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Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

  • Symposium: Bone Repair and Regeneration
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Dynamization involves a reduction in fixation construct stiffness during bone healing, allowing increased interfragmentary movement of the fracture through physiologic weightbearing and muscle contraction. Within some optimal range, interfragmentary movement stimulates healing, but this range likely varies across stages of bone healing.

Questions/purposes

How does the time of dynamization affect the cartilage formation, bony bridging, and bone resorption in a rat fracture-healing model?

Methods

Unilateral external fixators, stabilizing a 1-mm gap, were dynamized at 1 (D1 group, n = 10), 3 (D3 group, n = 11), or 4 (D4 group, n = 11) weeks postoperatively. Continuously 5 weeks stiff (S group, n = 10) and flexible (F group, n = 11) fixation were included for comparison. After 5 weeks, healing was evaluated by histomorphometric methods.

Results

Advanced healing, indicated by less cartilage and a greater rate of bony bridging, was observed in the S group compared to the D1 or F group. In contrast, the D3 and D4 groups had less cartilage and more bridging compared to the S group. Also, the S group had less cortical resorption than the F and D1 groups.

Conclusions

These data suggest late dynamization at the onset of bony bridging led to enhanced healing, whereas dynamization at the early stage of cartilage differentiation delayed healing.

Clinical Relevance

Although our observations from this small-animal study cannot be directly transferred to humans, these data suggest, once bony bridging begins, dynamization may stimulate bone healing and accelerate remodeling.

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Acknowledgments

The authors thank Dr. Anja Peters for her substantial contributions to the histologic analysis, Ursula Maile and Marion Tomo for their assistance with histologic preparation, and Dr. Christine Bausewein and John Besse for their help during the operative procedures.

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Authors and Affiliations

  1. Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstr 14, 89081, Ulm, Germany

    Bettina M. Willie PhD, Robert Blakytny PhD, Melanie Glöckelmann DVM, Anita Ignatius DVM & Lutz Claes PhD

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  1. Bettina M. Willie PhD
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  2. Robert Blakytny PhD
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  3. Melanie Glöckelmann DVM
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  4. Anita Ignatius DVM
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  5. Lutz Claes PhD
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Correspondence to Anita Ignatius DVM.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Willie, B.M., Blakytny, R., Glöckelmann, M. et al. Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model. Clin Orthop Relat Res 469, 3094–3101 (2011). https://doi.org/10.1007/s11999-011-1866-2

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