Effect of lymphedema on the recovery of fractures.

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Effect of lymphedema on the recovery of fractures.

Postby patoco » Sat Dec 15, 2012 2:04 pm

Lymphedema and Bone Fractures

Effect of lymphedema on the recovery of fractures.

Keywords: lymphedema; fracture; group; n/mm; osteoclast; bone; rat; osteotomy; callu; osteoblast; knit; heal; control group; recovery; bone heal;

Hüseyin Arslan, Abuzer Uludağ, Ahmet Kapukaya, Ayten Gezici, H Ibrahim Bekler, Aydin Ketani
Department of Orthopedic and Trauma Surgery, University of Dicle, School of Medicine, Diyarbakir, Turkey.

BACKGROUND
Lymphedema delays the healing of any wound by negatively affecting its inflammatory period. Whether it affects bone healing in a similar negative manner is unknown. Therefore, we experimentally investigated the effect of lymphedema on fracture recovery.

METHODS
We used thirty 200- to 250-g Sprague-Dawley rats for the experiment. The rats were randomly divided into two groups of 15 rats each for the experimental lymphedema and control groups. Lymphedema development was confirmed by measuring the circumference and diameter of the extremities together with lymphoscintigraphy. Twenty days after the development of lymphedema, a fracture model was created in both groups in the right tibia with mid-diaphyseal osteotomy and fixing with an intramedullary Kirschner wire. After 6 weeks, all rats were sacrificed and the callus tissue that formed along the osteotomy was compared between groups with respect to radiographic, histological, and biomechanical characteristics.

RESULTS
The three-point bending test yielded an average stiffness value of 1227 N/mm (n = 6) in the control group and 284 N/mm (n = 7) in the experimental lymphedema group (P < 0.05). At the end of week 6, radiographic evaluation showed that solid knitting was obtained in the control group, whereas in the lymphedema group delayed or no knitting was observed. In the control group, histological investigation revealed normal callus morphology. Trabecular bone was normal and osteoblast and osteoclast activity was clearly evident. The bone was stained homogeneously with hematoxylin and eosin, and ossification was within normal limits. In the lymphedema group, however, the histological appearance was mostly that of scar tissue. In addition, osteoblast and osteoclast activity was much less visible or absent.

CONCLUSIONS Lymphedema negatively affected bone healing in rats. However, the mechanism of this negative effect and its occurrence in humans are still unknown. Further experimental and clinical studies are needed to support and extend our findings.

Springerlink

Lymphedema of the hand and forearm following fracture of the distal radius.

Feb 2008

Kasper DA, Meller MM.

Source

Department of Orthopedic Surgery, Veterans Hospital, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081, USA.

Abstract

Lymphedema of the hand following a fracture of the distal radius is a disabling, but rare complication. Although the pathogenesis of this mechanism is poorly understood, extensive review of the literature suggests that an underlying cause of this lymphedema is psychogenic in nature. After numerous therapeutic modalities including intense physiotherapy, sympathetic nerve blocks and hospitalization, our patient still continued to persist with this debilitating disease. This article presents a case of Colles fracture complicated by nonpitting edema in a 62-year-old woman in whom psychogenic causes were not identified. The surgical procedure in our patient was uncomplicated and thus lymphedema was uncomplicated and thus lymphedema secondary to any vascular injury was ruled out. Questions that need to be addressed are whether the onset of the fracture induced an avascular anastomosis that led to the lymphedema. Our conclusions led us to believe the development of lymphedema of the distal radius following Colles fracture was idiopathic in our patient.

PubMed
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Re: Effect of lymphedema on the recovery of fractures.

Postby blubrdfrend » Mon Dec 17, 2012 8:35 pm

This is an informative article. I am concerned about the effects of lymphedema on a broken hip or leg.
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