Image-based radiodensity profilometry measures early remodeling at the bone-callus interface in sheep

Don't mind the gap: reframing the Perren strain rule for fracture healing using insights from virtual mechanical testing

Aims

The "2 to 10% strain rule" for fracture healing has been widely interpreted to mean that interfragmentary strain greater than 10% predisposes a fracture to nonunion. This interpretation focuses on the gap-closing strain (axial micromotion divided by gap size), ignoring the region around the gap where osteogenesis typically initiates. The aim of this study was to measure gap-closing and 3D interfragmentary strains in plated ovine osteotomies and associate local strain conditions with callus mineralization.

Methods

MicroCT scans of eight female sheep with plated mid-shaft tibial osteotomies were used to create image-based finite element models. Virtual mechanical testing was used to compute postoperative gap-closing and 3D continuum strains representing compression (volumetric strain) and shear deformation (distortional strain). Callus mineralization was measured in zones in and around the osteotomy gap.

Results

Gap-closing strains averaged 51% (mean) at the far cortex. Peak compressive volumetric strain averaged 32% and only a small tissue volume (average 0.3 cm3) within the gap experienced compressive strains > 10%. Distortional strains were much higher and more widespread, peaking at a mean of 115%, with a mean of 3.3 cm3 of tissue in and around the osteotomy experiencing distortional strains > 10%. Callus mineralization initiated outside the high-strain gap and was significantly lower within the fracture gap compared to around it at nine weeks.

Conclusion

Ovine osteotomies can heal with high gap strains (> 10%) dominated by shear conditions. High gap strain appears to be a transient local limiter of osteogenesis, not a global inhibitor of secondary fracture repair.

Adaptive Image Segmentation Reveals Substantial Cortical Bone Remodeling During Early Fracture Repair

The goal of this study was to develop an image analysis algorithm for quantifying the effects of remodeling on cortical bone during early fracture healing. An adaptive thresholding technique with boundary curvature and tortuosity control was developed to automatically identify the endocortical and pericortical boundaries in the presence of high-gradient bone mineral density (BMD) near the healing zone. The algorithm successfully segmented more than 47,000 microCT images from 12 healing ovine osteotomies and intact contralateral tibiae. Resampling techniques were used to achieve data dimensionality reduction on the segmented images, allowing characterization of radial and axial distributions of cortical BMD. Local (transverse slice) and total (whole bone) remodeling scores were produced. These surrogate measures of cortical remodeling derived from BMD revealed that cortical changes were detectable throughout the region covered by callus and that the localized loss of cortical BMD was highest near the osteotomy. Total remodeling score was moderately and significantly correlated with callus volume and mineral composition (r > 0.64, p < 0.05), suggesting that the cortex may be a source of mineral needed to build callus.

Embracing ethical research: Implementing the 3R principles into fracture healing research for sustainable scientific progress

As scientific advancements continue to reshape the world, it becomes increasingly crucial to uphold ethical standards and minimize the potentially adverse impact of research activities. In this context, the implementation of the 3R principles-Replacement, Reduction, and Refinement-has emerged as a prominent framework for promoting ethical research practices in the use of animals. This article aims to explore recent advances in integrating the 3R principles into fracture healing research, highlighting their potential to enhance animal welfare, scientific validity, and societal trust. The review focuses on in vitro, in silico, ex vivo, and refined in vivo methods, which have the potential to replace, reduce, and refine animal experiments in musculoskeletal, bone, and fracture healing research. Here, we review material that was presented at the workshop "Implementing 3R Principles into Fracture Healing Research" at the 2023 Orthopedic Research Society (ORS) Annual Meeting in Dallas, Texas.