Temporary Distraction and Compression of a Diaphyseal Osteotomy Accelerates Bone Healing

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Abstract

Mechanical strain during callus distraction is known to stimulate osteogenesis. It is unclear whether this stimulus could be used to enhance the healing of a normal fracture without lengthening the bone. This study tested the hypothesis that a slow temporary distraction and compression of a diaphyseal osteotomy accelerates fracture healing. Fourteen sheep underwent a middiaphyseal osteotomy of the right tibia, stabilized by external fixation. An external fixator allowed either a temporary axial distraction (TD group; n = 6) or a constant fixation (C group; n = 8). Distraction began 7 days postoperatively at a rate of 0.5 mm twice per day for 2 days with subsequent shortening of 1.0 mm twice on the third day. The procedure was repeated four times. Fluorochrome labeling was performed postoperatively. After 8 weeks the sheep were sacrificed and healing was evaluated using densitometric, biomechanical, and histological methods. Bending stiffness of the tibiae after 8 weeks was 58% higher in the TD group than in the C group. The volume of the periosteal callus was significantly (p = 0.05) higher in the TD group (3.9 cm3) than in the C group (2.7 cm3). There was 20% more bone in the fracture gap of the TD group than the C group. There was a significantly higher bone formation rate in the TD group than in the C group. This study demonstrated the feasibility of fracture healing stimulation by the temporary application of distraction and compression. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:772-777, 2008

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