Radiation‐induced alterations of fracture healing biomechanics

Pelker, Richard R.; Friedlaender, Gary E.; Panjabi, Monahar M.; Kapp, Daniel; Doganis, Andrew

doi:10.1002/jor.1100020114

Cited by 38 publications

(16 citation statements)

References 13 publications

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“…The effects of radiation on bone have been attributed to the impaired proliferation of normal functioning osteoblasts, as well as its effects on neoangiogenesis in fracture healing [6,7,17,18]. Furthermore, soft tissue sarcoma resection poses other potential adverse effects on bone.…”

Section: Introductionmentioning

confidence: 99%

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Kim

Healey

Morris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background High-dose radiation retards bone healing, compromising the surgical results of radiation-induced fractures. Prosthetic replacement has traditionally been reserved as a salvage option but may best achieve the clinical goals of eliminating pain, restoring function and avoiding complications. Questions/purposes We asked whether patients undergoing prosthetic replacement at index surgery for radiationrelated subtrochanteric or diaphyseal fractures of the femur had fewer complications than those undergoing open reduction internal fixation at index operation. Methods We retrospectively reviewed records from 1045 patients with soft tissue sarcomas treated with surgical resection and high-dose radiation therapy between 1982 and 2009 and identified 37 patients with 39 fractures. We recorded patient demographics, diagnosis, type of surgical resection, total radiation dose, fracture location and pattern, years after radiation the fracture occurred, type of surgical fixation, and associated complications. Results Patients undergoing prosthetic replacement at index surgery had a lower number of major complications and revision surgeries than those undergoing index open reduction internal fixation. Patients undergoing open reduction internal fixation at index surgery had a nonunion rate of 63% (19 of 30). Fractures located in the metaphysis were more likely to heal than those located in the subtrochanteric or diaphyseal regions. Conclusions Radiation-induced fractures have poor healing potential. Our data suggest an aggressive approach to fracture treatment with a prosthetic replacement can minimize complications and the need for revision surgery.

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Section: Introductionmentioning

confidence: 99%

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Kim

Healey

Morris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The corrosive impact of these radiationinduced side effects can be unrelenting and their complex management is rarely remedial. Radiation therapy changes the biologic environment of bone, resulting in a severe attenuation of cellularity and fibrosis [4,5], decreased vascular density, obliteration of small blood vessels, poor fracture and soft tissue healing [6][7][8][9], impaired growth [10], and the late devastating complication of osteoradionecrosis. The bone subjected to X-ray radiation therapy (XRT) demonstrates increased bone resorption, decreased osteogenesis, and reduced [11,12] mechanical strength [13] that predisposes the patients to the debilitating problem of late pathologic fractures with disastrous functional consequences [14].…”

Section: Introductionmentioning

confidence: 99%

Stem Cell Therapy Remediates Reconstruction of the Craniofacial Skeleton After Radiation Therapy

Deshpande

Gallagher

Donneys

et al. 2013

Stem Cells and Development

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This study utilized transplanted bone marrow stromal cells (BMSCs) as a cellular replacement therapy to remedy radiation-induced injury and restore impaired new bone formation during distraction osteogenesis (DO). BMSC therapy brought about the successful generation of new bone and significantly improved both the rate and quality of a bony union of irradiated, distracted [X-ray radiation therapy (XRT)/DO] murine mandibles to the level of nonirradiated DO animals. The bone mineral density and bone volume fraction were also significantly improved by the BMSC replacement therapy showing no difference when compared to nonirradiated animals. Finally, a biomechanical analysis examining the yield, failure load, and ultimate load also demonstrated a significantly improved structural integrity in BMSC-treated XRT/DO mandibles over XRT/DO alone. These results indicate that administration of BMSCs intraoperatively to a radiated distraction gap can function as an adequate stimulant to rescue the ability for irradiated bone to undergo DO and produce a healed regenerate of a vastly superior quality and strength. We believe that the fundamental information on the optimization of bone regeneration in the irradiated mandible provided by this work has immense potential to be translated from the bench to the bedside to lead to improved therapeutic options for patients suffering from the disastrous sequelae of radiation therapy.

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“…Conversely, fracture displacement and irradiation of the fracture site were associated with abnormal fracture healing, including delayed union, malunion, and nonunion. Radiation-related alterations in fracture healing, including poor progression between the biomechanical stages of healing and a higher susceptibility to failure in torsion, have been demonstrated in animal models [8,35,38]. Prolonged healing times and high rates of nonunion after radiotherapy have also been demonstrated in patients undergoing treatment for soft tissue malignancies [27,32].…”

Section: Discussionmentioning

confidence: 99%

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ibrahim

Haughom

Fillingham

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Non-Hodgkin's lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.Questions/purposes The objective of this study was to compare patients treated for NHL of bone with and without radiation in terms of (1) overall survival; (2) pretreatment complications; (3) posttreatment complications; and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Methods A retrospective analysis of all patients with biopsy-proven NHL of bone diagnosed at our institution between 1985 and 2013 was undertaken; 70 patients met our criteria for inclusion with minimum followup of 6 months (median, 55 months; range, 10-219 months). Overall survival at 5 and 10 years was estimated and compared between two groups of patients: one group treated with systemic therapy alone (chemotherapy, rituximab; 46 patients [66%]) and the other with combined modality therapy (systemic therapy and radiotherapy; 24 patients [34%]). During the period in question, indications for radiotherapy included bulky disease, an abbreviated course of systemic therapy, and an incomplete response to systemic therapy. Patients not meeting these criteria generally received systemic therapy alone. With the available sample size, it was estimated that a difference in survival of approximately 30% would have to be present for detection with 80% power (a = 0.05, b = 0.2, n = 70, D = 30%). Pretreatment and posttreatment complications occurring in both patient groups were retrospectively reviewed with special emphasis on fracture healing after treatment. MSTS scores were obtained for 45 patients with appendicular tumors at a median followup of 42 months (range, 10-215 months). Results With the data available, no difference in KaplanMeier survivorship was observed between patients treated with and without radiation at 5 years (98%; 95% confidence interval [CI], 93%-100% versus 95%; 95% CI, 85%-100%; p = 0.281). Patients who were treated with radiation were

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Radiation‐induced alterations of fracture healing biomechanics

Cited by 38 publications

References 13 publications

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Stem Cell Therapy Remediates Reconstruction of the Craniofacial Skeleton After Radiation Therapy

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

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