Mark D. Markel

Quantification of bone healing: Comparison of QCT, SPA, MRI, and DEXA in dog osteotomies

Four noninvasive imaging modalities were used to quantitatively evaluate and compare tibial osteotomy healing in dogs. Quantitative computed tomography (QCT), magnetic resonance imaging (MRI), single-photon absorptiometry (SPA), and dual-energy x-ray absorptiometry (DEXA) were the four techniques examined. Bilateral tibial osteotomies were performed in 32 dogs divided into four groups. The osteotomies were stabilized with a 2-mm gap using unilateral external skeletal fixation. Dogs were anesthetized, imaged with the four noninvasive techniques, and killed at 2-12 weeks. Invasive techniques were used to determine: 1) the torsional properties of the bone; and 2) the local stiffness properties and calcium content within the bone. The techniques which had the strongest associations with the torsional properties of the osteotomies were QCT, SPA and DEXA. Generally, QCT and SPA had marginally stronger correlations than DEXA; but, overall, there were no differences between the techniques. MRI had the poorest associations with the torsional properties of the osteotomies. Generally, QCT had the strongest correlations with local material properties, such as indentation stiffness and calcium content. SPA had the second strongest correlations with calcium content and had the third strongest correlations with indentation stiffness behind DEXA. DEXA had the third strongest correlations for calcium content. With the exception of some of the correlations with indentation stiffness, MRI had the poorest associations with the local parameters studied.

Formation of bone in tibial defects in a canine model. Histomorphometric and biomechanical studies.

The histomorphometric, material, and structural properties of the reparative tissue and bone that formed in a two-millimeter tibial defect in dogs were determined at two, four, eight, and twelve weeks after the operation. At two weeks, the tibial defect was filled mainly with undifferentiated connective tissue. After two weeks, the relative proportion of undifferentiated connective tissue decreased and the amount of bone progressively increased throughout the twelve weeks. New bone formed primarily by intramembranous ossification, with a small degree of endochondral ossification. At twelve weeks, bone occupied 62 per cent of the defect. The calcium content of the reparative tissue increased between four and eight weeks and then, at twelve weeks, reached a plateau of 77 per cent that of normal cortical bone. Anisotropy of the new bone that formed in the defect increased from 13.8 per cent to 26 per cent, and the mean width of the trabecular bone increased 27 per cent between the eighth and twelfth weeks. Maximum torque and torsional stiffness increased between two and eight weeks and then, by twelve weeks, the values leveled off at 44 and 29 per cent of the values for intact bone. Indentation stiffness increased between the fourth and twelfth weeks; at twelve weeks, it was 22 per cent of the stiffness of normal cortical bone. Indentation stiffness increased 283 per cent between eight and twelve weeks, despite insignificant changes in calcium content, amount of new bone, non-osseous space, water content, or volume of trabecular bone during this time. This change in indentation stiffness did correlate with increases in anisotropy of the new bone between eight and twelve weeks.

Quantitative CT for the evaluation of bone healing

SummaryQuantitative computed tomography (QCT) was used to quantitate the structural strength and local material properties of healing tibial osteotomies in 32 dogs. Dogs were divided into four equal groups, euthanatized at either 2, 4, 8, or 12 weeks and imaged with QCT. Invasive techniques were used to determine (1) the torsional properties of the bone; (2) the local stiffness properties and calcium content within the bone; and (3) histologically determined new bone formation and porosity. QCT was strongly associated with the maximum torque (R2=0.44) and torsional stiffness (R2=0.69) of the healing bone. QCT had strong correlations with the local stiffness (R2=0.64), calcium content (R2=0.61), new bone (R2=0.84), and porosity (R2=0.84) of healing tissues.

The determination of bone fracture properties by dual-energy X-ray absorptiometry and single-photon absorptiometry: A comparative study

SummaryDual-energy X-ray absorptiometry (DEXA) and single-photon absorptiometry (SPA) were used to quantitate the structural strength and local material properties of healing tibial osteotomies in 32 dogs. Dogs were divided into four equal groups, euthanatized at either 2, 4, 8, or 12 weeks, and imaged with DEXA and SPA. Invasive techniques were used to determine (1) the torsional properties of the bone, (2) the local stiffness properties and calcium content within the bone, and (3) new bone formation and porosity by histology. There were no differences between SPA and DEXA in their associations with the torsional properties of bone. SPA and DEXA had strong correlations with the ultimate torque (R2=0.76, 0.51) and the torsional stiffness (R2=0.68, 0.53) of bone. SPA and DEXA of periosteal callus, endosteal callus, and cortical bone had similar associations with indentation stiffness, calcium content, new bone formation, and porosity. SPA of gap tissue had significantly stronger associations with these four parameters than DEXA (P<0.05). Correlation coefficients (R2) with these local material properties ranged as high as 0.82 for SPA with new bone formation in the gap tissue and 0.73 for DEXA with indentation stiffness of periosteal callus.

Fixation of canine tendons to metal

For the purpose of developing a method to attach tendons directly to the prosthesis, canine supraspinatus tendons were attached in vitro to a metallic surface, using 3 different fixation devices: a spiked polyacetal washer (Synthes), a spiked soft tissue fixation plate (Synthes), and a newly designed Enhanced Tendon Anchor (ETA), which straddled the tendon with interlocking spikes oriented at a 20-degree angle. 2 methods were used: 1) the tendon was fixed directly to the metallic surface, or 2) a bone block containing the tendon insertion was fixed to the metallic surface. The specimens were tested for initial fixation strength in tension to failure; intact bone-muscle-tendon-bone units were used as controls. Bone block fixations were stronger than direct tendon fixations when the spiked washer or the ETA was used; this was not true of the fixation plate. The ETA was stronger than the other techniques in ultimate strength in both direct tendon fixation and bone block fixation. The soft tissue fixation plate was found to be weaker than the other techniques in bone block fixation.

Prevention of large colon displacements and volvulus.

Results of these studies have demonstrated that colopexy of the left large colon to the abdominal wall is a relatively simple and quick procedure that is permanent 1 year after surgery. The technique does not appear to be associated with long-term weight loss or abdominal pain after surgery. It has been used in pregnant mares, both experimentally and clinically, without apparent complications. In addition, horses used for pleasure-riding and show hunting have returned to performance and have not had complications. Large colon resection is a useful technique, especially for animals with strangulating large intestinal lesions. The surgeon must decide whether a technique to prevent recurrence should be performed at the first surgery or whether it should be performed only in horses with recurrence of these lesions. Until a large number of large colon resections or colopexies are performed on horses either at the initial surgery or after recurrence, it is impossible to predict the true efficacy of these techniques.

Prevention and Management of Peritonitis in Horses

Peritonitis and adhesions in the horse are best managed through prevention. Perioperative antimicrobial therapy, nonsteroidal anti-inflammatory therapy, experienced personnel, and good surgical techniques should minimize complications after surgery. Despite preventative measures, some horses still develop peritonitis after surgery. Immediate, intensive treatment is necessary to enhance their chances for survival.

The effects of therapeutic doses of irradiation on experimental bone graft incorporation over a porous-coated segmental defect endoprosthesis

The incorporation of autogeneic bone graft into a porous coated segmental endoprosthesis after high-dose irradiation was studied in dogs. A mid-diaphyseal defect was surgically created and then reconstructed with a porous-coated segmental endoprosthesis in 16 dogs. Autogeneic bone grafts were placed over the porous-coated regions of the endoprosthesis and at the endoprosthesis-bone junctions to achieve extracortical fixation. In eight dogs, the reconstructed femora were treated with a time-equivalent dose of 5500 cGy, delivered over a five-week period, beginning three weeks after surgery. In eight dogs, which served as the control group, the reconstructed femora were not irradiated. Dogs were killed 12 weeks after surgery, and the reconstructed femora were evaluated clinically, roentgenographically, mechanically, and histologically. Extracortical bone formation and bone ingrowth into the porous-coated segmental endoprosthesis were significantly inhibited by high-dose irradiation. Nonirradiated reconstructed femora had higher maximum torque at the implant-bone junction than irradiated femora. Nonirradiated femora had significantly greater bone ingrowth within the porous space than irradiated femora. Intracortically, irradiated femora had greater unlabeled bone and less porosity as well as more new bone than nonirradiated femora at 12 weeks postsurgery. Extracortically, irradiated femora had greater original cortical bone and less porosity as well as more new bone than nonirradiated femora at 12 weeks postsurgery. Mineral apposition was less in the irradiated femora from the initiation of radiotherapy to the time of killing five weeks after cessation of irradiation.

Effect of Therapeutic Irradiation on Extracortical Fixation and Bone Ingrowth in an Autogenously Bone Grafted Segmental Defect Prosthesis

Recent advances in the staging of musculoskeletal sarcomas, improvements in diagnostic imaging, and the use of preoperative chemotherapy have enabled the orthopedic oncologist to offer limb salvage surgery to an increasingly larger number of patients as an alternative to amputation. The reconstruction of large osseous defects following the resection of malignant tumors is difficult, not only because of the size of the defect but also because of the unpredictable incorporation of bone grafts following chemotherapy or irradiation. The reconstruction of bone defects has recently been facilitated with the use of custom-made porous coated segmental defect replacement (SDR) prostheses [1–3]. In order to obtain the optimal fixation of segmental defect replacement (SDR) prostheses, the concept of extracortical bone bridging and ingrowth was advocated as it has been shown to be effective in both animal models and clinical studies [4–8].