The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia

Reichert, Ines; McCarthy, I. D.; Hughes, Sean

doi:10.1302/0301-620x.77b3.7744943

Cited by 129 publications

(45 citation statements)

References 13 publications

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“…Bone metabolism is more rapid in rats compared with man, but we consider it justifiable to assume that the changes are similar to those occurring in patients in whom cemented or cementless prosthesis are inserted, and when load bearing is avoided. The periosteal and endosteal reaction, and the revascularisation seen after reaming, have been recorded in fractures of human long bones and do not differ quantitatively from what is seen in the experimental model [18,26]. However, what occurs in rats in 90 days would take several years in man.…”

Section: Discussionmentioning

confidence: 77%

The reaction to nailing or cementing of the femur in rats

Pazzaglia

Andrini

Nucci

1997

International Orthopaedics

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Section: Discussionmentioning

confidence: 77%

The reaction to nailing or cementing of the femur in rats

Pazzaglia

Andrini

Nucci

1997

International Orthopaedics

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“…In the lateral view, a minor correction into flexion with slight anterior translation was achieved as planned recommendation is preservation of the endosteum by cortical osteotomies [83]. Some authors hypothesise that reaming may compromise endosteal blood supply and, thus, affect the quality of the regenerate [135,136]. However, there is evidence that the periosteal blood supply may increase after intramedullary nailing, which is particularly important for effective distraction osteogenesis [76,137].…”

Section: Intramedullary Fixation: General Considerationsmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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“…Reamed intramedullary nailing results in increased contact area between the implant and the bone surface and thus increases stability, permitting early weight bearing and eventually facilitating fracture union [10,11]. Although reaming disrupted the blood flow to the cortex, it induced a 6-fold increase in the periosteal blood flow to overcome lack of endosteal blood flow and improve fracture healing [12].…”

Section: Discussionmentioning

confidence: 99%

Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures-A comparative study

et al. 2016

Int J of Biomed & Adv Res

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Tibial fractures were the most common long bone fracture. These were treated by intramedullary nailing. Treatment of reamed versus unreamed intramedullary nailing was still controversial. This comparative study was conducted in the department of orthopaedic surgery in Mahatma Gandhi Memorial Hospital, Warangal, Telangana state, India with an aim to know the efficacy of both treatments. In this study the average duration of surgery was 72±12 min, the average time to full weight-bearing was 9.2 weeks and the average time to union of the fracture was 14 weeks. The unreamed intramedullary nailing group demonstrated a significantly higher rate of fracture non-union (R 3%, U 6%) and malunion (R 6%, U 9%). The significantly higher incidences of implant exchange, a higher risk of screw failure and dynamization were noticed in the unreamed intramedullary nailing group. Regarding the adverse effects like infection, compartment syndrome and knee pain there was no significant difference between two groups.

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The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia

Cited by 129 publications

References 13 publications

The reaction to nailing or cementing of the femur in rats

The reaction to nailing or cementing of the femur in rats

Current concepts of leg lengthening

Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures-A comparative study

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