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Effect of lymphedema on the recovery of fractures

  • Hüseyin Arslan
  • Abuzer Uludağ
  • Ahmet Kapukaya
  • Ayten Gezici
  • H. Ibrahim Bekler
  • Aydın Ketani
Original article

Abstract

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.

Keywords

Trabecular Bone Lymphedema Fracture Healing Callus Tissue Inguinal Area 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Japanese Orthopaedic Association 2007

Authors and Affiliations

  • Hüseyin Arslan
    • 1
  • Abuzer Uludağ
    • 1
  • Ahmet Kapukaya
    • 1
  • Ayten Gezici
    • 2
  • H. Ibrahim Bekler
    • 3
  • Aydın Ketani
    • 4
  1. 1.Department of Orthopedic and Trauma Surgery, University of DicleSchool of MedicineDiyarbakirTurkey
  2. 2.Department of Nuclear Medicine, University of DicleSchool of MedicineDiyarbakirTurkey
  3. 3.Department of Orthopedic and Trauma Surgery, University of YeditepeSchool of MedicineIstanbulTurkey
  4. 4.Department of Histology and Embryology, University of DicleSchool of Veterinarian MedicineDiyarbakirTurkey

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