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Researchers working on OREF-funded grants found ways to speed fracture healing so that patients can return to routine activities more quickly.

AAOS Now

Published 10/1/2008
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Amy Kile

Better care for everyday and exceptional problems

OREF-funded research triggers advances in orthopaedic care

Advancements have been the norm since orthopaedics began as a medical specialty. Not only has every orthopaedic subspecialty changed dramatically, treatments for common and traumatic orthopaedic ailments and deformities have improved through time as well, in large measure due to the specialty’s commitment to ongoing research and education.

Several of the projects that led to these advances began with funding from the Orthopaedic Research and Education Foundation (OREF) and were made possible by generous gifts from the orthopaedic community, primarily from AAOS fellows, candidates, and emeritus members.

“I’ve been in orthopaedics for about 40 years and it’s been an incredible life,” says longtime OREF supporter Victor Goldberg, MD, of Cleveland. “I’ve done what I love to do, and I understand the importance of the future. Discoveries won’t happen overnight; just like any other investment, you have to have patience.”

Patience pays
With OREF funding, researchers learned that early, limited movement—rather than complete immobilization—enables fracture patients to heal stronger and return to daily activities sooner. Research funded by OREF provided a new understanding of the metabolic response to traumatic injuries, which led to less pain and faster healing for long-bone fractures. An OREF-funded study also demonstrated that tight glucose control can help fractures heal faster in patients with diabetes mellitus. Osteoporosis treatments, developed with the help of OREF funding, reduce the risk of sustaining a fracture at all.

“The basic techniques learned in our OREF-funded studies were important in beginning to understand bone diseases that the orthopedic surgeon sees every single day,” says William H. Harris, MD, of Boston. Dr. Harris received an OREF grant that helped fund his tetracycline labeling study of metabolic bone diseases.

“Now, osteoporosis has been successfully addressed by medicines, such as bisphosphonates and intermittent use of parathyroid hormone injections, which either inhibit or block resorption of bone, or increase bone formation,” he says. “The OREF grant played an important role in establishing tetracycline labeling research.”

Better care for injured and ailing joints

Bone morphogenetic protein (BMP) research was the result of work begun with OREF funding. Additional research, also supported by OREF funding, resulted in the next generation of BMPs and collagraft, a synthetic bone graft substitute that meant better bone fusions and prosthetic joints that function better and last longer.

OREF also provided funding for investigations of the causes of joint distress in patients with rheumatoid arthritis (RA) and other arthritic conditions. When scientists realized that RA is an autoimmune disease, they could begin to see how the environment leading to the destruction of bone, cartilage, and ligaments developed. More importantly, they could investigate specific therapies and approaches to stop the destruction and care for arthritic joints.

“Looking back, you can see how OREF-funded work enabled other people to develop specific therapeutic drugs,” Dr. Goldberg explains. “Many current drug treatments are directed toward specific chemokines, or mediators of inflammation.”

Lessening the trauma
Traumatic injury treatments are also on the list of OREF-funded orthopaedic advancements, including the following emerging treatments:

  • new methods to stimulate healing and improve outcomes for older children and adults who have sustained from ischemic hip injuries
  • new knowledge of the forces transferred from the hand to the elbow, which could lead to better treatment for forearm injuries that disrupt stability between the radius and ulna
  • anterior decompression for spinal cord injury

“I believe the whole concept of anterior decompression for spinal cord injuries, which was developed in conjunction with the initial OREF-funded experimental work, has revolutionized the care of spinal cord injuries,” said Henry H. Bohlman, MD, of Cleveland, who received OREF research grants in 1974 and 1978. “This has now become accepted worldwide, with stabilization, as the treatment of choice and has resulted in far superior recovery of neurologic function and paralysis.”

Better treatment results
OREF-funded investigations are searching for the cause of clubfoot deformity—localizing the gene that causes the deformity to develop better treatment strategies—and analyzing current treatment strategies to determine which methods optimize results.

“It is difficult for doctors to agree on the best method for assessing the results of treatment for clubfoot and other foot deformities, which makes it difficult to agree upon the best method for treatment,” said John G. Thometz, MD, of Milwaukee. “This research attempts to identify which parameters define an optimal functional result for treatment for congenital clubfoot patients and will help orthopedic surgeons standardize results to improve patient care.”

Supporting the future
All of these orthopaedic advancements were realized through education and research, which, in turn, require financial support.

“If my generation doesn’t provide for the young people coming into orthopaedics now to continue research,” says

Dr. Goldberg, “20 to 40 years from now, orthopaedics will not have reached its full potential of devising unique, effective ways to manage orthopaedic problems. I feel very strongly that supporting research and education is a responsibility and that my contribution is doing something for the future.”

For more information on OREF, visit www.oref.org or contact Ed Hoover, vice president, development at hoover@oref.org or (847) 384-4354.

Amy Kile is publications manager with OREF. She can be reached at kile@oref.org