The effect of devascularisation upon early bone healing in dynamic external fixation

Abstract

We examined the effect of periosteal devascularisation upon the early healing of osteotomies of sheep tibiae held in an instrumented external fixation system with an axial stiffness of 240 N/mm. At 14 days, cortical blood flow measured by the microsphere technique was 19.3 ml/min/100g in the well-vascularised osteotomies, but only 1.7 ml/min/100g in the devascularised osteotomies, despite an increase in medullary flow (p less than 0.0005). Delay in healing of the devascularised osteotomies was suggested by an in vivo monitoring system and confirmed by post-mortem mechanical testing. We suggest that the osteogenic stimulus of dynamic external fixation is dependent on the early restoration of cortical blood flow in devascularised fractures.

Depression of bone blood flow after blunt trauma:A fracture study in the adult rabbit

“…Our errors are smaller than those of Chidgey et al (1986) and similar to those of Smith et al ( 1 9 9 0~ Strachan et al ( 1990). Keller et al (1991), Wallace et al (1991). and our own figures after osteotomy (Triffitt et al 1993).…”

Restoration of bone flow following fracture and reaming in rat femora

“…Flow was increased not only at the fracture site, but throughout the cortex. Our results confirm those of other studies on fracture healing (Rhinelander 1974, Wallace et al 1991. The increased perfusion in this phase of healing would seem to be more than adequate for delivery of nutrients to the healing tissue.…”

Comparison of the healing of open tibial fractures covered with either muscle or fasciocutaneous tissue in a murine model

“…Exclusion of surrounding soft tissue from a tibial fracture denuded of periosteum in an ovine model resulted in decreased cortical blood flow and delayed healing compared to controls. 18 This study, however, did not compare muscle with skin and fascia.…”