Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2016; 7(7): 418-425
Published online Jul 18, 2016. doi: 10.5312/wjo.v7.i7.418
Evaluation of bone remodeling in regard to the age of scaphoid non-unions
Susanne Rein, Uwe Hanisch, Hans-Eberhard Schaller, Hans Zwipp, Stefan Rammelt, Stefan Weindel
Susanne Rein, Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, 06112 Halle (Saale), Germany
Susanne Rein, Hans Zwipp, Stefan Rammelt, Center of Orthopaedics and Traumatology, University Medicine “Carl Gustav Carus” Dresden, Technical, University Dresden, 01307 Dresden, Germany
Uwe Hanisch, Institute of Pathology, “Carl Thiem” Hospital, 03048 Cottbus, Germany
Hans-Eberhard Schaller, Deptartment of Plastic, Hand, Reconstructive and Burn Surgery, Trauma Center Tuebingen-University, 72076 Tuebingen, Germany
Stefan Weindel, Deptartment of Hand, Aesthetic and Plastic Surgery, Hospital of Linth, 8730 Uznach, Switzerland
Author contributions: All authors made substantive intellectual contributions to this study, whether in the contributions to conception and design (Rein S, Hanisch U, Schaller HE, Zwipp H, Rammelt S, Weindel S), or acquisition of data (Rein S, Schaller HE, Weindel S), or analysis and interpretation of data (Rein S, Hanisch U, Schaller HE, Zwipp H, Rammelt S, Weindel S), or drafting and revising the manuscript critically (Rein S, Hanisch U, Schaller HE, Zwipp H, Rammelt S, Weindel S).
Institutional review board statement: This study was approved by the University of Tübingen Institutional review board (approval number: 367/2007A).
Informed consent statement: All patients gave their informed consent prior to surgery.
Conflict-of-interest statement: This study was financially supported by Zimmer Company, Münsingen, Switzerland. It is declared that the company was not involved in planning the experiment, and did not take part in data collection, analyses, interpretation of data or writing of the manuscript. The authors declare that they have no competing interests and disclose any financial conflicts of interest that may influence interpretation of this study and/or results.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Susanne Rein, MD, PhD, Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Merseburger Straße 165, 06112 Halle (Saale), Germany. susanne.rein@web.de
Telephone: +49-345-1326333 Fax: +49-345-1326334
Received: January 22, 2016
Peer-review started: January 22, 2016
First decision: March 1, 2016
Revised: March 26, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 18, 2016
Processing time: 170 Days and 23.8 Hours
Abstract

AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions (SNU) with immunohistochemistry.

METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin (HE), tartrate resistant acid phosphatase (TRAP), CD 68, osteocalcin (OC) and osteopontin (OP). Histological examination was performed in a blinded fashion.

RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU (P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts (P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts (P = 0.008; r = 0.43). SNU older than 6 mo showed a significant decrease of the number of fibroblasts (P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.

CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.

Keywords: Bone remodeling; Histology; Immunohistological staining; Scaphoid non-union; Scaphoid; Wrist joint

Core tip: The bone remodeling in regard to the age of scaphoid non-union is investigated with immunohistochemistry. Multinuclear osteoclasts showed a significant decrease in relation of the age of scaphoid non-union, but smoking and the age of the patients had no influence on bone remodeling. Most of the immunhistochemical findings of bone remodeling do not correlate with the age of the scaphoid non-unions, which indicates a permanent imbalance of bone formation and resorption.