The vascular response to fracture micromovement

Abstract

Micromovement has been shown to promote the healing of experimental fractures, but its role in the clinical management of fractures with soft-tissue injury is less certain. In a 2-mm transverse osteotomy of the ovine tibia held in an instrumented external fixator, axial interfragmentary displacement was quantified in vivo for six weeks after osteotomy. Group I (n = 11) had an axial fixation stiffness of 460 N/mm and Group II (n = 12) had a stiffness of 238 N/mm. With a 25% difference in micromovement, a fourfold change in corticomedullary blood flow was observed at two weeks after osteotomy (p < 0.01). Although by six weeks mechanical properties in torsion were similar, there were marked differences in the periosteal cross-sectional perimeter, area, and intracortical porosity that complemented the hemodynamic changes. The early vascular response is very sensitive to the initial mechanical environment, and appears to precede and determine the organization of osteogenesis. Further understanding of this relationship may prove to be of direct clinical relevance in the augmentation of healing of devascularized diaphyseal fractures.