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Commanding bone By Amy DiCresce
“In
the last 10 years, we have learned that bones can stretch and be
regenerated,” said Dr. J. Tracy Watson, professor of orthopaedic surgery
at the Wayne State University School of Medicine. In the past, broken bones
were treated by “setting them” in casts. New techniques utilizing
autologous growth factors (AGF) allow Dr. Watson and his colleagues at
University Orthopaedics to stretch, reshape and even grow new bone where
none previously existed. Dr.
Watson was the first physician in Michigan--and one of the first in the
country--to use autologous growth factors to heal broken bones. This highly
specialized orthopaedic procedure helps people who have lost large portions
of bone during a car accident, for example, or for those who have weak
bones and fractures that don’t heal effectively. Autologous
bone grafting uses the patient’s own blood to stimulate natural bone
growth, providing an alternative to the painful process of harvesting bone
from other parts of the body. Plus, traditional bone grafts require a large
amount of bone to be pulled from a specific area. Sometimes, it’s
impossible to get a “spare” piece of bone that’s big enough to fit.
With AGF, the body uses its own natural materials to generate new,
authentic bone. Dr.
Watson describes it this way, “If you are missing a segment of bone, you
need the healthy cells around it to fill into the empty space. But how do
you generate that bone growth and restrengthen the entire structure?” He
uses a bricks-and-mortar approach. Consider
each end of the healthy bone as a separate brick. Dr. Watson brings the
bricks together by applying mortar between them. In this case, the mortar
is a special putty that is made from a patient’s own blood and proteins.
Doctors extract a portion of the blood and spin it in a centrifuge,
separating the platelets, red blood cells and bone growth hormones for
future use. Autologous growth factors, the exciting piece of this
combination, are platelet-rich extracts that enhance formation of new bone
cells and stimulate solid bone growth at the graft site. The patient’s
blood is carefully refined and combined with bone grafting material,
producing a putty-like substance. “We
apply the putty where we want the bone to grow,” said Dr. Watson. “The
putty contains osteogenic factors that enhance bone repair and
regeneration. Eventually, the patient’s own bone heals from the putty,
creating a stronger structure for a more complete recovery.” Joan Hardy, a 67-year-old woman who had trouble healing after she was hit by a car, has recovered her strength, thanks to AGF treatment. Following her accident, the bones in her arm would not fully heal. “The only way I could move that arm is if I picked it up with my other hand and lifted it,” she said.
In
the past year, Dr. Watson has done more than 50 autologous bone grafts with
a 95 percent success rate. Although it’s not necessary for every broken
bone, it is often recommended for people with severe breaks, missing bone
fragments, and those with a weakened skeletal system. And
the news keeps getting better. They are evaluating new techniques to inject
the bone putty directly through the skin, diminishing the need for invasive
surgery. “It’s a great way to harvest the body’s own growth hormones
to help the bone heal itself without having to make a number of
incisions,” said Dr. Watson. How it all began
Wires
in the frame are tightened at precise levels every day, gently guiding the
bone into its proper place. Patients turn the “clickers” themselves,
with specific directions from the physician. For example, if patients have
one leg shorter than the other, they can use the Ilizarov external fixator
to gradually distract the shorter leg until both are balanced. This
gentle pulling, which works much like braces on the teeth, can have a
profound impact. In an adult patient, bone can grow up to one centimeter
every month, and bone shifts approximately one millimeter each day.
Although it may sound arduous, it could be the difference between saving
the limb and amputation. “When you stretch bone, it thins out temporarily, and then fills in,” said Dr. Watson. “It’s a slow process, and it requires total daily compliance, but it can mend bone defects, reshape deformities, alter leg length, and allow infected bone to be cut out, so the healthy bone can regenerate.”
Dr.
Watson recalls a patient who had a serious bone infection in his leg and
was on the verge of amputation. “The infection had destroyed 18
centimeters of bone in his leg, but he wanted to do anything he could to
save it. We cut out the infected segment of bone and applied the Ilizarov
device to pull the healthy bone segments back together. It was very
gradual, but eventually, the two healthy segments of the bone were brought
together and the leg was saved.” To achieve solid union at the docking site, cancellous bone graft augmentation is generally recommended, but it is sometimes difficult to achieve. This is what got Dr. Watson working on autologous growth factors. He sometimes had trouble making the two healthy bones heal together and began searching for some sort of material to fill in the empty spaces and make the bones fuse. The bone putty, which uses AGF to stimulate bone growth, was the perfect solution. It uses real bone as a bridge between the healthy bones.
Dr. Watson and his colleagues at University Orthopaedics have established the Institute for Skeletal Restoration in conjunction with Wayne State University and the Detroit Medical Center. Through the institute, they are providing expert care to people with bone breaks and injuries. Their affiliation with a major academic trauma center allows them to treat patients with complex difficulties that can not be treated elsewhere. Dr. Watson is the only person in the Detroit area to provide Ilizarov and AGF treatments.
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