The role of soft-tissue traction forces in bone segment transport for callus distraction

Horas, Konstantin; Schnettler, Reinhard; Maier, Gerrit Steffen; Schneider, Gaby; Horas, U.

doi:10.1007/s11751-015-0220-8

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…From ex vivo approaches, a large number of existing studies in the literature have examined these changes by analyzing samples harvested after the slaughter of their specimens. 5,13,16,18,20,21,27,28,44 Muscles tend to adapt to limb elongation due to the lengthening of their fibers and the addition of new sarcomeres under a slight extension. 30,35 However, excessive elongation (> 30% of the initial length) could trigger important histological changes, and a reduction of ST stiffness.…”

Section: Introductionmentioning

confidence: 99%

“…30,35 However, excessive elongation (> 30% of the initial length) could trigger important histological changes, and a reduction of ST stiffness. 27 Tendons and ligaments present a lower capacity to adapt to bone lengthening than muscles, 5 and also suffer an important reduction in their mechanical properties 13,21 especially in adult patients. BL can increase the pressure on joint contacts, 44 limiting limb mobility or producing significant histological changes in joint tissues.…”

Section: Introductionmentioning

confidence: 99%

“…20 Finally, bone lengthening could cause problems in the cardiovascular system and alterations in blood flow which could endanger the patient. 21 Despite the extensive information provided by these studies, their tissue characterization is generally limited to specific time-points of the consolidation phase. The diversity in protocols, animal models, and analysis methods in histological studies or the boundary and environmental conditions during mechanical testing also prevent the standardization of quantitative conclusions.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone Lengthening Study

et al. 2020

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Bone lengthening is a bone regeneration technique with multiple clinical applications. One of the most common complications of this treatment is the lack of adaptation of the surrounding soft tissue to their extension. A better understanding of the mechanobiology of the tissues involved in distraction osteogenesis would allow better control of the clinical cases. Bone lengthening treatments were performed in vivo in the metatarsus of Merino sheep, measuring the distraction forces by means of an instrumented fixator. The tissue relaxation after distraction was analyzed in this study. A viscoelastic model was also applied to distraction data to assess the mechanical behavior of the tissues during the distraction phase. Tissue relaxation is similar to other bone regeneration processes which do not imply surrounding soft tissue extension, e.g. bone transport. The effects of this tissue on distraction forces are limited to the first minutes of distraction and elongations above 4% of the original length with the protocol applied. Moreover, the surrounding soft tissue initially loses some of its viscoelasticity and subsequently suffers strain hardening from day 5 of distraction until the end of the distraction phase, day 15. Finally, anatomical changes were also evidenced in the elongated limb of our specimens.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone Lengthening Study

et al. 2020

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“…Other factors must be taken into consideration when attempting to mitigate the risk of flap loss, with one of which being rate of bone transport. While Jupiter et al [62] concluded that the free tissue and the native tissue undergo equal amounts of stretch and lengthening, Horas et al [103] noted a difference in speed between bone transport and soft-tissue movement, which could potentially jeopardize the vascular pedicle secondary. This risk increases with the amount of transport needed.…”

Section: Discussionmentioning

confidence: 99%

Review of soft tissue coverage options in distraction osteogenesis of the extremity

Stoneburner¹,

Azadgoli²,

Howell³

et al. 2020

PAR

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Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps (12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.

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“…For instance, bone transport trusts on the long-standing distraction osteogenesis to gradually move an osteotomized surrounded bony fragment towards the position of the original defect while simultaneously forming a bone callus on the other side, the docking site [2][3][4]. However, this regeneration process carries inherent risks, particularly concerning viscoelastic and structural alterations in the neighboring soft tissues (e.g., skin, tendons, or muscles) [5][6][7][8]. Another traditional solution lies in incorporating autogenic and allogenic bone grafts to encourage cell regenerative activity in the gap, mainly vascularized free fibular or Papineau open cancellous bone grafting [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Gait analysis: An effective tool to mechanically monitor the bone regeneration of critical-sized defects in tissue engineering applications

Blázquez-Carmona,

Mora-Macías,

Morgaz

et al. 2023

PLoS ONE

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Introduction Tissue engineering has emerged as an innovative approach to treat critical-size bone defects using biocompatible scaffolds, thus avoiding complex distraction surgeries or limited stock grafts. Continuous regeneration monitoring is essential in critical-size cases due to the frequent appearance of non-unions. This work evaluates the potential clinical use of gait analysis for the mechanical assessment of a tissue engineering regeneration as an alternative to the traditional and hardly conclusive manual or radiological follow-up. Materials and methods The 15-mm metatarsal fragment of eight female merino sheep was surgically replaced by a bioceramic scaffold stabilized with an external fixator. Gait tests were performed weekly by making the sheep walk on an instrumented gangway. The evolution of different kinematic and dynamic parameters was analyzed for all the animal’s limbs, as well as asymmetries between limbs. Finally, potential correlation in the recovery of the gait parameters was evaluated through the linear regression models. Results After surgery, the operated limb has an altered way of carrying body weight while walking. Its loading capacity was significantly reduced as the stance phases were shorter and less impulsive. The non-operated limbs compensated for this mobility deficit. All parameters were normalizing during the consolidation phase while the bone callus was simultaneously mineralizing. The results also showed high levels of asymmetry between the operated limb and its contralateral, which exceeded 150% when analyzing the impulse after surgery. Gait recovery significantly correlated between symmetrical limbs. Conclusions Gait analysis was presented as an effective, low-cost tool capable of mechanically predicting the regeneration of critical-size defects treated by tissue engineering, as comparing regeneration processes or novel scaffolds. Despite the progressive normalization as the callus mineralized, the bearing capacity reduction and the asymmetry of the operated limb were more significant than in other orthopedic alternatives.

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The role of soft-tissue traction forces in bone segment transport for callus distraction

Cited by 9 publications

References 19 publications

Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone Lengthening Study

Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone Lengthening Study

Review of soft tissue coverage options in distraction osteogenesis of the extremity

Gait analysis: An effective tool to mechanically monitor the bone regeneration of critical-sized defects in tissue engineering applications

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