Histological study of the docking site after bone transport. Temporal evolution in a sheep model

Abstract

Introduction: Bone transport appears to be a solution for segmental bone defects; specifically, the "docking site" is where the transported segment meets the target segment at the end of the process. A lack of its consolidation is one of the major causes of failure for this technique. Many studies have been performed in order to enhance the consolidation of the docking site, but histological changes occurring in it remain unknown. The aim of this study was to determine microscopic changes present in this area, from distraction to remodeling, in order to clarify the best options to facilitate the success of this technique.

Materials and methods: Ten adult sheep were submitted to bone transport using an Ilizarov external fixator. Histomorphometry and immunohistochemical studies were performed in the docking site to determine the main types of ossification, the evolutions of tissues and blood vessels and the distributions of collagen I and II.

Results: Ossification was mainly intramembranous with some areas of endochondral ossification. Fibrous tissue was predominant until 98 days after surgery. The area occupied by blood vessels increased until 50 days after surgery, when it decreased slowly until the end of the study.

Conclusions: As far as the authors know, this is the first histological study performed in the docking site reporting the complete evolution of tissues until the end of remodeling, showing results contrary to those published by others authors. This could help to clarify information about its union and may be useful for future investigations about techniques for improving the consolidation of the docking site in humans.

Keywords: Bone transport; Docking site; Ilizarov; Intramembranous; Ossification.