„Ischemic“ Distraction Regenerate: Interpretation, Definition, Problems and Solutions

Abstract

The purpose of the study was to define «ischemic» distraction regeneration which happens during the compromised course of distraction osteogenesis and to show the effectiveness of the mechanical action on such regenerates in patients with bone defects and pseudarthrosis.Materials and methods. Seventeen patients with long bone defects (forearm and lower leg) were successfully treated. They had compromised distraction osteogenesis during the transosseous osteosynthesis stages and developed ischemic regenerates. The mean size of the defects relative to the contralateral segment in the forearm bones was 22.3% and 20% in patients with defects in the lower leg bones. Mechanical stimulation of compromised bone formation was used by means of compression and compaction of problematic distraction regenerates with two techniques. In group I, an additional osteotomy of the fragment under lengthening was performed. In group II, regenerates were compacted to the height of the regenerate connective tissue layer until its bony parts contacted. We used descriptive statistics methods.Results. The process of bone tissue formation restored in all patients due to the mechanical impact on the zones of compromised distraction osteogenesis, and its complete organotypic remodeling followed.Conclusion. Based on clinical and radiological signs of a compromised course of distraction osteogenesis, the notion of «ischemic regenerate» was defined and its manifestations were described. A retrospective analysis of the results of mechanical action on compromised distraction regenerates through compression and compaction without a change in the osteosynthesis technology shows its effectiveness.