By Richard A. Berger MD PhD, Arnold-Peter C. Weiss MD
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Additional info for Hand Surgery. 2 Volume Set
Hemophilic Arthropathy In uncontrolled hemophilia, a hyperplastic synovitis results in response to repeated bleeding into the joint. Destructive enzymes from the blood within the joint and the hypertrophic synovium erode articular cartilage and lead to secondary degenerative changes (127). The manifestations of hemophilic arthropathy are more significant in larger weight-bearing joints and are not usually seen in the hand. INFECTION Osteomyelitis Osteomyelitis or infection of bone implies the involvement of bone and its marrow.
Bone reacts with osteolysis, osteogenesis, or osteonecrosis. In the right circumstances, bone has great healing and remodeling potential. Cartilage, however, is the weak link owing to its avascularity and low cellular activity. Cartilage responds poorly to any adverse condition, and the damage is usually irreversible. Synovial tissue changes its role in pathologic conditions. The exudative response of the synovium sets off an acute inflammatory reaction that leads to release of damaging cytokines.
The various alternatives that are in clinical use are briefly discussed. Aspirates from the bone marrow provide a rich source of progenitor cells, which play an important role in fracture healing. Bone marrow injection into the fracture site has been successfully reported as a treatment of scaphoid nonunions, among other conditions (87). DBM is another substance that has been widely used. DBM is combined with glycerol or other carriers and is available in gel, putty, or sheet form. Used alone and in combination with autogenous bone marrow, the main role of DBM is for the filling of bone defects (88).