The Effect of the Dynamic Compression Plate on Cortical Vascularity after Fracture Healing: a Study in the Beagle Dog

Abstract

Aim: The use of dynamic compression plates (DCP) has been associated with cortical bone porosis which has been postulated by some to occur secondary to the disruption of cortical blood flow beneath the plate. This hypothesis has prompted the development of novel plate designs that minimize the area of contact between plate and bone. However, the evidence that supports an ischemic etiology for the cortical porosis beneath the DCP comes primarily from studies in intact plated bones. There are few studies that utilize a fracture model to examine the effects of plating with the DCP on cortical bone perfusion. The goal of this study was to evaluate cortical bone vascularity beneath the DCP via injection studies after healing in a beagle fracture model.
Methods: An unilateral osteotomy was created in the radii of ten skeletally mature female dogs and a DCP was implanted. Twelve weeks after surgery, the dogs were euthanized and the cortical vascularity was visualized and digitally analyzed.
Results: Our results showed no significant difference in the cortical vascularity beneath the plate when compared to the cortex opposite the plate. However, the cortex of the non-plated/non-fractured control had significantly less vascularity than the cortices from the fractured, plated bones (p < 0.05).
Conclusion: The DCP has been used successfully in fracture management for the past thirty years. This study does not support the premise that the DCP prevents normal revascularization following fracture fixation and healing. The purported disadvantage of the high contact DCP may be negligible following healing and remodeling of fractured long bones.

DCP - Internal fixation - Porosis - India ink - Radius

References

• 1 Anderson L D, Sisk D, Tooms R E, Park W I. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna.  J Bone Joint Surg [Am]. 1975;  57 287
• 2 Baumgaertel F, Buhl M, Rahn B A. Fracture healing in biological plate osteosynthesis.  Injury. 1998;  29 (Suppl 3) C 3-6
• 3 Chapman M W, Gordon J E, Zissimos A G. Compression-plate fixation of acute fractures of the diaphysis of radius and ulna.  J Bone Joint Surg [Am]. 1989;  71 159-169
• 4 Hidaka S, Gustilo R B. Refracture of bones of the forearm after plate removal.  J Bone Joint Surg [Am]. 1984;  66 1241-1243
• 5 Gautier E, Rahn B A, Perren S M. Effect of steel versus composite plastic plates on internal and external remodelling of intact long bones.  Orthop Trans. 1986;  10 391
• 6 Gelberman R H, Bauman T D, Menon J, Akeson W H. The vascularity of the lunate bone and Kienbock’s disease.  J Hand Surg [Am]. 1980;  5 272-278
• 7 Jacobs R R, Rahn B A, Perren S M. Effects of plates on cortical bone perfusion.  J Trauma. 1981;  21 91-95
• 8 Jain R, Podworny N, Hearn T, Anderson G I, Schemitsch E H. Effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture.  J Orthop Trauma. 1997;  11 490-495
• 9 Jain R, Podworny N, Hupel T M, Weinberg J, Schemitsch E H. Influence of plate design on cortical bone perfusion and fracture healing in canine segmental tibial fractures.  J Orthop Trauma. 1999;  13 178-186
• 10 Kregor P J, Senft D, Parvin D, Campbell C, Toomey S, Parker C, Gillespy T, Swiontkowski M F. Cortical bone perfusion in plated fractured sheep tibiae.  J Orthop Res. 1995;  13 715-724
• 11 Magerl F, Wyss A, Brunner C, Binder W. Plate osteosynthesis of femoral shaft fractures in adults. A follow-up study.  Clin Orthop. 1979;  62-73
• 12 McKee M D, Seiler J G, Jupiter H B. The application of the limited contact dynamic compression plate in the upper extremity: an analysis of 114 consecutive cases.  Injury. 1995;  26 661-666
• 13 Moyen B J, Lahey P J, Weinberg E H, Harris W H. Effects on intact femora of dogs of the application and removal of metal plates. A metabolic and structural study comparing stiffer and more flexible plates.  J Bone Joint Surg [Am]. 1978;  60 940-947
• 14 Mullaji A B, Jupiter J B. Low-contact dynamic compression plating of the clavicle.  Injury. 1994;  25 41-45
• 15 Paradis G R, Kelly P J. Blood flow and mineral deposition in canine tibial fractures.  J Bone Joint Surg [Am]. 1975;  57 220-226
• 16 Perren S M. The concept of biological plating using the limited contact-dynamic compression plate (LC-DCP). Scientific background, design and application.  Injury. 1991;  22 (Suppl 1) 1-41
• 17 Perren S M, Cordey J, Rahn B A, Gautier E, Schneider E. Early temporary porosis of bone induced by internal fixation implants. A reaction to necrosis, not to stress protection?.  Clin Orthop. 1988;  139-151
• 18 Rhinelander F W. The normal microcirculation of diaphyseal cortex and its response to fracture.  J Bone Joint Surg [Am]. 1968;  50 784-800
• 19 Rhinelander F W. Tibial blood supply in relation to fracture healing.  Clinical Orthopaedics & Related Research. 1974;  105 34-81
• 20 Ruedi T P, Luscher J N. Results after internal fixation of comminuted fractures of the femoral shaft with DC plates.  Clin Orthop. 1979;  74-76
• 21 Ruedi T, Webb J K, Allgower M. Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft.  Injury. 1976;  7 252-257
• 22 Simpson N S, Goodman L A, Jupiter J B. Contoured LCDC plating of the proximal ulna.  Injury. 1996;  27 411-417
• 23 Slatis P, Karaharju E, Holstrom T, Ahonen J, Paavolainen P. Structural changes in intact tubular bone after application of rigid plates with and without compression.  J Bone Joint Surg [Am]. 1978;  60 516-522
• 24 Smith S R, Bronk J T, Kelly P J. Effect of fracture fixation on cortical bone blood flow.  J Orthop Res. 1990;  8 471-478
• 25 Swiontkowski M F, Senft D, Taylor S, Agnew S G, Santoro V. Plate design has an effect on cortical bone perfusion.  Orthop Trans. 1992;  387
• 26 Tonino A J, Davidson C L, Klopper P J, Linclau L A. Protection from stress in bone and its effects. Experiments with stainless steel and plastic plates in dogs.  J Bone Joint Surg [Br]. 1976;  58 107-113
• 27 Wolff J. The Law of Bone Remodelling. Springer-Verlag, Berlin 1986
• 28 Woo S L, Akeson W H, Coutts R D. et al . A comparison of cortical bone atrophy secondary to fixation with plates with large differences in bending stiffness.  J Bone Joint Surg [Am] . 1976;  58 190-195