Year Book: The Tension-Stress Effect on the Genesis and Growth of

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Tissues: Part I. The Influence of Stability of Fixation and Soft-Tissue Preservation. Ilizarov-GA. Original Article: Clin Orthop. 1989 Jan. 238. pp 249-281. ABSTRACT Gradual traction on living tissues creates stresses that can stimulate and maintain the regeneration and active growth of certain tissue structures. This principle is called the Law of Tension-Stress. The application of this principle allows control of osseous healing and the shaping processes of bone and soft tissue. To determine the optimal conditions for osteogenesis during limb lengthening, and to assess the changes in soft tissues undergoing elongation, 3 series of experiments were performed on canine tibia. The experiments were done with 480 adult dogs divided into 5 groups. In the first 3 groups, open transverse osteotomy of the tibial diaphysis, periosteum, and bone marrow was performed, and longitudinal distraction was achieved with the transfixion-wire Ilizarov circular external skeletal fixator used in configurations of differing stability. The last 2 groups of dogs were stabilized with the same Ilizarov fixator, but with two thirds and total preservation of bone marrow, periosteum, and intramedullary nutrient blood vessels at the osteotomy level. Osteogenic activity was least in the group with the most mobility between bone ends. Osteogenesis overtook distraction and consolidated bone prematurely in the group of maximal preservation of bone marrow, blood vessels, and periosteum. In the group with two thirds preservation, osteogenesis proceeded more actively than in any of the 3 groups with complete transverse osteotomy.