Effects of plates on cortical bone perfusion

Area of Science:

• Orthopedic surgery
• Vascular biology
• Biomedical engineering

Background:

• Surgical procedures involving bone fixation can compromise blood supply.
• Understanding the impact of surgical techniques and hardware on bone perfusion is crucial for healing.
• Periosteal stripping and bone plate application are common orthopedic interventions.

Purpose of the Study:

• To investigate the effects of subperiosteal and extraperiosteal exposure on sheep tibial cortex perfusion.
• To evaluate the impact of different bone plating forces and types on intraosseous vascularity.
• To compare the ischemic effects of semitubular plates versus dynamic compression plates.

Main Methods:

• Sheep tibial cortex perfusion was assessed using disulphine blue dye.
• Subperiosteal and extraperiosteal exposures were performed.
• Semitubular plates and dynamic compression plates were applied with varying forces (20 kp and 200 kp).
• Ischemia beneath the plates was quantified.

Main Results:

• Subperiosteal stripping decreased perfusion, while extraperiosteal exposure did not.
• Both low and high forces of semitubular plates caused significant ischemia.
• Dynamic compression plates induced significantly greater ischemia at high forces compared to low forces.

Conclusions:

• Subperiosteal stripping poses a greater risk to tibial cortex perfusion than extraperiosteal exposure.
• Bone plate selection and applied force significantly influence the degree of ischemia, with dynamic compression plates at high forces being particularly detrimental.
• Minimizing periosteal stripping and optimizing plate fixation forces are important to preserve bone vascularity during orthopedic procedures.