Información del artículo
Durante la consolidación de las fracturas se administran muchos fármacos vía sistémica que alteran en mayor o menor grado la evolución de las mismas. También la condicionan el estado nutricional del enfermo, así como la presencia de hábitos tóxicos (alcohol y tabaco). Es importante conocer cuáles afectan más a la consolidación para elegir los que interfieren menos con ésta. Desde un punto de vista práctico se debe tener especial cuidado en utilizar los antiinflamatorios no esteroideos (AINE) con prudencia los primeros días, suministrar un adecuado aporte nutricional (sobre todo de proteínas), dejar de fumar, suspender el uso de fármacos para la osteoporosis y evitar el uso de ciprofloxacino (si hay otras alternativas).
Palabras clave:
consolidación
fracturas
factores locales
factores sistémicos
During fracture healing many drugs are administered systemically that alter, to a greater or lesser degree, the evolution of the injuries. Healing is also conditioned by the patient's nutritional status, and any habits that may exert a negative impact (alcohol or drugs). As to therapeutic drugs, it is important to know which affect healing most, so as to choose those that interfere less with this process. From the practical point of view, especial care must be taken to use non-steroidal antiinflammatory drugs (NSAIDs) carefully during the first few days, to provide an adequate nutritional intake (especially proteins), to get the patient to stop smoking, to discontinue the use of drugs for the treatment of osteoporosis and to avoid the use of cyprofloxacin (if other valid alternatives exist).
Keywords:
healing
fractures
local factors
systemic factors
El Texto completo está disponible en PDF
Bibliografía
[1]
Einhorn T.A..
Enhancement of fracture healing by molecular of Physical means: an Overview..
Enhancement of fracture healing by molecular of Physical means: an Overview., pp. 223-238
[2]
Buckwalter J.A., Einhorn T.A., Marsh J.L..
Bone and joint healing..
Bone and joint healing., pp. 245-271
[3]
Day S.M., Ostrum R.F., Chao E.Y.S., Rubin C.T., Aro H.T., Einhorn TA..
Bone injury, regeneration and repair..
Bone injury, regeneration and repair., pp. 372-399
[4]
Schenk R.K., Hunziker E.B..
Histologic and ultrastructural features of fracture healing..
Histologic and ultrastructural features of fracture healing., pp. 117-146
[5]
Munuera L., Cordero J..
Ingeniería tisular ósea..
Ingeniería tisular ósea., (2001),
[6]
Hogevold H.E., Grogaard B., Reikeras O..
Effects of short-term treatment whith corticosteroids and indomethacin on bone healing. A mecanical study of osteotomies in rats..
Acta Orthop Scand. , 63 (1992), pp. 607-611
[7]
Keller J..
Effects of indomethacin and local prostaglandin E2 on fracture healing in rabbits..
Dan Med Bull. , 43 (1996), pp. 317-329
[8]
Giannoudis P.V., McDonald D.A., Matthws S.J., Smith R.M., Furlong A.J., De Boer P..
Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs..
J Bone Joint Surg. , 82-B (2000), pp. 655-658
[9]
Dimar J.R., Ante W.A., Zhang Y.P., Glassman S.D..
The effects of nonsteroidal anti-inflamatory drugs on posterior spinal fusions in the rat..
Spine. , 21 (1996), pp. 1870-1876
[10]
Martin G.J., Boden S.D., Titus L..
Recombinant human bone morphogenetic protein-2 overcomes the inhibitory effect of ketorolac, a nonsteroidal anti-inflamatory drug (NSAID), on posterolateral lumbar intertransverse process spine fusion..
Spine. , 24 (1999), pp. 2188-2193
[11]
Aspenberg P..
Drugs and fracture repair..
Acta Orthop. , 76 (2005), pp. 741-748
[12]
Vega Jimena MV. Analgésicos y consolidación de fracturas [tesis doctoral]. Jaén: Universidad de Jaén; 2003..
[13]
Huo M.H., Troiano N.W., Pelker R.R., Gundberg C.M., Friedlander G.E..
The influence of ibuprofen on fracture repair: biomechanical, biochemical, histologic and histomorphometric parameters in rats..
J Orthop Res. , 9 (1991), pp. 383-390
[14]
Endo K., Sairyo K., Komatsubara S., Sasa T., Egawa H., Ogawa T., et-al..
Cyclooxygenase-2 inhibitor delays fracture healing in rats..
Acta Orthop. , 76 (2005), pp. 470-474
[15]
Gerstenfeld L.C., Thiede M., Seibert K., Mielke C., Phippard D., Svagr B., et-al..
Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs..
J Orthop Res. , 21 (2003), pp. 670-675
[16]
Wheeler P., Batt M.E..
Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review..
Br J Sports Med. , 39 (2005), pp. 65-69
[17]
Burd T.A., Hughes M.S., Anglen J.O..
Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone non-union..
J Bone Joint Surg Br. , 85-B (2003), pp. 700-705
[18]
Bergenstock M., Min W., Simon A.M., Sabatino C., O’Connor J.P..
A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats..
J Orthop Trauma. , 19 (2005), pp. 717-723
[19]
Schemitsch E.H., Bhandari M..
Bone healing and grafting..
Bone healing and grafting., pp. 19-30
[20]
Dodds R.A., Catterall A., Bitensky L., Chayen J..
Effects on fracture healing of an antagonist of the vitamin K cycle..
Calcif Tissue Int. , 36 (1984), pp. 233-238
[21]
Einhorn T.A., Gundberg C.M., Devlin V.J., Warman J..
Fracture healing and osteocalcin metabolism in vitamin K deficiency..
Clin Orthop. , 237 (1988), pp. 219-225
[22]
Street J.T., McGrath M., O’Regan K., Wakai A., McGuinness A., Redmond H.P..
Thromboprophylaxis using a low molecular weight heparin delays fracture repair..
Clin Orthop. , 381 (2000), pp. 278-289
[23]
Huddleston P.M., Steckelberg J.M., Hanssen A.D., Rouse M.S., Bolander M.E., Patel R..
Ciprofloxacin inhibition of experimental fracture healing..
J Bone Joint Surg. , 82-A (2000), pp. 161-173
[24]
Perry A.C., Prpa B., Rouse M., Piper K.E., Hanssen A.D., Steckelberg J.M., et-al..
Levofloxacin and trovafloxacin inhibition of experimental fracture-healing..
Clin Orthop. , (2003), pp. 95-100
[25]
Hazan E.J., Hornicek F.J., Tomford W., Gebhardt M.C., Mankin H.J..
The effect of adjuvant chemotherapy on osteoarticular allografts..
Clin Orthop. , 385 (2001), pp. 176-181
[26]
Paavolainen P., Taivainen T., Michelsson J.E., Lalla M., Penttinen R..
Calcitonin and fracture healing. An experimental study on rats..
J Orthop Res. , 7 (1989), pp. 100-106
[27]
Lindgren J.U., Narechania R.G., McBeath A.A., Lange T.A., De-Luca H.F..
Effects of 1,24 dihydroxyvitamin D3 and calcitonin on fracture healing in adult rats..
Clin Orthop. , 160 (1981), pp. 304-308
[28]
Ekeland A., Gautvik K.M., Underdal T..
Calcitonin producing tumour. Effects on fracture repair and normal bone in rats..
Acta Orthop Scand. , 54 (1983), pp. 760-767
[29]
Peter C.P., Cook W.O., Nunamaker D.M., Provost M.T., Seedor J.G., Rodan G.A..
Effect of alendronate on fracture healing and bone remodeling in dogs..
J Orthop Res. , 14 (1996), pp. 74-79
[30]
Li C., Mori S., Li J., Kaji Y., Akiyama T., Kawanishi J., et-al..
Long-term effect of incadronate disodium (YM-175) on fracture healing of femoral shaft in growing rats..
J Bone Miner Res. , 16 (2001), pp. 429-436
[31]
Odvina C.V., Zerwekh J.E., Rao D.S., Maaluf N., Gottschalk F.A., Pak C.Y.C..
Severely suppressed bone turnover: a potential complication of alendronate therapy..
J Clin Endocr Metab. , 90 (2005), pp. 1294-1301
[32]
Rosier R.N., Bukata S.V..
Bone metabolism and metabolic bone diseases..
Bone metabolism and metabolic bone diseases., pp. 19-30
[33]
Monaghan B.A., Kaplan F.S., Lyttle C.R., Fallon M.D., Boden S.D., Haddad J.G..
Estrogen receptors in fracture healing..
Clin Orthop. , 280 (1992), pp. 277-280
[34]
Skripitz R., Aspenberg P..
Parathyroid hormone – a drug for ofthopaedic surgery?..
Acta Orthop Scand. , 75 (2004), pp. 654-662
[35]
Alkhjary Y.M., Gerstenfeld L.C., Krall E., Westmore M., Sato M., Mitlak B.H., et-al..
Enhancement of experimental fracture-healing by systemic administration of recombinant human parathyroid hormone (PTH 1-34)..
J Bone Joint Surg Am. , 87(A) (2005), pp. 731-741
[36]
Andreassen T.T., Fledelius C., Ejersted C., Oxlund H..
Increases in callus formation and mechanical strength of healing fractures in old rats treated with parathyroid hormone..
Acta Orthop Scand. , 72 (2001), pp. 304-307
[37]
Meier C.R., Schlienger R.G., Kraenzlin M.E., Schlegel B., Jick H..
HMG-CoA reductase inhibitors and the risk of fractures..
JAMA. , 283 (2000), pp. 3205-3210
[38]
Pasco J.A., Kotowicz M.A., Henry M.J., Sanders K.M., Nicholson G.C..
Statin use, bone mineral density and fracture risk..
Arch Intern Med. , 162 (2002), pp. 537-540
[39]
Skoglund B., Forslund C., Aspenberg P..
Simvastatin improves fracture healing in mice..
J Bone Miner Res. , 17 (2002), pp. 2004-2008
[40]
Jensen J.E., Jensen T.G., Smith T.K., Johnston D.A., Dudrick S.J..
Nutrition in orthopaedic surgery..
J Bone Joint Surg. , 64-A (1982), pp. 1263-1272
[41]
Koval K.J., Maurer S.G., Su E.T., Aharonoff G.B., Zuckerman J.D..
The effects of nutritional status on outcome after hip fracture..
J Orthop Trauma. , 13 (1999), pp. 164-169
[42]
Einhorn T.A., Bonnarens F., Burstein A.H..
The contribution of dietary protein and mineral to the healing of experimental fractures. A biomechanical study..
J Bone Joint Surg Am. , 68(A) (1986), pp. 1389-1395
[43]
Yamaguchi M., Igarashi A., Misawa H., Tsurusaki Y..
Enhancement of albumin expression in bone tissues with healing rat fractures..
J Cell Biochem. , 89 (2003), pp. 356-363
[44]
Rossi L., Migliaccio S., Corsi A., Marzia M., Bianco P., Teti A., et-al..
Reduced growth and skeletal changes in Zinc-deficient growing rats are due to impaired growth plate activity and inanition..
J Nutr. , 131 (2001), pp. 1142-1146
[45]
Elmstahl S., Gullberg B., Janzon L., Johnell O., Elmstahl B..
Increased incidence of fractures in middle-aged and elderly men with low intake of phosphorus and zinc..
Osteoporos Int. , 8 (1998), pp. 333-340
[46]
Igarashi A., Yamaguchi M..
Increase in bone growth factors with healing rat fractures: the enhancing effect of zinc..
Int J Mol Med. , 8 (2001), pp. 433-438
[47]
Namkung-matthai H., Appleyard R., Jansen J., Hao Lin J., Maastricht S., Swain M., et-al..
Osteoporosis influences the early period of fracture healing in a rat osteoporotic model..
Bone. , 28 (2001), pp. 80-86
[48]
Martínez M.E., del Campo M.T., García J.A., Sánchez-Cabezudo M.J., Medina S., García Cimbrelo E., et-al..
Concentraciones de vitamina D en pacientes con fractura de cadera en Madrid..
Med Clin (Barc). , 106 (1996), pp. 41-44
[49]
Delgado-Martínez A.D., Martínez M.E., Carrascal M.T., Rodríguez-Avial M., Munuera L..
Effect of 25-OH-vitamin D on fracture healing in elderly rats..
J Orthop Res. , 16 (1998), pp. 650-653
[50]
Ömeroglu H., Ates Y., Akkus O., Korkusuz F., Bicimoglu A., Akkas N..
Biomechanical analysis of the effects of single high dose vitamin D3 on fracture healing in a healthy rabbit model..
Arch Orthop Trauma Surg. , 116 (1997), pp. 271-275
[51]
Doetsch A.M., Faber J., Lynnerup N., Watjen I., Bliddal H., Danneskiold-Samsoe B..
The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study..
Calcif Tissue Int. , 75 (2004), pp. 183-188
[52]
Delgado Martínez A.D..
Influencia de la vitamina D en la consolidación de fracturas en ratas ancianas..
Influencia de la vitamina D en la consolidación de fracturas en ratas ancianas., (2001),
[53]
Sugimoto M., Hirota S., Sato M., Kawahata H., Tsukamoto I., Yasui N., et-al..
Impaired expression of noncollagenous bone matrix protein mRNAs during fracture healing in ascorbic acid-deficient rats..
J Bone Miner Res. , 13 (1998), pp. 271-278
[54]
Michelson J., Cohen A..
Incidence and treatment of fractures in Thalasemia..
J Orthop Trauma. , 2 (1988), pp. 29-32
[55]
Ness A.R., Cappuccio F.P., Atkinson R.W..
Plasma vitamin C in men and women from different ethnic backgrounds living in England..
Int J Epidemiol. , 28 (1999), pp. 450-455
[56]
Schmuck A., Ravel A., Coudray C., Alary J., Franco A., Roussel A.M..
Antioxidant vitamins in hospitalized elderly patients: analysed dietary intakes and biochemical status..
Eur J Clin Nutr. , 50 (1996), pp. 473-478
[57]
de Carvalho M.J., Guilland J.C., Moreau D., Boggio V., Fuchs F..
Vitamin status of healthy subjects in Burgundy (France)..
Ann Nutr Metab. , 40 (1996), pp. 24-5117
[58]
van der Wielen R.P., van Heereveld H.A., de Groot C.P..
Nutritional status of elderly female nursing home residents; the effect of supplementation with a phisiological dose of water-soluble vitamins..
Eur J Clin Nutr. , 49 (1995), pp. 665-674
[59]
Alcántara Martos T..
Efecto de la vitamina C en la consolidación de fracturas en ratas ODS viejas [Tesis doctoral]..
Efecto de la vitamina C en la consolidación de fracturas en ratas ODS viejas [Tesis doctoral]., (2004),
[60]
Yilmaz C., Erdemli E., Selek H., Kinik H., Arikan M., Erdemli B..
The contribution of vitamin C to healing of experimental fractures..
Arch Orthop Trauma Surg. , 121 (2001), pp. 426-428
[61]
Sarisözen B., Durak K., DinÇer G..
The effects of vitamins E and C on fracture healing in rats..
J Int Med Res. , 30 (2002), pp. 309-313
[62]
Bitensky L., Hart J.P., Catterall A., Hodges S.J., Pilkington M.J., Chayen J..
Circulating vitamin K levels in patients with fractures..
J Bone Joint Surg Br. , 70(B) (1988), pp. 663-664
[63]
Tsugawa N., Shiraki M., Suhara Y., Kamao M., Tanaka K., Okano T..
Vitamin K status of healthy Japanese women: age-related vitamin K requirement for gamma-carboxylation of osteocalcin..
Am J Clin Nutr. , 83 (2006), pp. 380-386
[64]
Porter S.E., Hanley E.N..
The musculoskeletal effects of smoking..
J Am Acad Orthop Surg. , 9 (2001), pp. 9-17
[65]
Ziran B., Cheung S., Smith W., Westerheide K..
Comparative efficacy of 2 different demineralized bone matrix allografts in treating long-bone nonunions in heavy tobacco smokers..
Am J Orthop. , 34 (2005), pp. 329-332
[66]
Chakkalakal D.A., Novak J.R., Fritz E.D., Mollner T.J., McVicker D.L., Lybarger D.L., et-al..
Chronic ethanol consumption results in deficient bone repair in rats..
Alcohol Alcohol. , 37 (2002), pp. 13-20
[67]
Elmali N., Ertem K., Ozen S., Inan M., Baysal T., Guner G., et-al..
Fracture healing and bone mass in rats fed on liquid d iet containing ethanol..
Alcohol Clin Exp Res. , 26 (2002), pp. 509-513
[68]
Chakkalakal D.A..
Alcohol-induced bone loss and deficient bone repair..
Alcohol Clin Exp Res. , 29 (2005), pp. 2077-2090
[69]
Perrien D.S., Wahl E.C., Hogue W.R., Feige U., Aronson J., Ronis M.J., et-al..
IL-1 and TNF antagonists prevent inhibition of fracture healing by ethanol in rats..
Toxicol Sci. , 82 (2004), pp. 656-660
