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      Early Changes in Bone Density, Microarchitecture, Bone Resorption, and Inflammation Predict the Clinical Outcome 12 Weeks After Conservatively Treated Distal Radius Fractures: An Exploratory Study : EARLY CHANGES IN BONE PARAMETERS AND WRIST FRACTURE OUTCOME

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          The biology of fracture healing.

          The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes. Although there is still much to be learned to fully comprehend the pathways of bone regeneration, the over-all pathways of both the anatomical and biochemical events have been thoroughly investigated. These efforts have provided a general understanding of how fracture healing occurs. Following the initial trauma, bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, commonly only obtained by open reduction and internal fixation. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodelling steps necessary. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus. This primary callus later undergoes revascularisation and calcification, and is finally remodelled to fully restore a normal bone structure. In this article we summarise the basic biology of fracture healing. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Development of the QuickDASH: comparison of three item-reduction approaches.

            The purpose of this study was to develop a short, reliable, and valid measure of physical function and symptoms related to upper-limb musculoskeletal disorders by shortening the full, thirty-item DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure. Three item-reduction techniques were used on the cross-sectional field-testing data derived from a study of 407 patients with various upper-limb conditions. These techniques were the concept-retention method, the equidiscriminative item-total correlation, and the item response theory (Rasch modeling). Three eleven-item scales were created. Data from a longitudinal cohort study in which the DASH questionnaire was administered to 200 patients with shoulder and wrist/hand disorders were then used to assess the reliability (Cronbach alpha and test-retest reliability) and validity (cross-sectional and longitudinal construct) of the three scales. Results were compared with those derived with the full DASH. The three versions were comparable with regard to their measurement properties. All had a Cronbach alpha of > or = 0.92 and an intraclass correlation coefficient of > or = 0.94. Evidence of construct validity was established (r > or = 0.64 with single-item indices of pain and function). The concept-retention method, the most subjective of the approaches to item reduction, ranked highest in terms of its similarity to the original DASH. The concept-retention version is named the QuickDASH. It contains eleven items and is similar with regard to scores and properties to the full DASH. A comparison of item-reduction approaches suggested that the retention of clinically sensible and important content produced a comparable, if not slightly better, instrument than did more statistically driven approaches.
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              Direct three-dimensional morphometric analysis of human cancellous bone: microstructural data from spine, femur, iliac crest, and calcaneus.

              The appearance of cancellous bone architecture is different for various skeletal sites and various disease states. During aging and disease, plates are perforated and connecting rods are dissolved. There is a continuous shift from one structural type to the other. So traditional histomorphometric procedures, which are based on a fixed model type, will lead to questionable results. The introduction of three-dimensional (3D) measuring techniques in bone research makes it possible to capture the actual architecture of cancellous bone without assumptions of the structure type. This requires, however, new methods that make direct use of the 3D information. Within the framework of a BIOMED I project of the European Union, we analyzed a total of 260 human bone biopsies taken from five different skeletal sites (femoral head, vertebral bodies L2 and L4, iliac crest, and calcaneus) from 52 donors. The samples were measured three-dimensionally with a microcomputed tomography scanner and subsequently evaluated with both traditional indirect histomorphometric methods and newly developed direct ones. The results show significant differences between the methods and in their relation to the bone volume fraction. Based on the direct 3D analysis of human bone biopsies, it appears that samples with a lower bone mass are primarily characterized by a smaller plate-to-rod ratio, and to a lesser extent by thinner trabecular elements.
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                Author and article information

                Journal
                Journal of Bone and Mineral Research
                J Bone Miner Res
                Wiley
                08840431
                September 2014
                September 2014
                August 20 2014
                : 29
                : 9
                : 2065-2073
                Affiliations
                [1 ]Department of Human Movement Sciences; Maastricht University; Maastricht The Netherlands
                [2 ]Research School NUTRIM; Maastricht University; Maastricht The Netherlands
                [3 ]Centre on Aging and Mobility; University of Zurich; Zurich Switzerland
                [4 ]Department of Internal Medicine; Maastricht University Medical Center; Maastricht The Netherlands
                [5 ]Department of Medical Informatics; RWTH Aachen University; Aachen Germany
                [6 ]Department of Orthopaedic Surgery; Maastricht University Medical Center; Maastricht The Netherlands
                [7 ]Research School CAPHRI; Maastricht University; Maastricht The Netherlands
                [8 ]Department of Family Medicine; Maastricht University; Maastricht The Netherlands
                [9 ]Department of Trauma Surgery; Maastricht University Medical Center; Maastricht The Netherlands
                [10 ]Central Diagnostic Laboratory; Maastricht University Medical Center; Maastricht The Netherlands
                [11 ]Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
                [12 ]Biomedical Research Center; Hasselt University; Hasselt Belgium
                [13 ]Department of Internal Medicine; Viecuri Medical Center Venlo; Venlo The Netherlands
                [14 ]Department of Rheumatology; Maastricht University Medical Center; Maastricht The Netherlands
                Article
                10.1002/jbmr.2225
                24644096
                bd488cac-62a7-4eb5-a76a-296afb97e0f2
                © 2014

                http://doi.wiley.com/10.1002/tdm_license_1.1

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