Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum

Kojimoto, Haruo; Yasui, Natsuo; Goto, Teppei; Matsuda, Shuichi; Shimomura, Yutaka

doi:10.1302/0301-620x.70b4.3403595

Cited by 356 publications

(179 citation statements)

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“…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. However, local ischemia, due to disruption of medullary vessels during extensive distraction, may also account for the appearance of cartilaginous islands, especially in the early stages of distraction.…”

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%

“…Ilizarov and others firmly recommended corticotomies to preserve medullary blood flow [26,80,83]. However, this is difficult to perform and experimental work revealed that complete bone separation (osteotomy) is equally effective [76,82,[84][85][86][87]. Dual-energy X-ray absorptiometry (DEXA) and histomorphometrical studies showed that the periosteum produces up to five-fold more callus than bone marrow during lengthening [74,75,88,89].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

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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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“…Some authors have expressed concern that intramedullary nailing may compromise the endosteal blood supply of diaphyseal bone and thus affect the quality of newly formed bone during leg-lengthening procedures [8,15,18]. However, it has been shown that the periosteum and surrounding soft tissue can support osteogenesis and permit new bone formation, and it is also known these issues are particularly important for effective distraction osteogenesis [9,19,20]. In addition, Rhinelander [16] noted that reconstitution of the medullary vasculature is most likely complete within 2 weeks after reaming.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, medullary callus may contribute to vascular regeneration despite reaming, whereas plugging the canal with cement would prevent this response. Kojimoto [9] demonstrated in a rabbit model that the periosteum plays a more important role in the regeneration of distraction-callus than the endosteum.…”

Section: Discussionmentioning

confidence: 99%

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Kim

Lee

Kim

et al. 2008

International Orthopaedics (SICOT)

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The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

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Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum

Cited by 356 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

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

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