Tibial Remodelling During Bone Defect Management Using Multilevel Fragment Lengthening (Experimental Findings)

The aim of the investigation was to reveal the features of tibial recovery during multilevel fragment lengthening for filling in an extensive bone defect in the conditions of maintained and disturbed intraosseous artery blood flow bed in the experiment.

Material and Мethods. The experiment modeled the conditions of tibial bone defect filling by bi-level lengthening of the proximal and distal fragments in the conditions of a preserved and disturbed medullary blood flow. The experiment included 54 dogs divided into 4 groups. Radiographic, angiographic, histological, and statistical methods were used in the study.

Results. Changes in the architecture of the tibial vascularity net were not accompanied by rough hemodynamic circulatory disorders and depended on the period of the study and initial features of blood supply to the fragments. The conditions of the proximal fragment lengthening were more beneficial for medullary blood flow recovery and new bone formation. Both periosteal and endosteal bone structures took an active part in the distraction osteogenesis. Active periosteal osteogenesis resulted in formation of new bone layers on the periphery of the transported fragments in all the cases. Unified intraosseous nutrient artery vascular bed was formed six months after the external fixator removal. Distraction regenerates by multilevel lengthening of the distal tibial fragment were formed mainly due to the periosteal osteogenesis. Distal fragment lengthening featured a hypoplastic type of bone formation. No active bone tissue remodeling was observed in distal fragment lengthening. Periosteal layers of cancellous bone tissue were not identified on the entire periphery of bone fragments.

Conclusion. Prolonged disturbance in the major medullary blood flow occurs in multilevel lengthening of the distal fragment. Blood supply to the transported fragments is provided by periosteomedullary anastomoses. There is no complete recovery of the tibial nutrient artery net at 1.5-year follow-up.

1. Ilizarov G.A. Sposob zameshcheniya defekta dlinnoy trubchatoy kosti [Method of replacing a long bone defect]. Inventor’s Certificate No.1124269/31-1. 1971.
2. Vascularization of tibia when compensating diaphyseal defect by elongation of one of the fragments according to G.A. Ilizarov’s method. Arkhiv anatomii, gistologii i embriologii 1989; 11: 21–27.
3. Shevtsov V.I., Borzounov D.Y., Petrovskaya N.V., Osipova E.V. The characteristic features of the reorganization of tibial arterial bed for filling the defect of leg bones using the technique of multilevel lengthening of the proximal fragment (experimental study). Geniy ortopedii 2005; 2: 5–13.
4. Ilizarov G.A. Transosseous osteosynthesis. Theoretical and clinical aspects of the regeneration and growth of tissue. Springer-Verlag-Heidelberg 1992; 802 p., http://dx.doi.org/10.1007/978-3-642-84388-4.
5. Green S.A., Jackson J.M., Wall D.M., Marinow H., Ishkanian J. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop 1992; 280: 136–142, http://dx.doi.org/10.1097/00003086-199207000-00016.
6. Paley D., Maar D.C. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma 2000; 14(2): 76–85, http://dx.doi.org/10.1097/00005131-200002000-00002.
7. El-Alfy B., El-Mowafi H., El-Moghazy N. Distraction osteogenesis in management of composite bone and soft tissue defects. Int Orthop 2010; 34(1): 115–118, http://dx.doi.org/10.1007/s00264-008-0574-3.
8. Smith W.R., Elbatrawy Y.A., Andreassen G.S., Philips G.C., Guerreschi F., Lovisetti L., Catagni M.A. Treatment of traumatic forearm bone loss with Ilizarov ring fixation and bone transport. Int Orthop 2007; 31(2): 165–170, http://dx.doi.org/10.1007/s00264-006-0172-1.
9. Liodakis E., Kenawey M., Krettek C., Wiebking U., Hankemeier S. Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rob: the long-term outcomes. Int Orthop 2011; 35(9): 1397–1402, http://dx.doi.org/10.1007/s00264-010-1094-5.
10. Kocaoglu M., Eralp L., Rashid H.U., Sen C., Bilsel K. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am 2006; 88(10): 2137–2145, http://dx.doi.org/10.2106/JBJS.E.01152.
11. Borzunov D.Y. Long bone reconstruction using multilevel lengthening of bone defect fragments. Int Orthop 2012; 36(8): 1695–1700, http://dx.doi.org/10.1007/s00264-012-1562-1.
12. Gough J.A. A method of injecting the blood-vessels for roentgenological studies and simultaneously embalming. The Anatomical Record 1920; 18(2): 193–203, http://dx.doi.org/10.1002/ar.1090180209.
13. Trueta J., Buhr A.J. The vascular contribution to osteogenesis. V. The vasculature supplying the epiphysial cartilage in rachitic rats. J Bone Joint Surg Br 1963; 45: 572–581.
14. Yang L., Li Q., Zhou Z. Changes of blood circulation of the extremity with tibia shaft defects treated with external fixation. Zhonghua Wai Ke Za Zhi 2000; 38(2): 145–147.
15. Yang L., Li Q., Zhou Z. Changes of blood circulation of the extremity after external fixation for tibia shaft defect: an experimental study. Chin J Traumatol 2001; 4(2): 89–92.
16. Shevtsov V.I., Gordievskikh N.I., Bunov V.S., Petrovskaya N.V. Changes in blood flow during tibial thickening by the Ilizarov method. Bull Exp Biol Med 2002; 134(6): 525–527, http://dx.doi.org/10.1023/a:1022988423449.

Borzunov D.Y. Tibial Remodelling During Bone Defect Management Using Multilevel Fragment Lengthening (Experimental Findings). Sovremennye tehnologii v medicine 2016; 8(1): 64, https://doi.org/10.17691/stm2016.8.1.09