Injury
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Synthetic scaffolding has been used in the treatment of bone defects and fractures for over 100 years. They remain a critical tool in the treatment of large-volume bone defects, and their role as potential substitues for human bone graft continues to expand. Various materials are used commercially to produce osteoconductive scaffolds including ceramics (both bioactive and bioinert) and select polymers, all of which offer distinct advantages and dissadvantages. While currently used principally as osteoconductive conduits for growth, the role of bone-graft substitues in fracture treatment is likely to change, as biomaterial research moves towards utilizing current and future scaffold materials as delivery systems for biologic fracture treatments.
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Review
Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions?
Nonunion is a common complication following long-bone fracture, with a prevalence that ranges from 2.5-46%, depending on the location and severity of the injury to the bone, soft tissue, and vascular structures. The treatment of nonunions involves addressing the biology of fracture repair and the mechanical stability of fracture fixation, which are interrelated. ⋯ In addition, new advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors, such as bone morphogenetic proteins, to accelerate bone healing. This article reviews the benefits of iliac crest bone graft relative to those of other modalities in the treatment of nonunions.
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The maintenance of stable bone mass during adult life, following rapid skeletal growth during childhood, is the result of a carefully controlled balance between the activities of bone forming (osteoblast) and bone resorbing (osteoclast) cells. Although skeletal turnover continues throughout adult life, the net effect of formation and resorption on bone mass is zero in healthy individuals. Later in life, bone mass begins to fall as resorption outpaces formation, particularly in post-menopausal women, which leads to increased fracture risk. ⋯ Although the biology of cultured MSCs is reasonably well understood, the biology of MSCs in vivo in both bone turnover and fracture repair remains poorly understood. The recent phenotypic characterization of in vivo MSCs and the ability to prospectively purify such cells will open up new avenues of research into a better understanding of the role of MSCs in bone turnover. The purpose of this article is to review bone and fracture biology from the perspective of recent advances in our understanding of MSCs and to highlight the major deficiencies in our current knowledge.
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Comparative Study
Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers.
Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database. ⋯ This study found that drivers and passengers have different upper extremity injury patterns but the direction of impact also plays an important role.
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Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients.
There is increasing evidence for acute traumatic coagulopathy occurring prior to emergency room (ER) admission but detailed information is lacking. ⋯ There is a high frequency of established coagulopathy in multiple injury upon ER admission. The presence of early traumatic coagulopathy was associated with the amount of intravenous fluids administered pre-clinically, magnitude of injury, and impaired outcome.