Bone Formation and Adaptive Morphology of the Anterior Tibial Muscle in 3-mm Daily Lengthening Using High-Fractional Automated Distraction and Osteosynthesis with the Ilizarov Apparatus Combined with Intramedullary Hydroxyapatite-Coated Wire

Abstract

Purpose. We studied osteogenesis and morphofunctional features of the anterior tibial muscle using 3-mm high-frequency automated lengthening with the Ilizarov apparatus alone and in combination with intramedullary nailing. Material and Methods. Tibia was lengthened with a round-the-clock automated distractor at a 3-mm daily rate for 10 days in 16 mongrel dogs. In group 1 (n = 8), a 1.8-mm intramedullary titanium wire coated with hydroxyapatite was introduced into the tibial canal followed by Ilizarov frame mounting and transverse osteotomy of the diaphysis. Distraction mode was 0.025 mm x 120 increments a day. In group 2 (n = 8), distraction mode was the same but nailing was not used. Bone formation and the anterior tibial muscle were studied at two time points: (1) upon distraction completion; (2) three months after the apparatus removal. Bone formation was studied radiographically. Muscle preparations were examined histologically and stereomicroscopically. Results. There was a threefold reduction in the distraction time in both groups. Consolidation took 13.83±4.02 days in group 1 and 33.7±2.4 days in group 2. Muscle macropreparations of the experimental limb in group 1 at study time points did not show significant differences from intact tissues. Muscle histostructure in both groups was characterized by activation of angiogenesis and myohistogenesis, but the volumetric density of microvessels in the lengthening phase was three times higher in group 1. Conclusion. Combined technology significantly reduces the total lengthening procedure and does not compromise limb functions. Intramedullary HA-coated wires promote faster bone formation. The muscle was able to exhibit structural adaptation and plasticity of a restitution type.

Use of carbon dioxide fractional laser in the management of lower limb ischemia in patients with diabetes: a case report

“…The process of distraction histogenesis can recreate a vascular network, which enhances the wound repair process. 17,18 Notably, the ulcer in the middle of the tibia was atypical in this patient. The precise execution of periosteal distraction and bone transport in this specific region poses a significant risk of postoperative subperiosteal or bone marrow infection.…”

“…The process of distraction histogenesis can recreate a vascular network, which enhances the wound repair process. 17 , 18 …”

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…It was stated that teriparatide treatment during the consolidation phase of distraction osteogenesis doubled the mineralization rate of the regenerate when compared to no treatment. The experiment on a canine model attempted automated high-frequency distraction with a daily 3-mm rate and confirmed that the bone had the potential for regeneration under the conditions described but there were concerns about the response of soft tissues and joints[ 78 ]. Histological differences were observed in bone and muscle tissue when Ilizarov fixation was supplemented by intramedullary HA-coated thin nails compared with no intramedullary stabilization in that experiment.…”

Distraction osteogenesis in combined sequential use of external fixation and nailing (lengthening and then nailing): An experimental study in rabbits

“…The importance of intraosseous and periosteal blood supply for the formation of bone regenerate has been proven by experimental studies 1–8 . With intramedullary reinforcement of the regenerate with wires, a positive effect on its tissue regeneration was noted 9,10 . When using an intramedullary nail, it is impossible to avoid disruption of the intraosseous blood supply 5 .…”