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Effect of re-implanted particles from intramedullary reaming on mechanical properties and callus formation

A LABORATORY STUDY

¹ Department of Orthopaedics and Trauma Surgery, Hugstetterstrasse 55, D-79106 Freiburg, Germany.
² Icotec ag, CH-9450, Altstäten, Switzerland.
³ 1302 Wrights Lane, West Chester, Pennsylvania 19380, USA.
⁴ AO Research Institute, Clavadelerstrasse 8, 7270 Davos, Switzerland.
⁵ Department of Orthopaedic and Trauma Surgery, Klinikum Karlsruhe, Moltkestrasse 90, D 46733, Karlsruhe, Germany.

Correspondence should be sent to Dr T. O. Hammer; e-mail: thorsten.hammer{at}uniklinik-freiburg.de

This study investigated the quality and quantity of healing of a bone defect following intramedullary reaming undertaken by two fundamentally different systems; conventional, using non-irrigated, multiple passes; or suction/irrigation, using one pass. The result of a measured re-implantation of the product of reaming was examined in one additional group. We used 24 Swiss mountain sheep with a mean tibial medullary canal diameter between 8 mm and 9 mm. An 8 mm ‘napkin ring’ defect was created at the mid-diaphysis. The wound was either surgically closed or occluded. The medullary cavity was then reamed to 11 mm. The Reamer/Irrigator/Aspirator (RIA) System was used for the reaming procedure in groups A (RIA and autofilling) and B (RIA, collected reamings filled up), whereas reaming in group C (Synream and autofilling) was performed with the Synream System. The defect was allowed to auto-fill with reamings in groups A and C, but in group B, the defect was surgically filled with collected reamings. The tibia was then stabilised with a solid locking Unreamed Humerus Nail (UHN), 9.5 mm in diameter. The animals were killed after six weeks. After the implants were removed, measurements were taken to assess the stiffness, strength and callus formation at the site of the defect.

There was no significant difference between healing after conventional reaming or suction/irrigation reaming. A significant improvement in the quality of the callus was demonstrated by surgically placing captured reamings into the defect using a graft harvesting system attached to the aspirator device. This was confirmed by biomechanical testing of stiffness and strength. This study suggests it could be beneficial to fill cortical defects with reaming particles in clinical practice, if feasible.

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				K. J. Burkhart and P. M. Rommens Intramedullary application of bone morphogenetic protein in the management of a major bone defect after an Ilizarov procedure J Bone Joint Surg Br, June 1, 2008; 90-B(6): 806 - 809. [Abstract] [Full Text] [PDF]