Temporary distraction and compression of a diaphyseal osteotomy accelerates bone healing

Abstract

Mechanical strain during callus distraction is known to stimulate osteogenesis. It is unclear whether this stimulus could be used to enhance the healing of a normal fracture without lengthening the bone. This study tested the hypothesis that a slow temporary distraction and compression of a diaphyseal osteotomy accelerates fracture healing. Fourteen sheep underwent a middiaphyseal osteotomy of the right tibia, stabilized by external fixation. An external fixator allowed either a temporary axial distraction (TD group; n ¼ 6) or a constant fixation (C group; n ¼ 8). Distraction began 7 days postoperatively at a rate of 0.5 mm twice per day for 2 days with subsequent shortening of 1.0 mm twice on the third day. The procedure was repeated four times. Fluorochrome labeling was performed postoperatively. After 8 weeks the sheep were sacrificed and healing was evaluated using densitometric, biomechanical, and histological methods. Bending stiffness of the tibiae after 8 weeks was 58% higher in the TD group than in the C group. The volume of the periosteal callus was significantly (p ¼ 0.05) higher in the TD group (3.9 cm 3 ) than in the C group (2.7 cm 3 ). There was 20% more bone in the fracture gap of the TD group than the C group. There was a significantly higher bone formation rate in the TD group than in the C group. This study demonstrated the feasibility of fracture healing stimulation by the temporary application of distraction and compression. ß

Distraction Osteogenesis and Its Challenges in Bone Regeneration

“…Numerous variations of this technique have been described: alternated cycles of compression and distraction the same day, and compression for a period of 1 or more weeks followed by distraction for the same duration (Claes et al, 2008).…”

Accordion Maneuver with Modified Ilizarov Frame for treatment of recalcitrant nonunion of shaft of femur in a patient with Pycnodysostosis

“…7 Claes concluded that temporary cyclic distraction and compression could enhance better bone healing by producing early increased bone volume that had higher bending rigidity. 8 Transformational Osteogenesis is a technique in Ilizarov system used in nonunion to stimulate healing. The tools used in this method are compression and distraction depending on the type of tissues between the fragments.…”

A new intramedullary sustained dynamic compression nail for the treatment of long bone fractures: a biomechanical study

“…Higher amount of periosteal new bone formation was observed. [31][32][33] Shortening of fracture gaps by compression can improve the healing process. Thus the main effect of this procedure is the reduction of the fracture gap distance, which is known to improve the bone healing.…”