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Evidence for a humoral mechanism for enhanced osteogenesis after head injury DE Garland J. Bone Joint Surg. Am. 74:152-153, 1992.
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Copyright
1992 by The Journal
of Bone
and Joint
Surgery.
Incorporated
Correspondence A Letter
to the
and double one-half
pages
referring
reasonable dence,
must
(including
typed
letter
Editor
spaced
in length.
to a recent
period including
be signed
after
To
be
Journal the
the reply
and must
article’s
ofthe
be printed
without
for
must
be
publication.
author approval
a a
within
such
Editor:
of “Evidence after
for
Head
callus
implied
which
was
was
no
had
between
intervention, become
less
and
not
this
entity,
of the
femur
but
documented
brain
entity
due
of the
femur
traction With
more
of
The
was
an
increased
callus
Clinical
to union
a patient
who
treatment
who
may
may of
be closely
heterotopic ated
only
and
that, that
early
fracture-sites. not
could been
coma,
152
injury.
a traumatic
a
for
more
Spencer
demonstrated
were
evolved
as a basic-science
results
Discussion
local to
this
and
delineate
To date,
reviews
substantiate
spasticity
agent
might
of a specific
a generalized It can trauma, of may
and callus. exert
be
increased
therefore
injury, increased
who
of the
osteoblast
mechanism we
complex
local
factors
Genetic some
to influence
site
than
influence
play
view
may
these
interactions
this
on repair
be
work
as a Other
be involved.
It remains
and
the
relative
M.Bidner,M.D. 967
Mooney
K2A
3A3,
Ontario Ian
of
Road Canada
M. Rubins,
M.D.
J. Zukor,
M.D.
David David Royal
the
M.D.
Goltzman, Victoria
Montreal
all
Hospital
Avenue
H3A
West
1AI.Canada
femur 1.
response
have
location
of the
paramount
predisposition,
had
may
phenomenon.
systemic,
callus
expected
that
clinical
patients
for cells
Ottawa,
forms a femoral
be argued
not’3.
a neurogenic
brain
other
healing were
to that
and
substanti-
healing
with
of each.
for formation
with
Several
a traumatic
who
a humoral
or
heal
accelerated
Sandy
humerus,
callus
injury.
have
from
sub-
is treated
fractures
in those
section,
to explain
both
that
his
not
osteogenesis.
in our
in trying
of the
counterpoint
that
Beyond
bone brain
a
he cites
does
size
who
increased
suggest
he
in the serum
activity
enhanced
research
on and
that,
callus.
that
have
that
of the
a traumatic
operated
factors,
further
has
demonstrated
who
stated
importance
This
be clinically
heals
important
have
who
prevalence who
period, in the
spinal
an interesting
studies
of a long
In particular,
These
point
size
is no increase
growth-factor
we
or the
of the
in a fracture
have
gives in patients
a fifteen-year
there
he misses
of both
an increased
fracture
in patients
in this
As
patients
none
to union
orthopaedic
injury,
he provides
for heterotopic and
is correct,
operatively
90242
reply: to the
demonstrates
We demonstrated
phenotype.
starting
and injury,
who
mechanisms
it can
California
brain
rapidly
work
injury,
involved
that
after
to union
and
in patients
loca-
brain
as non-neurogenic
Presently,
Center Highway
687 Pine humoral
formation and
in
operative
that
time
callus
a head
or a decrease
population’.
femur
Medical
contribution
overview
over
in a patient
observation.
at our
time
studies
both
and
claim
controlled
Our
in patients
propensity
Division
Imperial
Dr. Go/tzman
Unfortunately,
well brain
injury
non-operatively
the
East
union””.
iatrogenic
increased
brain to healing
injury.
non-operatively excessive
peripheral
However,
to the of the
has
some-
period
general
assumption
who
internal
was
a traumatic
the
be present,
treated
forthcoming5’3.
fracture,
this
and
at some
has
Amigos
a traumatic
formation
the
in the
of a femur,
bones
Los
brain-injured
observations
the
response
in
clinical
decrease
fracture
who
for M.D.
System
7601
have
It clearly
examined
own stantiate
treated
with
occur.
been
A circulating that
If
in a patient has
as
clearly
Fracwithout
The
traumatic
brain
functional
in callus
treated
long
or some
necessarily
paper.
bone
was observed.
callus
time
and
Garland’s
who
perspective.
traumatic
ortho-
healing
proximal
one
ossification
fracture
well
associated
with not
historical
a fifteen-year
bone
the
of other
to, at, and bone5.
need
alter
as
Dr.
applaud of patients and
cord
poor
injury’5’69.
in a patient
injury,
we of our
a spinal
traumatic
an increase brain
that
Dr. Zukor,
point
population”#{176}.
over
of a long to
from
heterotopic
reviews
of an operatively
be intertwined
the
cord-injured
exuberant
had
general
to demonstrate
appear
distal
stimulus
the
a traumatic
of a humerus,
ossification
and
in fractures
brain
from decreased
to differ
While
non-
reduction
in patients
appears traumatic
differed
with
Dr. Rubins,
management
callus
and
copious
to include
possibly
Dr. Bidner,
not
of survival.
callus
open Although
the
E. Garland,
Downey,
has
as a so-called
prognosis,
response
repair
has
rates
modified
has
does The
response
intervention, common.
failed
in time
who
exuberant
article,
Mechanism
Nervous
Rancho
and
non-operatively
again,
in this
Injury.” Central
of frac-
union
fatal
Once
compared
have
reviews
of delayed
and
that
of a clinical
This
was
response,
specific
care
mean
it is a part
orthopaedic
rate
anticipated
observations
institution
and
exuberant
treated
appearance
fracture
callus.
to observe
acute
risk.
its
time
emerged
Head
of traumatic
a Humoral
callus,
that
a neurogenic
recently
neurogenic
necessarily
established
for
of This
instances,there
limb
in a patient
not
a!.
of heterotopic
initially
more
consequently
tions239.
has
orthopaedic
observed,
callus.
injury were
became
times
entity
after
years
ofperipheral
failed
high
et
to question.
or anesthetic
fixation
allegedly
only
to improved
because
outcome,
With
was
“Evidence
Ossification
not
or that
exuberant
peripheral
Recently,
not
of the
open
Traumatic tures
tibia
presence
is therefore
paedic
was
mentioned.
term
In some the
does
cascade itself.
in
Douglas
Bidner many
The
neglected
in traction.
a surprisingly
union”’#{176}. The
and
Heterotopic
conclusion
observed
bridge
in the
which
by
cord.
fracture.
fracture
placed
and
initially
spinal
the
occurred
commonly
tures
injury
the
often
on
from
the
effect
been
in the
fracture
as a consequence
factor occurs
and
have
role
is the
more important agent.
are elevated
response
a cause
also
a minor
Osteogenesis
1990),
circumferential
at a distance
fracture-response operated
large
to the
and
Enhanced
Sept. was
an injury
an early
often
premise for
1144-1149,
in fracture-healing who
callus
to the
Mechanism
(72-A:
callus
in patients
exception
a Humoral
Injury”
Exuberant ago
I take
Since
could
only event
humoral
clinical
response.
of the correspondents.
factors
An elevated
a subsequent
no letter
play
initiating
factor might be as an initiating
humoral
injury.
may
the
humoral ossification
Many brain
to
title To the
factor since
circulating heterotopic
correspon-
be subjected
However,
humoral
fracture-healing,
and
publication,
will
abridgment.
the final
one
received
All
orauthors,
circulating
typewritten,
not exceed
considered
article
the editorialprocess,includingpossible will
by all authors,
references),
roles duration
of fractures.
A
D. E.: Clinical
ossification lations.
in of
Garland,
2.
Garland, head-injured
in the C/in.
Orthop.,
D. E.,
and
adult.
observations
spinal
cord
233:
86-101,
Dowling, C/in.
Downloaded from www.ejbjs.org on November 21, 2006 THE JOURNAL
and
on fractures traumatic
OF
heterotopic
injured
popu-
1988.
Veronica:
Orthop.,
and
brain
176:
BONE
Forearm
fractures
190-196,
1983.
AND
JOINT
in the
SURGERY
