Published online Jul 18, 2016. doi: 10.5312/wjo.v7.i7.418
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
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.
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.