Bone healing

Treatments used for various types of fractures are cast immobilization, traction, and internal fixation. A plaster or fiber glass cast is the most commonly used device for fracture treatment. Most broken bones heal successfiiUy once properly repositioned, ie, fixed in place via a cast. This type of cast or brace is known as an orthosis. It allows limited or controlled movement of nearby joints. This treatment is desirable for certain fractures. 

TGF-P Bone healing, skin ulcers, detached retinas... 

Nutritional rickets PO 0.5 mg as a single dose or 13-50 mcg/day until healing occurs. Renal osteodystrophy PO 0.25-0.6 mg/24 hr adjusted as necessary to achieve normal serum calcium levels and promote bone healing. 

Ikeda, T., Yanagiguchi, K., and Hayashi, Y. (2002). Application to dental medicine—In focus on dental caries and alveolar bone healing. Bioindustry 19, 22-30 (in Japanese). 

Gerstenfeld LC, Einhorn TA. COX inhibitors and their effects on bone healing. Expert Opin Drug Saf. 2004 3 131-136. 

Harder AT, An YH. The mechanisms of the inhibitory effects of nonsteroidal anti-inflammatory drags on bone healing a concise review. J Clin Pharmacol. 2003 43 807-815. 

Comfrey (Symphytum officionale). Ointments made from comfrey are used topically for wound and bone healing. Comfrey tea and pills have been prescribed by herbalists to treat gastrointestinal ulcers and diarrhea. However, the FDA advised dietary supplement manufacturers to take comfrey off the market in 2001 because of the gathering evidence that comfrey taken internally causes severe liver toxicity. The FDA also noted the lack of evidence for comfrey s effectiveness. Comfrey should not be used by pregnant women or breastfeeding mothers. 

L3. Lind, M., Growth factor stimulation of bone healing. Effects on osteoblasts, osteomies, and implants fixation. Acta Orthoped. Scand. 283, 2-37 (1998). 

Our interest in the role of trace elements in bone metabolism developed in a rather bizarre fashion. Ve became interested in the orthopedic problems of a prominent professional basketball player. Bill Walton. Several years ago he was plagued by frequent broken bones, pains in his joints and an inability to heal bone fractures. We hypothesized that he might be deficient in trace elements as a result of his very limited vegetarian diet. In cooperation with his physician, we were able to analyze Walton s serum. We found no detectable manganese (Mn). His serum concentrations of copper (Cu) and zinc (Zn) were below normal values. Dietary supplementation with trace elements and calcium (Ca) was begun. Over a period of several months his bones healed and he returned to professional basketball (1,2). In cooperation with several other orthopedic physicians, we analyzed serum from other patients with slow bone healing. Several of these patients also had abnormally low Zn, Cu and Mn levels. 

Rickets, which is diagnosed by X-rays of leg bones, heals promptly with 4000 lU of oral vitamin D per day, with treatment for a month. In performing this treatment, the physician needs to monitor plasma 25 hydroxyvitamm D to make certain that they are raised to the normai range. The bone abnormalities (visible by X-ray) disappear gradually over the course of 3-9 months. Parents are instructed to take their infants outdoors for about 20 minutes per day with their faces exposed in order to prevent deficiency. Osteomalacia is treated by eating 2500 ID/day for about three months. Measurements of 25-hydroxyvitamin D, calcium, and parathyroid hormone are also part of the treatment process. 

Trovafloxacin inhibited growth and extracellular matrix mineralization in MC3T3-E1 osteoblast-like cell cultures (12). The ICso was 0.5 pg/ml, which is below clinically achievable serum concentrations. The authors suggested that the clinical relevance of this observation to bone healing in orthopedic patients should be evaluated. 

Hyperparathyroidism and aluminium hydroxide lead to aluminium-related bone disease however, total parathyroidectomy does not lead to failure of aluminium mobilization after renal transplantation. This man had satisfactory graft function, and the aluminium excretion that was achieved by deferoxamine suggests that the renal transplant was not the limiting factor for the mobihzation of aluminium. The most likely explanation was that he developed adynamic bone through a combination of vitamin D deficiency, hypoparathyroidism, and aluminium deposition. Vitamin D supplementation failed to prevent the osteodystrophy on its own. When aluminium chelation therapy was used, bone healing occurred and his symptoms improved. 

Children and adolescents given cumulative doses of 32-112 g/m had only transient disturbances in renal function (9). In five children with renal tubular Fanconi syndrome caused by ifosfamide, all went on to develop rickets in the face of declining renal function. None had had pre-existing tubular damage and the syndrome developed at cumulative doses of ifosfamide of 39-99 g/m. There were low serum bicarbonate and phosphate concentrations, and supplementation of these resulted in bone healing but not renal recovery (10). 

Godden D. Effects of NSAIDs on bone healing have been widely reported in maxillofacial journals. BMJ 1999 318(7191) 1141. 

Leucine stimulates bone healing, skin healing, and release of enkephalins (natural painkillers). It also stimulates insulin release. 

Schmoekel H, Schense JC, Weber FE, Gratz KW, Gnagi D, Muller R, and Hubbell JA. Bone Healing in the Rat and Dog with Nonglycosylated BMP-2 Demonstrating Low Solubility in Fibrin Matrices./ Orthop Res 2004 22 (2) 376-381. 

Ideally, bone substitute materials should be replaced by mature bone without transient loss of mechanical support. Unfortunately, at present there is no material available fulfilling these requirements. Consequently, mechanically unstable bone defects ought to be stabilised with a non-resorbable metallic fixation made from stainless steel or titanium and the bone defect filled with a bone graft substitute. While the mechanical properties of the bone graft substitute are of minor importance, much more important it is to optimise the resorption rate of the bone graft substitute to minimise the time required for bone healing (Bohner, 2010). To control the resorption rate several strategies such as modification of the... 

Correlation between primary stability and bone healing of surface treated titanium implants in the femoral epiphyses of rabbits. J. Mater. Sci. - Mater. Med, 25 (8), 1941-1951. 

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