Distraction Osteogenesis in the Combined and Sequential Use of Transosseous and Intramedullary Osteosynthesis: Experimental Study

Cover Page

Abstract

Background. The methods of “lengthening over the nail” (LON) and the sequential use of the external fixation and nailing in the option “lengthening and then the nail” (LATN) are characterized by ignoring non-observance of the formulated by G.A. Ilizarov is the most important condition for optimizing the osteogenesis process, namely, the preservation of medullary blood supply and osteogenic bone marrow tissue. At the same time, in clinical practice, there was no negative effect of the intramedullary nail on the formation of the regenerate. In experimental studies, the activation of periosteal bone formation during LON is noted. But the active periosteal bone formation detected in clinical practice with a sequential technique has not been confirmed by experimental studies.

The aim of the study was to compare the organotypical rebuilding of the distraction regenerate during tibial lengthening in rabbits according to Ilizarov, over the intramedullary fixator and with the sequential use of the external fixation and nailing.

Materials and Methods. The study was carried out on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into 3 groups of 18 animals. In Gr-1 (control), the tibia was lengthened by 1 cm in a mini-Ilizarov apparatus at a rate of 1 mm per day for 4 sessions step. In Gr-2, the LATN technique was modeled. After the end of lengthening, an intramedullary fixator was implanted installed, the apparatus with the presence of wires only in the base supports was kept as an imitation of blocking the intramedullary fixator. In Gr-3, lengthening was performed over the intramedullary fixator; at the end of lengthening, the wires were left only in the base supports. The fixation period was is 30 days. The total duration of the experiment is 45 days. On the 10th, 15th, 20th, 30th, 45th day X-ray, CT and morphological studies were performed during the experiment.

Results. In the experimental groups, a more pronounced periosteal bone formation in the area of regenerates was noted, while in Gr-3 (LON) cortical plates were formed mainly from the periosteal component, and in Gr-2 (LATN) wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values are noted. Endosteal bone formation was preserved in all groups.

Conclusion. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the organotypical rebuilding of the bone tissue of the regenerates. All zones of bone formation are present, including endosteal, with intense periosteal bone formation. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN) in the form of the formation of wide cortical plates due to the intermediate and periosteal zones of the regenerate.

About the authors

E. A. Shchepkina

Vreden National Medical Research Center of Traumatology and Orthopedics; Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: shchepkina_elena@mail.ru
ORCID iD: 0000-0001-6132-0305

Elena A. Shchepkina — Cand. Sc. (Med), Associate Professor, Senior Researcher, Scientific Department of the Treatment of Injuries and Their Consequences; Associate Professor at the Department of Traumatology and Orthopedics and the Department of General Medical Practice (Family Medicine)

St. Petersburg

Russian Federation

I. V. Lebedkov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: positivism@mail.ru
ORCID iD: 0000-0003-1484-5971

Ivan V. Lebedkov — Orthopedic Surgeon, Traumatology and Orthopedic Department No.1

St. Petersburg

Russian Federation

G. I. Netylko

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: doctornetylko@mail.ru
ORCID iD: 0000-0001-5074-6204

Georgy I. Netylko — Dr. Sci. (Med.), Leading Researcher, Scientific Department for Prevention and Treatment of Wound Infection

St. Petersburg

Russian Federation

L. N. Solomin

Vreden National Medical Research Center of Traumatology and Orthopedics; St. Petersburg State University

Email: solomin.leonid@gmail.com
ORCID iD: 0000-0003-3705-3280

Leonid N. Solomin — Dr. Sci. (Med.), Professor, Leading Researcher, Scientific Department of the Treatment of Injuries and Their Consequences; Professor at the Department of General Surgery

St. Petersburg

Russian Federation

L. O. Anisimova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: anisanat@mail.ru
ORCID iD: 0000-0003-0119-1155

Larisa O. Anisimova — Cand. Sc. (Med), Researcher, Scientific Department for Prevention and Treatment of Wound Infection

St. Petersburg

Russian Federation

V. V. Trushnikov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: trushnikov@list.ru
ORCID iD: 0000-0002-9067-5137

Vladislav V. Trushnikov — Head of the Pathological Department

St. Petersburg

Russian Federation

I. V. Sushkov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: face@neicon.com

Ivan V. Sushkov — Radiologist

St. Petersburg

Russian Federation

References

  1. Kojimoto H., Yasui N., Goto T., Matsuda S., Shimomura Y. Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. J Bone Joint Surg Br. 1988;70(4):543-549. doi: 10.1302/0301-620X.70B4.3403595.
  2. DeCoster T.A., Simpson A.H., Wood M., Li G., Kenwright J. Biologic model of bone transport distraction osteogenesis and vascular response. J Orthop Res. 1999;17(2):238-245. doi: 10.1002/jor.1100170213.
  3. Choi I.H., Ahn J.H., Chung C.Y., Cho T.J. Vascular proliferation and blood supply during distraction osteogenesis: a scanning electron microscopic observation. J Orthop Res. 2000;18(5):698-705. doi: 10.1002/jor.1100180504.
  4. Ганг Л. Новые достижения и секреты, раскрытые при изучении дистракционного остеогенеза. Гений ортопедии. 2007;(1):130-136.
  5. Ерофеев С.А. Особенности репаративного остеогенеза и управление дистракционным остеогенезом при чрескостном остеосинтезе. В кн.: Основы чрескостного остеосинтеза. Под. ред. Л.Н. Соломина. М.: БИНОМ; 2014. Т.1. С. 220-250.
  6. Bragdon B., Lybrand K., Gerstenfeld L. Overview of biological mechanisms and applications of three murine models of bone repair: closed fracture with intramedullary fixation, distraction osteogenesis, and marrow ablation by reaming. Curr Protoc Mouse Biol. 2015;5(1):21-34. doi: 10.1002/9780470942390.mo140166.
  7. Hvid I., Horn J., Huhnstock S., Steen H. The biology of bone lengthening. J Child Orthop. 2016;10(6):487-492. doi: 10.1007/s11832-016-0780-2.
  8. Szabó A., Janovszky Á., Pócs L., Boros M. The periosteal microcirculation in health and disease: An update on clinical significance. Microvasc Res. 2017;110:5-13. doi: 10.1016/j.mvr.2016.11.005.
  9. Попков Д.А. Применение интрамедуллярного армирования при удлинении конечностей. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2005;(2):65-69.
  10. Popkov A.V., Kononovich N.A., Filimonova G.N., Gorbach E.N., Popkov D.A. Bone Formation and Adaptive Morphology of the Anterior Tibial Muscle in 3-mm Daily Lengthening Using High-Fractional Automated Distraction and Osteosynthesis with the Ilizarov Apparatus Combined with Intramedullary Hydroxyapatite-Coated Wire. Biomed Res Int. 2019;2019:3241263. doi: 10.1155/2019/3241263.
  11. Илизаров Г.А., Шрейнер А.А. Новый метод закрытой флексионной остеотомии (экспериментальное исследование). Ортопедия, травматология, протезирование. 1979;(1):9-18.
  12. Fernandes H.P., Barronovo D.G., Rodrigues F.L., Hono M. Femur lengthening with monoplanar external fixator associated with locked intramedullary nail. Rev Bras Ortop. 2016;52(1):82-86. doi: 10.1016/j.rboe.2016.03.007.
  13. Burghardt R.D., Manzotti A., Bhave A., Paley D., Herzenberg J. E. Tibial lengthening over intramedullary nails a matched case comparsion with Ilizarov tibial lengthening. Bone Joint Res. 2016;(5):1-10. doi: 10.1302/2046-3758.51.2000577.
  14. Boutsiadis A., Iosifidou E., Nikolaos X., Hatzokos I. Lengthening Over an Existing Intramedullary Nail In Cases of Post-traumatic Femoral Shortening. Technical Note. Case Series Study. Open Orthop J. 2016;10:12-18. doi: 10.2174/1874325001610010012.
  15. Свешников П.Г., Жиленко В.Ю., Медведчиков А.Е., Буров Е.В., Есин Д.Ю. Комбинированный остеосинтез в лечении пациентов с посттравматическими деформациями, укорочениями и дефект-псевдоартрозами бедренной кости. Современные проблемы науки и образования. 2017;(5):169. Режим доступа: http://science-education.ru/ru/article/view?id=27007
  16. Бондаренко А.В., Плотников И.А., Гусейнов Р.Г. Лечение посттравматических дефектов диафиза большеберцовой кости методом комбинированного последовательного билокального и блокирующего остеосинтеза. Политравма. 2020;(1):23-30.
  17. Birch J.G. A brief history of limb lengthening. J Pediatr Orthop. 2017;(37):1-8. doi: 10.1097/BPO.0000000000001021.
  18. Xu W.G. Comparison of intramedullary nail versus conventional Ilizarov method for lower limb lengthening: a systematic review and meta-analysis. Orthop Surg. 2017;9(2):159-166. doi: 10.1111/os.12330.
  19. Sheridan G.A., Fragomen A.T., Rozbruch S.R. Integrated Limb Lengthening Is Superior to Classical Limb Lengthening: A Systematic Review and Meta-analysis of the Literature. J Am Acad Orthop Surg Glob Res Rev. 2020;4(6):e20.00054. doi: 10.5435/JAAOSGlobal-D-20-00054.
  20. Paley D., Herzenberg J.E., Paremain G., Bhave A. Femoral lengthening over an intramedullary nail. A matchedcase comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am. 1997;79(10):1464-1480. doi: 10.2106/00004623-199710000-00003.
  21. Kocaoglu M., Eralp L., Kilicoglu O., Burc H., Cakmak M. Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg Am. 2004;86(11): 2406-2411. doi: 10.2106/00004623-200411000-00007.
  22. Щуров В.А., Попков А.В., Новиков И.К., Мурадисинов С.О. Показатели физического и психического здоровья больных при оперативном удлинении конечности. Национальная Ассоциация Ученых. 2017;6(33):17-20.
  23. Li G., Berven S., Athanasou N.A., Simpson A.H. Bone transport over an intramedullary nail. A case report with histologic examination of the regenerated segment. Injury. 1999;30(8):525-534. doi: 10.1016/s0020-1383(99)00112-6.
  24. Еманов А.А., Митрофанов А.И., Борзунов Д.Ю., Колчин С.Н. Экспериментально-клиническое обоснование комбинированного остеосинтеза при замещении дефектов длинных костей (предварительное сообщение). Травматология и ортопедия России. 2014;1(71):16-23.
  25. Lin C.C., Huang S.C., Liu T.K., Chapman M.W. Limb lengthening over an intramedullary nail. An animal study and clinical report. Clin Orthop Relat Res. 1996;(330):208-216. doi: 10.1097/00003086-199609000-00028.
  26. Kristiansen L.P., Steen H. Lengthening of the tibia over an intramedullary nail, using the Ilizarov external fixator. Major complications and slow consolidation in 9 lengthenings. Acta Orthop Scand. 1999;70(3):271-274. doi: 10.3109/17453679908997806.
  27. Степанов М.А., Кононович Н.А., Горбач Е.Н. Репаративная регенерация костной ткани при удлинении конечности методикой комбинированного дистракционного остеосинтеза. Гений ортопедии. 2010;(3):89-94.
  28. Matsoukis J., Thomine J.M., Khallouk R., Biga N. [Secondary locked nailing of the leg after external fixation. 25 cases]. Rev Chir Orthop Reparatrice Appar Mot. 1991;77(8):555-561. (In French).
  29. Rozbruch S.R., Kleinman D., Fragomen A.T., Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res. 2008;466(12):2923-2932. doi: 10.1007/s11999-008-0509-8.
  30. Emara K., Farouk A., Diab R. Ilizarov technique of lengthening and then nailing for height increase. J Orthop Surg (Hong Kong). 2011;19(2):204-208. doi: 10.1177/230949901101900215.
  31. National Research Council. Guide for the Care and Use of Laboratory Animals. Washington (DC): The National Academies Press; 1996.
  32. Соломин Л.Н. Метод унифицированного обозначения чрескостного остеосинтеза. В кн.: Основы чрескостного остеосинтеза. Под. ред. Л.Н. Соломина. М.: БИНОМ; 2014. Т.1. С. 45-55.
  33. Илизаров Г.А., Ирьянов Ю.М. Особенности остеогенеза в условиях напряженного растяжения. Бюллетень экспериментальной биологии и медицины. 1991;109(2):194-196.
  34. Щепкина Е.А, Лебедков И.В., Соломин Л.Н., Нетылько Г.И. Экспериментальное обоснование комбинированного и последовательного применения чрескостного и интрамедуллярного блокируемого остеосинтеза. Достижения Российской травматологии и ортопедии. Материалы ХI всероссийского съезда травматологов-ортопедов. СПб: Издательство ВВМ; 2018. Т. I. С. 354-357.
  35. Pithioux M., Roseren F., Jalain C., Launay F., Charpiot P., Chabrand P. et al. An Efficient and Reproducible Protocol for Distraction Osteogenesis in a Rat Model Leading to a Functional Regenerated Femur. J Vis Exp. 2017;(128):56433. doi: 10.3791/56433.
  36. Halanski M.A., Yildirim T., Chaudhary R., Chin M.S., Leiferman E. Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model. Clin Orthop Relat Res. 2016;474(4):1028-1037. doi: 10.1007/s11999-015-4646-6.
  37. Sun X.T., Easwar T.R., Stephen M., Song S.H., Kim S.J., Song H.R. Comparative study of callus progression in limb lengthening with or without intramedullary nail with reference to the pixel value ratio and the Ru Li’s classification. Arch Orthop Trauma Surg. 2011;131(10): 1333-1340. doi: 10.1007/s00402-011-1302-9.
  38. Muzaffar N., Hafeez A., Modi H., Song H.R. Callus patterns in femoral lengthening over an intramedullary nail. J Orthop Res. 2011;29(7):1106-1113. doi: 10.1002/jor.21353.

Statistics

Views

Abstract: 243

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies