Primary resective shortening followed by distraction osteogenesis for limb reconstruction: A comparison with simple lengthening

Resective distraction osteogenesis is a new approach to treat segmental diaphyseal bone defects by primary limb shortening and secondary distraction osteogenesis from the same site. A rabbit model was introduced to compare the bone‐regeneration characteristics of this technique with those of simple lengthening procedures. Twenty‐four skeletally mature New Zealand White rabbits were divided into two equal groups. In the test group, limbs were lengthened after a 10‐mm segmental diaphyseal bone resection and limb shortening. In the control group, a simple subperiosteal osteotomy for limb lengthening was performed without resection. New bone formation was evaluated mechanically, radiologically, histomorphometrically, and densitometrically. Bone bridging occurred in all animals. Normalized mechanical values for the newly reconstructed tibiae demonstrated similar torsional stiffness (71 ± 3.3 compared with 71 ± 8.2%; p = 0.95) and strength (64 ± 5.3 compared with 68 ± 7.3%; p = 0.66) in the two groups. The average normalized callus diameter was significantly greater in the test group than in the control group (p < 0.01). The remodeling index calculated from densitometry, however, showed a significantly less progressed stage of remodeling in the test group (p < 0.05). Histomorphometric analysis of the callus center supported this finding, showing significantly lower values for trabecular thickness (p < 0.05) and total bone volume (p < 0.01) in the test group. The results demonstrated the possibility of new bone formation after resection and monofocal shortening. This suggests a new therapeutic option to treat diaphyseal segmental bone defects.

[1]  R. Gustilo,et al.  JSBS classics. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. Retrospective and prospective analyses. , 1976, The Journal of bone and joint surgery. American volume.

[2]  S. Lounici,et al.  Comparison of two systems for tibial external fixation in rabbits. , 1999, Laboratory animal science.

[3]  J. Cañadell,et al.  Distraction Osteogenesis of the Lower Extremity with Use of Monolateral External Fixation. A Study of Two Hundred and Sixty-one Femora and Tibiae* , 1998, The Journal of bone and joint surgery. American volume.

[4]  L. Schweiberer,et al.  [Primary shortening--secondary lengthening. A new treatment concept for reconstruction of extensive soft tissue and bone injuries after 3rd degree open fracture and amputation of the lower leg]. , 1998, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....

[5]  R. Feibel,et al.  Combined Muscle Flap and Ilizarov Reconstruction for Bone and Soft Tissue Defects , 1996, Clinical orthopaedics and related research.

[6]  G. Muschler,et al.  Bone Transport Using Intramedullary Fixation and a Single Flexible Traction Cable , 1996, Clinical orthopaedics and related research.

[7]  J. Pfeil,et al.  Extremitätenverlängerung, Deformitätenkorrektur, Pseudarthrosenbehandlung , 1996 .

[8]  H. Plenk,et al.  Effect of bone cylinder length on distraction osteogenesis in the rabbit tibia , 1995, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  S. Green,et al.  Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. , 1994, Clinical orthopaedics and related research.

[10]  J. L. Marsh,et al.  Chronic infected tibial nonunions with bone loss. Conventional techniques versus bone transport. , 1994, Clinical orthopaedics and related research.

[11]  R. Brutscher.  6. Application and techniques of callus distraction , 1994 .

[12]  J. Sales de Gauzy,et al.  Primary shortening followed by callus distraction for the treatment of a posttraumatic bone defect: case report. , 1993, The Journal of trauma.

[13]  Gavriil Abramovich Ilizarov,et al.  Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue , 1991 .

[14]  G. Giebel.  [Delayed fracture healing of the upper arm]. , 1991, Der Unfallchirurg.

[15]  C. Josten,et al.  [Spongiosa-plasty and transport corticotomy--an alternative or supplementary procedure?]. , 1991, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[16]  L. Schweiberer,et al.  [First fully implantable intramedullary system for callus distraction--intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results]. , 1990, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[17]  J. Kenwright,et al.  The timing of distraction of an osteotomy. , 1990, The Journal of bone and joint surgery. British volume.

[18]  R. Gustilo,et al.  The management of open fractures. , 1990, The Journal of bone and joint surgery. American volume.

[19]  G A Ilizarov,et al.  The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. , 1989, Clinical orthopaedics and related research.

[20]  T. Goto,et al.  Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. , 1988, The Journal of bone and joint surgery. British volume.

[21]  H S Byrd,et al.  Management of Open Tibial Fractures , 1985, Plastic and reconstructive surgery.

[22]  R. Pelker,et al.  Effect of freezing on histologic and biomechanical failure patterns in the rabbit capital femoral growth plate , 1985, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.