Traumatized periosteum: Its histology, viability, and clinical significance.

Abstract

The periosteum covers the surface of long bone except at the joints. During fracture fixation, we found the periosteum is ragged and damaged. Our objective is to determine the microscopic picture of traumatized periosteum in terms of the degree of damage, cell type, stromal tissue, and vascularity. Periosteum of 1cm*1cm is harvested at 1cm, 3cm, and 5cm proximal and distal to fracture site following fracture of a long bone in 20 humans. Ragged and damaged periosteum mainly consists of an outer fibrous layer with many hemorrhagic tissue and neovascularization. Osteoprogenitor cells were seen only in 12 out of 97 samples, mostly harvested 5 cm from the fracture site. The innermost layer of the periosteum remains attached to the bone surface after separating the fibrous layer following a fracture. The use of a periosteal elevator on the bone surface further damages the inner layer of the periosteum. Using a scalpel to separate the periosteum or merely pulling it away from the bone surface will decrease damage to the inner cambium layer. Fracture reduction can be achieved by indirect means at least 5 cm away from the fracture site.

Increased β 2 -adrenergic signaling promotes fracture healing through callus neovascularization in mice

“…The importance of callus vascularization in bone regeneration is best illustrated by several clinical studies demonstrating that vascular disease is a major risk factor for fracture nonunion ( 33 , 50 ). Similarly, damage to the periosteum, whose integrity is a prerequisite for sufficient callus vascularization, impairs bone healing ( 51 ). The neuropeptide αCGRP, which signals through the G protein–coupled calcitonin receptor–like receptor, is known to be highly expressed in the periosteum and essential for adequate fracture healing ( 36 ).…”

Increased beta2-adrenergic signaling is a targetable stimulus essential for bone healing by promoting callus neovascularization

“…The importance of callus vascularization in bone regeneration is best illustrated by several clinical studies that clearly demonstrate that vascular disease is a major risk factor for fracture nonunion (35,50). Similarly, damage to the periosteum, whose integrity is a prerequisite for sufficient callus vascularization, impairs bone healing (51). In this regard, the neuropeptide Cgrp is known to be highly expressed in the periosteum and essential for adequate fracture healing (38).…”

From Free Tissue Transfer to Hydrogels: A Brief Review of the Application of the Periosteum in Bone Regeneration

“…From other work, clinicians procured periosteal samples at 1 cm, 3 cm, and 5 cm proximal and distal to the fracture sites of long bones in 20 patients. However, they found the majority of the harvested periostea only contained the outer fibrous layer, while the inner cambium layers remained attached to the bone surfaces [ 40 ]. Simon et al stimulated the proliferation of the cambium layer by incising the periosteum and scoring to the cortical bone.…”