Cargando…

Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review

BACKGROUND AND PURPOSE: Studies of fracture healing have mainly dealt with shaft fractures, both experimentally and clinically. In contrast, most patients have metaphyseal fractures. There is an increasing awareness that metaphyseal fractures heal partly through mechanisms specific to cancellous bon...

Descripción completa

Detalles Bibliográficos
Autores principales: Sandberg, Olof H, Aspenberg, Per
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016903/
https://www.ncbi.nlm.nih.gov/pubmed/27357416
http://dx.doi.org/10.1080/17453674.2016.1205172
_version_ 1782452643014115328
author Sandberg, Olof H
Aspenberg, Per
author_facet Sandberg, Olof H
Aspenberg, Per
author_sort Sandberg, Olof H
collection PubMed
description BACKGROUND AND PURPOSE: Studies of fracture healing have mainly dealt with shaft fractures, both experimentally and clinically. In contrast, most patients have metaphyseal fractures. There is an increasing awareness that metaphyseal fractures heal partly through mechanisms specific to cancellous bone. Several new models for the study of cancellous bone healing have recently been presented. This review summarizes our current knowledge of cancellous fracture healing. METHODS: We performed a review of the literature after doing a systematic literature search. RESULTS: Cancellous bone appears to heal mainly via direct, membranous bone formation that occurs freely in the marrow, probably mostly arising from local stem cells. This mechanism appears to be specific for cancellous bone, and could be named inter-trabecular bone formation. This kind of bone formation is spatially restricted and does not extend more than a few mm outside the injured region. Usually no cartilage is seen, although external callus and cartilage formation can be induced in meta­physeal fractures by mechanical instability. Inter-trabecular bone formation seems to be less sensitive to anti-inflammatory treatment than shaft fractures. INTERPRETATION: The unique characteristics of inter-trabecular bone formation in metaphyseal fractures can lead to differences from shaft healing regarding the effects of age, loading, or drug treatment. This casts doubt on generalizations about fracture healing based solely on shaft fracture models.
format Online
Article
Text
id pubmed-5016903
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Taylor & Francis
record_format MEDLINE/PubMed
spelling pubmed-50169032016-10-01 Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review Sandberg, Olof H Aspenberg, Per Acta Orthop Articles BACKGROUND AND PURPOSE: Studies of fracture healing have mainly dealt with shaft fractures, both experimentally and clinically. In contrast, most patients have metaphyseal fractures. There is an increasing awareness that metaphyseal fractures heal partly through mechanisms specific to cancellous bone. Several new models for the study of cancellous bone healing have recently been presented. This review summarizes our current knowledge of cancellous fracture healing. METHODS: We performed a review of the literature after doing a systematic literature search. RESULTS: Cancellous bone appears to heal mainly via direct, membranous bone formation that occurs freely in the marrow, probably mostly arising from local stem cells. This mechanism appears to be specific for cancellous bone, and could be named inter-trabecular bone formation. This kind of bone formation is spatially restricted and does not extend more than a few mm outside the injured region. Usually no cartilage is seen, although external callus and cartilage formation can be induced in meta­physeal fractures by mechanical instability. Inter-trabecular bone formation seems to be less sensitive to anti-inflammatory treatment than shaft fractures. INTERPRETATION: The unique characteristics of inter-trabecular bone formation in metaphyseal fractures can lead to differences from shaft healing regarding the effects of age, loading, or drug treatment. This casts doubt on generalizations about fracture healing based solely on shaft fracture models. Taylor & Francis 2016-10 2016-06-29 /pmc/articles/PMC5016903/ /pubmed/27357416 http://dx.doi.org/10.1080/17453674.2016.1205172 Text en © 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. https://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0)
spellingShingle Articles
Sandberg, Olof H
Aspenberg, Per
Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title_full Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title_fullStr Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title_full_unstemmed Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title_short Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: A narrative review
title_sort inter-trabecular bone formation: a specific mechanism for healing of cancellous bone: a narrative review
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016903/
https://www.ncbi.nlm.nih.gov/pubmed/27357416
http://dx.doi.org/10.1080/17453674.2016.1205172
work_keys_str_mv AT sandbergolofh intertrabecularboneformationaspecificmechanismforhealingofcancellousboneanarrativereview
AT aspenbergper intertrabecularboneformationaspecificmechanismforhealingofcancellousboneanarrativereview