Christian Deininger (Salzburg / AT), Amelie Deluca (Salzburg / AT), Valeska Hofmann (Salzburg / AT; Tübingen / DE), Herbert Tempfer (Salzburg / AT), Andreas Traweger (Salzburg / AT), Andrea Wagner (Salzburg / AT), Maximilian Wenzel (Salzburg / AT), Thomas Freude (Salzburg / AT), Florian Wichlas (Salzburg / AT)
Abstract text (incl. references and figure legends)
For the treatment of pseudarthrosis or larger bone defects, periosteal flaps in combination with autologous bone grafting as revision surgery is a possible technique. The aim of this study in a rat animal model was to analyze whether a vascular pedicled or non-vascular periosteal flap can also improve healing of an acute diaphyseal femoral fracture.
Three groups were formed (N=31) of male Sprague Dawley rats (Fig.1): Vascular pedicled periosteal flap (PF, n=13), non-vascular periosteal flap (PF_lig n=13), and fracture without periosteal flap (F n=5). A 0.66 mm Gigli saw was used to create a diaphyseal fracture on the right femur. Plate osteosynthesis (1.5 mm angular stable 5-hole plate) of the fracture was performed. The therapy was prospectively randomized. The periosteal flap was prepared together with the supplying vessel from the medial femoral conydus with the aid of surgical loupes and fixed to the plate and onto the fracture with a suture (Fig. 1). In the PF_lig group, the vessel was ligated. The F group did not receive one. After the endpoint (6 weeks postoperatively), evaluation by µ-CT scans was performed to determine the newly formed bone volume (Bone Volume/Tissue Volume (BV/TV)) in the fracture zone. Biomechanics with a 3-point bending test, and descriptive histologic examination (RGB Trichrome staining) were conducted.
There was no significant increase in bone volume in the PF group compared to the PF_lig (p=0.6684) and fracture group (p= 0.4669) regarding BV/TV, also the PF_lig and fracture group showed no significant difference (p= 0.3271). The 3-point bending test also showed no significant difference in maximum forces among all groups: PF to PF_lig (p= 0.7536) and to the fracture group (p= 0.9137). Pf_lig to the fracture group (p= 0.6398).
The findings indicate that, in contrast to a pseudarthrosis or a large bone defect, the healing process of a diaphyseal fracture cannot be improved by a periosteal flap, vascular pedicled or without a vessel.
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