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External fixation compared to intramedullary nailing of tibial fractures in the rat.

Sigurdsen UE, Reikeras O, Utvag SE - Acta Orthop (2009)

Bottom Line: At 60 days, however, the intramedullary nailed bones had more strength, greater callus area, and higher bone mineral content in the callus segment compared to externally fixated fractures.Tibial shaft fractures in the rat treated with external fixation and intramedullary nailing show a similar healing pattern in the early phase of fracture healing, while at the time of healing intramedullary nailing provides improved densitometric properties and superior mechanical properties compared to external fixation.Clinical findings indicate that intramedullary nailing in human tibial fractures may be more advantageous for bone healing than external fixation, in a similar way.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty Division Akershus University Hospital, University of Oslo, Norway. u.e.w.sigurdsen@medisin.uio.no

ABSTRACT

Background and purpose: It is not known whether there is a difference in bone healing after external fixation and after intramedullary nailing. We therefore compared fracture healing in rats after these two procedures.

Methods: 40 male rats were subjected to a standardized tibial shaft osteotomy and were randomly assigned to 2 treatment groups: external fixation or intramedullary nailing. Evaluation of half of each treatment group at 30 days and the remaining half at 60 days included radiography, dual energy radiographic absorbtiometry, and mechanical testing.

Results: Radiographically, both treatment groups showed sign of fracture healing with gradual bridging of the fracture line, while with intramedullary nailing the visible collar of callus was increased peripherally, indicative of periosteal healing. At 30 days, densitometric and mechanical properties were similar in the 2 groups. At 60 days, however, the intramedullary nailed bones had more strength, greater callus area, and higher bone mineral content in the callus segment compared to externally fixated fractures.

Interpretation: Tibial shaft fractures in the rat treated with external fixation and intramedullary nailing show a similar healing pattern in the early phase of fracture healing, while at the time of healing intramedullary nailing provides improved densitometric properties and superior mechanical properties compared to external fixation. Clinical findings indicate that intramedullary nailing in human tibial fractures may be more advantageous for bone healing than external fixation, in a similar way.

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Rat tibial diaphyseal fracture 60 days after intramedullary nailing.
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Figure 0002: Rat tibial diaphyseal fracture 60 days after intramedullary nailing.

Mentions: The rats were randomly assigned to external fixation (n = 20) or intramedullary nailing (n = 20). The external fixator has been described previously (Mark et al. 2003) (Figure 1). 2 pins (1.0 mm in diameter) were inserted proximal to the fracture and 2 distal. The core drill-holes in the tibia were 0.8 mm. Fixator-bone offset was 6 mm. The external fixators were placed anterolaterally, giving the animals freedom of physical movement. The nails were inserted from the proximal side into the bone marrow cavity through the anterior tip of the tibial plateau to the distal tibiofibular junction, with the knee in a flexed position (Figure 2). The nails were cut flush to the bony surface at the insertion side. There was no reaming or locking of the nail. The medial and posterior segments were left attached to the bone. The operation wound was closed in 2 layers, with absorbable suture. A layer of transparent film dressing was then sprayed on the sutured wound.


External fixation compared to intramedullary nailing of tibial fractures in the rat.

Sigurdsen UE, Reikeras O, Utvag SE - Acta Orthop (2009)

Rat tibial diaphyseal fracture 60 days after intramedullary nailing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823217&req=5

Figure 0002: Rat tibial diaphyseal fracture 60 days after intramedullary nailing.
Mentions: The rats were randomly assigned to external fixation (n = 20) or intramedullary nailing (n = 20). The external fixator has been described previously (Mark et al. 2003) (Figure 1). 2 pins (1.0 mm in diameter) were inserted proximal to the fracture and 2 distal. The core drill-holes in the tibia were 0.8 mm. Fixator-bone offset was 6 mm. The external fixators were placed anterolaterally, giving the animals freedom of physical movement. The nails were inserted from the proximal side into the bone marrow cavity through the anterior tip of the tibial plateau to the distal tibiofibular junction, with the knee in a flexed position (Figure 2). The nails were cut flush to the bony surface at the insertion side. There was no reaming or locking of the nail. The medial and posterior segments were left attached to the bone. The operation wound was closed in 2 layers, with absorbable suture. A layer of transparent film dressing was then sprayed on the sutured wound.

Bottom Line: At 60 days, however, the intramedullary nailed bones had more strength, greater callus area, and higher bone mineral content in the callus segment compared to externally fixated fractures.Tibial shaft fractures in the rat treated with external fixation and intramedullary nailing show a similar healing pattern in the early phase of fracture healing, while at the time of healing intramedullary nailing provides improved densitometric properties and superior mechanical properties compared to external fixation.Clinical findings indicate that intramedullary nailing in human tibial fractures may be more advantageous for bone healing than external fixation, in a similar way.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty Division Akershus University Hospital, University of Oslo, Norway. u.e.w.sigurdsen@medisin.uio.no

ABSTRACT

Background and purpose: It is not known whether there is a difference in bone healing after external fixation and after intramedullary nailing. We therefore compared fracture healing in rats after these two procedures.

Methods: 40 male rats were subjected to a standardized tibial shaft osteotomy and were randomly assigned to 2 treatment groups: external fixation or intramedullary nailing. Evaluation of half of each treatment group at 30 days and the remaining half at 60 days included radiography, dual energy radiographic absorbtiometry, and mechanical testing.

Results: Radiographically, both treatment groups showed sign of fracture healing with gradual bridging of the fracture line, while with intramedullary nailing the visible collar of callus was increased peripherally, indicative of periosteal healing. At 30 days, densitometric and mechanical properties were similar in the 2 groups. At 60 days, however, the intramedullary nailed bones had more strength, greater callus area, and higher bone mineral content in the callus segment compared to externally fixated fractures.

Interpretation: Tibial shaft fractures in the rat treated with external fixation and intramedullary nailing show a similar healing pattern in the early phase of fracture healing, while at the time of healing intramedullary nailing provides improved densitometric properties and superior mechanical properties compared to external fixation. Clinical findings indicate that intramedullary nailing in human tibial fractures may be more advantageous for bone healing than external fixation, in a similar way.

Show MeSH
Related in: MedlinePlus