Distraction Bone Healing

Karaharju, Erkki; Aalto, Kari; Kahri, Arvi; Lindberg, L.‐A.; Kallio, Tapio; Karaharju‐Suvanto, Terhi; Vauhkonen, Matti; Peltonen, Jari

doi:10.1097/00003086-199312000-00009

Cited by 51 publications

(16 citation statements)

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“…Expression of these proteins by hypertrophic chondrocytes has also been observed in vivo in selected cartilage regions. In situ hybridization and/or immunohistochemistry shows that human, rat, and chicken hypertrophic chondrocytes may be capable of synthesizing of type I collagen [8,17,18,19,20,21], osteocalcin [18,21], osteopontin [22], and osteonectin [23,24]. In addition, Galotto et al [25] have shown that preosteoblasts and osteocytes share the same membrane protein as hypertrophic chondrocytes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports on distraction osteogenesis at low rates of distraction (0.5-1.0 mm/day) in the human [3,4], dog [5][6][7], and sheep [8,9] show that the bone forms by intramembraneous ossification and no endochondral ossification is observed. However, in the rabbit model of leg lengthening, direct cartilage formation from the central fibrous tissue of the regenerate is observed [10,11].…”

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confidence: 98%

“…Induction of osteogenesis by means of an osteotomy, followed by fixation with an external fixator and subsequent controlled distraction of the callus, is a developing technique with widespread clinical application in the treatment of bone defects, limb deformities, and fracture nonunions [1,2]. Previous reports on distraction osteogenesis at low rates of distraction (0.5-1.0 mm/day) in the human [3, 4], dog [5][6][7], and sheep [8,9] show that the bone forms by intramembraneous ossification and no endochondral ossification is observed. However, in the rabbit model of leg lengthening, direct cartilage formation from the central fibrous tissue of the regenerate is observed [10,11].…”

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confidence: 99%

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The Role of Chondrocytes in Intramembranous and Endochondral Ossification During Distraction Osteogenesis in the Rabbit

Simpson

Triffitt

1999

Calcified Tissue International

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We have used a rabbit leg-lengthening model for detailed studies of the histology of distraction osteogenesis. Some unusual features of the endochondral ossification that occurs during the rapid transition of cartilage to bone in the regenerate were observed. Histological staining techniques together with immunohistochemistry and nonradioactive in situ mRNA hybridization for cartilage and bone-related molecules have been used to document the presence of an overlapping cartilage-bone phenotype in cells of the cartilage-bone transitional region. In those particular areas, some chondrocytes appeared to be directly transformed into newly formed bone trabeculae which are surrounded by bone matrix. Acid phosphatases were found within the cartilage matrix in some of the cartilage/bone transitional regions and type I collagen mRNA and type II collagen protein were found together in some of the marginal hypertrophic chondrocytes. This study indicates an unusual role of chondrocytes in the process of ossification at a distraction rate of 1.3 mm/day in the rabbit. Further direct evidence is required to prove the hypothesis that the hypertrophic chondrocytes may transdifferentiate into bone cells in this model.

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Section: Discussionmentioning

confidence: 99%

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confidence: 98%

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confidence: 99%

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The Role of Chondrocytes in Intramembranous and Endochondral Ossification During Distraction Osteogenesis in the Rabbit

Simpson

Triffitt

1999

Calcified Tissue International

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“…Intra-membranous bone formation is the underlying biological process of callotasis [8,26,27,78,80,93,100,101]. Typically, it evolves in defined radiological and histological zones: central type I collagen with adjacent vascular periosteal and endosteal ingrowth comprising osteoblasts depositing osteoid along the collagen bundles, laterally neighboured by longitudinal columns of mineralised bone stretching out parallel to the distraction forces and eventually bridging transversely [8,100,[102][103][104].…”

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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“…Most histological studies have shown that the main mode of bone formation during distraction osteogenesis is intramembranous ossification (Delloye et al 1990, Karaharju et al 1993, Aronson and Shen 1994. However, using a rat model, Yasui et al (1997) found that the mode of ossification changed during distraction osteogenesis: endochondral bone formation was marked in the early stage of distraction, but intramembranous bone formation predominated later.…”

Section: Discussionmentioning

confidence: 99%