HSS Journal

, Volume 6, Issue 1, pp 43–48 | Cite as

Local Soft Tissue Compression Enhances Fracture Healing in a Rabbit Fibula

  • Simon Morr
  • Ernest C. Chisena
  • Emre Tomin
  • Michael Mangino
  • Joseph M. Lane
Original Article

Abstract

Local soft tissue compression of fractures enhances fracture healing. The mechanism remains uncertain. Past studies have focused on intermittent soft tissue compression. We report a preliminary study assessing the relationship between constant soft tissue compression and enhanced fracture healing in an osteotomy model designed to minimize confounding variables. Fibulae of nine New Zealand white rabbits were bilaterally osteotomized, openly stabilized, and fitted with spandex stockinets. Soft tissue at the osteotomy site was unilaterally compressed using a deforming element (load = 26 mmHg). The contralateral side was saved as the control and was not compressed. Osteotomies were monitored with weekly radiographs. All fibulae in both groups were healed 6 weeks postoperatively. Micro-CT analysis of bone mineral density (BMD) and bone volume (BV) was then performed on both the experimental and control sides. Radiographic measurement of transverse callus-to-shaft ratios (TCSR) was compared. BMD of the experimental callus was greater than the noncompressed controls. BV and TCSR were not different between controls and experimental osteotomies. Constant local soft tissue compression produced significant increases in BMD, but not in BV or transverse callus size, indicating significant measurable increases in callus composition without significant change in gross dimensions. Our experimental design minimizes confounding factors, such as micromotion, immobilization, and altered venous flow, suggesting that these are not the primary mechanisms for fracture healing enhancement. Further studies with more animals and study groups are necessary to confirm efficacy and identify optimal compression pressures and schedules.

Keywords

soft tissue compression fracture healing osteotomy bone mineral density (BMD) bone volume (BV) micro-CT 

References

  1. 1.
    Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA, Compartment syndrome in open tibial fractures. J. Bone Joint Surg. Am. 1986; 68: 1348–1353PubMedGoogle Scholar
  2. 2.
    Bronk JT, Meadows TH, Kelly PJ, The relationship of increased capillary filtration and bone formation. Clin. Orthop. 1993; 293: 338–345PubMedGoogle Scholar
  3. 3.
    Butt RP, Bishop JE, Mechanical load enhances the stimulatory effect of serum growth factors on cardiac fibroblast procollagen synthesis. J. Mol. Cell. Cardiol. 1997; 29(4): 1141–1151CrossRefPubMedGoogle Scholar
  4. 4.
    Challis MJ, Gaston P, Wilson K, Jull GA, Crawford R, Cyclic pneumatic soft-tissue compression accelerates the union of distal radial osteotomies in an ovine model. J. Bone Joint Surg. Br. 2006; 88(3): 411–415CrossRefPubMedGoogle Scholar
  5. 5.
    Challis MJ, Jull GJ, Stanton WR, Welsh MK, Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a randomised controlled trial. Aust. J. Physiother. 2007; 53(4): 247–252PubMedGoogle Scholar
  6. 6.
    Challis MJ, Welsh MK, Jull GA, Crawford R, Effect of cyclic pneumatic soft tissue compression on simulated distal radius fractures. Clin. Orthop. Relat. Res. 2005; 433: 183–188CrossRefPubMedGoogle Scholar
  7. 7.
    Chen AH, Frangos S, Kilaru S et al, Intermittent pneumatic compression devices—physiological mechanisms of action. Eur. J. Endovasc. Surg. 2001; 21: 383–392CrossRefGoogle Scholar
  8. 8.
    Dale PA, Bronk JT, O’Sullivan ME et al, A new concept in fracture immobilization: the application of a pressurized brace. Clin. Orthop. 1993; 295: 264–269PubMedGoogle Scholar
  9. 9.
    Hargens AR, Akeson WH, Mubarak SJ et al, Tissue fluid pressures: from basic research tools to clinical applications. J. Orthop. Res. 1989; 7: 902–909CrossRefPubMedGoogle Scholar
  10. 10.
    Heppenstall RB, Grisilis G, Hunt TK, Tissue gas tensions and oxygen consumption. Clin. Orthop. 1975; 106: 357–365CrossRefPubMedGoogle Scholar
  11. 11.
    Hewitt JD, Harrelson JM, Dailiana Z, Guilak F, Fink C, The effect of intermittent pneumatic compression on fracture healing. J. Orthop. Trauma. 2005; 19(6): 371–376CrossRefPubMedGoogle Scholar
  12. 12.
    Jiang C, Giger ML, Kwak SM, Chinander MR, Martell JM, Favus MJ, Normalized BMD as a predictor of bone strength. Acad. Radiol. 2000; 7(1): 33–39CrossRefPubMedGoogle Scholar
  13. 13.
    Khanna A, Gougoulias N, Maffulli N, Intermittent pneumatic compression in fracture and soft-tissue injuries healing. Br. Med. Bull. 2008; 88(1): 147–156CrossRefPubMedGoogle Scholar
  14. 14.
    Knighton DR, Hunt TK, Oxygen tension regulates the expression of angiogenesis factor by macrophages. Science 1983; 221: 1283–1285CrossRefPubMedGoogle Scholar
  15. 15.
    Koman LA, Hardaker WT Jr, Goldner JL, Wick catheter in evaluating and treating compartment syndromes. S. Med. J. 1981; 74: 303–309Google Scholar
  16. 16.
    Matsen FA. Compartment Syndrome. New York: Grune and Stratton; 1980Google Scholar
  17. 17.
    Matsen FA, Mayo KA, Sheridan GW, Krugmire RB, Monitoring of intramuscular pressure. Surgery 1976; 79: 702–709PubMedGoogle Scholar
  18. 18.
    Matsen FA III, Winquist RA, Krugmire RB Jr, Diagnosis and management of compartmental syndromes. J. Bone Joint Surg. Am. 1980; 62-A: 286–291Google Scholar
  19. 19.
    McQueen MM, Court-Brown CM, Compartment monitoring in tibial fractures. The pressure threshold for decompression. J. Bone Joint Surg. Br. 1996; 78(1): 99–104PubMedGoogle Scholar
  20. 20.
    Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH, Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J. Bone Joint Surg. Am. 1978; 60-A: 1091–1095Google Scholar
  21. 21.
    Nicholson PH, Strelitzki R, On the prediction of Young’s modulus in calcaneal cancellous bone by ultrasonic bulk and bar velocity measurements. Clin. Rheumatol. 1999; 18(1): 10–16CrossRefPubMedGoogle Scholar
  22. 22.
    O’Sullivan ME, Bronk JT, Chao EYS et al, Experimental study of the effect of weight bearing on fracture healing in the canine tibia. Clin. Orthop. 1994; 302: 273–283PubMedGoogle Scholar
  23. 23.
    Otter MW, Bronk JT, Wu DD et al, Inflatable brace-related streaming potentials in living canine tibias. Clin. Orthop. 1996; 324: 283–291CrossRefPubMedGoogle Scholar
  24. 24.
    Ouyang X, Majumdar S, Link TM, Lu Y, Augat P, Lin J, Newitt D, Genant HK, Morphometric texture analysis of spinal trabecular bone structure assessed using orthogonal radiographic projections. Med Phys. 1998; 25(10): 2037–2045CrossRefPubMedGoogle Scholar
  25. 25.
    Owen CA, Mubarak SJ, Hargens AR et al, Intramuscular pressures with limb compression clarification of the pathogenesis of the drug-induced muscle-compartment syndrome. N. Engl. J. Med. 1979; 300(21): 1169–1172PubMedCrossRefGoogle Scholar
  26. 26.
    Park SH, Silva M, Effect of intermittent pneumatic soft-tissue compression on fracture-healing in an animal model. J Bone Joint Surg. 2003; 85-A(8): 1446–1453PubMedGoogle Scholar
  27. 27.
    Park SH, Silva M, Intermittent pneumatic soft tissue compression: changes in periosteal and medullary canal blood flow. J. Orthop. Res. 2008; 26(4): 570–577CrossRefPubMedGoogle Scholar
  28. 28.
    Parsons M, Kessler E, Laurent GJ, Brown RA, Bishop JE, Mechanical load enhances procollagen processing in dermal fibroblasts by regulating levels of procollagen C-proteinase. Exp. Cell Res. 1999; 252(2): 319–331CrossRefPubMedGoogle Scholar
  29. 29.
    Rutten S, Nolte PA, Korstjens CM, van Duin MA, Klein-Nulend J, Low-intensity pulsed ultrasound increases bone volume, osteoid thickness and mineral apposition rate in the area of fracture healing in patients with a delayed union of the osteotomized fibula. Bone 2008; 43(2): 348–354CrossRefPubMedGoogle Scholar
  30. 30.
    Sarmiento A, Latta LL, Functional fracture bracing. J. Am. Acad. Orthop. Surg. 1999; 7: 66–75PubMedGoogle Scholar
  31. 31.
    Schwartz JT, Brumback RJ, Lakatos R et al, Acute compartment syndrome of the thigh: a spectrum of injury. J. Bone Joint Surg. Am. 1989; 71-A: 392–400Google Scholar
  32. 32.
    Wachter NJ, Krischak GD, Mentzel M, Sarkar MR, Ebinger T, Kinzl L, Claes L, Augat P, Correlation of bone mineral density with strength and microstructural parameters of cortical bone in vitro. Bone 2002; 31(1): 90–95CrossRefPubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2009

Authors and Affiliations

  • Simon Morr
    • 2
  • Ernest C. Chisena
    • 1
  • Emre Tomin
    • 2
  • Michael Mangino
    • 3
  • Joseph M. Lane
    • 2
  1. 1.North Shore-Long Island Jewish Health System—Nassau CountyBio-Chem Bracing CorporationCenterportUSA
  2. 2.The Hospital for Special SurgeryNew YorkUSA
  3. 3.Bay Orthopedic and Rehabilitation Supply Co. Inc.Huntington StationUSA

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