The experience of use the bioactive coated intramedullary flexible nailiing in treatment of long bone fracture

The study concerns a new method of treatment of bone fractures of upper and lower limbs based on osteogenesis stimulation by intramedullary implants with bioactive organic hydroxyapatite (HA). The method decreases consolidation period of diaphyseal fractures to 2-4 times. A technology of osteosynthesis and bone formation dynamics at the fracture zone and around the implant is described.

↵​Efficacy of Multi-ion Doped Plasma Spray Nano-hydroxyapatite Coated Titanium Implants in Long Bone Fracture Repair in Dogs- Radiographical and Bone Markers Evaluation

Background: Fracture of long bones is a common orthopaedic condition noticed in dogs and its primary goal is to completely restore the function of the injured limb as early as possible. Osteo-conductivity of hydroxyapatite can be improved further by decreasing the particle size to nanometre range and incorporation of inorganic materials in hydroxyapatite can enhance osteoblast cell material interactions. Strontium, Zinc, Silver and Fluorine are known to play an important role in the bone formation and also affect bone material characteristics such as crystallinity, degradation behaviour and mechanical properties. When doped with plasma spray nanohydroxyapatite, these multi-ions cause no harm to the physical environment during the degradation process of hydroxyapatite as these are nontoxic and play significant role in bone metabolism, growth and nourishment. Bone markers have tremendous potential as a rapid and sensitive method for assessing the response of the skeleton to medical or surgical interventions providing valuable information regarding bone turn over in animals. Hence, the current study was undertaken to evaluate the potential of multi-ion doped nano-hydroxyapatite coated intramedullary titanium implants in long bone fracture repair in dogs compared to the conventional intramedullary titanium implants through radiographical studies and evaluation of bone markers. Methods: Radiographical evaluation, Sandwich ELISA kits developed by Bioassay technology laboratory. Result: Plasma spray nano-hydroxyapatite coated titanium intramedullary implants have shown excellent osteo-conductivity when doped with multi-ions of Strontium, Zinc, Silver and Fluorine facilitating rapid osteoblastic activity and rapid bone turnover at the fracture site and complete fracture healing by 3rd week post-operatively as evidenced by radiographic scores and a peak BALP (Canine Bone Alkaline Phosphatase) values and early limb usage. Bone reabsorption and bone tissue remodelling due to osteoclastic action at the fracture site was quicker when the multi-ion doped nano-hydroxyapatite coated titanium intramedullary implants were used which is evidenced by the radiographic scores and highest CTX (Canine C-telopeptide of Type 1 Collagen) values indicating completion of fracture healing and near completion of bone tissue remodelling by 9th post-operative week in long bone fracture repair in dogs.

Randomized Control Trial of Short Infusion of Low Dose Ketamine Vs Intravenous Morphine as Adjunct Analgesia for Acute Long Bone Fracture Pain in Emergency Department

BackgroundKetamine is known as an alternative for pain control, but reports of emergency reactions limits its widespread use. We assessed the efficacy of short infusion of low dose ketamine (LDK) compared with intravenous morphine (MOR) as adjunct analgesia for acute long bone fracture pain.MethodsPatients aged 18-60 years old, with acute long bone fracture and with numerical pain rating scale (NPRS) of 6 or more after 3mg intravenous morphine were eligible for enrolment. Subjects were consented and randomized to either short infusion LDK (0.3mg/kg) over 15 minutes or intravenous morphine (MOR) (0.1mg/kg) over 5 minutes. Evaluations of NPRS score and vital signs occurred at 15, 30, 60, 90 and 120 minutes. The primary outcome from this study was the mean reduction of numerical pain rating scale (NPRS) score from baseline and the mean time to achieve ³ 3 score reductions in NPRS. The secondary outcomes were the incidence of adverse events and mean consumption of rescue analgesia.ResultsFifty-eight subjects were enrolled (MOR 27, LDK 31). Demographic variables and baseline NPRS scores MOR (8.33) vs LDK (8.84) were similar. The mean reduction of NPRS were significantly different between LDK (Mean= 3.1, SD=2.03) and MOR (Mean =1.8, SD 1.59), p= 0.009 at 30 minutes. Incidence of dizziness was reported higher in Ketamine group 19.4% (p=0.026).ConclusionWhen used as an adjunct, short infusion low-dose ketamine at 0.3mg/kg over 15minutes provides greater analgesic effect in comparison to intravenous morphine alone for acute long bone fracture pain but has higher incidence of dizziness.Trial RegistrationNational Medical Research Register: https://www.nmrr.gov.my/ Registered 24 November 2017 ID:NMRR-17-3184-38970

Comparison of Outcome of Bone Autograft and Allograft in Union of Long Bone Fractures

Background and Purpose There are few studies addressing the rate of application of bone allograft and its use; hence, the present study aimed to compare the clinical outcomes of using bone allograft and autograft in patients with long bone fracture. Method In this clinical trial study, all patients who underwent bone graft surgery with the diagnosed long bone fractures of upper and lower limbs at Shahid Beheshti Hospital were included in the research. Patients were divided into two groups, autograft and allograft, according to type of treatment. They were evaluated for their union, complications, and range of motion. Results In the present study, 124 people were studied. Among them, 100 patients were eligible and included in the study. The allograft and autograft groups did not have any statistical significant differences in terms of age, sex, location, causes of fracture, and surgical methods. Results of the present research on patients in terms of fracture site indicated that there was no significant relationship between the two groups in rate of union (P = 0.18). Allograft and autograft had no difference in terms of complications. Studied range of motion indicated that patients were not different in terms of their ranges of motion. Conclusion Based on findings of the present study, allograft could be a suitable substitute for the autograft. The two graft methods were similar in terms of complications, union, and ranges of motion.

Development of selective bispecific Wnt mimetics for bone loss and repair

The Wnt signaling pathway is intricately connected with bone mass regulation in humans and rodent models. We designed an antibody-based platform that generates potent and selective Wnt mimetics. Using this platform, we engineer bi-specific Wnt mimetics that target Frizzled and low-density lipoprotein receptor-related proteins and evaluate their effects on bone accrual in murine models. These synthetic Wnt agonists induce rapid and robust bone building effects, and correct bone mass deficiency and bone defects in various disease models, including osteoporosis, aging, and long bone fracture. Furthermore, when these Wnt agonists are combined with antiresorptive bisphosphonates or anti-sclerostin antibody therapies, additional bone accrual/maintenance effects are observed compared to monotherapy, which could benefit individuals with severe and/or acute bone-building deficiencies. Our data support the continued development of Wnt mimetics for the treatment of diseases of low bone mineral density, including osteoporosis.