Effects of Natural Substances on Healing of Long Bone Fractures: A Narrative Review of Traditional Persian Medicine

Fractures, especially leg fractures, are one of the most common problems in the world, and it causes a considerable economic and social burden for patients and societies. Orthopedic surgery plays the most important role in the treatment of fractures, but it is expensive and requires anesthesia which has a variety of side effects. Besides surgery and conventional treatments, it seems that the use of natural substances as complementary therapy can be useful. In Traditional Persian Medicine (TPM) manuscripts, many diverse natural substances, especially medicinal herbs, are mentioned as useful medications for fracture healing. The aim of this study was to investigate medicinal plants and natural substances used in TPM as useful in fracture healing, by an overview of traditional knowledge as compared with new investigations. The main manuscripts of TPM, including the Canon of Medicine, Tohfat-ol-Moemenin, Exir-e–azam and Makhzan-ol-advieh, were assembled through a literature search, to select the substances used in fracture healing. Also, current evidence on related substances were studied through a search of Google Scholar and PubMed databases. In this study, eleven substances were identified and categorized into three groups: plants, animals, and minerals. The results of our study showed that the most cited substances were used due to their effects on fracture or wound healing, inflammations, and pain. This historical assessment can help in obtaining new data about natural substances for faster fracture healing, which may lead to subsequent opportunities to assess their potential medicinal use. [GMJ. 2016;5(4):165-72]

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What is the role of ultrasound in fracture management?

Bone and Joint Research ◽

10.1302/2046-3758.87.bjr-2018-0215.r2 ◽

2019 ◽

Vol 8 (7) ◽

pp. 304-312 ◽

Cited By ~ 4

Author(s):

J. A. Nicholson ◽

S. T. J. Tsang ◽

T. J. MacGillivray ◽

F. Perks ◽

A. H. R. W. Simpson

Keyword(s):

Image Processing ◽

Fracture Healing ◽

Bone Fractures ◽

Therapeutic Ultrasound ◽

Long Bone ◽

Future Application ◽

Current Evidence ◽

Potential Clinical Benefit ◽

Fracture Management

Objectives The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management. Methods A review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”. Results The use of ultrasound in musculoskeletal medicine has expanded rapidly over the last two decades, but the diagnostic use in fracture management is not routinely practised. Early studies have shown the potential of ultrasound as a valid alternative to radiographs to diagnose common paediatric fractures, to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. Ultrasound has also been shown to be advantageous in the early identification of impaired fracture healing; with the advent of 3D image processing, there is potential for wider adoption. Detection of implant-related infection can be improved by ultrasound mediated sonication of microbiology samples. The use of therapeutic ultrasound to promote union in the management of acute fractures is currently a controversial topic. However, there is strong in vitro evidence that ultrasound can stimulate a biological effect with potential clinical benefit in established nonunions, which supports the need for further investigation. Conclusion Modern ultrasound image processing has the potential to replace traditional imaging modalities in several areas of trauma practice, particularly in the early prediction of impaired fracture healing. Further understanding of the therapeutic application of ultrasound is required to understand and identify the use in promoting fracture healing. Cite this article: J. A. Nicholson, S. T. J. Tsang, T. J. MacGillivray, F. Perks, A. H. R. W. Simpson. What is the role of ultrasound in fracture management? Diagnosis and therapeutic potential for fractures, delayed unions, and fracture-related infection. Bone Joint Res 2019;8:304–312. DOI: 10.1302/2046-3758.87.BJR-2018-0215.R2.

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Development and Biocompatibility Characterization of a BioMEMS Sensor for Monitoring the Progression of Fracture Healing

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206670 ◽

2009 ◽

Author(s):

Brandon G. Santoni ◽

Rohat Melik ◽

Emre Unal ◽

Nihan Kosku Perkgoz ◽

Debra A. Kamstock ◽

...

Keyword(s):

United States ◽

Fracture Healing ◽

Bone Fractures ◽

Financial Burden ◽

Early Period ◽

The United States ◽

Long Bone ◽

Extremity Injuries ◽

Manual Manipulation

Orthopaedic extremity injuries present a large medical and financial burden to the United States and world-wide communities [1]. Approximately six million long bone fractures are reported annually in the United States and approximately 10% of these fractures do not heal properly. Though the exact mechanism of impaired healing is poorly understood, many of these non-unions result when there is a communited condition that does not proceed through a stabilized healing pathway [2]. Currently, clinicians may monitor healing visually by radiographs, or via manual manipulation of the bone at the fracture [3]. Unfortunately, the course of aberrant fracture healing is not easily diagnosed in the early period when standard radiographic information of the fracture is not capable of discriminating the healing pathway. Manual assessment of fracture healing is also an inadequate diagnostic tool in the early stages of healing [4].

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Development of a Bioabsorbable Glass-Reinforced-Glass Intra-Osseous Scaffold for Fracture Healing

Journal of Biomimetics Biomaterials and Tissue Engineering ◽

10.4028/www.scientific.net/jbbte.9.81 ◽

2011 ◽

Vol 9 ◽

pp. 81-91

Author(s):

Philip Boughton ◽

Y. Chen ◽

C. Thompson ◽

G. Roger ◽

Jari Hyvarinen ◽

...

Keyword(s):

Fracture Healing ◽

Bone Fractures ◽

Stress Shielding ◽

Long Bone ◽

Hematopoietic Tissue ◽

Shear Tests ◽

Intramedullary Canal ◽

Long Bone Fracture ◽

Torsional Loads ◽

Mechanically Stabilized

Intramedullary (IM) nails are routinely used to stabilize long bone fractures. They can however lead to stress shielding, pain, migration, obstruct hematopoietic tissue, become a loci for infection, and require subsequent surgical retrieval. Novel intra-osseous scaffold (IOS™) prototypes for fracture healing have been developed to function as a regenerative scaffold to enhance callous formation under mechanically stabilized conditions then resorb. Prototype fixation pins and rod systems were formed from glass-reinforced-glass. Flexion, torsion and shear tests were performed to evaluate the composite pins and rods. A modular rod design was successfully deployed and dilated while in a deformable state. When fitted and gripping the intramedullary canal then set in a rigid state. An obliquely sectioned ovine femur was used as a long bone fracture model for deployment and mechanical verification. Flexural support provided by the intramedullary scaffold was superior to multiple k-wire fixation, while the k-wire approach was more stabilizing under torsional loads. Glass reinforced glass samples were mechanically tested after soaking for up to 4 weeks in saline. Strength and modulus of the composite was reduced to approximately 25% of initial values after 2 weeks.

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Prognostic Significance of Alkaline Phosphatase Activity and Callus Volume in Operatively Treated Bone Fractures

Collegium Antropologicum ◽

10.5671/ca.44.1.6 ◽

2020 ◽

Vol 44 (1) ◽

pp. 43-48

Author(s):

Ante Muljačić ◽

Matea Majstorović-Matejić ◽

Marko Guberina ◽

Ognjen Živković ◽

Renata Poljak-Guberina

Keyword(s):

Alkaline Phosphatase ◽

Fracture Healing ◽

Bone Fractures ◽

Prognostic Significance ◽

Bone Alkaline Phosphatase ◽

Long Bone ◽

Long Bone Fractures ◽

Rapid Healing ◽

Relationship Of ◽

Callus Volume

Total and bone alkaline phosphatase are indicators of bone formation, a process essential in bone healing. The aim of this study was to assess the relationship of both total and bone alkaline phosphatase with the course and features of healing in surgically treated long bone fractures as compared to the callus volume. In this study, total and bone alkaline phosphatase levels and the callus volume were measured in two patients with long bone fractures. Fracture healing was rapid in one patient and slow in the other. Depending on the healing outcome, on day 7 an increase in the case of slow healing and a decrease in the case of rapid healing was noted for both total and bone alkaline phosphatase. In the case of slow healing, the callus volume was significant whereas in the case of rapid healing the callus was almost invisible on day 7. This result indicates a possible prognostic significance of aforementioned clinical biochemical and radiographic parameters in the monitoring of long bone fracture healing.

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Correlating mRUST scoring with fracture healing in the mouse model

Proceedings of IMPRS ◽

10.18060/24703 ◽

2020 ◽

Vol 3 ◽

Author(s):

Anthony McGuire ◽

Adam Knox ◽

Caio de Andrade Staut ◽

Melissa Kacena ◽

Roman Natoli ◽

...

Keyword(s):

Mouse Model ◽

Fracture Healing ◽

Bone Fractures ◽

Healing Process ◽

Fracture Repair ◽

Long Bone ◽

Post Surgery ◽

Method Of Assessment ◽

Non Destructive

Background/Objective: Long bone fractures are an expensive and frequent cause of disability in humans. Research seeking to accelerate and improve the healing process is more essential than ever. Animal models, mice especially, provide an inexpensive and reproducible model of in vivo fracture healing. However, many measures of murine fracture healing outcomes are either expensive or destructive, limiting their ability to be translated to clinical studies. We seek to determine how these measures such as biomechanics, µCT, and histology correlate to the relatively new, inexpensive, and non-destructive method of mRUST scoring in a mouse model. Methods: One hundred and thirty-five, 12-week old male C57BL6/J mice were divided into nine groups of 15 mice. Mice underwent a surgically created, femoral fracture. At biweekly timepoints, anteroposterior and lateral radiographs were taken, and 15 mice were sacrificed at each time point (7, 10, 14, 17, 21, 24, 28, 35, and 42 days post-surgery) for biomechanical, µCT, and histological analyses. The modified Radiographic Union Scale for Tibial fractures (mRUST scoring) provides a score based on the visualization of a callus and fracture line in four cortices on the radiographs. Data analysis will be performed to determine the degree of correlation between mRUST scoring and other fracture healing outcomes. Results/Conclusion: Data collection in this experiment is still forthcoming. Upon successful completion of this project, we will have established numerical correlations between mRUST scoring and other fracture healing outcomes, such as biomechanics, µCT microarchitecture, and histology. These correlations will provide a powerful tool in future mouse fracture healing studies, as data on the state and strength of fracture repair could be determined by simple radiograph. Scientific/Clinical Policy Impact and Implications: This study will both provide future murine fracture studies with an inexpensive and non-destructive method of assessment that is more directly translatable to human fracture studies.

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Lithium for Fracture Treatment (LiFT): a double-blind randomised control trial protocol

BMJ Open ◽

10.1136/bmjopen-2019-031545 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031545 ◽

Cited By ~ 4

Author(s):

Diane Nam ◽

Phumeena Balasuberamaniam ◽

Katrine Milner ◽

Monica Kunz ◽

Kathak Vachhani ◽

...

Keyword(s):

Fracture Healing ◽

Bone Fractures ◽

Fracture Site ◽

Long Bone ◽

Randomised Control Trial ◽

Secondary Outcome ◽

Double Blind ◽

Carbonate Group ◽

Main Trial ◽

Radiographic Union

IntroductionFracture healing can fail in up to 10% of cases despite appropriate treatment. While lithium has been the standard treatment for bipolar disorder, it may also have a significant impact to increase bone healing in patients with long bone fractures. To translate this knowledge into clinical practice, a randomised clinical trial (RCT) is proposed.Methods and analysisA multicentre double blind, placebo-controlled RCT is proposed to evaluate the efficacy of lithium to increase the rate and predictability of long bone fracture healing in healthy adults compared to lactose placebo treatment. 160 healthy individuals from 18 to 55 years of age presenting with shaft fractures of the femur, tibia/fibula, humerus or clavicle will be eligible. Fractures will be randomised to placebo (lactose) or treatment (300 mg lithium carbonate) group within 2 weeks of the injury. The primary outcome measure will be radiographic union defined as visible callus bridging on three of the four cortices at the fracture site using a validated radiographic union score. Secondary outcome measures will include functional assessment and pain scoring.Ethics and disseminationParticipant confidentiality will be maintained with publication of results. Research Ethics Board Approval: Sunnybrook Research Institute (REB # 356–2016). Health Canada Approval (HC6-24-C201560). Results of the main trial and secondary endpoints will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration numberNCT02999022.

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An Evidence-based Study on Pharmacological Treatments of Non-Alcoholic Fatty Liver Disease Based on Traditional Persian Medicine

Current Traditional Medicine ◽

10.2174/2215083805666190902114137 ◽

2020 ◽

Vol 6 (3) ◽

pp. 188-202

Author(s):

Fatemeh Sadat Hasheminasab ◽

Haleh Tajadini ◽

Mohammad Setayesh

Keyword(s):

Liver Disease ◽

Medicinal Plants ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Current Evidence ◽

Evidence Based ◽

Alcoholic Fatty Liver ◽

Persian Medicine ◽

Traditional Persian Medicine ◽

Alcoholic Fatty Liver Disease

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the most prevalent liver diseases regarded as the primary cause of chronic liver disease, which may lead to hepatic failure. Despite the recent developments in the treatment of NAFLD, the necessity to find more efficient treatments has led to investigation on medicinal plants. Traditional Persian Medicine (TPM) is one of the oldest medical schools in the world. For treatment of NAFLD, different medicinal plants have been employed in TPM. Objective: Considering the public welcome for herbal medicines, the current evidence-based review study is conducted to investigate herbal remedies for NAFLD in TPM. Methods: Medicinal plants for treating NFALD were extracted according to three famous textbooks of Persian medicine. Then anti-obesity, hypolipidemic, hypoglycemic, antioxidative and hepatoprotective effects of these medicinal plants were investigated according to modern medicine. For this purpose, databases including Scopus, web of sciences, Pubmed, Google scholar and science direct were searched. Results: Investigations of Persian medicine textbooks resulted in deriving 53 herbs, which are useful for treating NAFLD. Searching through aforesaid databases showed that most of these plants can help to treat this disease in at least 2 ways. 25 herbs are effective in all 5 mentioned effects. Conclusion: It should be considered that in Persian medicine, first-line treatment is correction of life style, then if necessary, herbs are prescribed. However, this study showed that many herbs mentioned in Persian medicine for treatment of NAFLD might have a potential to aid patient with this disease.

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Effect of Intramedullary Nailing Patterns On Interfragmentary Strain in a Mouse Femur Fracture: a Parametric Finite Element Analysis

Journal of Biomechanical Engineering ◽

10.1115/1.4053085 ◽

2021 ◽

Author(s):

Gregory Lowen ◽

Katherine Garrett ◽

Moore-Lotridge Stephanie ◽

Sasidhar Uppuganti ◽

Scott A. Guelcher ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Fracture Healing ◽

Bone Repair ◽

Bone Fractures ◽

Fracture Site ◽

Fracture Repair ◽

Long Bone ◽

Design Parameters ◽

Element Analysis

Abstract Delayed long bone fracture healing and nonunion continue to be a significant socioeconomic burden. While mechanical stimulation is known to be an important determinant of the bone repair process, understanding how the magnitude, mode, and commencement of interfragmentary strain (IFS) affect fracture healing can guide new therapeutic strategies to prevent delayed healing or non-union. Mouse models provide a means to investigate the molecular and cellular aspects of fracture repair, yet there is only one commercially available, clinically-relevant, locking intramedullary nail (IMN) currently available for studying long bone fractures in rodents. Having access to alternative IMNs would allow a variety of mechanical environments at the fracture site to be evaluated, and the purpose of this proof-of-concept finite element analysis study is to identify which IMN design parameters have the largest impact on IFS in a murine transverse femoral osteotomy model. Using the dimensions of the clinically relevant IMN as a guide, the nail material, distance between interlocking screws, and clearance between the nail and endosteal surface were varied between simulations. Of these parameters, changing the nail material from stainless steel (SS) to polyetheretherketone (PEEK) had the largest impact on IFS. Reducing the distance between the proximal and distal interlocking screws substantially affected IFS only when nail modulus was low. Therefore, IMNs with low modulus (e.g., PEEK) can be used alongside commercially available SS nails to investigate the effect of initial IFS or stability on fracture healing with respect to different biological conditions of repair in rodents.

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