Influence of stable fixation on trabecular bone healing: a morphologic assessment in dogs

Abstract

The healing patterns of trabecular bone are different from those of compact bone. In order to investigate further this observation, a histomorphometric assessment was undertaken. The influence of internal fixation devices on trabecular bone healing was also studied. Intercondylar osteotomies were produced in 19 dogs and fixed with screws. All dogs were killed between 1 and 14 weeks; eight of them had the screws removed 4 weeks after osteotomy and were killed 4 or 10 weeks later. The results of morphometry were compared to the histologic and radiologic pictures. Anatomic reduction with stable fixation led to contact healing characterized by a narrow endosteal bone formation at the osteotomy site that disappeared only after union was complete (4 weeks). In gap healing, the endosteal bone formation was greater. Internal fixation devices appeared to cause a diffuse osteopenia once union was complete. Their removal just after completion of union seems to prevent the bone loss. Screws induced bone formation around their threads; after they were removed, the reaction disappeared but the screw holes were not filled with normal trabeculae 10 weeks later. Union of fractures through trabecular bone can be assessed radiologically. A decrease of band-like bone density at the fracture site indicates completion of union. This is the optimal time for implant removal. It prevents the osteopenia observed in cases of continuous presence of screws.