Fracture vascularity and bone healing: A systematic review of the role of VEGF

Academic Dept of Trauma & Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, UK.
Injury (Impact Factor: 2.14). 10/2008; 39 Suppl 2(Suppl 2):S45-57. DOI: 10.1016/S0020-1383(08)70015-9
Source: PubMed


Fracture healing constitutes a complex and delicate physiological process. Local vascularity at the site of the fracture has been identified as one of the most significant parameters influencing the healing procedure. VEGF is the most important component of the regeneration of the vascular system at the fracture site. The aim of this review is to determine the evidence supporting the direct role of VEGF in the enhancement of fracture healing and the possible clinical use of VEGF for non-unions. The literature search was performed via the internet using the Medline. The key words which were searched in the abstracts were the terms "VEGF", "angiogenesis", "fracture", "bone" and "healing". Twenty-five articles were relevant to the topic of interest. A total of 11 articles were excluded from our research due to non conformity of their content to the inclusion criteria. Evidence retrieved suggests that VEGF could be extremely valuable for the treatment of critical size bone defects and that VEGF could have a direct effect on osteoprogenitor cells, mainly by promoting the differentiation of osteoblasts and by increasing the mineralisation of the regenerated bone. The former observation could have very interesting repercussions for the field of non-unions and the latter for the field of osteoporosis.

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Available from: Vassilios S Nikolaou, Nov 15, 2015
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    • "The increase in blood flow around the fracture during the healing process increases the temperature of the surrounding tissue. As the bone heals, the temperature around the fracture site should start to decrease [1] [2] [3] [4] [5]. These temperature changes can be detected by infrared thermography, which is a non-invasive and harmless method of "
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    ABSTRACT: Introduction: The bone healing process is very complex. In simple terms, bone healing comprises three basic steps, the inflammation phase, the repair phase and the remodelling phase. The increase in blood flow around the fracture during the healing process increases the temperature of the surrounding tissue. Infrared thermography is a method of measuring body temperature that can detect temperature changes during bone healing. Studies on the application of thermography in traumatology are scarce, and there are no studies of thermal changes during normal bone healing. The authors have tried to determine the dynamics of thermal changes during bone healing. Material and methods: The Flir ThermaCam B2 (FLIR Systems, Inc., Oregon, USA) was used for all measurements. Thermographic recordings were made one, three, five, 11 and 23 weeks after fracture. The contralateral, healthy, forearm was used for comparison. Results: A total of 25 patients of mean age 65.9±10.4 years (range 50-80 years) with fracture of the distal radius were examined in this study. The mean temperature difference between healthy and fractured distal forearm one week after fracture was 1.20±0.48°C, three weeks after fracture was 1.42±0.54°C, five weeks after fracture was 1.04±0.53°C, 11 weeks after fracture was 0.50±0.30°C, and 23 weeks after fracture was 0.22±0.25°C. Conclusion: Preliminary findings during this research showed significant temperature changes during healing of distal radius fractures. Infrared thermography is a simple and reliable method in clinical practice that could be used as a good follow-up method in traumatology, but further investigations on more patients are needed.
    Full-text · Article · Nov 2015 · Injury
    • "E-mail: andreas.traweger@pmu. remain clinically challenging (Gomez-Barrena et al., 2011; Keramaris et al., 2008; Steinmann and Herkowitz, 1992). Currently, autologous iliac crest bone grafting represents the gold standard for treating large defects in the clinic. "
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    ABSTRACT: Despite significant advancements in bone tissue-engineering applications, the clinical impact of bone marrow stromal cells (BMSCs) for the treatment of large osseous defects remains limited. Therefore, other cell sources are under investigation for their osteogenic potential to repair bone. In this study, tendon-derived stromal cells (TDSCs) were evaluated in comparison to BMSCs to support the functional repair of a 5 mm critical-sized, segmental defect in the rat femur. Analysis of the trilineage differentiation capacity of TDSCs and BMSCs cultured on collagen sponges revealed impaired osteogenic differentiation and mineral deposition of TDSCs in vitro, whereas chondrogenic and adipogenic differentiation was evident for both cell types. Radiographic assessment demonstrated that neither cell type significantly improved the healing rate of a challenging 5 mm segmental femoral defect. Transplanted TDSCs and BMSCs both led to the formation of only small amounts of bone in the defect area, and histological evaluation revealed non-mineralized, collagen-rich scar tissue to be present within the defect area. Newly formed lamellar bone was restricted to the defect margins, resulting in closure of the medullary cavity. Interestingly, in comparison to BMSCs, significantly more TDSC-derived cells were present at the osteotomy gap up to 8 weeks after transplantation and were also found to be located within newly formed lamellar bone, suggesting their capacity to directly contribute to de novo bone formation. To our knowledge, this is the first study investigating the in vivo capacity of TDSCs to regenerate a critical-sized defect in the rat femur. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Oct 2015 · Journal of Tissue Engineering and Regenerative Medicine
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    • "K. Joensuu et al. / Orthopaedics & Traumatology: Surgery & Research 101 (2015) 381–386 fracture healing [10] [11] "
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    ABSTRACT: Despite recent advances in bone tissue engineering, efficient bone formation and vascularization remains a challenge for clinical applications.
    Full-text · Article · May 2015 · Revue de Chirurgie Orthopédique et Traumatologique
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