Bone regenerate formation in cortical bone during distraction lengthening. An experimental study.

The aim of this study was to delineate the pattern of bone regeneration from cortical bone segments during distraction lengthening. The lengthening procedure was applied for various periods through the Ilizarov system on the forearms of mature dogs. Bone was sectioned either by corticotomy, preserving the nutrient artery integrity, or by osteotomy. When an osteotomy was performed, the marrow cavity was in some cases plugged with either resorbable bone wax or nonresorbable material. Under distraction, both periosteal and medullary callus on either side of the gap gave rise to new bone trabeculae. The trabeculae on either side were oriented along the direction of distraction and progressively approached one another. This striated callus emerging from both sides was the most characteristic pattern of bone regeneration subsequent to distraction lengthening. Fusion was achieved approximately four weeks after the end of the lengthening period. Most of the new bone was formed by membranous ossification; some cartilaginous nodules developed. Corticalization of the bone trabeculae that had begun at three months was not fully achieved at five months after the lengthening period. There were no differences found in the pattern of bone healing and the amount of newly formed bone after corticotomy or osteotomy with or without resorbable bone wax plugging.