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Experimental lengthening of tibial diaphysis by callus distraction: The role of periosteum, bone marrow and age factor

Experimental lengthening of tibial diaphysis by callus distraction: The role of periosteum, bone marrow and age factor

Medical Journal of Hiroshima University 40(5): 389-403

Tibial lengthening was performed on 25 immature rabbits 8 weeks of age and on 18 mature rabbits more than 40 weeks of age. Tibial diaphysis slightly distal to the tibio-fibular junction was subperiosteally osteotomized (periosteum or bone marrow was removed in some cases), fixed for a certain waiting period, and then distracted at 0.35 mm/12 hours, using a hemilateral external fixator. Radiographs, histological sections, and microangiographs were studied to evaluate the pattern of bone formation. In immature rabbits, regardless whether bone marrow removal was made or not, the distraction gap became adequately filled with periosteal callus, whereas periosteum resection resulted in scanty callus formation and failure of new bone formation. In contrast, bone marrow removal in mature rabbits brought about thin, cloudy periosteal callus formation, resulting in failure of new tubular cortex formation. The histological examination suggested that the ossification mode was mainly intramembranous in the vascular areas, while some cartilage nests were observed in the relatively avascular areas beneath the peeled periosteum. In this model, osteotomy distal to the entrance of the diaphyseal nutrient artery and obstruction of the medullary cavity caused by the inserted screws brought about inadequate medullary blood supply and poor endosteal callus formation of the distal bone fragment end. The results of this study indicated that in callus distraction attention should be made to preserve not only the periosteum but also bone marrow and its blood supply especially in adult cases.

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