Regional Fracture Site Blood Flow Following Compression Plate Intramedullary Rod and External Fixation

Abstract

Fractures and fracture healing both produce important alterations in physiological environment of bone. The initial response is dependent on an adequate blood supply [17, 19, 20]. Several studies have demonstrated the effect of various forms of fixation on the blood supply to the fracture site, and two specific cortical areas have received special attention [1]. Following compression plating there is a decrease in vascular filling immediately beneath the applied plate [13, 16]. Avascularity of cortical bone may last for several weeks [2]. Following the insertion of an intramedullary rod, large areas of the endosteal cortex are rendered avascular [3–5, 7, 17]. Blood flow to the fracture site is affected by the degree of fixation. Blood flow to rigidly plate-fixed fractures is less than that to rod fixed fractures [15] or to externally fixed fractures [9]. This may reflect differences in bone turnover. The aims of this study were to compare the effects of the commonly used fixation methods, compression plate, intramedullary rod and external fixation on regional cortical bone blood flow in an experimental tibial fracture. This study would enable quantitation of the effect of these fixation devices to be determined immediately following the fracture, at the peak of the vascular response and at fracture healing.