Journal•ISSN: 0020-1383
Injury-international Journal of The Care of The Injured
Elsevier BV
About: Injury-international Journal of The Care of The Injured is an academic journal published by Elsevier BV. The journal publishes majorly in the area(s): Poison control & Medicine. It has an ISSN identifier of 0020-1383. Over the lifetime, 13457 publications have been published receiving 334178 citations.
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TL;DR: Analysis of the data indicates that 14 different fractures should now be considered to be potentially osteoporotic, which is more than double the number of previously thought to be possible.
Abstract: The epidemiology of adult fractures is changing quickly. An analysis of 5953 fractures reviewed in a single orthopaedic trauma unit in 2000 showed that there are eight different fracture distribution curves into which all fractures can be placed. Only two fracture curves involve predominantly young patients; the other six show an increased incidence of fractures in older patients. It is popularly assumed that osteoporotic fractures are mainly seen in the thoracolumbar spine, proximal femur, proximal humerus and distal radius, but analysis of the data indicates that 14 different fractures should now be considered to be potentially osteoporotic. About 30% of fractures in men, 66% of fractures in women and 70% of inpatient fractures are potentially osteoporotic.
2,545 citations
TL;DR: An overview of bone grafts and graft substitutes available for clinical applications is presented and osteoinductive growth factors, osteogenic cells, and an osteoconductive scaffold are provided.
Abstract: Autograft is considered ideal for grafting procedures, providing osteoinductive growth factors, osteogenic cells, and an osteoconductive scaffold. Limitations, however, exist regarding donor site morbidity and graft availability. Allograft on the other hand, posses the risk of disease transmission. Synthetic graft substitutes lack osteoinductive or osteogenic properties. Composite grafts combine scaffolding properties with biological elements to stimulate cell proliferation and differentiation and eventually osteogenesis. We present here an overview of bone grafts and graft substitutes available for clinical applications.
1,805 citations
TL;DR: The basic biology of fracture healing is summarized, which includes an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus.
Abstract: The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes. Although there is still much to be learned to fully comprehend the pathways of bone regeneration, the over-all pathways of both the anatomical and biochemical events have been thoroughly investigated. These efforts have provided a general understanding of how fracture healing occurs. Following the initial trauma, bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, commonly only obtained by open reduction and internal fixation. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodelling steps necessary. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus. This primary callus later undergoes revascularisation and calcification, and is finally remodelled to fully restore a normal bone structure. In this article we summarise the basic biology of fracture healing.
1,379 citations
TL;DR: The main goal of this article is to provide a simple, but comprehensive presentation of CaP compounds.
Abstract: Calcium phosphate (CaP) compounds are becoming of increasingly great importance in the field of biomaterials and, in particular, as bone substitutes. Recent discoveries have accelerated this process, but have simultaneously rendered the field more complicated for the everyday user. Subtle differences in composition and structure of CaP compounds may have a profound effect on their in vivo behaviour. Therefore, the main goal of this article is to provide a simple, but comprehensive presentation of CaP compounds. Reference is made to the most important commercial products.
885 citations
TL;DR: The available scientific evidence supports the view that all the 4 known factors contributing to bone restoration should be given an equal acknowledgment and recognition and the traditional discussed triangular concept should be reconsidered and be accepted as the 'diamond concept'.
Abstract: Fracture healing is a complex physiological process. With the latest advances made in molecular biology and genetics it is now known that it involves the spatial and temporal coordinated action of several different cell types, proteins and the expression of hundreds of genes working towards restoring its structural integrity without scar formation. The standard tissue engineering approach to provide solutions for impaired fracture healing, bone restoration and regeneration includes the utilisation of growth factors, scaffolds and mesenchymal stem cells (triangular concept). However, although the mechanical environment is discussed and is considered as an important element in bone regeneration, its importance is often underestimated and it is not always given the necessary attention. The available scientific evidence supports the view that all the 4 known factors contributing to bone restoration should be given an equal acknowledgment and recognition. The traditional discussed triangular concept therefore should be reconsidered and be accepted as the 'diamond concept'.
880 citations