Intramedullary Pressure With Particular Reference to Massive Diaphyseal Bone Necrosis Experimental Observations

Abstract

As A result of Lexer's1 experimental studies, the anatomic distribution of blood vessels in long bones is now clearly understood. But there has been so little concrete experimental study of the function of these vessels, in the voluminous literature dealing with growth, repair, regeneration, atrophy, necrosis and other disorders of bone, that their fundamental physiologic reactions remain, with few exceptions, unknown.Axhausen2 found focal epiphyseal bone necroses associated with resorption and incomplete repair in embolism of epiphyseal vessels. Although Streptococci were cultivated from these lesions he attributed the degenerative change to ischemia rather than bacteria because of the absence of inflammation.Nussbaum3 experimentally verified the ischemic nature of the lesions described by Axhausen. Nussbaum's work is of particular interest because it is one of the few dealing with experimental vascular insufficiency of epiphyseal bones.Muller4 observed focal necrosis of compact human bone in advanced arterial sclerosis due, he believed, to infarction. He attributed the brittleness of senile bone to these lesions and emphasized the 'difficulty of producing prolonged bone ischemia by simple arterial occlusion. In no instance did he encounter medullary necrosis.The experiments of Johnson5 constitute the first fundamental contribution to our knowledge of the r6le played by each of the three components of the blood vascular system of long bones in bone repair. Johnson concluded that outer cortical bone is supplied and its viability maintained by periosteal vessels; whereas the internal portion of the shaft and metaphyses is supplied and kept viable by the nutrient and metaphyseal vessels.Brunschwig6 produced extensive bone and marrow necrosis in experimental animals by actually destroying most of the periosteal, metaphyseal and nutrient vascular connections. In some of his experiments the necrosis involved almost the entire shaft and marrow. Infarction occurred only in animals with unclosed epiphyseal lines, and in no instance was there sequestration.While Brunschwig had shown that bone and marrow could be killed by extensive interference with their blood supply, Drinker and Drinker7 first studied 'blood flow and cytology of living marrow vessels perfused with dif-

The Mechanical Environment of Bone Marrow: A Review

“…49 Numerous subsequent studies tried to elucidate the possible relationship between the medullary pressure and the hemodynamics of the bone ( Table 1). The systemic blood pressure in animals has been reported to be in the range of 110-140 mmHg, whereas the normal intramedullary pressure (IMP) was generally about 30 mmHg which is approximately one fourth of the systemic blood pressure (Table 1).…”

Friction burns within the tibia during reaming

“…7,12,13 When considering the generation of heat, the following questions need to be addressed; what is the temperature threshold above which thermal necrosis occurs, to what extent does the temperature rise during reaming and, most importantly, what is the effect of the tourniquet? Thermal injury to bone has been reported with temperatures between 43° and 68°C.…”

Hemodynamics of the juvenile knee

“…They found an IOP between 2.7 and 4.0 kPa. A number of authors have later discussed the methodological problems in IOP registration (Larsen 1938, Herzig & Root 1959, Azuma 1964, Michelsen 1967, Wilkes 1969, Polster 1970, Lemperg & Arnoldi 1978, Tmdevold 1983. The sources of error so far recognized vary with animal age and size, the site of measurement and the pressure registration technique.…”

“…Most pressures within bones reported are diaphyseal bone marrow pressures of the tibiain dogs (Rothmann 1913, Kalser et al 1952. Larsen 1938.…”