Sports Medicine: Just the Facts

CHAPTER 11 • BONE INJURY AND FRACTURE HEALING 65

Autogenous Bone Marrow

• Independent of cancellous or cortical bone


• Contains osteogenic precursor cells

OSTEOCONDUCTIVEMETHODS(HOLLINGER
ET AL, 1996)

• Support ingrowth of capillaries, perivascular tissues,
  and osteoprogenitor cells from host


• Examples: Ceramic materials (Hydroxyapatite), bioac-
  tive glasses, and synthetic polymers (poly-lactic and
  glycolic acid).

OSTEOINDUCTIVEMETHODS

• Mitogenesis of undifferentiated mesenchymal cells to
  form osteoprogenitor cells
  •Growth-promoting proteins. Several factors are
  known to be associated with healing:
  
  
  1. TGF-Beta
     2.Insulin-like growth factor(IGFs)
     3.Bone Morphogenetic Proteins(BMPs)
     a. Glycoproteins known to induce bone.
     b.Several BMPs are known to exist: (1) BMP-3
     (Osteogenin) induces rapid differentiation of
     mesenchymal tissue to bone. (2) Induce endo-
     chondral bone formation in segmental defects
     (Yasko et al, 1992).
  
  
  
  


• Systemic factors: Injury to bone marrow enhances
  osteogenesis at distant skeletal sites.
  a. Factors thought to be responsible: (1) IGF-I and IGF-II,
  (2) parathyroid hormone, and (3) prostaglandins.
  b. Isolation and clinical development of these factors
  may lead to systemic treatment of fractures.

ELECTROMAGNETICFIELDS

• Bone has a piezoelectric potential that is load-induced
  owing to two factors:
  a. Current is induced by deformation of collagen.
  b. Electrokinetic current produced by the strain-
  induced flow of charged extracellular fluids


• Pulsed electromagnetic fields(PEMFs) are intended
  to noninvasively induce electrical currents to replace
  endogenous currents in the absence of loading.


• Double-blind trial shown to double the number of
  healed fractures (tibial nonunions) (Yasko et al,
  1992).

LOW-INTENSITYULTRASOUND(LIU)
(DAY E TAL, 1999)

• The sole intervention approved by the Food and Drug
  Administration (FDA) to augment the healing of fresh
  fractures.
  
  
  • Shown to increase calcium incorporation in both dif-
    ferentiating cartilage and bone cell cultures
  
  
  • Evidence that it can modulate gene expression, influ-
    ence second messenger activity of chondroblasts and
    osteoblasts, enhance blood flow, and accelerate and
    augment fracture healing.
  
  
  • In a study of distal radius fractures, LIU decreased
    time to healing by 38% as compared to placebo treat-
    ment (Day et al, 1999).
  
  
  
  

REFERENCES

Boden SD, Kaplan FS: Calcium homeostasis. Orthop Clin North

Am21:31–42, 1990.

Boden SD, Zdeblick TA, Sandhu HS, et al: The use of rhBMP-2 in

interbody fusion cages: Definitive evidence of Osteoinduction in

humans: A preliminary report. Spine25:376–381, 2000.

Brighton CT: Principles of fracture healing: Part I. The biology of

fracture repair, in Murray JA (ed.): Instructional Course

Lectures XXXIII. St. Louis, MO, CV Mosby, 1984, pp 60–82.

Burchardt H, Enneking WF: Transplantation of bone. Surg Clin

North Am58:403–427, 1978.

Carter DR, Blenman PR, Beaupre GS: Correlations between

mechanical stress history and tissue differentiation in initial

fracture healing. J Orthop Res6:736–748, 1988.

Connolly JF: Clinical use of marrow osteoprogenitor cells to

stimulate Osteogenesis. Clin Orthop355 (suppl):S257–S266,

1998.

Daftari TK, Whitesides TE, Heller JG, et al: Nicotine on the

revascularization of bone graft. An experimental study in rab-

bits. Spine19:904–911, 1994.

Day SM, Ostrum RF, Chao EY, et al: Bone injury, regeneration

and repair, in Buckwalter JA, Einhorn TA, Simon SR (eds.):

Orthopaedic Basic Science. Rosemont, IL, American Acad-

emy of Orthopaedic Surgeons Press, 1999, pp. 392–398.

Einhorn TA: Enhancement of fracture-healing. J Bone Joint Surg

77A:940–956, 1995.

Gazdag AR, Lane JM, Glaser D, et al: Alternative to autogenous

bone graft: Efficacy and indications. J Am Acad Orthop Surg

3:1–8, 1995.

Geesink RG, Hoefnagels NH, Bulstra SK: Osteogenetic activity

of OP-1 bone morphogenetic protein (BMP-7) in a human

fibular defect. J Bone Joint Surg81B:710–718, 1999.

Glassman SD: The effect of postoperative nonsteroidal anti-

inflammatory drug administration on spinal fusion. Spine

23:834–838, 1998.

Glassman SD, Anagnost AC, Parker A, et al: The effect of ciga-

rette smoking and smoking cessation on spinal fusion. Spine

25:2608–2615, 2000.

Hollinger JO, Brekke J, Gruskin E, et al: Role of bone substitutes.

Clin Orthop324:55–65, 1996.

Hruska KA, Rolnick F, Duncan RL, et al: Signal transduction in

osteoblasts and osteoclasts, in Noda M (ed.): Cellular and

Molecular Biology of Bone. San Diego, CA, Academic Press,

1993, pp 413–444.