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Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions
The scaphoid is the most frequently fractured carpal bone and prone to non‐union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was t...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979627/ https://www.ncbi.nlm.nih.gov/pubmed/29488208 http://dx.doi.org/10.1111/joa.12795 |
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author | Schmidle, Gernot Ebner, Hannes Leonhard Klima, Günter Pfaller, Kristian Fritz, Josef Hoermann, Romed Gabl, Markus |
author_facet | Schmidle, Gernot Ebner, Hannes Leonhard Klima, Günter Pfaller, Kristian Fritz, Josef Hoermann, Romed Gabl, Markus |
author_sort | Schmidle, Gernot |
collection | PubMed |
description | The scaphoid is the most frequently fractured carpal bone and prone to non‐union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non‐union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate‐resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = −0.427, P = 0.026) and decreasing healing activity for the gap region (r = −0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non‐unions (SNUs) and the scoring of healing parameters make it possible to analyse the healing capacity of SNUs at certain time points. This information is important as it can assist the surgeon in the selection of the most appropriate SNU treatment. |
format | Online Article Text |
id | pubmed-5979627 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-59796272018-06-06 Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions Schmidle, Gernot Ebner, Hannes Leonhard Klima, Günter Pfaller, Kristian Fritz, Josef Hoermann, Romed Gabl, Markus J Anat Original Articles The scaphoid is the most frequently fractured carpal bone and prone to non‐union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non‐union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate‐resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = −0.427, P = 0.026) and decreasing healing activity for the gap region (r = −0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non‐unions (SNUs) and the scoring of healing parameters make it possible to analyse the healing capacity of SNUs at certain time points. This information is important as it can assist the surgeon in the selection of the most appropriate SNU treatment. John Wiley and Sons Inc. 2018-02-27 2018-06 /pmc/articles/PMC5979627/ /pubmed/29488208 http://dx.doi.org/10.1111/joa.12795 Text en © 2018 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Schmidle, Gernot Ebner, Hannes Leonhard Klima, Günter Pfaller, Kristian Fritz, Josef Hoermann, Romed Gabl, Markus Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title | Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title_full | Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title_fullStr | Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title_full_unstemmed | Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title_short | Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
title_sort | time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979627/ https://www.ncbi.nlm.nih.gov/pubmed/29488208 http://dx.doi.org/10.1111/joa.12795 |
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