Osteogenesis and Histostructure of Femoral Muscles When Modeling a Femoral Fracture with Immediate or Delayed Osteosynthesis Using an Interlocking Intramedullary Antegrade Rod

Interlocked intramedullary osteosynthesis is the most common method for treating femoral shaft fractures. The aim — to reveal specifi c characteristics of the histostructure of canine femoral muscles when healing femoral fractures under osteosynthesis using interlocking intramedullary reinforcement with an antegrade metal rod. Femoral shaft fractures were modelled in 9 mongrel dogs. The fractures were fi xed with an intramedullary rod. In Group I (n=4), osteosynthesis was started immediately after bone injury. In Group II (n=5), osteosynthesis was started 4 days after fracture (delayed osteosynthesis). M. biceps femoris and M. quadriceps femoris were studied. In Group I and Group II, bone healing occurred following 42 and 70 days, respectively. A unifi ed bone marrow cavity and cortical layer had been formed by day 70 and day 100 in Group I and Group II, respectively. The histostructure of M. quadriceps femoris in Group I remained largely unchanged throughout the experiment, while M. biceps femoris underwent the process of structural reorganization on days 42 and 70 of the experiment. The Group of delayed osteosynthesis demonstrated changes in the histostructure of both muscles, including an increased diversity of fi bre diameters, an increased number of nuclei in myocytes, fi brosis of the interstitial space and perimysial arterial vessels. These changes were more pronounced in M. biceps femoris. Three months after injury, the histostructure of the muscles under study, even in the Group of delayed osteosynthesis, had no signifi cant differences and tended to the intact norm. In femoral fractures, the earliest possible fi xation of bone fragments with an inter locking antegrade intramedullary rod is recommended. A complete bone healing in such cases occurs a month earlier than in those with delayed osteosynthesis. The femoral muscles of the anterior group are injured to a lesser extent than those of the posterior group.

1. Azizov M.Zh., Dursunov A.M., Abdulkhakov N.T., Saidiakhmatkhonov S.S. Blo kiruyushchiy intramedullyarnyy osteosintez pri diafi zarnykh perelomakh dlinnykh kostey [Interlocking intramedullary osteosynthesis for shaft fractures of long bones]. Vestnik ekstrennoy meditsiny [Herald of Emergency Medicine]. 2011;(4):38–42. (In Russian).

2. Antoniadi Yu.V., Chernitsin D.N., Zhiryakov D.L., Mukmenov M.M., Zhuravlev A.A., Zverev F.N. Zakrytyy intramedullyarnyy osteosintez v lechenii perelomov kostey nizhney konechnosti v usloviyakh gorodskoy bolnitsy [Closed intramedullary osteosynthesis in the treatment of fractures of the lower limb bones in a city hospital]. In: Mat-ly Vseross. nauchno-prakt. konf. “Ilizarovskie chte niya” [Materials of All-Russian Scientifi cPractical Conference “Ilizarov Readings”]. Kurgan, 2010. P. 30–31. (In Russian).

3. Barabash A.P., Barabash A.Yu., Zuev P.P. Doklinicheskoe issledovanie nadezhnosti intramedullyarnykh sterzhney dlya osteosinteza u patsientov s oskolchatymi perelomami diafi za bedrennoy kosti cheloveka [Preclinial study of the reliability of intramedullary rods for osteosynthesis in patients with human comminuted femoral shaft fractures]. Vestnik Dagestanskoj gosudarstvennoj medicinskoj akademii [Herald of Dagestan State Medical Academy]. 2016;18(1):42–49. (In Russian).

4. Dergachev V.V., Aleksandrov A.N., Vankhalskiy S.B., Onatskiy Yu.V., Kotenko R.S., Kolesnikov A.M. Intramedullyarnyy blokiruyushchiy osteosintez — sovremennaya metodika, novye slozhnosti, oslozhneniya [Intramedullary interlocking osteosynthesis — modern technique, new diffi culties, complications]. Trauma. 2011;12(4):20– 23. (In Russian).

5. Emanov A.A., Gorbach E.N., Antonov N.I., Martel I.I. Osobennosti osteogeneza pri lechenii diafi zarnykh perelomov bedrennoy kosti v zavisimosti ot tyazhesti travmy (eksperimental’noe issledovanie) [Osteogenesis characteristics in the treatment of femoral shaft fractures depending on injury severity (An experimental study)]. Aktual’nye voprosy veterinarnoy biologii [Actual Problems of Veterinary Biology]. 2013;19(3):72–77. (In Russian).

6. Ivanov D.V., Barabash A.P., Barabash A.Yu. Intramedullyarnyy sterzhen novogo tipa dlya osteosinteza diafi zarnykh perelomov bedra [An intramedullary rod of new type for osteosynthesis of femoral shaft fractures]. Russian Journal of Biomechanics. 2015;(1):1005–1012. (In Russian).

7. Kovalenko A.N., Moiseev Yu.I. Vnedrenie intramedullyarnogo osteosinteza s blokirovaniem v praktiku travmatologiches kogo otdeleniya. Problemy i resheniya [Introduction of intramedullary osteosynthesis with interlocking into the trauma unit practice. Problems and solutions]. In the book: Mat-ly Vseross. nauchno-prakt. konf. “Ilizarovskie chteniya” [Materials of All-Russian Scientifi c-Practical Conference “Ilizarov Readings”]. Kurgan, 2010. P. 173–174. (In Russian).

8. Kotelnikov G.P., Miroshnichenko V.F. Zakrytye travmy konechnostey [Closed injuries of the limbs]. Moscow: GEOTAR-Media Publ., 2009. 496 p. (In Russian).

9. Kotelnikov G.P., Mironov S.P. Travmatologiya: nats. ruk-vo [Traumatology: national guide]. Moscow: GEOTAR-Media Publ., 2018. 776 p. (In Russian).

10. Plotnikov I.A., Bondarenko A.V. Oslozhneniya intramedullyarnogo blokiruemogo osteosinteza diafi zarnykh perelomov bedra u patsientov s politravmoy [Complications of intramedullary interlocked osteosynthesis of femoral shaft fractures in patients with polytrauma]. Polytrauma. 2012;(1):15–20. (In Russian).

11. Sergeev S.V., Al-Bareda A.Ya.S. Intramedullyarnyy osteosintez diafi zarnykh perelomov bedrennoy kosti [Intramedullary osteosynthesis of femoral shaft fractures]. Meditsina kriticheskikh sostoyaniy [Medicine of Critical States]. 2012;(2):7–20. (In Russian).

12. Sitnik A.A. Intramedullyarnyy blokiruemyy osteosintez dlinnykh trubchatykh kostey. Obshchaya tekhnika vypolneniya, rezultaty i perspektivy [Intramedullary interlocked osteosynthesis of long tubular bones. General technique of performance, results and prospects]. Russian Medical Journal. 2007;(4):22–25. (In Russian).

13. Sitnik A.A., Volotovskiy P.A., Beletskiy A.V. Vosstanovlenie myagkikh tkaney pri otkrytykh perelomakh goleni [Soft tissue recovery in open fractures of the leg]. Meditsinskie novosti [Medical News]. 2016;(11):37–41. (In Russian).

14. Shevtsov V.I., Filimonova G.N. Perednyaya bolshebertsovaya myshtsa sobak na etapakh postnatalnogo i distraktsionnogo morfogeneza [Canine anterior tibial muscle at the stages of postnatal and distraction morphogenesis]. Genius of Orthopaedics. 2008;(1):74–80. (In Russian).

15. Bhave A., Shabtai L., Woelber E., Apelyan A., Paley D., Herzenberg J.E. Muscle strength and knee range of motion after femoral lengthening. Acta Orthop. 2017;88(2):179– 184. DOI: 10.1080/17453674.2016.1262678.

16. Bleakney R., Maffulli N. Ultrasound changes to intramuscular architecture of the quadriceps following intramedullary nailing. J. Sports Med. Phys. Fitness. 2002;42(1):120–125.

17. Burghardt R.D., Herzenberg J.E., Specht S.C., Paley D. Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening. J. Bone Joint Surg. Br. 2011;93(5):639–643. DOI: 10.1302/0301-620X.93B5.25986.

18. Hedström M., Sjöberg K., Brosjö E., Aström K., Sjöberg H., Dalén N. Positive effects of anabolic steroids, vitamin D and calcium on muscle mass, bone mineral density and clinical function after a hip fracture. A randomised study of 63 women. J. Bone Joint Surg. Br. 2002;84(4):497–503.

19. Hennrikus W.L., Kasser J.R., Rand F., Millis M.B., Richards K.M. The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old. J. Bone Joint Surg. Am. 1993;75(4):508–513.

20. Pires R.E.S., Fernandes H.J.A., Belloti J.C., Balbachevsky D., Faloppa F., Reis F.B. Como são tratadas as fraturas diafi sárias fechadas do femur no Brasil? Estudo transversal [How are closed femoral dia physeal fractures treated in Brazil? A cross-sec tio nal study]. Acta Ortop. Bras. 2006;14(3):165–169. (In Portuguese).

21. Ricci W.M., Gallagher B., Haidukewych G.J. Intramedullary nailing of femoral shaft fractures: current concepts. J. Am. Acad. Orthop. Surg. 2009;17(5):296–305.

22. Sanzarello I., Calamoneri E., D’Andrea L., Rosa M.A. Algorithm for the management of femoral shaft fractures in children. Musculoskelet. Surg. 2014;98(1):53–60. DOI: 10.1007/s12306-013-0299-3.

23. Shalaby H., Simpson Н. Femoral lengthening using the intramedullary skeletal kinetic distractor. In: 5th Meeting of the A.S.A.M.I. International (St. Petersburg, 2008): Program and abstract book. Kurgan, 2008. P. 338–340.

24. Shemshaki H.R., Mousavi H., Salehi G., Eshaghi M.A. Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children. J. Orthop. Traumatol. 2011;12(1):45–48. DOI: 10.1007/s10195-011-0128-0.