Biomechanics of Fracture Healing

Morgan, Elise F.; Einhorn, Thomas A.

doi:10.1002/9781118453926.ch12

Cited by 5 publications

(1 citation statement)

References 62 publications

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“…In the early stages of callus development, it will have limited strength but as the callus progressively matures, the strength and stiffness increases. 38 , 39 …”

Section: Discussionmentioning

confidence: 99%

PHOSPHO1 is essential for normal bone fracture healing

Morcos

Al-Jallad

et al. 2018

Bone & Joint Research

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ObjectivesBone fracture healing is regulated by a series of complex physicochemical and biochemical processes. One of these processes is bone mineralization, which is vital for normal bone development. Phosphatase, orphan 1 (PHOSPHO1), a skeletal tissue-specific phosphatase, has been shown to be involved in the mineralization of the extracellular matrix and to maintain the structural integrity of bone. In this study, we examined how PHOSPHO1 deficiency might affect the healing and quality of fracture callus in mice.MethodsTibial fractures were created and then stabilized in control wild-type (WT) and Phospho1-/- mice (n = 16 for each group; mixed gender, each group carrying equal number of male and female mice) at eight weeks of age. Fractures were allowed to heal for four weeks and then the mice were euthanized and their tibias analyzed using radiographs, micro-CT (μCT), histology, histomorphometry and three-point bending tests.ResultsThe μCT and radiographic analyses revealed a mild reduction of bone volume in Phospho1-/- callus, although it was not statistically significant. An increase in trabecular number and a decrease in trabecular thickness and separation were observed in Phospho1-/- callus in comparison with the WT callus. Histomorphometric analyses showed that there was a marked increase of osteoid volume over bone volume in the Phospho1-/- callus. The three-point bending test showed that Phospho1-/- fractured bone had more of an elastic characteristic than the WT bone.ConclusionOur work suggests that PHOSPHO1 plays an integral role during bone fracture repair and may be a therapeutic target to improve the fracture healing process.Cite this article: M. W. Morcos, H. Al-Jallad, J. Li, C. Farquharson, J. L. Millán, R. C. Hamdy, M. Murshed. PHOSPHO1 is essential for normal bone fracture healing: An Animal Study. Bone Joint Res 2018;7:397–405. DOI: 10.1302/2046-3758.76.BJR-2017-0140.R2.

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“…In the early stages of callus development, it will have limited strength but as the callus progressively matures, the strength and stiffness increases. 38 , 39 …”

Section: Discussionmentioning

confidence: 99%

PHOSPHO1 is essential for normal bone fracture healing

Morcos

Al-Jallad

et al. 2018

Bone & Joint Research

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The Effect of Bolus Vitamin D3 Supplementation on Distal Radius Fracture Healing: A Randomized Controlled Trial Using HR-pQCT

Heyer

Jong

Willems

et al. 2020

Journal of Bone and Mineral Research

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Vitamin D is an important factor in bone metabolism. Animal studies have shown a positive effect of vitamin D3 supplementation on fracture healing, but evidence from clinical trials is inconclusive. A randomized controlled trial was performed to assess the effects of vitamin D3 supplementation on fracture healing using HR‐pQCT–based outcome parameters. Thirty‐two postmenopausal women with a conservatively treated distal radius fracture were included within 2 weeks postfracture and randomized to a low‐dose (N = 10) and a high‐dose (N = 11) vitamin D intervention group receiving a 6‐week bolus dose, equivalent to 700 and 1800 IU vitamin D3 supplementation per day, respectively, in addition to a control group (N = 11) receiving no supplementation. After the baseline visit 1–2 weeks postfracture, follow‐up visits were scheduled at 3–4, 6–8, and 12 weeks postfracture. At each visit, HR‐pQCT scans of the fractured radius were performed. Cortical and trabecular bone density and microarchitectural parameters and microfinite element analysis–derived torsion, compression, and bending stiffness were assessed. Additionally, serum markers of bone resorption (CTX) and bone formation (PINP) were measured. Baseline serum levels of 25OHD3 were <50 nmol/L in 33% of all participants and <75 nmol/L in 70%. Compared with the control group, high‐dose vitamin D3 supplementation resulted in a decreased trabecular number (regression coefficient β: −0.22; p < 0.01) and lower compression stiffness (B: −3.63; p < 0.05, together with an increase in the bone resorption marker CTX (B: 0.062; p < 0.05). No statistically significant differences were observed between the control and low‐dose intervention group. In conclusion, the bolus equivalent of 700 U/day vitamin D3 supplementation in a Western postmenopausal population does not improve distal radius fracture healing and an equivalent dose of 1800 IU/day may be detrimental in restoring bone stiffness during the first 12 weeks of fracture healing. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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