Muhammed Uslu1, Bilal Yılmaz2, Hamisi Mwarindano Mraja3, Mustafa Fatih Daşcı1, Elif Yaprak Saraç4, Bedri Onur Küçükyıldırım5, Mehmet Akif Güleç1, Serdar Yüksel1

1Department of Orthopedics and Traumatology, Health Sciences University, Bağcılar Training and Research Hospital, Istanbul, Türkiye
2Department of Orthopedics and Traumatology, Birecik State Hospital, Şanlıurfa, Türkiye
3Department of Orthopedics and Traumatology, Istanbul Spine Center & Orthopedics, Group Florence Nightingale Hospitals, Istanbul, Türkiye
4Department of Molecular Biology-Genetics and Biotechnology, Istanbul Technical University, Istanbul, Türkiye
5Department of Mechanical Engineering, Yıldız Technical University, Istanbul, Türkiye

Keywords: Cephalexin, femur, fracture healing, rat.


Objectives: The aim of this study was to examine the effects of cephalexin on the fracture union histomorphometrically, radiologically, biomechanically, immunohistochemically, and histopathologically in a rat femur fracture model and to evaluate the effects of the antibiotics to be used in the prophylaxis of fracture infection on the union of the fracture.

Materials and methods: A total of 48 male Wistar rats were divided into four groups as two-week control (C2) and cephalexin (CEP2) and four-week control (C4) and cephalexin (CEP4). After establishment of standard fracture model on right femurs, 60 mg/kg/day of cephalexin was applied to CEP2 and CEP4 by oral gavage. Radiological, biomechanical, histopathological, immunohistochemical, and histomorphometric examinations were performed on amputated femurs.

Results: Callus volume of CEP4 group significantly increased compared to CEP2 group (p=0.005), while no significant difference was found in the bone mineral density and callus/bone volume among the groups (p>0.05). There was no significant difference in flexural strength between the C4 and CEP4 groups (p=0.093). Histological healing scores increased from Week 2 to Week 4 (p=0.002) and inflammation scores decreased in both control and cephalexin groups (p=0.010 and p=0.008); however, no significant difference was found in healing and inflammation scores (p>0.05). The CD34+ immunoreactivity in the CEP2 group was significantly higher than the C2 group (p=0.029). Collagen type III level was significantly lower in the CEP2 and CEP4 groups compared to the corresponding control groups (p=0.008 and p=0.016, respectively).

Conclusion: Cephalexin did not exert any radiological, histopathological, histomorphometric, biomechanical, and immunohistochemical adverse effects on the femoral fracture healing model in rats; however, it showed positive effects on CD34 and Collagen type III levels. Based on these findings, antibiotherapy with cephalexin may be considered as a safe treatment for fracture union.

Citation: Uslu M, Yılmaz B, Mraja HM, Daşcı MF, Yaprak Saraç E, Küçükyıldırım BO, et al. The effects of cephalexin on fracture healing in a rat femur fracture model. Jt Dis Relat Surg 2023;34(2):413-424. doi: 10.52312/jdrs.2023.994

Ethics Committee Approval

The study protocol was approved by the Local Ethics Committee for Animal Experiments of Bagcilar Education and Research Hospital (date: 27.12.2019, no: 2019-217).

Author Contributions

Writing, editing: M.U.; Analysis and interpretation of data: B.Y.; Literature review: H.M.M.; Revised drafted article: M.F.D.; Data processing and statistic: E.Y.S.; Interpretation of data: B.K.; Critical review, supervision: M.A.G.; Supervision, proofreading: S.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.