Temporary distraction and compression of a diaphyseal osteotomy accelerates bone healing.
Mechanical strain during callus distraction is known to stimulate osteogenesis. It is unclear whether this stimulus could be used to enhance the healing of a normal fracture without lengthening the bone. This study tested the hypothesis that a slow temporary distraction and compression of a diaphyseal osteotomy accelerates fracture healing. Fourteen sheep underwent a middiaphyseal osteotomy of the right tibia, stabilized by external fixation. An external fixator allowed either a temporary axial distraction (TD group; n = 6) or a constant fixation (C group; n = 8). Distraction began 7 days postoperatively at a rate of 0.5 mm twice per day for 2 days with subsequent shortening of 1.0 mm twice on the third day. The procedure was repeated four times. Fluorochrome labeling was performed postoperatively. After 8 weeks the sheep were sacrificed and healing was evaluated using densitometric, biomechanical, and histological methods. Bending stiffness of the tibiae after 8 weeks was 58% higher in the TD group than in the C group. The volume of the periosteal callus was significantly (p = 0.05) higher in the TD group (3.9 cm(3)) than in the C group (2.7 cm(3)). There was 20% more bone in the fracture gap of the TD group than the C group. There was a significantly higher bone formation rate in the TD group than in the C group. This study demonstrated the feasibility of fracture healing stimulation by the temporary application of distraction and compression.
Claes
Lutz
L
Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany. lutz.claes@uni-ulm.de
Augat
Peter
P
Schorlemmer
Sandra
S
Konrads
Christian
C
Ignatius
Anita
A
Ehrnthaller
Christian
C
D000818:Animals; D019245:Compressive Strength; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000502:physiology*; D004195:Disease Models, Animal; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D010012:Osteogenesis / Q000502:physiology*; D010027:Osteotomy; D012756:Sheep; D013314:Stress, Mechanical; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed