Effect of lymphedema on the recovery of fractures.

swollen back, rash, Lymph node fibrosclerosis, Immunodificient Limb, DVT, venous insufficiency, inflammation, inflammatory response, bone fractures

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Effect of lymphedema on the recovery of fractures.

Postby patoco » Mon Dec 17, 2007 8:44 am

Effect of lymphedema on the recovery of fractures.

J Orthop Sci. 2007 Nov;

Arslan H, Uludağ A, Kapukaya A, Gezici A, Bekler HI, Ketani A.
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.



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Healing of tibial fracture and response of local lymphatics

Postby patoco » Fri Dec 21, 2007 6:46 am

After posting the above article, I ran accross this brief study that help to understand the physiology of what transpires between the lymphatics and bone fractures:

The healing of tibial fracture and response of the local lymphatic system.

Szczesny G, Olszewski WL, Gewartowska M, Zaleska M, Górecki A.
Department of Surgical Research and Transplantology, Medical Research
Centre, Polish Academy of Sciences, Warsaw, Poland.

BACKGROUND: Damage of tissues by mechanical injury and inflammation is followed by reaction of the regional lymphoid tissue, lymphatics, and lymph nodes. In our previous lymphoscintigraphic studies, we showed that closed fractures of a lower limb cause reaction of the local lymphoid tissue. There was dilation of lymphatics draining the
site of the fracture and enlargement of inguinal lymph nodes. These
changes persisted even after clinical healing of the fracture. In the
long-lasting nonhealing fractures, the lymphoscintigraphic pictures
were different. The draining lymphatics became obliterated, and the
lymph nodes disappeared.

METHODS: In this study, we tried to correlate the lymphoscintigraphic images, reflecting the immune events at the fracture site, with the immunohistochemical observations of the biopsy specimens obtained during corrective operations from the healing and nonhealing fracture gaps. Thirty-eight patients with closed fracture of the tibia without
traumatic skin changes were studied.

RESULTS: We confirmed that closed tibial fracture evokes response of the regional lymphatic system. Normal fracture healing with immune cell infiltrates and foci of ossification was accompanied by dilated
lymphatics and enlarged lymph nodes. Prolonged nonhealing fracture
with lack of cellular reaction in the gap proceeded with decreased
mass of lymph nodes.

CONCLUSION: This study provides evidence for existence of a
functional axis between wound of bone and surrounding soft tissue and
the local lymphatic (immune) system. We hypothesize that the fast
healing is regulated by influx into the wound of lymph node
regulatory cells, whereas prolonged healing causes gradual exhaustion
of the regional lymph node functional elements, and reciprocally
impairment in sending regulatory cells to the fracture gap.

PMID: 18090016 [PubMed - in process]

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