Periosteal Distraction Osteogenesis: An Effective Method for Bone Regeneration

Abstract

The treatment of bone defects is challenging and controversial. As a new technology, periosteal distraction osteogenesis (PDO) uses the osteogenicity of periosteum, which creates an artificial space between the bone surface and periosteum to generate new bone by gradually expanding the periosteum with no need for corticotomy. Using the newly formed bone of PDO to treat bone defects is effective, which can not only avoid the occurrence of immune-related complications, but also solve the problem of insufficient donor. This review elucidates the availability of PDO in the aspects of mechanisms, devices, strategies, and measures. Moreover, we also focus on the future prospects of PDO and hope that PDO will be applied to the clinical treatment of bone defects in the future.

Figure 1

The mechanism (a) and devices (b, c, d) of PDO. (a) PDO creates an artificial space between the bone surface and periosteum to generate new bone by expanding the periosteum, muscle, and skin at the same time. (b) U-shaped distractor composes of three different parts: fixation frame, distraction rod, and titanium mesh. Bilateral fixation legs can be fixed rigidly to the surface of cortical bone by titanium screws, and then through the rotation of middle distraction rod, the titanium mesh can be lifted off the ground of bone and distract the periosteum simultaneously. (c) SMA leaves out distraction screws. (d) Biodegradable PLLA/HA mesh instead of titanium mesh for distracting periosteum.

Figure 2

Protocol of PDO applied in different studies. The latency periods of PDO are different from 0 days to 14 days, the distraction periods of PDO are different from 0 days to 32 days, and the speed is 0.2–1.0 mm/d; the consolidation periods of PDO are different from 1 week to 3 months.