To compare tibial fracture healing in rats with or without soft-tissue attachment.
Methods.
The left tibias of 30 Wistar rats were osteotomised and equally randomised into 3 groups. In the avascular segmental fracture group, an 8-mm bone segment were first removed and then immediately put back. In the vascular segmental fracture group, the 8-mm bone segment was not displaced, with periosteal and muscular attachments. In the simple fracture group, a simple fracture in the middle tibia was made. All tibias were then stabilised with an intramedullary nail through the patellar tendon, and the wound was closed with sutures. After 8 weeks, all left tibias and 9 of the intact right tibias were harvested. Bone mineral content and density of the calluses were assessed using dual energy X-ray absorptiometry scanning. The maximum torsional strength, rigidity, and energy to failure of the tibias were measured.
Results.
All tibias healed (callus formation), without mal-union or pin migration. The 3 groups did not differ significantly in terms of torsional strength, rigidity, energy to failure, bone mineral content, and bone mineral density. The mean torsional strength of the 9 intact tibias was significantly higher than the healed tibias (14.9 vs. 10.6 Nmm, p=0.021).
Conclusion.
Soft-tissue detachment from bone segments did not impair bone healing in rats.
HoldenCE. The role of blood supply to soft tissue in the healing of diaphyseal fractures. An experimental study. J Bone Joint Surg Am1972;54:993–1000.
2.
RhinelanderFWPhillipsRSSteelWMBeerJC. Microangiography in bone healing. II. Displaced closed fractures. J Bone Joint Surg Am1968;50:643–62.
3.
GustilioRBMendozaRMWilliamsDN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma1984;24:742–6.
4.
UtvagSEGrundnesORindalDBReikerasO. Influence of extensive muscle injury on fracture healing in rat tibia. J Orthop Trauma2003;17:430–5.
5.
GodinaM. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg1986;78:285–92.
6.
HarryLESandisonAPaleologEMHansenUPearseMFNanchahalJ. Comparison of the healing of open tibial fractures covered with either muscle or fasciocutaneous tissue in a murine model. J Orthop Res2008;26:1238–44.
7.
CalderonWChangNMathesSJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg1986;77:785–94.
8.
RichardsRRSchemitschEH. Effect of muscle flap coverage on bone blood flow following devascularization of a segment of tibia: An experimental investigation in the dog. J Orthop Res1989;7:550–8.
9.
RichardsRRMcKeeMDPaitichCBAndersonGIBertoiaJT. A comparison of the effects of skin coverage and muscle flap coverage on the early strength of union at the site of osteotomy after devascularization of a segment of canine tibia. J Bone Joint Surg Am1991;73:1323–30.
10.
SchemitschEHWeinbergJAMcKeeMDRichardsRR. The relative importance of intramedullary, intracortical, and extraosseous soft-tissue blood flow to the repair of devascularized canine tibial cortex. Ann Plast Surg1997;38:623–31.
11.
StreetJBaoMdeGuzmanLBuntingSPealeFVJrFerraraN. Vascular endothelial growth factor stimulates bone repair by promoting angiogenesis and bone turnover. Proc Natl Acad Sci U S A2002;99:9656–61.
12.
PufeTWildemannBPetersenWMentleinRRaschkeMSchmidmaierG. Quantitative measurement of the splice variants 120 and 164 of the angiogenic peptide vascular endothelial growth factor in the time flow of fracture healing: A study in the rat. Cell Tissue Res2002;309:387–92.
13.
HarryLEPaleologEM. From the cradle to the clinic: VEGF in developmental, physiological, and pathological angiogenesis. Birth Defects Res C Embryo Today2003;69:363–74.
14.
SivakumarBHarryLEPaleologEM. Modulating angiogenesis: More vs less. JAMA2004;292:972–7.
15.
OniOOGreggPJ. An investigation of the contribution of the extraosseous tissues to the diaphyseal fracture callus using a rabbit tibial fracture model. J Orthop Trauma1991;5:480–4.
16.
OwenM. The origin of bone cells. Int Rev Cytol1970;28:213–38.
17.
McKibbinB. The biology of fracture healing in long bones. J Bone Joint Surg Br1978;60:150–62.
18.
GustiloRBAndersonJT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am1976;58:453–8.
19.
GustiloRBSimpsonLNixonRRuizAIndeckW. Analysis of 511 open fractures. Clin Orthop Relat Res1969;66:148–54.
20.
SauerHDSchoettleH. The stability of osteosyntheses bridging defects. Arch Orthop Trauma Surg1979;95:27–30.
21.
O'LoughlinPFMorrSBogunovicLKimADParkBLaneJM. Selection and development of preclinical models in fracture-healing research. J Bone Joint Surg Am2008;90(Suppl 1):79–84.
22.
JowseyJ. Studies of Haversian systems in man and some animals. J Anat1966;100:857–64.
23.
BaronRTrossRVigneryA. Evidence of sequential remodeling in rat trabecular bone: Morphology, dynamic histomorphometry, and changes during skeletal maturation. Anat Rec1984;208:137–45
24.
ConnollyCKLiGBunnJRMushipeMDicksonGRMarshDR. A reliable externally fixated murine femoral fracture model that accounts for variation in movement between animals. J Orthop Res2003;21:843–9.
25.
ButlerMSBrumbackRJEllisonTSPokaABathonGHBurgessAR. Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur. J Bone Joint Surg Am1991;73:1492–502.
26.
KempfIGrosseABeckG. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am1985;67:709–20.
27.
WinquistRAHansenST. Segmental fractures of the femur treated by closed intramedullary nailing. J Bone Joint Surg Am1978;60:934–9.
28.
WissDABrienWWStetsonWB. Interlocked nailing for treatment of segmental fractures of the femur. J Bone Joint Surg Am1990;72:724–8.
29.
BellSNDooleyBJO'BrienBMBrightNF. Cortical bone grafts with muscle pedicles. An experimental study of survival and ability to bridge a bone gap. J Bone Joint Surg Br1985;67:804–8.
30.
DavisPKMazurJMColemanGN. A torsional strength comparison of vascularized and nonvascularized bone grafts. J Biomech1982;15:875–80.
31.
ZucmanJMaurerPBerbessonC. The effect of autografts of bone and periosteum in recent diaphyseal fractures. An experimental study in the rabbit. J Bone Joint Surg Br1968;50:409–22.
32.
NatherABalasubramaniamPBoseK. Healing of non-vascularised diaphyseal bone transplants. An experimental study. J Bone Joint Surg Br1990;72:830–4.
33.
NatherAGohJCLeeJJ. Biomechanical strength of non-vascularised and vascularised diaphyseal bone transplants. An experimental study. J Bone Joint Surg Br1990;72:1031–5.
34.
ReikerasOShegarfiHNaperCReinholtFPRolstadB. Impact of MHC mismatch and freezing on bone graft incorporation: An experimental study in rats. J Orthop Res2008;26:925–31.
35.
KerryRMMasriBAGarbuzDSDuncanCP. The vascularized scaphoid window for access to the femoral canal in revision total hip arthroplasty. Instr Course Lect1999;48:9–11.
36.
ZweymüllerKASteindlMMelmerT. Anterior windowing of the femur diaphysis for cement removal in revision surgery. Clin Orthop Relat Res2005;441:227–36.
