T. Sam Lindholm

Effect of ibuprofen on heterotopic ossification after hip replacement

A double-blind, placebo-controlled study was made of the influence of the anti-inflammatory agent ibuprofen on heterotopic ossification after total hip replacement for arthrosis, fracture or rheumatoid arthritis. Seven drop-outs left 21 patients on medication and 22 on placebo in two comparable groups. Heterotopic ossification appeared in one third of the patients in the ibuprofen group and in three fourths in the control group 12 months after surgery. Five patients in the latter group developed true heterotopic bone, compared to one of the patients on medication. Heterotopic ossification was as common among osteoarthritic patients as among others. There was no difference in the range of motion at 12 months postoperatively between patients with and without heterotopic ossification. In the 22 patients with heterotopic ossification this was demonstrated in all but eight within 6 weeks, and in only three did it appear later than 3 months postoperatively. Five of the six patients who showed heterotopic bone with trabecular structure were male. Since inflammation is a dominant feature in the postoperative phase, the effect of ibuprofen on heterotopic ossification is probably its inhibition of the synthesis of prostaglandins. This implies that prevention is most successful if commenced before or at the time of operation.

Effect of Ibuprofen on Mass and Composition of Fracture Callus and Bone: An Experimental Study on Adult Rat

Sixty adult male rats were used to study the effect of the anti-inflammatory drug Ibuprofen on fracture callus and perpendicular skeleton. After experimental periods of 3 and 9 weeks, fracture callus and both fractured and unfractured tibiae were examined with respect to bone mass and composition and 45Ca metabolism. No significant changes were found in the composition of fracture callus during treatment. Significantly diminished parameters of both fractured and unfractured tibia were observed for wet and dry weights, ash content, and organic matter after 3 weeks but the bone mass had become almost restored and the changes were non-significant during treatment 9 weeks following fracturing. The 45Ca activity was elevated significantly in fracture callus and fractured tibia 3 weeks after fracturing but had definitely declined to physiological levels at 9 weeks. Serum 45Ca activity was significantly elevated during Ibuprofen treatment. The findings support the concept that Ibuprofen lessens the bone mass and composition of both fractured and unfractured tibia and also activates the calcium metabolism in fracture callus. In the long run, however, this effect is weakened and the bone changes are become almost normal. Some explanations regarding these short-term effects of Ibuprofen are discussed.

Experimentally Induced Heterotopic Ossification in Rats Influenced by Anti-Inflammatory Drugs

This paper reports the effects of peroral administration of the two non-steroid anti-inflammatory drugs ibuprofen and flubiprofen on orthotopic and induced heterotopic bone. The treatment induced no effects on the mineral or hydroxyproline contents of femur compared with a control group. Nor could any generalized toxic effects of the treatment be detected with respect to bodyweights or serum values of calcium, phosphate or albumin. Treatment with the drugs was commenced one week before initiating the heterotopic bone formation by implanting pieces of demineralized bone matrix in the abdominal muscle of growing rats. A significant decrease in specific amounts of calcium and phosphate was noted in the induced new-formed bone 4 weeks after implantation, whereas no such effect was apparent 2 weeks after implantation.

I Reconstruction of Articular Surface by Transfixation of an Osteochondral Fragment to the Femoral Condyle Using a Bone Transpalnt: An experimental study

The aim of the study was to evaluate the surgical technique concerning reconstruction of the articular surface by transfixation of an osteochondral fragment to the femoral condyle in growing and young adult rabbits by means of bone transplants. After 1–312 days the specimens were examined macroscopically and by histology, fluorescence labelling and microradiography.The osteochondral fragment was stabilized to the condylar bed and histologically observed to unite within 3 weeks. The bone transplant participating actively in the healing process was almost totally resorted within about 3 months. Fibrous tissue, as well as fibrous and hyaline cartilage, filled out the cleavage in the articular surface. The late results achieved depended on the success of the primary reconstruction. Remodelling observed by fluorescence labelling activity continued for 4 months or more, when the distal tip of the bone transplant was essentially resorbed. Calcified tissue observed by microradiography commenced filling out the li...

Bilateral Posterior Dislocation of the Shoulder Combined with Fracture of the Proximal Humerus: A Case Report

A 28-year-old turner presented with bilateral posterior fracture-dislocation of the shoulders following an epileptic seizure. He was treated by open reduction of the humeral heads and fixation of the oblique fractures with screws. At the follow-up examination 2 years postoperatively shoulder mobility was satisfactory, and the patient could return to his previous work.

The Effect of 1α-Hydroxycholecalciferol on the Healing of Experimental Fractures in Adult Rats

Unilateral tibial fractures were produced in adult, 1-year-old, male Sprague-Dawley rats. The animals were then treated for 6 weeks with daily doses of 2.5 micrograms, 1.25 micrograms or 0.125 microgram 1alpha-hydroxycholecalciferol (1alpha-OH-D3). The aim of the investigation was to study the effect of this treatment on the healing process of the fracture and on the composition of the fractured bone. The general effect of 2.5 micrograms of 1alpha-OH-D3 was a significant loss of body weight (20 per cent) and hypercalcaemia. The lower dose levels, however, did not affect the body weight, and with a dose of 0.125 microgram the serum calcium level did not increase significantly. The healing rate of the fractures increased in all treatment groups as compared with the controls. The water content of the fractured tibias increased in the rats treated with 2.5 micrograms doses but decreased in the other groups. On the other hand the mineral content increased in the groups treated with 1.25 micrograms and 0.125 microgram doses and decreased in the largest dose group. Furthermore the amount of organic material per wet weight increased with the 2.5 micrograms dose and was mainly unchanged in the other groups. The hydrated bone density and the cortical thickness of the tibia increased most significantly in the group treated with 0.125 microgram but the trabecular bone area of the periosteal callus did not increase significantly. The conclusion is drawn that treatment with small doses of 1alpha-OH-D3 has a beneficial effect on the healing rate and on the mineralization of the fracture callus, and on cortical bone formation.

Effect of 1α-Hydroxyvitamin D3 on Cancellous Bone Matrix: An Experimental Study on Adult Rats

Two groups of adult male rats were treated perorally for 6 weeks with 0.1 microgram and 1.0 microgram of 1a-hydroxyvitamin D3 (1a-OH-D3), respectively. The effect of the treatment on cancellous bone matrix was studied by chemical analysis and morphometric measurements. The effect of the 1.0 microgram dose on the inorganic composition, and on the calcification of the cancellous bone matrix, was significantly more pronounced, decreasing the amount of glycosaminoglycans. The lower dose level, 0.1 microgram of 1a-OH-D3, increased the collagen metabolism, whereas the higher dose level did not. The amount of cancellous bone determined morphometrically increased significantly during treatment with both dose levels. 1a-OH-D3, converted in the organism to the hormonal form 1.25 (OH)2D3, induces new bone formation, probably by direct influence on the cancellous bone tissue itself.Two groups of adult male rats were treated perorally for 6 weeks with 0.1 μg and 1.0 μg of 1a-hydroxyvitamin D3 (la-OH-D3), respectively. The effect of the treatment on cancellous bone matrix was studied by chemical analysis and morphometric measurements. The effect of the 1.0 μg dose on the inorganic composition, and on the calcification of the cancellous bone matrix, was significantly more pronounced, decreasing the amount of glycosaminoglycans. The lower dose level, 0.1 μg of la-OH-D3, increased the collagen metabolism, whereas the higher dose level did not. The amount of cancellous bone determined morphometrically increased significantly during treatment with both dose levels. 1a-OH-D3, converted in the organism to the hormonal form 1.25 (OH)2D3, induces new bone formation, probably by direct influence on the cancellous bone tissue itself.

1α-Hydroxycholecalciferol and Calcium Deficiency Osteoporosis in Adult Rats

An attempt was made to reverse the osteoporotic changes caused by calcium deficiency in adult male rats, partly by a daily oral administration of 1 alpha-hydroxycholecalciferol (1 alpha-OH-D3) over a period of 6 weeks, partly by additionally changing to an optimal calcium intake during the same period of treatment. The results achieved show that 1 alpha-OH-D3 combined with an optimal calcium-containing diet significantly normalized the skeleton when compared with low or optimal calcium controls. 1 alpha-OH-D3 in combination with a contiuous intake of low calcium could not significantly restore these changes during the observation time. The bone matrix composition of collagen, glycosaminoglycans and nucleic acids did not change significantly during treatment. However, new bone formation as measured by uptake of fluoretic material was noted to increase pari passu with treatment with 1 alpha-OH-D3, combined either with an optimal or with a low calcium intake. The evidence of direct and/or indirect effects of 1 alpha-OH-D3 on the new bone formation is discussed.

Bone Mineral and Calcium Metabolism Before, During and After Treatment of Osteoporosis with 1α-Hydroxyvitamin D3 and Calcium

A series of osteoporotic patients treated for 25 months (average) with 1 alpha-hydroxyvitamin D3 (1 alpha-OHD3) supplemented with calcium were examined in respect of calcium metabolism and bone mineral changes before, during, and 12 months after cessation of treatment. The bone mineral content, which increased during treatment, showed a decreasing post-treatment tendency. The decrease was more obvious in patients with senile osteoporosis. The levels of serum calcium and phosphate stayed within normal levels. The urinary calcium excretion rate, which also rose during treatment, returned to pre-treatment values after discontinuing treatment. Excretion of urinary phosphate, however, showed a tendency towards further decrease. Serum PTH stayed within normal levels, while serum alkaline phosphatase, which was depressed during treatment, rose again after treatment. The investigation speaks in favour of a continuous administration of 1 alpha-OHD3 and calcium which is generally noted to increase bone mineral during long-term treatment.

II Reconstruction of Articular Surface Using an Autogenous Osteochondral Fragment Preserved Loose in the Joint Cavity: An experimental study

Fixation of an osteochondral fragment preserved as a loose body in the joint cavity to the condylar bed was studied in an experiment carried out in rabbits. An osteochondral fragment was detached from the medial femoral condyle and left loose in the joint cavity. In a second operation 7 days later the fragment was secured to its bed using a bone transplant for fixation. The observation time varied from 7 to 208 days, and the bone specimens were studied macroscopically, by histology, tetracycline labelling, and microradiography.It results that an osteochondral fragment retains its viability in the joint cavity and can be replaced to its bed with excellent or acceptable results in 84% of the cases.Fixation with a bone transplant affords a good stability, and the bone transplant itself participates in the healing process. Healing of the osteochondral fragment develops similarly as in cases where the osteochondral fragment was immediately fixed. Minimal degenerative changes developed, and the cleavage in the ...