TITLE

Testing of a New One-Stage Bone-Transport Surgical Procedure Exploiting the Periosteum for the Repair of Long-Bone Defects

AUTHOR(S)
Knothe Tate, Melissa L.; Ritzman, Todd F.; Schneider, Erich; Knothe, Ulf R.
PUB. DATE
February 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p307
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: A recently proposed one-stage bone-transport surgical procedure exploits the intrinsic osteogenic potential of the periosteum while providing mechanical stability through intramedullary nailing. The objective of this study was to assess the efficacy of this technique to bridge massive long-bone defects in a single stage. Methods: With use of an ovine femoral model, an in situ periosteal sleeve was elevated circumferentially from healthy diaphyseal bone, which was osteotomized and transported over an intramedullary nail into a 2.54-cm (1-in) critical-sized diaphyseal defect. The defect-bridging and bone-regenerating capacity of the procedure were tested in five groups of seven animals each, which were defined by the absence (Group 1; control) or presence of the pen- osteal sleeve alone (Group 2), bone graft within the periosteal sleeve (Groups 3 and 5), as well as retention of adherent, vascularized cortical bone chips on the periosteal sleeve with or without bone graft (Groups 4 and 5). The efficacy of the procedure was assessed qualitatively and quantitatively. Results: At sixteen weeks, osseous bridging of the defect was observed in all twenty-eight experimental sheep in which the periosteal sleeve was retained; the defect persisted in the remaining seven control sheep. Among the experimental groups 2 through 5, significant differences were observed in the density of the regenerated bone tissue; the two groups in which vascularized bone chips adhered to the inner surface of the periosteal sleeve (Groups 4 and 5) showed a higher mean bone density in the defect zone (p < 0.02) than did the other groups. In these two groups with the highest bone density, the addition of bone graft was associated with a significantly lower callus density than that observed with- out bone graft (p < 0.05). The volume of regenerate bone (p < 0.02) was significantly greater in the groups in which the periosteal sleeve was retained than it was in the control group. Among the experimental groups (groups 2 through 5), however, with the numbers studied, no significant differences in the volume of regenerate bone could be attributed to the inclusion of bone graft within the sleeve or to vascularized bone chips remaining adherent to the periosteum. Conclusions: The novel surgical procedure was shown to be effective in bridging a critical-sized defect in an ovine femoral model. Vascularized bone chips adherent to the inner surface of the periosteal sleeve, without the addition of morselized cancellous bone graft within the sleeve, provide not only a comparable volume of regenerate bone and composite tissue (callus and bone) but also a superior density of regenerate bone compared with that after the addition of bone graft. Clinical Relevance: These in vivo studies show, for the first time, the efficacy of the procedure and present a potential new way to regenerate bone in defects, such as those arising from tumor resection, débridement after infection, nonunion, or trauma, with use of a single-stage procedure.
ACCESSION #
23964957

 

Related Articles

  • Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening. Ryu, Keun; Kim, Bang; Hwang, Jin; Kim, Hyun; Lee, Dong; Ryu, Keun Jung; Kim, Bang Hyun; Hwang, Jin Ho; Kim, Hyun Woo; Lee, Dong Hoon // Clinical Orthopaedics & Related Research;Mar2016, Vol. 474 Issue 3, p816 

    Background: The lengthening over nail (LON) technique has gained popularity because it enables shorter periods of external fixation, prevents deformities during lengthening, and reduces the risk of refracture after removal of the frame compared with the classic Ilizarov method....

  • Gap nonunion of forearm bones treated by modified Nicoll's technique. Gupta, Dinesh K.; Kumar, Gaurav // Indian Journal of Orthopaedics;Jan-Mar2010, Vol. 44 Issue 1, p84 

    Background: The management of an atrophic nonunion with a gap following a fracture of the radius and/or ulna is a challenging problem. Various methods of treatment available in the literature are cortical tibial graft (Boyd), ulnar segment graft (Miller and Phalen), iliac crest graft (Spira),...

  • TRAUMATIC ANTERIOR DISLOCATION OF THE HIP COMBINED WITH FRACTURE OF THE IPSILATERAL FEMORAL SHAFT IN AN ADULT PATIENT: A CASE REPORT. Milcan, Abtullah // Anatolian Journal of Clinical Investigation;2012, Vol. 6 Issue 2, p136 

    Anterior dislocation of the hip with an ipsilateral fracture of the femoral shaft is not very common. After an automobile accident a 21 year old man and was admitted to Acıbadem Adana Hospital. Immediate reduction of the dislocation was planned, since the patient was polytraumatised open...

  • CORR Insights(®): Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening. Draenert, Klaus; Draenert, Klaus Dieter // Clinical Orthopaedics & Related Research;Mar2016, Vol. 474 Issue 3, p825 

    The author presents a commentary on the article Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening by Ryu and colleagues. Topics include evaluation of the problem of new bone formation in fracture healing, complications in...

  • Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail. Jones, Darron M.; Marsh, J. Lawrence; Nepola, James V.; Jacobs, Joshua J.; Skipor, Anastasia K.; Urban, Robert M.; Gilbert, Jeremy L.; Buckwalter, Joseph A. // Journal of Bone & Joint Surgery, American Volume;Apr2001, Vol. 83-A Issue 4, p537 

    Background: During routine follow-up of patients treated with a three-piece stainless-steel modular femoral nail, osteolysis and periosteal reaction around the modular junctions of some of the nails were noted on radiographs. The purpose of this study was to evaluate the prevalence, etiology,...

  • Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients Using a Lateral Trochanteric Entry Portal. Kim, Elliott J.; Crosby Jr., Samuel N.; Mencio, Gregory A.; Green, Neil E.; Lovejoy, Steven A.; Schoenecker, Jonathan G.; Martus, Jeffrey E. // Essential Surgical Techniques;Oct-Dec2014, Vol. 4 Issue 4, p1 

    The article offers step-by-step instructions for the use of a lateral trochanteric entry portal for rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients.

  • Effects of tiludronate on healing of femoral fracture in dogs. Abass, B. T.; Shekho, H. A. // Iraqi Journal of Veterinary Sciences;2009 Supplement, Vol. 23, p129 

    The clinical and radiological effects of systemic administration of tiludronate (bisphosphonate compound), was investigated on the healing of experimentally induced femoral fractures in twelve adult experimental dogs which were divided randomly into two groups (six for each). After induction of...

  • Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Said, Galal; Said, Hatem; El-Sharkawi, Mohammad // International Orthopaedics;Jul2011, Vol. 35 Issue 7, p1089 

    Methods: Fourteen patients with aseptic fractures that failed to unite after intramedullary nailing (IMN) of the femur were treated by augmentation of fixation by dynamic compression plate (DCP) with the nail in situ. In six of them that had axial or rotational malalignment, direct reduction of...

  • Limb Lengthening and Then Insertion of an Intramedullary Nail: A Case-matched Comparison. S. Rozbruch; Dawn Kleinman; Austin Fragomen; Svetlana Ilizarov // Clinical Orthopaedics & Related Research;Dec2008, Vol. 466 Issue 12, p2923 

    Abstract  Distraction osteogenesis is an effective method for lengthening, deformity correction, and treatment of nonunions and bone defects. The classic method uses an external fixator for both distraction and consolidation leading to lengthy times in frames and there is a risk...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics