An Experimental Study on the Significance of Muscle Tissue Interposition on Fracture Healing

Altner, Peter C.; Grana, Luis; Gordon, Michael J.

doi:10.1097/00003086-197509000-00035

Cited by 24 publications

(11 citation statements)

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“…Fracture instability, infection, soft tissue interposition, distraction of fracture fragments, poor vascularity, and soft tissue damage have been demonstrated to be significant factors contributing to the development of a nonunion fracture. [22][23][24][25] Several studies have demonstrated that muscle interposition into the fracture site may be an important factor in the displacement of a nonunion. 26,27 These studies lead us to hypothesize that a delayed union or nonunion may develop when there is a large amount of soft tissue interposed into the fracture site.…”

Section: Discussionmentioning

confidence: 99%

Low‐intensity pulsed ultrasound initiates bone healing in rat nonunion fracture model.

Takikawa

Matsui

Kokubu

et al. 2001

J of Ultrasound Medicine

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Low-intensity pulsed ultrasound exposure has been shown clinically to shorten the fracture repair process and to induce healing of nonunions in humans, but its mechanism of action remains unclear. In this study we investigated the effect and mechanism of low-intensity pulsed ultrasound on nonunion fracture healing in rat tibias. A consistently reproducible nonunion was produced in rat tibias by muscle interposition without osteotomy. This model was produced by creating a closed tibial fracture with only the distal end of the tibialis anterior muscle interposed into the fracture site. One limb was noninvasively exposed to low-intensity pulsed ultrasound (a 200-millisecond burst of sine waves of 1.5 MHz, repeating at 1.0 kHz) for 20 minutes daily. The incident intensity was approximately 30 mW/cm2. Rats were killed at intervals between 2 and 6 weeks. The events were assessed by radiographs, microfocus X-ray computed tomograms, and histologic examination. After 6 weeks of exposure, 7 of 14 nonunion fractures showed healing on radiologic assessment. The results of three-dimensional microfocus X-ray computed tomographic reconstruction and histologic examination also supported this finding. On the other hand, all control tibias remained in a state of nonunion during the same period. These results indicate that low-intensity pulsed ultrasound promotes healing in the rat nonunion fracture model.

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Section: Discussionmentioning

confidence: 99%

Low‐intensity pulsed ultrasound initiates bone healing in rat nonunion fracture model.

Takikawa

Matsui

Kokubu

et al. 2001

J of Ultrasound Medicine

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“…[1][2][3] The known causes of delayed or nonunion of fractures are multiple and include infection, mechanical instability, interposition of soft tissue, loss of vascularization, distraction of fragments, and extensive soft tissue damage. [4][5][6] The rate of nonunions after primary surgical treatment of humeral fractures has been reported from 0% to 29% 7,8 and in case of tibia from 8% to 10%. [9][10][11][12] Delayed or nonunions are being currently treated by plate and screw fixation, external wire fixators, or stable internal fixation in combination with bone grafting.…”

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confidence: 99%

Combination of anorganic bovine‐derived hydroxyapatite with binding peptide does not enhance bone healing in a critical‐size defect in a rabbit model

Sarahrudi

Mousavi

Grossschmidt

et al. 2008

Journal Orthopaedic Research

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Anorganic bovine-derived hydroxyapatite (ABM) in combination with binding peptid (P-15) has demonstrated the capacity to improve the healing of periodontal defects. This study evaluated the benefit of ABM/P-15 to promote healing of cortical long bone defects in a rabbit model. A 5-mm segmental bone defect was created in the femur and fixed with a plate. There were two treatment groups: no implant (n ¼ 12) and ABM/P-15 (n ¼ 12). At 4, 8, and 12 weeks, healing of the defect was evaluated with radiographs and histomorphometric examination of the treated femora. After 4 weeks, radiographs showed bone formation without signs of complete consolidation in three of four animals in the control group and two of four ABM/P-15 treated animals. At the later course of the treatment, no radiologic difference was evident between the treatment groups. Histomorphometric evaluation revealed an area of 1.29 AE 0.11 mm 2 and 0.97 AE 0.21 mm 2 of newly produced bone in animals of the control group and ABM/P-15 group after 4 weeks. After 8 and 12 weeks, animals in the control group had an area of 2.44 AE 0.62 mm 2 and 2.5 AE 0.2 mm 2 of newly produced bone within the osteotomy gap compared to 1.6 AE 0.65 mm 2 and 1.56 AE 0.27 mm 2 in the ABM/P-15 group (p ¼ 0.0004). An enhanced or accelerated ingrowth of bone, as reported in previous studies, was not observed. Our results imply that the ABM/P-15 is not a suitable graft for the treatment of critical-sized segmental defects in long bones. ß

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“…MacroPore resorbable protective sheets enable protected bone healing without the disadvan- tages of metal, including the possible necessity of removing the implants, the difficulty associated with radiographic assessment, and the effects of stress shielding. Spontaneous healing of large bone defects, including the donor sites in the ilium, appears to be generally limited by the interposition of adjacent musculature 1,16,17 The MacroPore OS Protective Sheeting is a resorbable implant that may be used to protect bone graft sites to facilitate bone regeneration. 18 Donor sites regenerate by a process similar to endosteal fracture repair.…”

Section: Discussionmentioning

confidence: 99%

Use of a resorbable sheet in iliac crest reconstruction in a sheep model

Cornwall

Wheeler²,

Thomas³

et al. 2002

Journal of Neurosurgery: Spine

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Object. Iliac crest bone graft harvesting can result in major complications, the rates of which range from approximately 6 to 8%. The objective of this study was to evaluate the postoperative regeneration of iliac crest donor defects in an animal model after harvesting a full-thickness tricortical graft. Methods. In skeletally mature sheep, a tricortical iliac crest graft was harvested. The graft sites were allowed to heal unprotected or protected with the resorbable polylactic acid sheet material, MacroPore OS Protective Sheeting. After 6 months of healing, the sites were assessed by examination of undecalcified histological sections. Histomorphometric measurements of the original defect area, the area of new bone within the defect site, and the percentage of defect filled with new bone were quantified for both control and protected groups. In all histological sections, new bone growth within the defect sites appeared normal, with no observed excessive inflammatory cells. The developing bone tissue appeared to be remodeling normally. For the unprotected sites, the area of new bone averaged 16.3 mm2 (± 7.2 mm2), and the percentage of the defect area filled with bone averaged 10.7% (± 6.5%). In the protected sites, the area of new bone averaged 64.8 mm2 (± 11.6 mm2) and the percentage of the defect area filled with bone averaged 25.9% (± 1.6%). Both differences in area of new bone growth and percentage of defect area filled were statistically significant. Literature review has indicated that regeneration of donor site defects is desirable. Conclusions. Based on the results of the present study, MacroPore resorbable Protective Sheeting can improve bone regeneration significantly within the donor site following tricortical iliac crest graft harvesting.

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An Experimental Study on the Significance of Muscle Tissue Interposition on Fracture Healing

Cited by 24 publications

References 0 publications

Low‐intensity pulsed ultrasound initiates bone healing in rat nonunion fracture model.

Low‐intensity pulsed ultrasound initiates bone healing in rat nonunion fracture model.

Combination of anorganic bovine‐derived hydroxyapatite with binding peptide does not enhance bone healing in a critical‐size defect in a rabbit model

Use of a resorbable sheet in iliac crest reconstruction in a sheep model

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