ABSTRACT
The incidence of fractures is greater in patients with hemodialysis than in the general
population. Surgically created arteriovenous fistulas are widely used in end-stage
renal failure patients for the vascular access of hemodialysis. Despite occurrence
of fracture at the fistula site in the forearm, bone mineral density is similar in
both arms. The effects of arteriovenous fistulas on fracture healing have not been
widely studied. The goal of this study was to test the hypothesis that a fracture
distal to a surgically-created arteriovenous fistula has negative effects in a rat
osteotomy model. The tibial bones were fractured in a monocortical fashion bilaterally.
No fixation method was used. The right side was used as control. On the left side
of the rat, a side-to-side arteriovenous anastomosis was done between the common femoral
vessels proximal to the fracture line under magnification with the operating microscope.
Three weeks later, bone segments, including the monocortical osteotomy line, were
removed and examined histopathologically. Although the gross appearance of callus
formation was not different in both groups, histopathologically, there were more dead
medullary bone and less cartilage cells around the osteotomy line in the bone associated
with the arteriovenous fistula. But with short-term evaluation of the fracture sites
after opening an arteriovenous connection proximal to the fracture site, no real difference
was noted related to fracture healing.
KEYWORDS
Bone healing - arteriovenous fistula - renal failure.
