EFFECT OF PERIOSTEAL STRIPPING ON CORTICAL BONE PERFUSION - A LASER-DOPPLER STUDY IN SHEEP

The goals of Internal fixation are an accurate reduction and stable fi xation in the presence of adequate bony vascularity. This can be achie ved by a variety of means including plate fixation. A certain amount o f periosteal stripping is necessary for proper open reduction of a fra cture and for proper prate application. With displaced diaphyseal frac tures, cortical bone perfusion (CBP) is already compromised. Further d amage, in terms of periosteal stripping for plate fixation, may not be acceptable, Little information is available as to what extent the per iosteum contributes to cortical bone perfusion. The purpose of this st udy was to determine the acute effects of periosteal stripping on coni cal bone perfusion in a sheep tibia model. Twenty-three sheep were ope rated on and had the medial aspect of their right tibia exposed. Corti cal bone perfusion measurements were obtained using laser Doppler flow metry prior to periosteal stripping and after periosteal stripping. Th e results of this study show that the cortical bone perfusion signific antly decreased by 20% after periosteal shipping over the entire lengt h of the tibia. We therefore conclude that the periosteum contributes to diaphyseal bone perfusion and that it is important to preserve this source with fractures where blood supply is already significantly com promised.