Bone Growth and Modeling Changes Induced by Periosteal Stripping in the Rat

Hernández, J; Serrano, S; Mariñoso, M.L.; Aubia, J; Lloreta, J.; Marrugat, J; Díez, Alfredo Escudero

doi:10.1097/00003086-199511000-00034

Cited by 15 publications

(16 citation statements)

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“…Although some have reported accelerated growth after stripping [1,9,10,13,25], more often growth acceleration has been reported after periosteal transection [16,19,31] and resection [8,16,20,28,32]. Our observed growth acceleration after periosteal transection, resection, full periosteal release, and repetitive transection appears similar to that reported in such studies (10%-30% over control limbs) [16].…”

Section: Discussionsupporting

confidence: 87%

“…Growth acceleration has been found to occur in many animal species after periosteal resection (cutting and removal of a circumferential strip of periosteum) [8,16,20,28,32]. However, the procedure of periosteal stripping (detaching the periosteum from the underlying bone without circumferentially cutting or removing the periosteum) has also been shown to accelerate physeal growth [1,9,10,13,25]. The two papers that demonstrate the most consistent and promising clinical results combined both circumferential periosteal transection with periosteal stripping or resection [7,15].…”

Section: Introductionmentioning

confidence: 99%

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Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

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Chaudhary

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Disruption of the periosteum has been used to explain overgrowth after long bone fractures. Clinically, various periosteal procedures have been reported to accelerate growth with varied results. Differences between procedures and study populations, in these prior studies, make drawing conclusions regarding their effectiveness difficult. Questions/purposes The purpose of this study was to (1) determine if all reported periosteal procedures accelerate growth and increase the length of bones; (2) study the relative duration of these growth-accelerating effects at two time points; and (3) identify the periosteal procedure that results in the most growth. The contralateral tibiae served as an operative sham control in all cohorts. Fluorochrome bone labeling was used to measure growth rates, whereas high-resolution Faxitron imaging was performed to measure tibial lengths. Comparisons were then made between (1) experimental and sham controls; and (2) different procedures. Eight additional nonsurgical animals were included as age-matched controls. Results Growth (in microns) was accelerated at the proximal tibial physis on the tibia undergoing the periosteal surgical procedures versus the contralateral control limb after the transection (411 ± 27 versus 347 ± 18, p \ 0.001 [mean ± SD]), resection (401 ± 33 versus 337 ± 31, p \ 0.001), and full periosteal release (362 ± 45 versus 307 ± 33, p \ 0.001), 2 weeks after the index procedure. Conversely, the periosteal stripping cohort trended toward less growth (344 ± 35) than the controls (356 ± 25; p = 0.08). No differences were found between limbs in the nonoperative controls. Tibial lengths for the experimental tibiae were longer at 2 weeks in the transection (1.6 ± 0.4 mm, p \ 0.001), resection (1.6 ± 0.9 mm, p = 0.03), and full periosteal release (1.7 ± 0.5 mm, p \ 0.001), whereas negligible differences were found between the tibiae of the nonoperative controls (0.13 ± 0.7 mm, p = 0.8) and stripping cohorts (0.10 ± 0.6 mm, p = 0.7). At 8 weeks, growth acceleration ceased at the proximal tibial physes in the transection cohort (174 ± 11 versus 176 ± 21, p = 0.8), Methods

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

Halanski

Yıldırım

Chaudhary

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Interestingly, motor denervation alone, as in post-polio states, does not impair development of an RAP (Frost, unpublished observations). A, RAP usually responds to local need (Hernandez et al, 1995). It causes three of the classical signs of inflammation: Edema, erythema, and increased warmth.…”

Section: Regional Acceleratory Phenomenon (Rap)mentioning

confidence: 99%

From Wolff's law to the Utah paradigm: Insights about bone physiology and its clinical applications

2001

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Efforts to understand our anatomy and physiology can involve four often overlapping phases. We study what occurs, then how, then ask why, and then seek clinical applications. In that regard, in 1960 views, bone's effector cells (osteoblasts and osteoclasts) worked chiefly to maintain homeostasis under the control of nonmechanical agents, and that physiology had little to do with anatomy, biomechanics, tissue-level things, muscle, and other clinical applications. But it seems later-discovered tissue-level mechanisms and functions (including biomechanical ones, plus muscle) are the true key players in bone physiology, and homeostasis ranks below the mechanical functions. Adding that information to earlier views led to the Utah paradigm of skeletal physiology that combines varied anatomical, clinical, pathological, and basic science evidence and ideas. While it explains in a general way how strong muscles make strong bones and chronically weak muscles make weak ones, and while many anatomists know about the physiology that fact depends on, poor interdisciplinary communication left people in many other specialties unaware of it and its applications. Those applications concern 1.) healing of fractures, osteotomies, and arthrodeses; 2.) criteria that distinguish mechanically competent from incompetent bones; 3.) design criteria that should let load-bearing implants endure; 4.) how to increase bone strength during growth, and how to maintain it afterwards on earth and in microgravity situations in space; 5.) how and why healthy women only lose bone next to marrow during menopause; 6.) why normal bone functions can cause osteopenias; 7.) why whole-bone strength and bone health are different matters; 8.) why falls can cause metaphyseal and diaphyseal fractures of the radius in children, but mainly metaphyseal fractures of that bone in aged adults; 9.) which methods could best evaluate whole-bone strength, "osteopenias" and "osteoporoses"; 10.) and why most "osteoporoses" should not have bone-genetic causes and some could have extraosseous genetic causes. Clinical specialties that currently require this information include orthopaedics, endocrinology, radiology, rheumatology, pediatrics, neurology, nutrition, dentistry, and physical, space and sports medicine. Basic science specialties include absorptiometry, anatomy, anthropology, biochemistry, biomechanics, biophysics, genetics, histology, pathology, pharmacology, and cell and molecular biology. This article reviews our present general understanding of this new bone physiology and some of its clinical applications and implications. It must leave to other times, places, and people the resolution of questions about that new physiology, and to understand the many devils that should lie in its details. (Thompson D'Arcy, 1917). Anat Rec 262: 2001.

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“…Disadvantages of external fixation are well known: depending upon the implant material, implant dimension or the permanent interaction with soft tissue, breaking of pins and pin infection are typical complications, whereas only infection played a minor role in this study (Hazan and Oron, 1993;Hernandez et al, 1995;Mark et al, 2003). Artefacts in radiological examinations are a common problem of all osteosynthesis implants but are more dominant in stainless steel than in titanium (Sullivan et al, 1994).…”

Section: Discussionmentioning

confidence: 83%