Professional Documents
Culture Documents
between vascular bony surfaces that are gradually pulled apart by gradual distraction. New bone formed bridges the gap & remodels to normal bone macrostructure. Tension stress effect on growth & genesis of tissues.
bone in almost any plane as D.O follows the vector of applied force. Age: as long as Pt had # healing potential. INDICATION: bone grafting, LLD, nonunion, deformity, bone defects 2* to trauma, infection, tumor.
Autograft is limited
No fear of transmission of antigens, bacteria,
viruses, dead foreign bodies. In infected wounds. Risk of # in B.G over extended period of time B.G will never incorporate in to living B.
Components of D.O
1. 2. 3.
Application of ext.fix stability, applies forces Corticotomy Postop period Latency period Distraction P. Consolidation P.
DEFINITION
CORTICOTOMY: low energy osteotomy, performed
using an osteotome to cut only the cortical surface thus preserving the medullary canal, nutrient vessel, endosteum, periosteum LATENCY PERIOD: Initial healing response is allowed to bridge the cut surfaces before distraction is initiated.
pulled apart each day. Rhythm: no of distractions per day Healing index: no of centimeters of N.B divided by no of months from the surgery to date of full wt bearing.
osseous tissues such as fibrocartilage in nonunion in to normal bone. Done through comb compression & distraction forces, augmented by corticotomy. Bone transportation: regeneration of intercalary B.D through corticotomy & distraction & tranf. Osteogenesis.
Atraumatic corticotomy.
Rate Rhythm of distraction.
HISTOLOGY
LATENCY P: similar to # healing DISTRACTION P: mesenchymal cells begin to
organize in to bridge of collagen & immature vascular sinusoids, bridge formed always parallel to direction of distraction. I Week Distraction: central zone of relatively avascular fibrous tissue bridges the 7 mm of C.gap. FIZ: fibrous interzone [no osteoid/ O.B]
II WEEK - Distraction
Clusters of osteoblasts appear on each side of FIZ
adj to vascular sinuses. Collagen bundles fuse with osteoid like M. 1* bone spicules enlarge gradually by circumferential apposition. Later osteoid began to mineralize the 1*B.S PMF[primary mineralisation front] PMF extend from both corticotomy site, towards the central FIZ.
III Week
Mineralization process continues.
elongation of bone spicules. Large thin sinusoids surround each micro column of new bone MCF [micro column formation]. At the end of D., FIZ ossifies & MCF unifies completely bridging the gap.
Physiology
Fibrous interzone assumes the role of growth
plate. [pseudo G.P] Intramembranous ossification in its purest form. [if stability] Local & regional blood supply is most important determining factor.
Pathophysiology
Excessive rate
Sporadic rhythm
Frame stability Poor local & regional stability Traumatic corticotomy Inadequate consolidation phase. Initial diastasis.
levels , protein synthesis & mitosis. Macromotion: [shear force] disrupt the delicate bone & vascular channels Peripheral vascular disease Traumatic corticotomy- disturb the local blood flow Initial diastasis- inhibit the formation of 1* fibrovascular bridge.
corticotomy. In any event, increase in distraction speed & rhythm cannot exceed 2 mm/ day.
distractions (rhythm of distraction) should be at least four, achieving a total of 1 mm of total distraction (rate of distraction) in four divided doses. constant distraction over a 24-hour period produces a significant increase in the regenerate quality
ASSESSMENT
Corticotomy: check for completeness in C-arm.
Distracting <2 mm, angulation < 10-15*, rotating < 20-30*. Adequate reduction of corticotomy gap. Length & alignment of D.G checked weekly or biweekly by X ray. N.B mineralization appears by 3rd wk of D. fuzzy, radiodense columns extending from both cut surfaces
area of host bone cut surfaces. N.B appears bulging, FIZ is narrowing distraction should be accelerated. N.B shows as hour glass appearance, FIZ widens D. rate reduced.
distraction, gap is gradually closed. QCT: [Quantitative C.T] measuring the mineralization of osteogenic area. Compared with similar region on normal contralateral limb described as % of normal. Normally FIZ- 25-35%, PMF- 40-55%, MCF- 6070%.
consolidation
Plain x rays monthly basis, condition of the
cortex & medullary canal are noted in the osteogenic area orthogonal views Bone density may appear reduced. QCT- demonstrates stability.
ACCORDION TECH
Monofocal compression- distraction tech for
nonunion treatment. Alternate compression & distraction maneuver is used 2-3 times to stimulate bone neogenesis. Local scar tissues are initially crushed to be transformed in to tissues capable of neogenesis.