The Histology of Distraction Osteogenesis Using Different External Fixators

Aronson, James; Harrison, Barry H.; Stewart, Charles L.; Harp, John H.

doi:10.1097/00003086-198904000-00013

Cited by 178 publications

(108 citation statements)

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“…The growth plate that forms under the influence of tension-stress was described by Ilizarov as having features of both physeal and intramembranous ossification, yet being neither. 28 While most authors agree with the concept that distraction osteogenesis leads primarily to direct or intramembranous bone formation, [29][30][31] some studies reveal at least a temporary endochondral pathway or transchondral mechanism described most often in a rabbit or rat model. [31][32][33] Ilizarov considered cartilage formation to be an unmistakable indication of unstable fixation.…”

Section: Discussionmentioning

confidence: 99%

Effect of pulsed electromagnetic fields on maturation of regenerate bone in a rabbit limb lengthening model

BARONE¹,

Sbordone

Ramaglia

2005

Journal Orthopaedic Research

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ABSTRACT:To study the effect of applying pulsed electromagnetic fields (PEMF) during the consolidation phase of limb lengthening, a mid-tibial osteotomy was performed in 18 adult New Zealand White rabbits and an external fixator was applied anteromedially. Animals were randomly assigned to treatment and control groups. After a 7-day latency period, the tibiae were distracted 0.5 mm every 12 h for 10 days. The treatment group received a 20-day course of PEMF for 60 min daily, coinciding with initiation of the consolidation phase. The control group received sham PEMF. Radiographs were performed weekly after distraction. Animals were euthanized 3 weeks after the end of distraction. Radiographic analysis revealed no significant difference in regenerate callus area between treatment and control tibiae immediately after distraction, at 1 week, 2 weeks, or 3 weeks after distraction ( p ¼ 0.71, 0.22, 0.44, and 0.50, respectively). There was also no significant difference in percent callus mineralization ( p ¼ 0.96, 0.69, 0.99, and 0.99, respectively). There was no significant difference between groups with respect to structural stiffness ( p ¼ 0.80) or maximal torque to failure ( p ¼ 0.62). However, there was a significant positive difference in mineral apposition rate between groups during the interval 1-2 weeks post-distraction ( p < 0.05). This difference was no longer evident by the interval 2-3 weeks post-distraction. While PEMF applied during the consolidation phase of limb lengthening did not appear to have a positive effect on bone regenerate, it increased osteoblastic activity in the cortical bone adjacent to the distraction site. Since the same PEMF signal was reported to be beneficial in the rabbit distraction osteogenesis when applied during distraction phase and consolidation phase, application of PEMF in the early phase may be more effective. Further work is necessary to determine optimal timing of the PEMF stimulation during distraction osteogenesis. ß

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Section: Discussionmentioning

confidence: 99%

Effect of pulsed electromagnetic fields on maturation of regenerate bone in a rabbit limb lengthening model

BARONE¹,

Sbordone

Ramaglia

2005

Journal Orthopaedic Research

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“…Preservation of periosteum as the main source of blood supply is critical [46,[75][76][77][78][79][80][81]. Its disruption significantly decelerates bone formation [75,82].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…Intra-membranous bone formation is the underlying biological process of callotasis [8,26,27,78,80,93,100,101]. Typically, it evolves in defined radiological and histological zones: central type I collagen with adjacent vascular periosteal and endosteal ingrowth comprising osteoblasts depositing osteoid along the collagen bundles, laterally neighboured by longitudinal columns of mineralised bone stretching out parallel to the distraction forces and eventually bridging transversely [8,100,[102][103][104].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

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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“…15 The new external fixator for segmental bone transport provides standardised and controlled distraction and maturation of callus, with accurate settings of the telescopic axial movement. In contrast to other systems 7,8,[16][17][18] the new ring fixator has a very high bending, torsional and axial stiffness in all planes, minimising uncontrolled IFM. The initial, designed axial telescopic movement can be monitored telemetrically and thus used to determine the rate of maturation over any selected period of study.…”

Section: Discussionmentioning

confidence: 98%

The influence of stiffness of the fixator on maturation of callus after segmental transport

Laule¹,

Wenger²,

Suger

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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T he treatment of large bony defects by callus distraction is well accepted, but the duration of treatment is long and the rate of complications increases accordingly. We have examined the effect of the stiffness of the axial fixator on reducing the time for maturation of callus.We created a mid-diaphyseal defect of 15 mm in the metatarsal bone in sheep and stabilised it with a ring fixator. After four days a bony segment was transported for 16 days at 1 mm per day. After 64 days the animals were divided into four groups, three with axial interfragmentary movement (IFM) of 0.5, 1.2 and 3.0 mm, respectively, and a control group.The 3.0 mm IFM group had the smallest bone density (p = 0.001) and area of callus and the largest IFM after 12 weeks; it also had typical clinical signs of hypertrophic nonunion. The most rapid stiffening of the callus was in the 0.5 mm group which had the smallest IFM (p = 0.04) after 12 weeks and radiological signs of bridging of the defect. These results indicate that suitable dynamic axial stimulation can enhance maturation of distraction callus when the initial amplitude is small, but that a large IFM can lead to delayed union. [Br] 2000;82-B:142-8. J Bone Joint Surg Received 21 July 1998; Accepted after revision 5 March 1999Callus distraction is widely used for the treatment of defects of tubular long bones.1,2 At the end of the distraction the young callus has low mechanical stiffness and strength; adequate time must then be allowed for maturation before the fixator can be removed. At least two-thirds of this time is dedicated to passive maturation and most complications such as loosening or infection of the pins occur during this phase if external fixation is used. 3,4 Loosening of the pins results in reduced mechanical stability and increased movement in young regenerate bone. In experimental studies on callus distraction, both deleterious and advantageous effects have been demonstrated on movement, depending on the amount. A small degree will induce regeneration and maturation of callus, 5 but if it exceeds a certain limit in the regenerate bone, maturation decreases and osseous bridging of the defect is inhibited, resulting in hypertrophic nonunion. 6 The specific range of movement which effectively stimulates young distraction callus is unknown. The movement which occurs normally in this tissue during the maturation phase can be estimated from in vitro measurements of fixators used in distraction osteogenesis. In a tibial Ilizarov fixator consisting of four rings, axial movement is in the range of 3 to 6 mm when axially loaded to 300 N, depending on the amount of pretension in the wires. 7,8When pretension is reduced or the wires loosened the axial movements are correspondingly higher. It is not possible to ensure that patients do not exceed the proposed load limits. More information, generated from the more finely-incremented interfragmentary movements (IFM), is still needed to estimate the degree of axial movement may be optimal or critical for the maturation of callus.Studi...

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The Histology of Distraction Osteogenesis Using Different External Fixators

Cited by 178 publications

References 0 publications

Effect of pulsed electromagnetic fields on maturation of regenerate bone in a rabbit limb lengthening model

Effect of pulsed electromagnetic fields on maturation of regenerate bone in a rabbit limb lengthening model

Current concepts of leg lengthening

The influence of stiffness of the fixator on maturation of callus after segmental transport

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