Perturbations of Vascularization and Circulation Due to Osteosynthetic Methods

Abstract

It is axiomatic to say that an adequate blood supply is necessary for initiation of the healing response (Trueta, 1963). The fracture in itself will alter blood flow and flow will be changed if treated by osteosynthetic methods. The surgeon treating fractures finds tibial fractures the most worrisome for two reasons: the tibia is so commonly a site of infection following trauma (Kelly et al., 1990) and it is a frequent site of compartment syndrome (Blick, 1986). Fixation of fractures leads to changes in bone structure. This has been principly emphasized in the tibia and in response to plate fixation. It has been postulated that this change in bone mass is secondary to alterations of fracture stability by various forms of fixation. Stated more clearly, changes in stability lead to decreased formation of bone and to increased resorption of existing bone, perhaps by decreasing the feedback mechanism of strain related potentials that may control bone remodeling, or alternatively, it may decrease transcapillary fluid flow to osteoblasts which contain necessary substrates for cell nutrition (Kelly and Bronk, 1990). Studies have shown that plates interfere with cortical remodeling (Akeson et al., 1976; Jacobs et al., 1981; Uhtoff et al., 1983). Effects of fixation on fracture healing have been recently reviewed (O’Sullivan et al., 1989). While there have been studies on the effects of intramedullary fixation on diaphyseal bone circulation (Dankwardt, 1969), no studies have systematically examined the effect of the three common forms of fracture fixation, external fixation (EF), intramedullary rod (IMR), and plate (PL), on bone remodeling and blood flow in a single study.