Innovative approach to distraction osteogenesis using a novel external fixator design. In vivo experimental rabbit model.

Distraction osteogenesis is an established surgical technique for bone lengthening. The procedure involves making osteotomies, in the bone and using a device to gradually separate, or "distract," the bone fragments. New Zealand white male rabbits underwent distraction osteogenesis on the right tibia and lengthening using external fixators at two different time points: a speed of 1.4 mm/day in 15 days and 2.1 mm/day in 10 days. Radiological analysis was used to determine the distraction osteogenesis rates during tibia lengthening in rabbits. The regenerated callus was carefully removed and subjected to biological and physicochemical analyses, such as scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR), and nuclear magnetic resonance (NMR) analyses. For both groups, quantitative radiography showed that the distraction-induced deficiency was filled over time in a consistent manner. However, the amount of the newly formed tissue in rabbits of the fast-lengthening group was less significant than that of the fast group. For five weeks, FTIR results showed that the mineral phases of the regenerated tissue of two groups were made up of biological apatite crystals, which are defined as carbonated calcium phosphate. The IR spectra confirmed the presence of phosphate (PO), hydroxyl (OH), and carbonate (CO) groups. NMR demonstrated that the PO group of the regenerated bone has practically a homogeneous and unique environment: chain PO-PO which represents the skeleton of the bone mineralization. SEM showed that at the same period of lengthening, endosteal surface evolved to a more homogeneous appearance similar to healthy bone. However, the fast-lengthening group presented a less homogeneous appearance, and a less hard cortical tissue formation; the Haversian aspect was incomplete. Histological analyses demonstrated that ossification took place according to three modalities: endochondral, endoconjunctive, and transchondroid. In conclusion, the bone rearrangement during rapid lengthening is delayed, while for the slow lengthening group, the regenerated bone is strongly ossified. The lamellae are organized into concentric circles, which surround a vertical Haversian canal.