Sesamoiditis/Sesamoid Fractures

[Guest]

I've had a medial semsamoid fracture for 2 years now. The little options for this annoying pain does not help because of the fear of other problems occuring in the future..bunions, arthiritis, etc. I would like to know if Gene Therapy (a new procedure for hard to heal fractures) is worth waiting for.

*note: I am trying to find out more on BMP (Bone mending protein). Whoever is interested can search the net for similar articles, and info on this new procedure.

*Please read the following article found on www.whitaker.org/news/gene.html
ANN ARBOR, MI, February 1, 1996 --- A team of tissue engineers at the University of Michigan MedicalCenter has developed a DNA gel that, when injected into a bad break, tricks the bone into mending. This marks the first time that gene therapy is being used to fix hard-to-heal fractures.
"Our therapy will hopefully ensure rapid, effective and functional healing of complex fractures, those with a history of not healing well, or those involving a significant defect in the bone," says U-M tissue engineer Steven Goldstein, Ph.D., professor of surgery and of mechanical engineering.

"Nonunions," or bones that don't heal, represent roughly 5 percent of all fractures. But, says Goldstein, there are also many fractures for which, with early DNA- based treatment, the chance of effective healing could be increased significantly.

In bone, as in most tissue, wound healing follows a highly ordered process. First there's damage, with bleeding; then there's clotting followed by "debridement," during which cells come in and clean out the site; then granulation tissue is created by the infiltration of fibroblasts and endothelial cells, which provide a sort of mesh to form a base for new tissue. At this point the body makes a key decision: whether to make new bone tissue and regenerate or simply develop scar tissue. Scientists aren't certain what determines the latter outcome, but they think it may be due to a lack of growth factors, inadequate blood supply or too much movement in theaffected area.

"We need to make sure bone goes down the healing pathway, toward regeneration," says Goldstein, co-founder of the Ann Arbor-based biotech company Matrigen, which is testing the gel in rats.

The DNA-infused gel is injected into the fracture site during the granulation phase of healing. It is made of nontoxic, degradable copolymers which, like a timed-release cold capsule, allow for sustained diffusion of DNA into the granulation cells. This gradual release enables control of protein expression for days or even months, recreating the sequence of events that naturally occurs in bone growth. Developed by biomaterials expert Robert Levy, M.D., professor of pediatrics and of pharmaceutics, the gel is based on the same material used in biodegradable sutures. Inside the body, the polymer molecules undergo a sort of surface erosion similar to what happens to a hard candy that melts in the mouth. When the molecules dissolve, the DNA is released. Once the DNA is taken up by the granulation cells, these cells become micro-pharmacies, dispensing the healing proteins and hormones needed to make new bone tissue. In essence, the incorporation of the DNA jump-starts the body's own bone-building process.

In initial experiments using a similar collagen-based gel to shuttle DNA to the fracture site, 15 out of 15 rats grew bone across a 5-mm gap. Studies using the newer copolymer DNA vector are under way. The team hopes to have the technology in clinical trials within two years.

Ultimately, says Matrigen co-founder Jeffrey Bonadio, M.D., associate professor of pathology, the gel may be administered in a scenario like this: A car accident victim arrives in the emergency room at 11 p.m.with a fracture that has poor healing prospects. The patient is cleaned up, stabilized and put to bed. The next day an "osteoinductive therapy team" injects the drug into the break site. The bone-growing proteins are programmed to start being released three days later, when the granulation tissue appears. All of these proteins are released within about eight weeks - the time it takes for a normal fracture to substantially heal.

In addition to bone, the technique eventually may be used to speed healing in other tissues, from torn tendons and cartilage to surgical wounds, Bonadio says.

[Guest]

Your question and scientific theory has many loopholes. First, cells do not take up other DNA and start to prduce it just because it is nearby. Secondly, a five mm gap should be healed without any problems in most people. Finally, almost every single fracture heals so no orthopedist would say that this is a tough to heal fracture and impose unnecessary treatments unless the standard of care failed. In response to your only question of this advertisement, a broken sesamoid will not heal after two years and having a fibrous union bond the gap. Even if everything you mentioned somehow worked, the fibrous tissue is already in place and no DNA will work through it.
[quote] I've had a medial semsamoid fracture for 2 years now. The little options for this annoying pain does not help because of the fear of other problems occuring in the future... [/quote]