Avoid cox inhibitors after skeletal surgery!
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Contraindications↗
Biomedical subjects
Per Aspenberg
Publications and source records attributed to Per Aspenberg.
The radioulnar joint in distal radial fractures.
We searched The Cochrane Library and Medline regarding the radioulnar joint in distal radial fractures and found no randomized or controlled studies. This review presents the descriptive literature by summarizing accepted views and controversies. There is only weak support for the commonly accepted treatments. Current research has shown that distal radial fractures are often associated with ligament injuries not seen on radiographs. These injuries can lead to laxity of the DRU-joint and subsequent worse outcome, which indicates that we must have a complete diagnosis including ligament injuries if we want to understand better the fracture and its sequelae. Randomized studies should be done before advocating surgical treatment of these unforeseen injuries.
Elbow Joint↗
Patients with laxity of the distal radioulnar joint after distal radial fractures have impaired function, but no loss of strength.
Laxity of the distal radioulnar (DRU) joint after distal radial fractures has a worse general outcome in patients before the usual age for development of osteoporosis. The hypothesis for this study was that patients with laxity also have less strength during supination and pronation. An apparatus for measuring strength in supination and pronation was constructed and validated. 20 patients were chosen from a cohort of 76 patients who had had distal radial fractures 6 years ago. The stability of the DRU-joint was tested manually by 2 examiners and the test's reliability was good. The DRU-joint was lax in 6 patients. No differences were found between patients with stable and lax DRU-joints as regards isometric grip strength, strength in supination or pronation or radiographic characteristics. However, subjectively evaluated hand function was impaired in those with lax DRU-joints. This was noted on the subjective part of the Gartland and Werley score and 13 questions concerning everyday activities. In conclusion, DRU-joint laxity was associated with impaired hand function, but no loss of strength in forearm rotation after distal radial fractures in non-osteoporotic patients.
Adult↗
Arthrodesis by percutaneous fixation: patellofemoral arthrodesis in rabbits without debridement of the joint.
Arthrodesis is usually performed with joint resection or at least with removal of cartilage. Our recent experience with successful fusion in all 11 rheumatoid ankles treated only with percutaneous fixation questions the necessity of debridement of the joint before arthrodesis. In this rabbit study we tested the hypothesis that joints fuse because of rigid fixation. 9 skeletally mature loop-ear dwarf female rabbits were operated on. With the knee in about 45 degrees of flexion, two 1.5 mm cortical screws were inserted through the patellofemoral joint in an anterior-posterior direction with the lag screw technique. 3 rabbits were excluded due to technical problems. Of the remaining 6 rabbits, 5 underwent bony fusion and 1 fibrous healing. Fusion was confirmed with Micro-CT in 2 cases and by histological examination in all 5 cases. In those 5 cases, bony fusion was seen in almost all areas with close contact. Therefore, fusion occurred not only in relation to the screws, but also between the screws and in the periphery of the patella. Our findings show that bony fusion can occur in a healthy joint without joint resection or debridement.
Animals↗
Simvastatin improves fracture healing in mice.
Recently, several articles have been published dealing with the anabolic effects on bone by statins. Mundy and associates discovered that several statins were able to activate the promotor of bone morphogenetic protein (BMP) 2. Additionally, oral simvastatin and lovastatin increased the cancellous bone volume in rats, presumably an effect of the increase of BMP-2. Other studies have followed, with conflicting results; some have found a positive bone metabolic effect of statins and others have not. Studies published so far have focused on osteoporosis. In this study, femur fractures were produced in 81 mature male BALB/c mice and stabilized with marrow-nailing. Forty-one mice were given a diet prepared with simvastatin, so that each mouse received an approximate dose of 120 mg/kg of body weight per day. The remaining mice received the same diet with the exception of the simvastatin. Bilateral femurs were harvested at 8, 14, and 21 days postoperatively (po), the marrow-nail was extracted, and diameters were measured. Biomechanical tests were performed on 42 mice, by way of three-point bending. Histological specimens were prepared using standard techniques. For statistical analysis, ANOVA with Scheffés post hoc test was used. At 8 days, the fracture callus was too soft for meaningful biomechanical testing. At 14 days, the callus of the simvastatin-treated mice had a 53% larger transverse area than controls (p = 0.001), the force required to break the bone was 63% greater (p = 0.001), and the energy uptake was increased by 150% (p = 0.0008). Stiffness and modulus of elasticity were not significantly affected. At 21 days, the fractures were histologically healed and the mechanical differences had disappeared. The contralateral unbroken bone showed a slight increase in transverse area because of the simvastatin treatment, but there was no significant effect on the force required to break the bone or on energy uptake. These results point to a new possibility in the treatment of fractures.
Animals↗
Platelet concentrate increases bone ingrowth into porous hydroxyapatite.
Platelets contain growth factors that are believed to stimulate early fracture repair. Autologous platelets can be sequestered, concentrated, and mixed with thrombin to yield a so-called autologous growth factor gel, which might enhance bone repair or bone graft incorporation. The effect of this platelet concentrate on total tissue and bone ingrowth into porous coralline hydroxyapatite was studied in a bone chamber rat model. Chambers with the platelet concentrate showed a significant increase in bone and total tissue ingrowth distance compared to untreated controls, indicating a platelet concentrate might enhance the clinical performance of porous hydroxyapatite in bone replacement.
Animals↗
Improved healing of transected rabbit Achilles tendon after a single injection of cartilage-derived morphogenetic protein-2.
BACKGROUND: Achilles tendon ruptures in humans might be treated more efficiently with the help of a growth factor. Cartilage-derived morphogenetic protein-2 has been shown to induce formation of tendon-like tissue. HYPOTHESIS: Cartilage-derived morphogenetic protein-2 has a positive effect on mechanical parameters for tendon healing in a rabbit model with Achilles tendon transection. STUDY DESIGN: Controlled laboratory study. METHODS: The right Achilles tendon of 40 rabbits was transected without tendon suture. Cartilage-derived morphogenetic protein-2 (10 micro g) or vehicle control (acetate buffer) was injected locally 2 hours postoperatively. All tendons were tested biomechanically at 8 and 14 days, and treated tendons were histologically and radiographically evaluated at 56 days. RESULTS: At 14 days, both failure load and stiffness of treated tendons were increased by 35%. The treated tendons had significantly larger callus size at 8 and 14 days. Histologic and radiographic examination showed no signs of ossification in the treated tendons after 56 days. CONCLUSIONS: A single injection of cartilage-derived morphogenetic protein-2 led to a stronger and stiffer tendon callus than that in the controls without inducing bone formation. CLINICAL RELEVANCE: Similar results from a larger animal model would suggest a possible future use of cartilage-derived morphogenetic protein-2 in the treatment of human Achilles tendon ruptures.
Achilles Tendon↗
Parecoxib impairs early tendon repair but improves later remodeling.
BACKGROUND: Cyclooxygenase-2 inhibitors inhibit bone repair. HYPOTHESIS: Cyclooxygenase inhibitors might also have a negative effect on early tendon repair, although a positive effect on late tendon repair previously has been shown. STUDY DESIGN: Controlled laboratory study. METHODS: Achilles tendon transection was performed on 80 rats. Sixty rats were given daily intramuscular injections of either parecoxib (6.4 mg/kg body weight) or saline for the first 5 days after surgery and sacrificed either at 8 or 14 days. The remaining 20 rats were given intramuscular parecoxib or saline injections from day 6 until sacrifice at 14 days. RESULTS: At 8 days, early parecoxib treatment caused a 27% decrease in force at failure (P = .007), a 25% decrease in maximum stress (P = .01), and a 31% decrease in energy uptake (P = .05). Stiffness and transverse area were not significantly affected. At 14 days, early parecoxib treatment caused a decrease in stiffness (P = .004). In contrast to early treatment, late parecoxib treatment caused a 16% decrease in cross-sectional area (P = .03) and a 29% increase in maximum stress (P = .04). CONCLUSIONS: During early tendon repair, a cyclooxygenase-2 inhibitor had a detrimental effect. During remodelling, however, inflammation appears to have a negative influence, and cyclooxygenase-2 inhibitors might be of value. CLINICAL RELEVANCE: The results suggest that cyclooxygenase-2 inhibitors should be used with care in the early period after tendon injury.
Achilles Tendon↗