Publication: Standard bone healing stages occur during
delayed bone healing, albeit with a different temporal
onset and spatial distribution of callus tissues
Authors
Peters, Anja ; Schell, Hanna ; Bail, Hermann J. ; Hannemann, Marion ; Schumann, Tanja ; Duda, Georg N. ; Lienau, Jasmin
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Publisher
Murcia: F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
Bone healing is considered as a
recapitulation of a developmental program initiated at
the time of injury. This study tested the hypothesis that
in delayed bone healing the regular cascade of healing
events, including remodeling of woven to lamellar bone,
would be similar compared to standard healing, although
the temporal onset would be delayed.
A tibial osteotomy was performed in sheep and
stabilized with a rotationally unstable fixator leading to
delayed healing. The sheep were sacrificed at 2, 3, 6, 9
weeks and 6 months postoperatively. The temporal and
spatial tissue distributions in the calluses and the bone
microstructure were examined by histology.
Although histological analysis demonstrated
temporal and spatial callus tissue distribution
differences, delayed healing exhibited the same
characteristic stages as those seen during uneventful
standard healing. The delayed healing process was
characterized by a prolonged presence of hematoma, a
different spatial distribution of new bone and delayed
and prolonged endochondral bone formation. A change
in the spatial distribution of callus formation was seen
by week 6 leading to bone formation and resorption of
the cortical bone fragments, dependent on the degree to
which the cortical bone fragments were dislocated. At 6
months, only 5 out of 8 animals showed complete bony
bridging with a continuous periosteum, although
lamellar bone and newly formed woven bone were
present in the other 3 animals.
This study demonstrates that during delayed bone healing all stages of the healing cascade likely take
place, even if bony consolidation does not occur.
Furthermore, the healing outcome might be related to the
periosteum’s regenerative capacity leading to bony union
or absence of bony bridging.
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