Periosteal Bone Formation on Medullary Evacuation: A Bone Formation Model

Danckwardt-Lillieström, G; Grevsten, Sven; Johansson, Henry; Olerud, S

doi:10.1517/03009734000000010

Cited by 7 publications

(2 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent with prior preclinical reaming studies, even in the absence of intramedullary nailing. 32,33 The mechanism of new periosteal rather than simply endosteal bone formation is unclear. It is possible that reaming creates a generalized inflammatory response affecting the periosteum, due to release of cancellation bone fragments, 34 multipotent progenitor cells, 35,36 and growth factors 37 from within the medullary canal.…”

Section: Discussionmentioning

confidence: 99%

Induction of periosteal bone formation by intraosseous BMP-2 injection in a mouse model of osteogenesis imperfecta

Cheng

Cantrill

Little

2019

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

PurposeSurgical interventions are routinely performed on children with osteogenesis imperfecta (OI) to stabilize long bones, often post fracture. We speculated that a combination of intramedullary reaming and intraosseous injection of recombinant bone morphogenetic protein-2 (BMP-2) could enhance periosteal ossification and ultimately cortical thickness and strength. This approach was conceptually tested in a preclinical model of genetic bone fragility.MethodsSix experimental groups were tested including no treatment, intramedullary reaming, and reaming with 5 µg BMP-2 injection performed in the tibiae of both wild type (WT) and Col1a2G610C/+ (OI, Amish mutation) mice. Bone formation was examined at a two-week time point in ex vivo specimens by micro-computed tomography (microCT) analysis and histomorphometry with a dynamic bone label.ResultsMicroCT data illustrated increases in tibial cortical thickness with intramedullary reaming alone (Saline) and reaming plus BMP-2 injection (BMP-2) compared to no intervention controls. In the OI mice, the periosteal bone increase was not statistically significant with Saline but there was an increase of +192% (p = 0.053) with BMP-2 injection. Dynamic histomorphometry on calcein label was used to quantify new woven bone formation; while BMP-2 induced greater bone formation than Saline, the anabolic response was blunted overall in the OI groups.ConclusionsThese data indicate that targeting the intramedullary compartment via reaming and intraosseous BMP-2 delivery can lead to gains in cortical bone parameters. It is suggested that the next step is to validate safety and functional improvements in a clinical OI setting.

show abstract

Section: Discussionmentioning

confidence: 99%

Induction of periosteal bone formation by intraosseous BMP-2 injection in a mouse model of osteogenesis imperfecta

Cheng

Cantrill

Little

2019

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…The Reamer–Irrigator–Aspirator (RIA) system (Synthes, Inc., West Chester, PA), which provides continuous irrigation and suction during the reaming of long bones, was first developed to reduce the incidence of fat embolism (FE) and thermal necrosis [ 1 , 2 ]. Although often times neglected in the current literature, it were Dankwardt–Lillieström and colleagues, who more than 50 years ago originated the suction irrigation reaming method and demonstrated in a preclinical rabbit model that clearance of the medullary canal of long bones prior to reaming or nail fixation might result in improved bone healing and less FE by reducing the expulsion of bone marrow into the blood vessels of the cortical bone [ 3 – 6 ]. Rooted in their concept and subsequent (technical) device advancements, the RIA system was attributed a potentially important role in the prevention of FE and a favorable local effect on the microstructure of the bone and, thus, on fracture healing [ 1 , 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Laubach

Weimer

Bläsius

et al. 2022

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction Complications associated with the application of the Reamer–irrigator–Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted. Materials and methods The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system. Results Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2–3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00–6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80–26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69–4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed. Conclusions The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.

show abstract

Design for Prodigious Size without Extreme Body Mass

Bertram¹

2016

Understanding Mammalian Locomotion

View full text Add to dashboard Cite

Periosteal Bone Formation on Medullary Evacuation: A Bone Formation Model

Cited by 7 publications

References 3 publications

Induction of periosteal bone formation by intraosseous BMP-2 injection in a mouse model of osteogenesis imperfecta

Induction of periosteal bone formation by intraosseous BMP-2 injection in a mouse model of osteogenesis imperfecta

Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Design for Prodigious Size without Extreme Body Mass

Contact Info

Product

Resources

About