Some Aspects of Longitudinal Bone Growth: An Experimental Study of the Rabbit Tibia

Sundén, G

doi:10.3109/ort.1967.38.suppl-103.01

Cited by 18 publications

(13 citation statements)

References 172 publications

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“…This effect has been demonstrated in studies on thermal conductivity in which a fourfold difference between dry and living bone tissue has been reported. 9 In our study the rise of temperature in the group of patients with a tourniquet appeared to be slightly higher, but this difference did not reach statistical significance. This finding is open to a number of interpretations.…”

Section: Discussionmentioning

confidence: 64%

“…Those who advocate the use of a tourniquet claim that it provides a bloodless field for surgery of the limb. Opponents claim that it prevents transfer of heat by convective blood flow 9 and is thus a potential risk factor for thermal necrosis. In order to test these arguments we have undertaken a prospective randomised, controlled trial measuring the rise of temperature during reaming of the tibia with and without the use of a tourniquet.…”

mentioning

confidence: 99%

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Friction burns within the tibia during reaming

Giannoudis¹,

Snowden

Matthews³

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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We have carried out a prospective, randomised trial to measure the rise of temperature during reaming of the tibia before intramedullary nailing. We studied 34 patients with a mean age of 35.1 years (18 to 63) and mean injury severity score of 10 (9 to 13). The patients were randomised into two groups: group 1 included 18 patients whose procedure was undertaken without a tourniquet and group 2, 16 patients in whom a tourniquet was used. The temperature in the bone was measured directly by two thermocouples inserted into the cortical bone near the isthmus of the tibial diaphysis. Reaming was carried out to at least 1.5 mm above the required diameter of the nail. Blood loss was assessed by recording the preoperative and postoperative haemoglobin (Hb) level.The minimum clinical follow-up was six months. In group 1 (no tourniquet), the mean Hb dropped 2.8 g/dl from 14.3 ± 1.02 g/dl to 11.5 ± 1.04 g/dl (p = 0.0001), whereas with the tourniquet, the mean decrease was 1.3 g/dl from 14 ± 1 g/dl to 12.7 ± 1.3 g/dl (p = 0.007). This difference was not statistically significant. The mean initial tibial temperature was 35.6°C (SD 0.6) and rose with reaming to levels between 36.3°C and 51.6°C. The highest temperatures were obtained with the largest reamers (11 and 12 mm, p = 0.0001) and the most rapid rise with the smallest diameters of medullary canal (8 or 9 mm). The rise of temperature was transient (20s).We were unable to identify any effect of the use of a tourniquet on the temperature achieved. Reamed intramedullary tibial nailing induces a transient elevation of temperature which is directly related to the amount of reaming.

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Friction burns within the tibia during reaming

Giannoudis¹,

Snowden

Matthews³

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…Post-operative changes, however, have been poorly investigated with these two imaging modalities. The effect of osteotomies on the proximal femoral vascularity in rabbit models have been well demonstrated histologically in previous studies [5][6][7] , confirming the effectiveness of this surgical procedure in producing healing of the proximal femur by means of neovascularization.…”

Section: Introductionmentioning

confidence: 54%

“…Surgical interventions, such as osteotomies, stimulate growth in long bones [5][6][7] . In these circumstances bone growth occurs in response to disturbances of the vascular supply to the proximal epiphysis and metaphysis.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intertrochanteric Osteotomy on the Proximal Femur of Rabbits: Assessment With Power Doppler Sonography and Scintigraphy

Doria

Cunha

Modena

et al. 2007

Clinics

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1Doria AS, Cunha FG, Modena M, Rodrigues CJ, Garcez AT, Junior RG, Bolliger Neto R, Melo IB, Buchpiguel C, Molnar LJ, Guarniero R. Effect of intertrochanteric osteotomy on the proximal femur of rabbits: assessment with power doppler sonography and scintigraphy. Clinics. 2007;62(6):741-8. OBJECTIVE:In bone injury, repair results in local increased vascularity and bone marrow remodeling. Characterizing the vascular and metabolic imaging patterns of the proximal femur following an intertrochanteric osteotomy may help clinicians decide proper management of the patient. Our objective was to measure Doppler sonography and scintigraphy interval changes in the proximal femur following intertrochanteric osteotomy and compare imaging and histomorphometric measurements in the late post-operative stage (6 weeks after surgery) in a rabbit model of bone injury. MATERIALS AND METHODS: Both hips of 12 adult rabbits were imaged with power Doppler sonography and scintigraphy prior to and after (7 days and 6 weeks) unilateral osteotomy. Accuracy of the imaging methods was evaluated using hip operative status and histomorphometric results (vascular fractional area and number of vessels per area unit) as reference standard measures. RESULTS: A significant difference in the mean number of pixels was noted between operated and non-operated femura in late post-operative power Doppler examinations (P=0.049). Although without reaching statistical significance, the AUC of Doppler measurements (AUC=0.99) was numerically greater than the AUC of scintigraphy measurements (AUC=0.857±0.099) (P=0.15) in differentiating proximal femura with regard to their fractional vascular areas in the late post-operative stage. In contrast, scintigraphy tended to perform better (AUC=0.984±0.022) than Doppler ultrasound (AUC=0.746±0.131) to demonstrate the vascularity intensity per area unit (P=0.07) in the late stage. CONCLUSION: Our results warrant further investigation to determine the value of different imaging modalities for assessment of pathologic changes following hip surgery. Power Doppler sonography demonstrated larger AUCs (representing higher accuracy) for the discrimination of vascular fractional areas and scintigraphy, for discrimination of the number of vessels per area unit.

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“…Our patients have demonstrated compromise of these principles by thermal injury due to inadequate reaming of narrow medullary cavities and prevention of heat transfer by convective blood flow (Sundén 1967;Leunig et al 1994) resulting from the use of a tourniquet.…”

Section: Discussionmentioning

confidence: 99%

Thermal Necrosis After Tibial Reaming for Intramedullary Nail Fixation

Leunig

Hertel

1996

The Journal of Bone and Joint Surgery. British volume

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We present three young men who sustained closed diaphyseal fracture of the tibia and later developed severe osteocutaneous necrosis induced by heat during intramedullary reaming. They all had a narrow medullary cavity and in all a tourniquet had been used. Each developed a pretibial cutaneous blister soon after operation. In the following month severe osteomyelitis ensued, requiring segmental resection and osteocutaneous reconstruction.

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Some Aspects of Longitudinal Bone Growth: An Experimental Study of the Rabbit Tibia

Cited by 18 publications

References 172 publications

Friction burns within the tibia during reaming

Friction burns within the tibia during reaming

Effect of Intertrochanteric Osteotomy on the Proximal Femur of Rabbits: Assessment With Power Doppler Sonography and Scintigraphy

Thermal Necrosis After Tibial Reaming for Intramedullary Nail Fixation

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