The International Society For Fracture Repair Newsletter May 2013 From the President, Dear ISFR colleagues, .
Takashi Matsushita President of ISFR
Proximal Humeral Fracture Workshop Edinburgh September 2012
There was lively debate at the first Proximal Humeral Workshop (PHF) organized by the International Society for Fracture Repair. The international panel comprised of orthopaedic surgeons who are specialists in the treatment of PHFs using different approaches. They were joined by experts in outcomes research, and experts from the allied fields of radiology and musculoskeletal bioengineering. Also in attendance were representatives from the orthopaedic and pharmaceutical industries. This proved to be the ideal forum for effective cross talk between providers and enablers who all had the common goal of improving the standard of care and treatment of patients who had sustained a PHF.
As this was the first workshop of the ISFR’s covering this particular topic, the aim was to throw open the field to all the participants (orthopaedic surgeons, engineers, epidemiologists, outcome scientists, and physiotherapist) to identify the really important issues. Therefore, we chose to set the scene by asking, “What doesn’t work in your hands and why?” More time was allocated to discussion than to formal presentations, that enabled all present to voice their views. In summary, the topics of importance that were raised by the groups included:
Emphasis upon instrumentation to optimize restoration of anatomy and correct position of Despite the variety of surgical treatment options that are implants available, PHFs remain difficult injuries to treat and are associated with unpredictable outcomes and not Implant and biologics related issues aimed in paruncommonly significant complications. ticular at reducing the incidence of implant reFor this reason, many clinicians prefer to treat these lated complications by augmenting fractures. injuries conservatively although surgeons who treat these Identifying methods for improving stability of vainjuries operatively on a regular basis have little doubt that, rus fractures. in the correct hands, the clinical outcome following surgical Establishing outcome measures that are of use to treatment is superior to conservative the Orthopaedic community management for the more complex injuries. Optimizing rehabilitation Where does the problem lie? There is little doubt that for many patients implant related and surgical factors influence the clinical outcome and need to be explored in more We would like to thank Acumed, Carbofix, Orthofix, depth. Synthes, Tornier & Zimmer for supporting this However, our current methods of assessment, both workshop . radiological and clinical have serious limitations and like2 wise need to be explored further.
Featuring‌.. Young Investigators Network The ARTOF Society was founded in 1997 by some of the most respected orthopedic and Trauma-surgeons with highest international reputation in order to build an independent platform of discussion and distribution of modern therapeutical concepts for all kind of trauma victims. The background of the promoted therapies is the scientific underlined concept of evidence based medicine. This knowledge is carried into the community of orthopedic and trauma surgeons regularly on conferences and in face to face training programs and hands on courses. We welcome support from those with a particular interest in promoting the optimal treatment of trauma victims, from manufactures of surgical devices to producers of casting materials, governmental institutions or insurers who are interested in the most cost and time effective of treatment options. Our last contributions were held at the SICOT Congress in Prague 2011, EFORT Kongress 2012 Berlin, SICOT Dubai 2012. The next contributions will be held in June 2013 in Istambul. Since the society is a strictly independent organization, it has an approved charity status within the European community and North America. President - Prof. Peter Biberthaler University Hospital Munich Rechts der Isar Secretary—Andreas Ruecker
Andreas Ruecker is an upper and lower limb trauma surgeon working as chief senior consultant at the Level 1 Trauma Centre of the University Hospital in Hamburg. Beside special interest in Geriatric Trauma, fracture repair and the treatment of fracture complications and revision surgery his special interests is in developing new surgical devices and techniques for fracture care. He is involved in medical education for students and surgeons.
3
International Society For Fracture Repair’s Young Investigator Network
The ISFR is dedicated to achieving scientific excellence in the field of fracture repair. This would not be achievable without the initiative and dedication of Young Investigators. The ISFR would like to establish the YIN to exchange ideas between peers and mentors. We would like to introduce a second member who presented at the ISFR biennial conference last November
Erica was honored to present her MSc work “Cell Therapy for Fracture Nonunion” at the 13th Biennial Conference of the International Society for Fracture repair in Kyoto, Japan. She plans to return to Toronto to defend her MSc in the summer of 2013 while completing an orthopaedic research project for her Yale MD thesis, and looks forward to continuing her pursuit of a career in musculoskeletal medicine and research. The Musculoskeletal Research Lab focuses on applying cell and molecular biology to stimulate bone repair after traumatic injury. Fracture is the most common outcome of traumatic injury; following high-energy breaks, the process of bone repair can be overwhelmed and debilitating fracture nonunion may develop. Recently the lab has focused on manipulating the complex interactions between angiogenesis and osteogenesis to stimulate bone regeneration in models of segmental bone loss. The goal of the work is to further the development of biologic strategies to address fracture repair, stimulating healing by targeting cellular and molecular mechanisms that are pathologic in nonunion.
A litany of evidence indicates fracture nonunion may stem from a failure of proper vascularization of the injury site. Endothelial progenitor cells (EPCs) are novel cellular agents that contribute to postnatal neovascularization and are hypothesized to play a role in angiogenesis following injury. Based on recent evidence that EPCs stimulate both osteogenesis and angiogenesis in vivo, and from a clinical pilot of EPCs for tibial nonunion, scientists at the Musculoskeletal Research Lab sought to investigate the different subtypes of EPC for their role in the fracture repair process by examining angiogenic and osteogenic potential. Late outgrowth endothelial cells (OECs) are a subtype of EPCs that display distinct surface markers, secretion products, enhanced proliferation and tubulogenesis in vitro; as such, OECs were determined to be promising cellular candidates to enhance fracture repair. EPCs and OECs were characterized by flow cytometry, ELISA, and functional Erica Giles was born and raised in Saskatchewan, Canada. An assays before comparing the cell therapies in a rat segmental enthusiasm for sport and an interest in injury rehabilitation led her defect model. While OECs possessed superior in vitro tubulogenesis to complete a BSc. Kinesiology with a minor in Psychology at the and BMP-2 expression, co-culture models showed inhibition of OEC University of Victoria in 2010. During her degree, she was tube formation in the presence of osteoblasts. Pilot work indicates developed a fascination with mechanobiology of the EPCs may be superior to OECs in healing critical-sized defects in a musculoskeletal system. rat femur, and it is hypothesized that this may be due to Her summers were spent completing orthopaedic research terms in differential expression of CXCR4 by EPCs. The work is a novel comCalgary Alberta under the mentorship of Dr. Paul Salo and Dr. Wal- parison of progenitor cell subtypes, and will contribute to developter Herzog with support from the National Sciences and Engineering ing focused EPC treatments as the cell type moves into clinical Research Council of Canada. orthopaedic applications. Upon graduation, she was awarded the Canadian Institute of Health Research graduate scholarship and the David E. Hastings award to pursue an MSc at the University of Toronto. Under the supervision of orthopaedic clinician-scientists Dr. Emil Schemitsch and Dr. Aaron Nauth, Erica led a project in translational orthopaedic research at the Musculoskeletal Lab of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, Ontario. After completing her lab work in 2012, Erica moved to the US and is now finishing her first year as a medical student at Yale University. 4
Announcement
FFN Association & FFN Membership | www.ff-network.org
FFN Global Congress 2013 | www.ffn-congress.com
FFN invites you to join the 2nd FFN Global Congress 2013 in Berlin, Germany from 29-31st August 2013 We encourage interaction and networking and this year you can participate in one of 2 ways: By submitting an abstract for a poster/presenatation or by submitting a workshop proposal. Registration now open Take advantage of early bird registration fees and register by 15th May 2013 For more information please refer to www.ffn-congress.com T
Prof. David Marsh President of the Fragility Fracture Network (FFN)
Prof. Karsten Dreinhรถfer Congress Chair
5