Traumatized periosteum: Its histology, viability, and clinical significance.

The periosteum covers the surface of long bone except at the joints. During fracture fixation, we found the periosteum is ragged and damaged. Our objective is to determine the microscopic picture of traumatized periosteum in terms of the degree of damage, cell type, stromal tissue, and vascularity. Periosteum of 1cm*1cm is harvested at 1cm, 3cm, and 5cm proximal and distal to fracture site following fracture of a long bone in 20 humans. Ragged and damaged periosteum mainly consists of an outer fibrous layer with many hemorrhagic tissue and neovascularization. Osteoprogenitor cells were seen only in 12 out of 97 samples, mostly harvested 5 cm from the fracture site. The innermost layer of the periosteum remains attached to the bone surface after separating the fibrous layer following a fracture. The use of a periosteal elevator on the bone surface further damages the inner layer of the periosteum. Using a scalpel to separate the periosteum or merely pulling it away from the bone surface will decrease damage to the inner cambium layer. Fracture reduction can be achieved by indirect means at least 5 cm away from the fracture site.