Healing of fractures

Smoking is especially harmful to diabetics who are already at an increased risk of cardiovascular disease, stroke, and kidney disease. The habit also negatively affects joints and interferes with the healing of wounds. Healing of fractures is delayed because smoking impairs the formation of new bone. Smokers are more likely to develop degenerative disorders and injuries of the spine. The risk for peptic ulcers is increased. Smoking also may upset thyroid function. 

J. Hertz, Studies in the Healing of Fractures, Oxford University Press, 1936. 

Significant bone loss caused by accidents, sports injuries, or diseases such as osteoporosis is frequently associated with severely impaired or nonhealing defects. Major economic issues arise from an increasingly aged population that typically exhibits slower healing of fractures, and this leads to a demand for new therapies to promote bone formation. Bone formation (osteogenesis) has long been appreciated to be dependent on vascularization, but not until... 

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. 

The regenerative capacity of bone is robust and effective at addressing wounds under normal conditions. A proportion of fractures, however, present conditions that are not conducive to regeneration and place the fracture at high risk for nonunion or delayed union. For example, fractures located at sites of marginal vascularity and those associated with a large area of bone loss repair with difficulty if at all. As a result, a great deal of effort has been invested in the development of treatment methods for fractures and defects at risk of nonunion, as they would not likely heal... 

Other investigators have also reported that phosphorus causes a decrease in urinary calcium (15,16) and promotes healing of skeletal fractures (15) ... 

Spontaneous reports of osteoporosis, osteopenia, bone fractures, and delayed healing of bone fractures have been seen in the isotretinoin population. While causality to isotretinoin has not been established, an effect cannot be ruled out. Physicians should use caution when prescribing isotretinoin to patients with a genetic predisposition for age-related osteoporosis, a history of childhood osteoporosis conditions, osteomalacia, or other disorders of bone metabolism. This would include patients diagnosed with anorexia nervosa and those who are on chronic drug therapy that causes drug-induced osteoporosis/osteomalacia and/or affects vitamin D metabolism, such as systemic corticosteroids and any anticonvulsants. 

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. 

It has been suggested that supplements may be beneficial in the healing of bone fractures. There is some evidence that patients with osteoporosis (Section 3.4.3) have low circulating concentrations of vitamin K, and some evidence that supplements ofvitaminKmay retard the progression of osteoporosis (Vermeer etal., 1995, 1996 Feskanichet al., 1999). 

The trace of the planar central zone of the microcrack-ladder is marked by the presence of negative crystals and inclusions. This characteristic indicates that microcrack-ladders must be related to healed longitudinal fractures. The formation of unhealed microcracks normal to the loading direction (i.e., the rungs of the ladders) can be understood as follows. Undulatory extinction and dislocation microstructures observed within the microcrack-ladders indicate that plasticity is restricted to a narrow zone ( 100 / m wide) within the otherwise-undeformed host crystal. Therefore, the host crystal responded elastically while the load was applied the elastic strain A/// being about 0.5 percent. Now, in the plastic zone of the... 

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