The Influence of Retrograde Femoral Nail Removal With and Without Interpositional Fat Grafting on Distal Femoral Physeal Behavior: A Sheep Study.
J Pediatr Orthop
; 42(10): e994-e1000, 2022.
Article
em En
| MEDLINE
| ID: mdl-36037439
ABSTRACT
BACKGROUND:
Previous investigations have demonstrated that up to 7% of the distal femoral physis can be violated using a rigid, retrograde nail without growth inhibition or arrest. The purpose of this investigation was to evaluate the behavior of the distal femoral physis after retrograde femoral nail removal in a sheep model, with and without placement of an interpositional fat graft.METHODS:
Retrograde femoral nails were placed in 8 skeletally immature sheep. Implants were removed at 8 weeks, with the residual defects left open (n=4) or filled with autologous fat graft (n=4). Differences in femoral length between surgical versus contralateral control femurs were measured after an additional 3 (n=4) or 5 months (n=4) before sacrifice, and the physis was evaluated histologically.RESULTS:
When compared with control limbs, femoral length was significantly shorter in limbs sacrificed at 3 months (mean 3.9±1.3 mm; range 2.7 to 5.7 mm) compared with limbs at 5 months (mean 1.0±0.4 mm; range 0.4 to 1.2 mm) ( P =0.005). No significant difference in mean shortening was appreciated in limbs without (2.4±1.6 mm) versus with fat grafting (2.5±2.3 mm) ( P =0.94). Histologic analysis revealed no osteoid formation across the physis in sheep sacrificed at 3 months, whereas there was evidence of early osteoid formation across the physis in sheep at 5 months. All specimens demonstrated evidence of an active physes.CONCLUSIONS:
Femurs undergoing retrograde implant placement were significantly shorter when compared with control limbs in sheep sacrificed at 3 months, whereas differences were nominal in sheep sacrificed at 5 months after retrograde implant removal, suggesting growth inhibition with nail removal improved with time. Fat grafting across the distal femoral physis did not result in a significant difference in femoral lengths. Histologic evidence at 5 months revealed early development of a bone bridge, emphasizing the importance of follow-up to skeletal maturity in patients treated with retrograde nailing across an open physis. LEVEL OF EVIDENCE Level IV.
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Base de dados:
MEDLINE
Assunto principal:
Fixação Intramedular de Fraturas
/
Lâmina de Crescimento
Limite:
Animals
Idioma:
En
Revista:
J Pediatr Orthop
Ano de publicação:
2022
Tipo de documento:
Article