Lead Exposure Inhibits Fracture Healing and Is Associated with Increased Chondrogenesis, Delay in Cartilage Mineralization, and a Decrease in Osteoprogenitor Frequency

Lead exposure continues to be a significant public health problem. In addition to acute toxicity, Pb has an extremely long half-life in bone. Individuals with past exposure develop increased blood Pb levels during periods of high bone turnover or resorption. Pb is known to affect osteoblasts, osteoclasts, and chondrocytes and has been associated with osteoporosis. However, its effects on skeletal repair have not been studied. We exposed C57/B6 mice to various concentrations of Pb acetate in their drinking water to achieve environmentally relevant blood Pb levels, measured by atomic absorption. After exposure for 6 weeks, each mouse underwent closed tibia fracture. Radiographs were followed and histologic analysis was performed at 7, 14, and 21 days. In mice exposed to low Pb concentrations, fracture healing was characterized by a delay in bridging cartilage formation, decreased collagen type II and type X expression at 7 days, a 5-fold increase in cartilage formation at day 14 associated with delayed maturation and calcification, and a persistence of cartilage at day 21. Fibrous nonunions at 21 days were prevalent in mice receiving very high Pb exposures. Pb significantly inhibited ex vivo bone nodule formation but had no effect on osteoclasts isolated from Pb-exposed animals. No significant effects on osteoclast number or activity were observed. We conclude that Pb delays fracture healing at environmentally relevant doses and induces fibrous nonunions at higher doses by inhibiting the progression of endochondral ossification

Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy

Structural allograft healing is limited because of a lack of vascularization and remodeling. To study this we developed a mouse model that recapitulates the clinical aspects of live autograft and processed allograft healing. Gene expression analyses showed that there is a substantial decrease in the genes encoding RANKL and VEGF during allograft healing. Loss-of-function studies showed that both factors are required for autograft healing. To determine whether addition of these signals could stimulate allograft vascularization and remodeling, we developed a new approach in which rAAV can be freeze-dried onto the cortical surface without losing infectivity. We show that combination rAAV-RANKL- and rAAV-VEGF-coated allografts show marked remodeling and vascularization, which leads to a new bone collar around the graft. In conclusion, we find that RANKL and VEGF are necessary and sufficient for efficient autograft remodeling and can be transferred using rAAV to revitalize structural allografts

Orthopedic surgeons’ views on the osteoporosis care gap and potential solutions: survey results

Abstract Introduction Osteoporosis is often not recognized until one or more fractures occur, yet post-fracture screening remains uncommon. Orthopedic surgeons are well situated to address this care gap. Both a protocol-based approach and fracture liaison services (FLS) have been proposed. The present surveys assess orthopedists’ attitudes to these alternative models for addressing this care gap. Methods Two digital surveys were sent to all orthopedic surgeons and orthopedic midlevel providers at a large level 1 trauma center 1.5 years apart. Results Thirty-six of 47 survey recipients (77%) responded to the first survey; all 55 recipients (100%) responded to the second. Respondents recognized the importance of osteoporosis care, the inadequacy of current measures, and the potential of orthopedic surgeons to help address this gap. Respondents reported regular encounters with fragility fracture patients but limited familiarity with core aspects of osteoporosis screening and treatment, especially pharmacotherapy. While some respondents (40%) reported willingness to attempt a protocol-based approach to addressing this care gap, many others expressed reservations (60%) and support for a FLS-based approach was much higher (95%). Conclusions A fracture liaison service model best fits the observed attitudes of orthopedic surgeons at this level 1 trauma center relative to a protocol-based approach. Protocol-based approaches may be preferable in alternate settings

Symptomatic sacrococcygeal joint dislocation treated using closed manual reduction: A case report with 36-month follow-up and review of literature

Dislocation of the sacrococcygeal joint is a rare injury from trauma to the buttocks, most often from falling backwards. Standard of care for this injury has not been determined because it is rare. Left untreated this can cause coccydynia in the long-term. Here we present a case report to describe the treatment of an anterior sacrococcygeal dislocation with closed manual reduction. A 13-year-old female presented to the emergency department with buttock pain after slipping backwards down the stairs. On X-ray the coccyx was in bayonette apposition to the anterior distal sacrum and shortened by 6 mm. To manage the injury, closed manual reduction of the sacrococcygeal joint was performed. To our knowledge, this is the first successful case of sacrococcygeal dislocation treated with closed manual reduction, resulting in complete relief of symptoms at 36 months follow-up. Sacrococcygeal dislocations can be treated with closed manual reduction, resulting in lower morbidity and faster recovery compared to surgical treatment

C1-2 Fixation Approach for Patients With Vascular Irregularities: A Case Report

In posterior spinal fusion (PSF), the vertebral artery is most vulnerable to injury at C1-2. C2 pedicle screws are often placed into the dorsomedial isthmus of C2. Alternative techniques include C2 laminar screws and wiring techniques. A 67-year-old male underwent PSF for persistent severe intractable neck pain and degeneration at C1-2. The patient had an enlarged left vertebral artery with midline migration into the C2 body. This pattern was within one standard deviation of normal; however, it rendered typical placement of a C2 pedicle screw unsafe. As a salvage, a C2 laminar screw was placed on the left to avoid risk of vertebral artery injury. The operation and recovery were without complication. C2 laminar screws can be viable alternatives to C2 pedicle screws in cases of midline vertebral artery migration or other vascular anomalies preventing normal safe placement of C2 pedicle screws

Helsesøster sine utfordringer i skolehelsetjenesten. En kvalitativ studie av hvilke utfordringer helsesøster møter i arbeidet med barn og unges psykososiale vansker

Bakgrunn: Formålet med studien er å undersøke helsesøster sine utfordringer i møte med barn og unges psykososiale vansker. Hensikten er å bidra med kunnskap og forståelse vedrørende forebyggende arbeid til barn og unge og hvilke forhold som gjør seg gjeldende innafor et sammensatt og komplekst fagområde. Problemstilling: Hvilke utfordringer møter helsesøster i arbeidet med barn og unges psykososiale vansker? Teori: Tidligere forskning rundt psykososial tematikk hos barn og unge, hvor forebygging og psykisk helse er sentrale begreper. Systemteori som innbefatter Bronfenbrenner sin bioøkologiske utviklingsmodell for helhetlig forståelse og tilnærming. Metode: Kvalitativ metode med en hermeneutisk fenomenologisk tilnærming med bruk av. Studiens utvalg er bestående av fire helsesøstre hvor alle er tilknyttet helsøstertjenesten og med flere års erfaring i skolehelsetjenesten. Helsesøstrene ble intervjuet ved bruk av en semistrukturert intervjuguide. Datamaterialet ble systematisk analysert ved anvendelse av Malteruds modifikasjon av Giorgis fenomenologiske analyse. Resultater: Resultatene viser til utfordringer for helsesøster på ulike nivåer. Disse omhandler sammensatte vansker hos barnet hvor vanskene kan bidra til utfordringer knytta til å etablere en trygg relasjon mellom barn og helsesøster. Mangel på ressurser begrenser helsesøster sine muligheter for individuell oppfølging. Videre er samarbeid med skolen en utfordring på grunn av ulik problemforståelse av barna. Helsesøster er i behov av formalisert samarbeid med spesialisthelsetjenesten. Det er videre behov for økt kunnskap hos barn og unge, på skolen og i helsesøsters fagfelt. Konklusjon: Forebygging av psykososiale vansker hos barn og unge er en utfordring med de ressurser helsesøster har tilgjengelig i skolehelsetjenesten. Nøkkelord: Helsesøster, barn og unge, psykososiale vansker, psykisk helse, forebygging, skolehelsetjeneste

Lead Exposure Inhibits Fracture Healing and Is Associated with Increased Chondrogenesis, Delay in Cartilage Mineralization, and a Decrease in Osteoprogenitor Frequency-4

<p><b>Copyright information:</b></p><p>Taken from "Lead Exposure Inhibits Fracture Healing and Is Associated with Increased Chondrogenesis, Delay in Cartilage Mineralization, and a Decrease in Osteoprogenitor Frequency"</p><p>Environmental Health Perspectives 2005;113(6):749-755.</p><p>Published online 14 Mar 2005</p><p>PMCID:PMC1257601.</p><p>This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.</p

Lead Exposure Inhibits Fracture Healing and Is Associated with Increased Chondrogenesis, Delay in Cartilage Mineralization, and a Decrease in Osteoprogenitor Frequency-1

<p><b>Copyright information:</b></p><p>Taken from "Lead Exposure Inhibits Fracture Healing and Is Associated with Increased Chondrogenesis, Delay in Cartilage Mineralization, and a Decrease in Osteoprogenitor Frequency"</p><p>Environmental Health Perspectives 2005;113(6):749-755.</p><p>Published online 14 Mar 2005</p><p>PMCID:PMC1257601.</p><p>This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.</p