Subscribe to RSS
Download PDF
DOI: 10.1055/s-0038-1633231
Interfragmentary Stability Influences Healing of Intra-articular Fractures. A Radiographic Study of Canine Femoral Condyle Fractures Repaired with Lag Screws
Publication History
Received for publication
31 July 1989
Publication Date:
10 February 2018 (online)
Summary
The influence of fracture stability on the healing of intra-articular fractures of canine medial femoral condyles repaired with lag screws was evaluated radiographically and at necropsy. In 14 dogs, one condylar fracture was repaired with stable interfragmentary compression using two 4.0 mm cancellous lag screws. In the contralateral stifle, the condylar fracture was apposed with a single 4.0 mm cancellous lag screw so that the bone fragments were unstable and had interfragmentary motion. In a control group (n = 4), an arthrotomy was performed and a lag screw inserted without creating a fracture in one stifle. In the contralateral stifle, a condylar fracture was created and not repaired.
Radiographically stable fracture gaps were slightly wider at one month than immediately post repair, but at two and three months were healed completely. Unstable fractures remained incompletely healed at one, two and three months. Osteophytes were detectable radiographically at three months. Unrepaired fractures remained completely unhealed and these joints had severe osteophyte formation at one month. At necropsy, all joints with intra-articular fractures had some osteophytes and erosion of the medial tibial plateau articular cartilage. It was concluded that interfragmentary compression was a critical factor in fracture healing and that lack of stability caused delayed union, osteophyte development and cartilage erosion.
A model was developed to permit the study of the healing of both stable and unstable condyle repair.
-
References
- 1 Sevitt S. Bone repair and fracture healing in man. Churchill-Livingstone; Edinburgh: 1981: 128-44.
- 2 Milgram J W. Injury to articular cartilage joint surfaces: II. Displaced fractures of underlying bone. Clin Orthop 1986; 206: 236-47.
- 3 Muller M E, Allgower M, Schneider R, Willenegger H. Manual of internal fixation. Techniques recommended by the AO group. 2nd ed.. Springer-Verlag; Berlin: 1979
- 4 Uhthoff H K, Goto S, Cerckel P-H. Influence of stable fixation on trabecular bone healing: A morphologic assessment in dogs. J Orthop Res 1987; 5: 14-22.
- 5 Mitchell N, Shepard N. Healing of articular cartilage in intra-articular fractures in rabbits. J Bone Joint Surg (Am) 1980; 62: 628-34.
- 6 Schatzker J. Principles of stable internal fixation. Can J Surg 1980; 23: 232-5.
- 7 Bagby G W, Janes J M. The effect of compression on the rate of fracture healing using a special plate. Am J Surg 1958; 95: 761-71.
- 8 Hutzschenreuter P, Perren S M, Steinemann S, Geret V, Klebl M. Some effects of rigidity of internal fixation on the healing pattern of osteotomies. Injury 1969; 1: 77-81.
- 9 Perren S M, Huggler A, Russenberger M, Allgower M, Mathys R, Schenk R, Willenegger H, Muller M E. The reaction of cortical bone to compression. Acta Orthop Scand 1969; (Supplement 125): 17-28.
- 10 Ashhurst D E. The influence of mechanical conditions on the healing of experimental fractures in the rabbit: a microscopical study. Phil Trans R Soc Lond B 1986; 313: 271-302.
- 11 Ruedi T P, Allgower M. The operative treatment of intraarticular fractures of the lower end of the tibia. Clin Orthop 1979; 138: 105-110.
- 12 Schatzker J, Lambert D C. Supracondylar fractures of the femur. Clin Orthop 1979; 138: 77-83.
- 13 Chrisman O D, Ladenbauer-Bellis I M, Panjabi M, Goeltz S. The relationship of mechanical trauma and the early biochemical reactions of osteoarthritic cartilage. Clin Orthop 1981; 161: 275-84.
- 14 Piermattei D L, Greeley R J. An atlas of surgical approaches to the bones of the dog and cat. 2nd ed.. WB Saunders Co; Philadelphia: 1979: 166-167.
- 15 McDevitt C A, Gilbertson E, Muir H. An experimental model of osteoarthritis; early morphological and biochemical changes. J Bone Joint Surg (Brit) 1977; 59: 24-35.
- 16 Adams M E, Billingham M E J. Animal models of degenerative joint disease. In: Current topics in pathology. Bone and joint disease. Ed. Berry C L. Springer-Verlag; 1982: 265-95.
- 17 Uhthoff H K, Rahn B A. Healing patterns of metaphyseal fractures. Clin Orthop 1981; 160: 293-303.
- 18 Smith G K. Biomechanics pertinent to fracture biology, reduction, and fixation. In: Textbook of small animal orthopaedics. Eds. Newton C D, Nunamaker D M. J B Lippincott; 1985: 200-1.
- 19 Perren S M. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop 1979; 138: 175-96.
- 20 Francis D J. Healing of experimentally produced intraarticular fractures in dogs. MVSc Thesis University of Sydney; 1986
- 21 Jarry L, Uhthoff H K. Differences in healing of metaphyseal and diaphyseal fractures. Can J Surg 1971; 14: 127-35.
- 22 Charnley J, Baker S L. Compression arthrodesis of the knee. A clinical and histological study. J Bone Joint Surg (Brit) 1952; 34: 187-99.
- 23 Sumner-Smith G, Bishop H M. Nonunion: pathogenesis and treatment. In: Bone in clinical orthopaedics. A study in comparative osteology. Ed. Sumner Smith G. WB Saunders Co; 1982: 399-415.
- 24 Sevitt S. The healing of fractures of the lower end of the radius. A histological and angiographic study. J Bone Joint Surg (Brit) 1971; 53: 519-531.
- 25 Glimcher M J, Kenzora J E. The biology of osteonecrosis of the human femoral head and its clinical implications. Clin Orthop 1979; 138: 294-309.
- 26 Schenk R K, Muller J, Willenegger H. Nonunion – the histological picture. In: Bone in clinical orthopaedics. A study in comparative osteology. Ed. Sumner-Smith G. WB Saunders Co; 1982: 415-27.
- 27 Marshall J L. Periarticular osteophytes. Initiation and formation in the knee of the dog. Clin Orthop 1969; 62: 37-47.
- 28 Gilbertson E M M. Development of periarticular osteophytes in experimentally induced osteoarthritis in the dog. A study using microradiographic, microangiographic and fluorescent bone-labelling techniques. Ann Rheum Dis 1975; 34: 12-25.