title: Reducing damage to the periosteal capillary network caused by internal fixation plating: An experimental study.
abstract: BACKGROUND
  The importance of the periosteum in fracture healing is well-known. Preserving periosteal vascularisation is essential during internal plate fixation of fractures.
  
  
  METHODS
  This was an experimental randomised, controlled animal study on nine sheep. Standard dynamic compression plate (DCP) and four different newly designed reefed plates, with different plate-bone contact surface areas and different reef directions, were fixated on to the tibia or radius. After two weeks the plates were removed and the underlying periosteum was analysed. Blood vessels were marked by immunohistochemical staining (CD31 and CD34), microphotographs were taken and blood vessels counted to calculate blood vessel density.
  
  
  RESULTS
  Median blood vessel density beneath the standard plate was significantly lower than in the intact periosteum (18.0 vs 27.7mm(3)/cm(3)). Blood vessel density in the periosteum beneath plates with reefs was significantly increased compared with the intact periosteum, and was highest beneath the plate with the lowest bone-plate contact area and crosswise reefs (51.5mm(3)/cm(3)), followed by plates with transverse, oblique and longitudinal reefs, respectively. The direction of the reefs did not have much influence on the periosteal capillary network. Lower contact surface area seems to be the main factor that increases blood vessel density beneath the plates.
  
  
  CONCLUSIONS
  The results show that plates with lower contact surface area stimulate angiogenesis in the underlying periosteum, which results in much higher blood vessel density compared with standard DCP. A randomised clinical trial is needed to prove the clinical relevance of these findings.
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; Department of Surgery, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, 10000 Zagreb, Croatia. Electronic address: aantabak@yahoo.com.
authors.forename: Anko
authors.initials: A
authors.lastname: Antabak
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Dino
authors.initials: D
authors.lastname: Papes
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Haluzan
authors.affiliation: Department of Pathology, School of Medicine, University of Zagreb, Salata 2, 10000 Zagreb, Croatia.
authors.forename: Sven
authors.initials: S
authors.lastname: Seiwerth
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Nino
authors.initials: N
authors.lastname: Fuchs
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Romic
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; Department of Surgery, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
authors.forename: Slavko
authors.initials: S
authors.lastname: Davila
authors.affiliation: Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; Department of Surgery, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Luetic
mesh_terms: D000818:Animals; D001860:Bone Plates; D002196:Capillaries / Q000293:injuries* / Q000473:pathology; D004195:Disease Models, Animal; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D017102:Fracture Healing / Q000502:physiology; D007150:Immunohistochemistry; D008833:Microcirculation; D010521:Periosteum / Q000098:blood supply*; D011884:Radius / Q000098:blood supply*; D011897:Random Allocation; D012756:Sheep; D013194:Staining and Labeling; D013314:Stress, Mechanical; D013977:Tibia / Q000098:blood supply*
keywords: Internal fixation plating; Periosteal vascularisation; Periosteum; Plate contact surface area; Plating