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Wound Healing

Fracture Healing

Bone fracture, or a break in a bone, is a very common wound. Almost all persons experience a bone fracture at some time in their lives. Because of the tensile strength needed in bone, particularly the long bones that support the weight of the skeleton, this type of wound generally takes longer to heal than soft tissue wounds. Bones that do not support as much weight, such as the clavicle, take about 6 weeks to heal after a fracture, but structural bones (such as the femur) that support skeletal weight can take 3-5 months to heal. Weight-supporting bones must be well stabilized (or immobilized) in order to heal. They must remain immobile in a splint or a cast while new bone forms. New bone formation, called callus, is evident on an x-ray about 10 days after the fracture has occurred. At this stage, the new bone is soft and flexible. Over weeks to months, replacement with hard bony tissue occurs and the bone is able to function again and support weight.

The same events of inflammation, proliferation, and remodeling that occur in soft tissue injury also occur with fractures, although these stages are spread over a longer time period.

The same therapeutic and supplement recommendations also apply to bone injury, although there is a particular importance for copper and zinc. Copper supplementation is important in fracture healing and in the early formation of collagen in the wound.

Copper, 8 mg daily, provides adequate supplementation and should be taken for 6 weeks for a fracture of a non-weight-bearing bone. It should be taken for 2-3 months for a major weight-bearing bone. Because copper is also a pro-oxidant, supplementation should be stopped after this period of time.

Zinc should be taken at a dose of 90 mg daily (as recommended earlier for healing of other wounds). Zinc's enhancement of fracture healing may be related to its effects on increasing IGF-1 and TGF-beta, both of which are growth factors discussed previously.

In an animal study, rats were divided into groups: one control and one supplemented with vitamin C. All had fractured tibias. After examination at four 5-day intervals, "It was seen that the vitamin C-supplemented group went through the stages of fracture healing faster compared with the control group" (Yilmaz et al. 2001).

Glucosamine and chondroitin should also be supplemented to encourage cartilage formation and repair if the fracture has extended along an articular (joint) surface and there is likely cartilage injury also.

Growth factors have been studied with respect to fracture healing. At the present time, most of this work is in the research stage, although even now synthetic bone grafts impregnated with growth factors such as IGF-1 are available (Schmidmaier et al. 2001; Spiroet al. 2001). Administration of IGF-1 has been found to enhance bone fracture healing, but so far the evidence for using TGF-beta has been conflicting (Tielinen et al. 2001). To date, the use of fibroblast growth factor (FGF) has also been discouraging (Nakajima et al. 2001).

Another growth factor important in bone healing is osteogenic protein-1 or OP-1. A study of OP-1 to enhance fracture healing is in its infancy, but preliminary results are encouraging (Blokhuis et al. 2001). As shown in animal studies, parathormone (parathyroid hormone) also has promise in enhancing fracture strength and early callus formation (Andreassen et al. 2001), although in humans, parathormone is being used primarily to treat osteoporosis and in fractures associated with osteoporosis. Several new drugs stimulating bone healing are being tested, and most of these exert their effects via various growth factors, especially IGF-1, TGF-b, and FGF. In the future, stem cells may be used to improve bone healing (Moutsatsos et al. 2001).

Adequate dietary intake of protein is important. In an animal model, three groups were studied: controls (20% protein), malnourished animals (6% protein), and renourished animals (6% protein, but fed a 20% diet in the postfracture period). The researchers found that in renourished animals, the cross-sectional area of the fracture callus (the bony deposit that forms around broken ends of bones during healing) was greater than in those in the malnourished and well-nourished animals. They concluded: "Protein deprivation has a profound detrimental effect on fracture healing" (Day et al. 2001). In general, the diet should contain an adequate amount of protein for healing of all wounds and proteins should definitely be supplemented. Glutamine and arginine, amino acids mentioned earlier in this article, should definitely be supplemented.

Smoking is especially harmful when the body is trying to provide substrates for adequate wound healing. Smoking has been shown to "adversely affect bone mineral density, lumbar disk disease, the rate of hip fractures, and the dynamics of bone and wound healing" (Porter et al. 2001).

For fractures complicated by a nonunion (the ends of the fractured bone do not rejoin), work has been done for over 20 years using various types of electrical stimulation on the bone ends to encourage union of the fracture site.

For additional information on accelerating healing of bone fractures, the reader is encouraged to refer to the protocol on Osteoporosis. Bone healing rates may be enhanced by following some of the recommendations for preventing and reversing age-associated bone loss, such as supplementing with the nutrients calcium, magnesium, boron, vitamin D3, and vitamin K; hormones such as DHEA and topical natural progesterone; and even a physician-prescribed bis-phosphonate drug such as Actonel.

SUMMARY

First, the type of wound, its cause, and its severity must be determined. Serious wounds must be evaluated and treated by a healthcare professional to prevent infection or development of serious complications. If there is any indication that the wound is not healing and has become infected, consult a healthcare professional immediately.

Next, the stage of healing of the wound should be identified. Then, follow the four principles of basic wound care: debride and cleanse, maintain a moist environment, prevent further injury, and provide supportive dietary nutrients for healing.

1. Arginine and glutamine are two essential amino acids that are required for protein synthesis. Take 10-22 grams daily of arginine and 2000 mg daily of glutamine.
2. Zinc and copper have been documented to promote wound healing. These minerals should be taken at least 2 hours apart to avoid antagonistic effects. Take 8 mg of copper daily for a limited time only during healing; take 90 mg of zinc.
3. Life Extension Mix provides vitamin C, vitamin E, vitamin B5, and other essential nutrients to support and enhance wound healing: 9 tablets daily.
4. Additional vitamin C may be supplemented several times daily to promote collagen formation and provide additional antioxidant protection. Consult with a healthcare provider for serious wounds.
5. Aloe vera has numerous healing properties in both oral and topical applications. As a juice, 2 ounces of aloe concentrate may be mixed with a 6-ounce beverage. Topical aloe vera creams may be applied several times daily.
6. The digestive enzyme bromelain may help promote healing, reduce pain, and prevent scar tissue formation by helping to break down protein: one 500-mg tablet with meals.
7. Curcumin may help promote new skin growth in both oral and topical solutions. Take one 900-mg capsule daily. A compounding pharmacy should be consulted for topical applications.
8. For skeletal fractures, glucosamine and chondroitin may promote healing. Four 1000-mg combination capsules, taken twice daily, are suggested. Several other nutrients mentioned for wound healing are also recommended for fracture healing.
9. Taken orally, centella may improve collagen formation and reduce the effects of inflammation: one 500-mg capsule daily, or applied as an ointment, 1-2 applications daily.
10. In people with adequate levels of HGH and IGF-1, wounds heal faster than in those with low levels. HGH supplementation should not be started during the catabolic period of critical illness because it increases the risk of mortality. However, people on an HGH antiaging protocol heal faster than others of their age. If HGH is not affordable, consider supplementing with 75-100 mg of DHEA during the healing process. Refer to the DHEA Replacement protocol for details.
11. For chronic or serious wounds, consider alternative treatments such as hyperbaric oxygen therapy, whirlpool therapy, ultrasound treatment, electrical stimulation, magnetic therapy, and therapeutic touch.
12. For wounds and fractures that do not heal as expected, it might be beneficial to seek help from a university orthopedic or plastic surgery section using local application of growth factors and new drugs that affect growth factors. For nonunion bone fractures, electrical stimulation is an option available at university hospitals as well as other institutions.

To learn what you can do to reduce the risk of medically induced complications, refer to the Foundation's Anesthesia and Surgical Precautions protocol.

Product availability

Cold-pressed, whole-leaf aloe vera juice concentrate; topical aloe vera ointment; arginine powder, tablets, capsules; glutamine powder, glutamine capsules; vitamin B5 powder and capsules; curcumin with bioperine; bromelain; zinc; copper; vitamin C; glucosamine-chondroitin caps; DHEA; and Life Extension Mix may be ordered by phoning (800) 544-4440 or by ordering online.