The course of bone healing is influenced by the initial shear fixation stability

Schell, Hanna; Epari, Devakara R.; Kassi, Jean-Pierre; Bragulla, Hermann; Bail, Hermann Josef; Duda, Georg N.

doi:10.1016/j.orthres.2005.03.005

Cited by 199 publications

(129 citation statements)

References 25 publications

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“…Unchanged or stagnant EESC on eleven FUS (in grade 1 cases) was attributed to impaired healing associated with hypertrophic fibrovascular tissue and callus, as indicated by osteosclerosis and joint fusion (ankylosis) seen on plain x-rays obtained simultaneously. Most likely, ineffective immobilization of the bone fragments was the underlying factor, causing hyperplasia of fibrous rather than of mineralized callus [32,40]. …”

Section: Discussionmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

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Section: Discussionmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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“…The animal model has been extensively reported 5,7 and is only briefly summarized in the next paragraph.…”

Section: Animal Model and Histologymentioning

confidence: 99%

“…During the remodeling phase, lamellar bone replaces woven bone, the callus is resorbed, and finally the original shape of the bone is restored. [7][8][9][10] To understand the progression of the healing process, and in particular the influence of the mechanical environment, a number of animal experiments have been performed. In these experiments, either "static" fixators with different degrees of stability [11][12][13][14] or "dynamic" fixators, which induce micro-movement to stimulate callus formation, 15,16 were used.…”

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confidence: 99%

“…In order to summarize the information of a group of animals, typically only the amount of the various tissue types (area fractions) are reported as quantitative outcome. 7,12,[19][20][21] This information is limited for two reasons. Firstly, area fractions are missing important topological information, that is, they do not provide location and distribution information.…”

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confidence: 99%

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Temporal tissue patterns in bone healing of sheep

Vetter

Epari

Seidel

et al. 2010

Journal Orthopaedic Research

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Secondary fracture healing in long bones leads to the successive formation of intricate patterns of tissues in the newly formed callus. The main aim of this work was to quantitatively describe the topology of these tissue patterns at different stages of the healing process and to generate averaged images of tissue distribution. This averaging procedure was based on stained histological sections (2, 3, 6, and 9 weeks post-operatively) of 64 sheep with a 3 mm tibial mid-shaft osteotomy, stabilized either with a rigid or a semi-rigid external fixator. Before averaging, histological images were sorted for topology according to six identified tissue patterns. The averaged images were obtained for both fixation types and the lateral and medial side separately. For each case, the result of the averaging procedure was a collection of six images characterizing quantitatively the progression of the healing process. In addition, quantified descriptions of the newly formed cartilage and the bone area fractions (BA/TA) of the bony callus are presented. For all cases, a linear increase in the BA/TA of the bony callus was observed. The slope was greatest in the case of the most rigid stabilization and lowest in the case of the least stiff. This topological description of the progression of bone healing will allow quantitative validation (or falsification) of current mechano-biological theories. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J. Orthop. Res. 28: 1440Res. 28: -1447Res. 28: , 2010 Keywords: bone healing; tissue pattern; osteotomy; animal model; averaged image Secondary fracture healing of long bones proceeds via the formation of a callus. 1-3 The task of the callus is to stabilize the fracture fragments resulting in a reduction of the strains in the fracture area, allowing the bone ends to be united. Usually the process of secondary fracture healing is subdivided into three main phases: the inflammatory phase, the reparative phase, and the remodeling phase. 4 These phases, however, are not well separated in time, and significant overlap can occur between them. During the inflammatory phase, vascular damage leads to hematoma formation. The reparative phase includes revascularization and the formation of fibrous tissue and cartilage, and new bone is formed at the periosteal side of the cortex by intramembranous ossification. [4][5][6] Soft callus bridging occurs via cartilage, which is later transformed into bone by endochondral ossification. During the remodeling phase, lamellar bone replaces woven bone, the callus is resorbed, and finally the original shape of the bone is restored. [7][8][9][10] To understand the progression of the healing process, and in particular the influence of the mechanical environment, a number of animal experiments have been performed. In these experiments, either "static" fixators with different degrees of stability [11][12][13][14] or "dynamic" fixators, which induce micro-movement to stimulate callus formation, 15,16 were used. These experiments d...

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“…The amount of callus formed is strongly influenced by inter-fragmentary movements: a generally stable fixation would generate small callus formation, whereas an unstable fracture fixation would form larger callus. [15][16][17] If the interfragmentary movement is too large, delayed union or nonunions might occur, 18 and as qualitative analysis suggests, shear movement further delays the healing process. [19][20][21] After 60 days, BMD and BMC values and biomechanical properties significantly improved in the group with combined tibia and fibula fracture to almost the same level as seen in the group with intact fibula.…”

Section: Discussionmentioning

confidence: 99%

Role of the fibula in lower leg fractures: An in vivo investigation in rats

Horn

Steen

Reikerås

2008

Journal Orthopaedic Research

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Whether or not the fibula should be fixated in combined fractures of the tibia and fibula remains controversial. Several clinical and biomechanical studies have investigated the role of the fibula in lower leg fractures without leading to a common conclusion. We assumed that an intact or stable fibula would provide better healing conditions in lower leg fractures treated with an intramedullary nail. In an in vivo study, 40 male Wistar rats were randomly assigned to two groups. In both groups, the tibia was osteotomized, whereas the fibula was left intact in one group and osteotomized in the other group. The tibia fracture was fixated with an intramedullary nail. After sacrifice of the animals, mineral density, mineral content, and mechanical characteristics of the healing osteotomies were evaluated. We found that a combination of tibia and fibula fracture significantly impaired fracture healing during the early phase after the incident, when treated with an intramedullary nail, suggesting that an intact or stabilized fibula provides additional support and better healing conditions to a tibia fracture. ß

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The course of bone healing is influenced by the initial shear fixation stability

Cited by 199 publications

References 25 publications

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Temporal tissue patterns in bone healing of sheep

Role of the fibula in lower leg fractures: An in vivo investigation in rats

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