ovariectomy/adverse effects , Vibration/therapeutic use , Absorptiometry, Photon , Bone Density/physiology , Femoral Fractures/etiology , Femoral Fractures/physiopathology , Osteoporotic Fractures/etiology , Osteoporotic Fractures/physiopathology , Osteoporotic Fractures/therapy , Random Allocation , Rats, Wistar , Reproducibility of Results , Time Factors , Treatment Outcome
Acta ortop. mex ; 29(3): 159-163, ilus
Article in Spanish | LILACS | ID: lil-773377


Antecedentes: Evaluar los resultados clínicos y radiográficos de las fracturas de húmero proximal tratadas mediante fijación con clavo intramedular, así como los factores de riesgo asociados a un mal resultado. Métodos: Se han revisado retrospectivamente a pacientes con un seguimiento mínimo de un año. Se realizó una revisión clínica objetiva mediante la escala de Constant y subjetiva del grado de satisfacción, EVA y valoración de discapacidad mediante la escala de DASH. Radiológicamente, los enfermos fueron revisados mediante radiografías AP y axial en el plano escapular. Resultados: Se incluyeron 46 pacientes, 91.3% se presentó clínicamente satisfechos con el tratamiento. La movilidad media fue de 155º de flexión, 60º de rotación lateral y rotación medial. La puntuación media del Constant fue de 70 y del DASH de 15 puntos. Se encontraron diferencias significativas en cuanto al Constant en menores de 60 años, no siendo éstas significativas con el tipo de fractura o teniendo en cuenta el DASH. Radiográficamente, la tasa de consolidación fue de 95.7%, apreciándose dos casos de seudoartrosis. En 17 pacientes se observó una consolidación en varo (38.6%). Se encontraron diferencias funcionales comparando los pacientes con consolidación en varo y consolidación anatómica. Discusión: La fijación mediante clavo intramedular es un tratamiento efectivo para las fracturas de húmero proximal, sobre todo para fracturas en dos partes del cuello quirúrgico. La alta tasa de colapso en varo, sobre todo en fracturas con gran conminución, puede acarrear una disminución en la movilidad.

Background: To assess the clinical and radiological results of fractures of the proximal humerus treated with intramedullary nail fixation as well as the risk factors associated with a poor outcome. Methods: Patients were analyzed retrospectively with a minimum follow-up of one year. An objective clinical assessment was made using the Constant scale, the subjective satisfaction scale, VAS, and the DASH scale to measure disability. The radiological assessment included AP and axial X-rays in the scapular plane. Results: Forty-six patients were enrolled. The clinical assessment showed that 91.3% of them were satisfied with treatment. Mean mobility was 155º of flexion, 60º of lateral and medial rotation. The mean Constant score was 70 and the DASH score was 15. Significant differences were found in the Constant score in individuals under 60 years of age, but they were not significant considering the type of fracture or the DASH score. X-rays showed a healing rate of 95.7%, with two cases of pseudarthrosis. Varus healing was observed in 17 patients (38.6%). Functional differences were found when patients with varus healing were compared with those who had anatomical healing. Discussion: Fixation with intramedullary nailing is an effective treatment for fractures of the proximal humerus, particularly for two-segment fractures of the surgical neck. The high rate of varus collapse, particularly in very comminuted fractures, may lead to decreased mobility.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Fracture Fixation, Intramedullary/methods , Fracture Healing/physiology , Fractures, Bone/surgery , Humerus/injuries , Bone Nails , Follow-Up Studies , Fractures, Comminuted/epidemiology , Patient Satisfaction , Pseudarthrosis/epidemiology , Retrospective Studies , Risk Factors , Treatment Outcome
Bauru; s.n; 2015. 135 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: lil-794227


O propósito deste estudo foi avaliar histologicamente o papel do laser de baixa intensidade (LB) no processo de cicatrização óssea de defeitos de tamanho crítico em calvárias de ratos tratados com osso bovino (BO) associados a regeneração óssea guiada (ROG). Foram utilizados 80 ratos machos adultos (Rattus norvegicus, albinus, Wistar), pesando entre 250 e 300 g. Um defeito ósseo de tamanho crítico (DTC) com 5 mm de diâmetro foi criado na calvária de cada animal. Os animais foram divididos aleatoriamente em 8 grupos de tratamento (n=10), sendo: 1) Grupo C (controle), 2) Grupo LB - laser de baixa intensidade (laser de baixa intensidade - GaAlAs, 730nm, 100mW, 6J, 210J/cm2), 3) Grupo BO (osso bovino), 4) Grupo ROG (membrana colágena), 5) Grupo BO/ROG (osso bovino/membrana colágena), 6) Grupo BO/LB (osso bovino/laser de baixa intensidade), 7) Grupo ROG/LB (membrana colágena/laser de baixa intensidade), 8) Grupo BO/ROG/LB (osso bovino/laser de baixa intensidade/membrana colágena). Após 30 dias, os animais foram submetidos à eutanásia. As variáveis avaliadas foram: área de osso neoformado (AON), extensão linear de osso (ELO) e área de partículas remanescentes (APR). Foi utilizado o teste paramétrico ANOVA, seguido pelo teste de Tukey. Todos os grupos apresentaram maiores médias de AON em relação ao grupo C, exceto os grupos BO, BO/ROG e BO/ROG/LB. Todos os grupos apresentaram médias de ELO estatisticamente diferente do grupo C, exceto o BO. O grupo BO/ROG/LB não apresentou maiores médias de AON e ELO que o Grupo BO/ROG, entretanto mostrou maior formação óssea na região da membrana quando utilizado o LB em associação ao BO/ROG na análise histológica. Maior APR foi observada nos grupos em que BO não foi irradiado pelo LB. Entretanto, não ocorreu diferença estatisticamente significativa entre APR nos grupos BO e BO/ROG, BO/LB e BO/ROG/LB, BO/ROG e BO/ROG/LB. O LB não levou a maior formação óssea histométrica quando associado ao BO/ROG, apesar de...

The purpose of this study was to evaluate histologically the low level laser (LB) on bone healing in critical-size calvarial defects (CSD) in rats treated with inorganic bovine bone (BO) and guided bone regeneration (GBR). Were used 80 male adult rats (Rattus norvegicus albinus Wistar) weighing 250 to 300 g. A bone defect of critical size (DTC) with 5 mm in diameter was created in the calvaria of each animal. The animals were randomly divided into 8 treatment groups (n = 10), 1) Group C (control), 2) Group LB - low level laser (low level laser - GaAlAs, 730nm, 100mW, 6J, 210J / cm2 ), 3) Group BO (bovine bone), 4) Group ROG (collagen membrane), 5) Group BO / ROG (bovine bone / collagen membrane), 6) Group BO/ LB (bovine bone / low level laser), 7) Group ROG / LB (collagen membrane / low level laser), 8) Group BO / LB / ROG (bovine bone /low level laser / collagen membrane). After 30 days, the animals were euthanized. The variables analyzed were newly formed bone area (AON), linear extension of bone (ELO) and area of remnant particles (APR). The parametric test ANOVA followed by Tukey's test was used. All groups have the highest mean AON compared to C group except the group BO, BO/ROG and BO / ROG / LB. All groups showed mean of ELO statistically different from group C, except the BO. The Group BO/ROG/LB did not show higher ELO and AON than Group BO/ROG, however showed increased bone formation in the membrane area when used LB with BO/ROG in the histological analysis. Higher APR was observed in the groups where BO is not irradiated by LB. However, there was no significant difference between APR in BO BO and BO/ROG groups, BO/LB and BO/ROG/LB groups. The LB has not provide greater histometric bone formation when combined with BO / ROG, despite promote greater bone formation in the histological analysis...

Animals , Male , Cattle , Rats , Skull/injuries , Bone Regeneration/physiology , Guided Tissue Regeneration/methods , Low-Level Light Therapy/methods , Bone Transplantation/methods , Fracture Healing/physiology , Random Allocation , Rats, Wistar , Reproducibility of Results , Time Factors , Treatment Outcome
Acta cir. bras ; 29(12): 794-800, 12/2014. graf
Article in English | LILACS | ID: lil-731029


PURPOSE: To evaluate the performance of composites consisting of fragmented cortical bone heteroimplant in association with methylmethacrylate preserved in 98% glycerin, in segmental bone defect of rabbit tibia medial metaphysis. METHODS: In this study were used twelve adult New Zealand rabbits, divided into three groups of four animals each: G30 (30 days), G60 (60 days) and G90 (90 days). The bone defects previously created in the tibia were filled with composites and both were evaluated by cone-beam computed tomography, immediately after surgery and after 30, 60, and 90 days. RESULTS: The composites fulfilled and remained in the sites of bone defects in all cases and were not registered signals of infection, migration or rejection. CONCLUSIONS: The implanted composites promoted the bone defects repair without signals of infection and/or rejection. The composites are one more option for bone defects repair. .

Animals , Rabbits , Biocompatible Materials/therapeutic use , Bone Substitutes/therapeutic use , Fracture Healing/physiology , Methylmethacrylates , Tibia/surgery , Models, Animal , Postoperative Period , Tomography, X-Ray Computed , Tibia , Tibial Fractures/drug therapy
Acta cir. bras ; 29(11): 765-770, 11/2014. tab, graf
Article in English | LILACS | ID: lil-728651


PURPOSE: To investigate the accelerating effects of low-intensity pulse ultrasound stimulation (LIPUS) on the fracture healing of distal radius. METHODS: A total of 81 patients with distal radius fracture were randomly divided into two groups: the ultrasound treatment group and the control group. Patients in the ultrasound treatment group were immobilized in a below-elbow cast and received LIPUS treatment 15 min/day, while the control group were immobilized by a plaster support and cast. The patients were followed up every week and took X-ray films. The initial and healed X-ray films and the gray value of fracture site were analyzed by Photoshop software. The effect of reposition was evaluated based upon Steward recommended by Dienst, combining with Aro's measuring method. RESULTS: Clinical fracture healing time in ultrasound group was significantly shorter than that in the control group (32.04 ± 2.58d vs. 40.75 ± 5.12d, p <0.01). In addition, the grey value changes of fracture sites of the ultrasound group were much higher than that of the control group. The reposition effects of fracture healing had no difference between the two groups (p >0.05). CONCLUSION: Low-intensity pulse ultrasound stimulation could accelerate fracture healing of the distal radius and promote local bone formation. .

Aged , Female , Humans , Male , Middle Aged , Fracture Healing/physiology , Radius Fractures/therapy , Ultrasonic Therapy/methods , Osteogenesis/physiology , Prospective Studies , Reproducibility of Results , Radius Fractures , Statistics, Nonparametric , Time Factors , Treatment Outcome
Clinics ; 69(9): 634-640, 9/2014. tab, graf
Article in English | LILACS | ID: lil-725403


OBJECTIVE: To compare normal and delayed bone healing by measuring ultrasound conduction velocity across the bone callus. METHODS: A model of transverse linear and 5 mm resection osteotomies of sheep tibiae was used. Fourteen sheep were operated on and were divided into two groups of seven according to osteotomy type. The procedure was performed on the right tibiae and the intact left tibiae were used as controls. The transverse and axial ultrasound velocities were measured at 30-day intervals for 90 days, after which the animals were killed and both the right and left tibiae were resected for in vitro biomechanical analysis. RESULTS: Both the transverse and axial ultrasound velocities progressively increased, but the increase was smaller for the delayed union that resulted from the resection osteotomy. The mechanical resistance was higher for the normally healed tibiae that resulted from a linear osteotomy; this result closely correlated with the ultrasound velocity results. Significant differences were found for the comparisons between the intact and operated tibiae in both groups and between the groups for both the transverse and axial ultrasound velocities, but the differences were greater for the latter. CONCLUSION: We conclude that in vivo transverse and axial ultrasound velocities provide highly precise information about the healing state of both linear and resection diaphyseal osteotomies, but the axial ultrasound velocity most likely has greater discriminatory power. This method has the potential for clinical application in humans. .

Animals , Fracture Healing/physiology , Tibia , Tibial Fractures , Biomechanical Phenomena , Bony Callus , Bony Callus , Disease Models, Animal , Osteotomy/methods , Reference Values , Reproducibility of Results , Sheep , Time Factors , Tibia/physiopathology , Tibia , Tibial Fractures/physiopathology , Tibial Fractures
Colomb. med ; 45(2): 67-71, Apr.-June 2014. ilus, tab
Article in English | LILACS | ID: lil-720244


Introduction: There is controversy in medical literature regarding the use of electromagnetic fields to promote bone healing. Methods: After designing and building devices capable of generating an electromagnetic field for this study, their safety was confirmed and the electromagnetic therapy was randomly allocated and compared to placebo in patients with fracture of the femoral diaphysis. Treatment began six weeks after the fracture and it was administered once a day, during 1 h, for eight consecutive weeks. Twenty devices were built, 10 of which were placebo-devices. Between June 2008 and October 2009, 64 patients were randomized in two different hospitals and were followed for 24 weeks. The mean age was 30 years (18-59) and 81% were males. Results: Healing observed at week 12 was 75% vs. 58% (p= 0.1); at week 18, it was 94% vs. 80% (p= 0.15); and at week 24, it was 94% vs. 87% (p= 0.43) for the device group and the placebo group, respectively. Discussion: This study suggests that an electromagnetic field stimulus can promote earlier bone healing compared to placebo in femoral diaphyseal fractures. Faster bone healing translates into sooner weight bearing, which - in turn - permits quicker return to normal daily activities.

Introducción: El uso de estimulación electromagnética como coadyuvante en la consolidación de fracturas es controversial en la literatura médica. Métodos: Para este estudio, se diseñó y construyó un dispositivo capaz de generar un campo electromagnético. Tras confirmar su seguridad se asignaron pacientes aleatoriamente con fractura diafisaria de fémur a recibir terapia electromagnética o placebo. La estimulación inició a las seis semanas de la fractura, 1 h diaria, por ocho semanas consecutivas. Se construyeron 20 dispositivos, 10 reales y 10 dispositivos-placebo. Entre junio 2008 y octubre 2009, ingresaron 64 pacientes al estudio de dos instituciones y fueron seguidos durante 24 semanas. El promedio de edad de los pacientes fue de 30 años (rango 18-59) y 81% eran de sexo masculino. Resultados: La consolidación observada para el grupo con el dispositivo y el grupo placebo fue: en la semana 12, 75% vs. 58% (p =0.1); en la semana 18, 94% vs. 80% (p =0.15) y en la semana 24, 94% vs. 87% (p =0.43). Discusión: Este estudio muestra una tendencia a la consolidación más temprana al estar expuesto a un campo electromagnético frente a placebo. Una consolidación más temprana permite un apoyo precoz y, así, más rápida reincorporación al trabajo y a las actividades cotidianas.

Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Femoral Fractures/therapy , Fracture Healing/physiology , Magnetic Field Therapy/methods , Double-Blind Method , Diaphyses/pathology , Follow-Up Studies , Time Factors , Treatment Outcome , Weight-Bearing/physiology
Acta ortop. mex ; 28(2): 82-87, mar.-abr. 2014. ilus
Article in Spanish | LILACS | ID: lil-720707


Antecedentes: Las fracturas de clavícula representan de 2 a 15% de las fracturas pediátricas. La literatura sugiere operar pacientes mayores de 9 años con acortamiento mayor o severa conminución en el trazo de fractura, pero nadie establece parámetros de acortamiento o angulación para el tratamiento conservador en niños. En pacientes pediátricos es importante tomar en cuenta el acortamiento relativo, es decir, aquel provocado por una fractura, ajustado a la longitud sana. Objetivo: Conocer la afectación del movimiento con relación al acortamiento relativo de clavícula en fracturas pediátricas tratadas de forma conservadora. Material y métodos: Estudio retrospectivo, longitudinal y observacional. Medimos radiográficamente el acortamiento relativo de la clavícula fracturada comparándola con el lado sano al momento de la fractura y una vez consolidada. El acortamiento se expresó en porcentajes. Las proyecciones utilizadas fueron: anteroposterior comparativa de hombros y panorámica con ambos hombros. Los pacientes se dividieron en 2 grupos: menores de 9 años y de 9 a 15 años. Resultados: Analizamos 94 fracturas, 31 mujeres y 63 hombres. No se presentó seudoartrosis o consolidación viciosa sintomática. El pronóstico fue bueno sin importar el porcentaje de acortamiento inicial. La edad y el acortamiento tienen una relación proporcional al periodo de rehabilitación y restitución de los arcos de movilidad sin molestias. Los rangos de valores registrados para acortamiento fueron de 9.5 a 28%. Conclusiones: Las indicaciones quirúrgicas por acortamiento para fracturas de clavícula pediátrica deben revisarse. Hemos observado buenos resultados a pesar del acortamiento mayor y desplazamiento total.

Background: Clavicle fractures represent 2-15% of pediatric fractures. The literature suggests operating on patients over 9 years of age with major shortening or severe comminution in the fracture line. However, no one establishes shortening or angulation parameters for conservative treatment in children. In pediatric patients it is important to take into account relative shortening, that is, the one caused by a fracture when compared with the length of the healthy clavicle. Objective: To know the effect of relative clavicle shortening on movement in pediatric fractures treated conservatively. Material and methods: Retrospective, longitudinal, observational study. We radiographically measured the relative shortening of the fractured clavicle comparing it with the healthy side at the time of the fracture and after fracture healing. Shortening was expressed in percentages. The following views were used: comparative anteroposterior view of the shoulders and panoramic view of both shoulders. Patients were divided into 2 groups: under 9 years and 9-15 years of age. Results: We analyzed 94 fractures; 31 in females and 63 in males. No pseudoarthrosis or symptomatic malunion occurred. The prognosis was good regardless of the initial shortening percentage. Age and shortening are proportionally related with the rehabilitation period and the restoration of painless ranges of motion. The value ranges recorded for shortening were 9.5 to 28%. Conclusions: The surgical indications for shortening resulting from pediatric clavicle fractures should be revised. We have observed good results despite major shortening and total displacement.

Adolescent , Child , Female , Humans , Male , Clavicle/pathology , Fracture Healing/physiology , Fractures, Bone/therapy , Age Factors , Clavicle/injuries , Fractures, Bone/rehabilitation , Longitudinal Studies , Prognosis , Retrospective Studies , Time Factors
Acta cir. bras ; 28(10): 744-750, Oct. 2013. ilus, tab
Article in English | LILACS | ID: lil-687750


PURPOSE: To systematically evaluate the clinical efficacy of reamed and nonreamed intramedullary nailing in treatment of closed tibial fractures with Cochrane systematic review methods. METHODS: According to the Cochrane systematic review methods, literatures were retrieved from Cochrane library, PubMed, EMbase and other database. Randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials about reamed and nonreamed intramedullary nailing in the treatment of closed tibial fractures were collected and RevMan 5.0 was chosen for meta-analysis. RESULTS: A total of seven studies were included in this meta-analysis. Reamed intramedullary nailing was better than nonreamed intramedullary nailing in nonunion rate [P = 0.02, RR = 0.46, 95% CI: (0.24, 0.91)] and implant failure rate [P <0.0001, RR = 0.36, 95% CI: (0.22, 0.57)]. No statistically significant difference was observed in malunion rate, compartment syndrome rate, postoperative infection [P = 0.18, RR = 0.50, 95% CI: (0.18, 1.383); P = 0 43, RR = 0.77, 95% CI: (0.40, 1.48); P = 0.27, RR = 0.38, 95% CI: (0.01, 7.87)]. CONCLUSION: Compared with the nonreamed intramedullary nailing, reamed intramedullary nailing can lead to better outcome in the treatment of closed tibial fractures.

Humans , Fracture Fixation, Intramedullary/methods , Fractures, Closed/surgery , Tibial Fractures/surgery , Fracture Fixation, Intramedullary/standards , Fracture Healing/physiology , Postoperative Complications , Randomized Controlled Trials as Topic , Treatment Outcome
Acta cir. bras ; 26(6): 426-432, Nov.-Dec. 2011. ilus, tab
Article in English | LILACS | ID: lil-604189


PURPOSE: To evaluate the bone healing of mandibular fractures following the use of Portland cement. METHODS: Thirty-two male Wistar rats were divided into control and experimental groups. In the control group the rats were submitted to a mandibular fracture, which was reduced, and the soft tissues were sutured. In the experimental group the rats had the mandibular fracture reduced and maintained with the Portland cement. The animals were euthanized 7 and 21 days after surgery by injecting a lethal dose of anesthetic. The following variables were studied: weight of the animals, radiographic images, histopathological features and time of surgery. RESULTS: A weight loss was observed in the specimens of both groups at the different times of evaluation, a greater difference in weight before and after surgery being found in the experimental group, which was statistically significant (p <0.05, p = 0.041). From the histological point of view, with a margin of error (5.0 percent) the only two significant differences (p <0.05) recorded in the variables were "Material deployed" and "Bone resorption" during the evaluations at 7 and 21 days, respectively. CONCLUSION: The Portland cement served to promote bone healing.

OBJETIVO: Avaliar a reparação óssea de fratura mandibular após o uso do cimento Portland (CP). MÉTODOS: Trinta e dois ratos machos Wistar foram divididos em grupo controle e grupo experimental. No grupo controle os ratos foram submetidos à fratura, redução e manutenção dos seguimentos com sutura dos tecidos moles. No grupo experimental foram submetidos a fratura, redução e manutenção dos segmentos fraturados com CP e sutura dos tecidos. Os animais foram eutanasiados com sete e 21 dias de pós-operatório através da injeção de dose letal dos anestésicos adotados. As variáveis estudadas foram: peso dos animais, avaliação tomográfica, avaliação histológica e tempo cirúrgico. RESULTADOS: Perda de peso foi observada nos espécimes de ambos os grupos nos diferentes intervalos de tempo considerados, sendo maior a diferença de peso antes e após cirurgia para o grupo experimental, que foi estatisticamente significante (p<0,05; p=0,041). Do ponto de vista histológico para a margem de erro fixada (5,0 por cento) as duas únicas diferenças significativas (p<0,05) foram registradas nas variáveis: "Material implantado" na avaliação com sete dias e "Reabsorção óssea" na avaliação com 21 dias. CONCLUSÃO: O cimento Portland atuou promovendo a reparação óssea.

Animals , Male , Rats , Bone Cements/therapeutic use , Bone Regeneration/physiology , Bone Remodeling/physiology , Fracture Healing/physiology , Mandibular Fractures/surgery , Mandibular Fractures , Rats, Wistar , Time Factors , Tomography, X-Ray Computed
J. appl. oral sci ; 19(5): 529-534, Sept.-Oct. 2011. ilus, tab
Article in English | LILACS | ID: lil-600855


OBJECTIVE: The purpose of this study was to perform histological and histometric analyses of the repair process of autogenous bone grafts fixed at rat calvaria with ethyl-cyanoacrylate adhesive. MATERIAL AND METHODS: Thirty-two rats were divided into two groups (n=16), Group I - Control and Group II - Adhesive. Osteotomies were made at the right parietal bone for graft obtainment using a 4-mm-diameter trephine drill. Then, the bone segments were fixed with the adhesive in the parietal region of the opposite side to the donor site. After 10 and 30 days, 8 animals of each group were euthanized and the calvarias were laboratorially processed for obtaining hematoxylin and eosin-stained slides for histological and histometric analyses. RESULTS: An intense inflammatory reaction was observed at the 10-day period. At 30 days, this reaction was less intense, despite the presence of adhesive at the recipient-site/graft interface. Graft incorporation to the recipient site was observed only at the control group, which maintained the highest graft size at 10 and 30 days. CONCLUSIONS: Although the fragment was stable, the presence of adhesive in Group II did not allow graft incorporation to the recipient site, determining a localized, discrete and persistent inflammatory reaction.

Animals , Male , Rats , Bone Regeneration/physiology , Bone Transplantation/methods , Cyanoacrylates , Tissue Adhesives , Fracture Healing/drug effects , Fracture Healing/physiology , Rats, Wistar , Skull/transplantation , Time Factors , Transplantation, Autologous , Wound Healing/physiology
Clinics ; 66(10): 1787-1792, 2011. ilus, tab
Article in English | LILACS | ID: lil-601914


OBJECTIVE: To perform a comparative analysis of the effects of platelet-rich plasma and centrifuged bone marrow aspirate on the induction of bone healing in rabbits. METHOD: Twenty adult, male New Zealand rabbits were randomly separated into two equal groups, and surgery was performed to create a bone defect (a cortical orifice 3.3 mm in diameter) in the proximal metaphysis of each rabbit's right tibia. In the first group, platelet-rich plasma was implanted in combination with β-tricalcium phosphate (platelet-rich plasma group), and in the second group, centrifuged bone marrow in combination with β-tricalcium phosphate (centrifuged bone marrow group) was implanted. After a period of four weeks, the animals were euthanized, and the tibias were evaluated using digital radiography, computed tomography, and histomorphometry. RESULTS: Seven samples from each group were evaluated. The radiographic evaluation confirmed the absence of fractures in the postoperative limb and identified whether bone consolidation had occurred. The tomographic evaluation revealed a greater amount of consolidation and the formation of a greater cortical bone thickness in the platelet-rich plasma group. The histomorphometry revealed a greater bone density in the platelet-rich plasma group compared with the centrifuged bone marrow group. CONCLUSION: After four weeks, the platelet-rich plasma promoted a greater amount of bone consolidation than the bone marrow aspirate concentrate.

Animals , Male , Rabbits , Bone Marrow Cells/physiology , Fracture Healing/drug effects , Osteogenesis/drug effects , Platelet-Rich Plasma/physiology , Tibia/injuries , Wound Healing/physiology , Bone Density , Biocompatible Materials/therapeutic use , Bone Regeneration/drug effects , Bone Regeneration/physiology , Bone Substitutes/therapeutic use , Calcium Phosphates/therapeutic use , Fracture Healing/physiology , Osteogenesis/physiology , Random Allocation , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Tibia
Clinics ; 66(12): 2113-2119, 2011. graf, tab
Article in English | LILACS | ID: lil-609010


OBJECTIVES: Previous studies have reported that osteoporosis due to estrogen deficiency influences fracture healing. Transforming growth factor (TGF-b) has been found to be involved in fracture healing via the regulation of the differentiation and activation of osteoblasts and osteoclasts. The current study aimed to determine the effects of estrogen on the expression of TGF-β1 during fracture healing in ovariectomized rats. METHODS: Thirty female Sprague-Dawley rats weighing 200-250 g were assigned to: (i) a sham-operated group that was given a normal saline; (ii) an ovariectomized control group that was given a normal saline; or (iii) an ovariectomized + estrogen (100 mg/kg/day) group that was treated with conjugated equine estrogen. The right femur of all rats was fractured, and a Kirschner wire was inserted six weeks post-ovariectomy. Treatment with estrogen was given for another six weeks post-fracture. At the end of the study, blood samples were taken, and the right femur was harvested and subjected to biomechanical strength testing. RESULTS: The percentage change in the plasma TGF-β1 level before treatment was significantly lower in the ovariectomized control and estrogen groups when compared with the sham group (p<0.001). After six weeks of treatment, the percentage change in the plasma TGF-β1 level in the estrogen group was significantly higher compared with the level in the ovariectomized control group (p = 0.001). The mean ultimate force was significantly increased in the ovariectomized rats treated with estrogen when compared with the ovariectomized control group (p = 0.02). CONCLUSION: These data suggest that treatment with conjugated equine estrogen enhanced the strength of the healed bone in estrogen-deficient rats by most likely inducing the expression of TGF-β1.

Animals , Female , Rats , Estrogens/deficiency , Femoral Fractures/blood , Fracture Healing/drug effects , Osteoporosis/complications , Transforming Growth Factor beta1/blood , Disease Models, Animal , Estrogens/administration & dosage , Femoral Fractures/drug therapy , Femoral Fractures/etiology , Fracture Healing/physiology , Ovariectomy , Osteoporosis/metabolism , Pilot Projects , Rats, Sprague-Dawley