Effect of Soft-Tissue Attachment on Tibial Fracture Healing in Rats

Abstract

Purpose.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

Tendon Healing in the Context of Complex Fractures

“…Complex fractures, such as open fractures (in which bone breaks through skin; mangled limbs), undergo a multifaceted healing process, with biological and mechanical factors contributing significantly to the healing process (e.g., need for revascularization, delivery of biological factors, and mechanical stability) [15–19]. For example, vascular injuries result in delayed healing in nearly 50% of all tibial fractures [20].…”

“…For example, vascular injuries result in delayed healing in nearly 50% of all tibial fractures [20]. Further complication and delay in fracture healing can be exacerbated by concomitant soft tissue injuries, such as tendon damage or rupture [19]. Yet diagnosis and treatment of soft tissue injuries at time of fracture may be missed clinically, as mentioned above, and poor soft tissue healing is a limiting factor for sufficient treatment and healing of musculoskeletal injuries [19,21–23].…”

“…Further complication and delay in fracture healing can be exacerbated by concomitant soft tissue injuries, such as tendon damage or rupture [19]. Yet diagnosis and treatment of soft tissue injuries at time of fracture may be missed clinically, as mentioned above, and poor soft tissue healing is a limiting factor for sufficient treatment and healing of musculoskeletal injuries [19,21–23]. For patients with complex fractures, the risk of deep infection increases with time following soft tissue debridement (approximately 22% increased risk if debridement is delayed for 48hr post-fracture), further exacerbating the risks associated with bone healing [24].…”

“…Fractures of the distal tibia have a higher susceptibility to open and complicated fractures due to the limited soft tissue coverage and structural anatomy [31]. The mode of fracture is a determining factor in the fracture healing process, and high-energy trauma often leads to damage to soft tissues that can delay the bone healing process [19,32–34]. This has been shown through enhancement of complex open fracture healing in presence of soft-tissue coverage during early stages of healing [19].…”

“…The mode of fracture is a determining factor in the fracture healing process, and high-energy trauma often leads to damage to soft tissues that can delay the bone healing process [19,32–34]. This has been shown through enhancement of complex open fracture healing in presence of soft-tissue coverage during early stages of healing [19]. In addition, anatomical location and the biomechanical properties of connective tissues may also be important determinants of the type of the injury.…”