Aetiology of Heterotopic Ossification - Rob Sneath 11/7/2002

Author Chalmers J. (Edinburgh), Gray D.H., Rush J. Title Observations on the induction of bone in soft tissues Reference JBJS 57(B): 1.(Feb’75) Summary Well structured experiments looking at the inductive capacity of various soft tissues to produce bone using bone decalcified with 0.6 N hydrochloric acid (dead) in rabbits. Muscle and fascia regularly permitted the induction of bone, while liver, spleen and kidney suppressed it. Take away message Suggested that three conditions must be present for the production of bone: 1. an inducing agent; 2. an osteogenic precursor cell; 3. an environment which is permissive to osteogenesis Author Urist M.(Los Angeles), Nakagawa M., Nakata N. and Nogami H. Title Experimental Myositis Ossificans Reference Arch Pathol Lab Med Vol 102, June 1978 Summary In these experiments the inducing agent was bone matrix gelatine and the precursor cells from muscle, which were separated by an acetate membrane in an avascular system in rats. Cartilage only, was produced in this set up, the product having to be transplanted into a vascularised muscle pouch to produce bone. Critique One of many publications by the team who discovered and did extensive work on BMP (Bone Morphogenetic Protein). They hypothesise that high oxygen saturation and low carbon dioxide tension may be essential requirements for bone tissue development. Author Chantraine A.(Geneva), Minaire P.(St. Etienne) Title Para-Osteo-Arthropathies. A New Theory and Modes of Treatment. Reference Scand J Rehab Med 13:31-37,1981 Summary Paper encompassing the clinical findings of heterotopic ossification in paraplegia and a research study involving calcium kinetic, bone circulatory, biochemical, and immunological experiments. Theory points mainly to the circulatory disturbances seen in paraplegics and local microtraumas to muscle Critique Research methodology and tabulated results absent. Far ranging theories not clearly proved in the paper Author Ho S.(Hawaii), Stern L., Bruno J., Wyrick J., Waymack J. and Alexander J Title Pharmacological inhibition of prostaglandin E2 in bone and it’s effect on pathological new bone formation in a rat burn model Reference Trans Orthop Res Soc. 1988;13:536 Summary PGE2 was inhibited with Indomethacin and Dexamethasone, with saline as a control. Both were shown to decrease bone formation in this model Critique Represents the first successful inhibition of postburn pathological bone formation pharmacologically.

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