Periosteal Stripping Induces Comparable Early Callus Formation but Late-Phase Regression: A Histomorphometric and Machine-Learning Analysis in a Rat Femoral Fracture Model
DOI:
https://doi.org/10.37275/bsm.v10i4.1567Keywords:
Fracture healing, Histomorphometry, Machine learning, Periosteum, TRAP stainingAbstract
Background: The periosteum is critical for fracture healing, serving as a reservoir for osteoprogenitor cells and vascular supply. A clinical paradox exists where periosteal stripping is considered detrimental yet is historically associated with hypertrophic overgrowth. This study investigates the temporal paradox of periosteal stripping, testing the hypothesis that it induces a biphasic response characterized by early inflammatory compensation followed by late-phase regenerative failure.
Methods: Twenty-four male Sprague-Dawley rats were randomized into four groups (n=6/group): Intact Periosteum (PI) and Periosteal Stripping (PS), evaluated at 14 and 28 days post-fracture. Mid-diaphyseal femoral fractures were stabilized with 1.0 mm K-wires. Healing was quantified using a validated Modified Allen-Huo Histological Score (0-10) and Trainable Weka Segmentation (TWS) for tissue classification. Osteoclast activity was assessed via Tartrate-Resistant Acid Phosphatase (TRAP) staining.
Results: At Day 14, the PS group exhibited healing comparable to the PI group (Median Score: 8.0 [IQR 8.0–9.0] vs. 8.0 [IQR 7.0–8.0]; p = 0.176), driven by hypertrophic soft callus formation rather than true osteogenesis. However, by Day 28, the PS group demonstrated significant regression (Median Score: 3.5 [IQR 3.0–4.8]) compared to the PI group (Median Score: 8.0 [IQR 8.0–8.0]; p = 0.006). Quantitative histomorphometry revealed significantly higher osteoclast density in the PS-28 group (TRAP+ cells: 18.5 ± 2.1/field) compared to PI-28 (4.2 ± 1.1/field; p < 0.001), indicating active resorption of the unstable callus.
Conclusion: Periosteal stripping does not accelerate early healing but induces a volume-matched inflammatory callus that fails to consolidate. The significant late-phase regression underscores the vital role of the cambium layer in definitive remodeling. Surgical preservation of the periosteum is mandated to prevent atrophic non-union.
Authors
- Chandra Budi Hartono1*
- Udi Herunefi Hancoro2
- Ida Bagus Budhi Surya Adnyana3
- 1Department of Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
- 2Department of Orthopedic Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
- 3Department of Digestive Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
Corresponding author Chandra Budi Hartono — chandrabudih13@gmail.com
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
As our aim is to disseminate original research article, hence the publishing right is a necessary one. The publishing right is needed in order to reach the agreement between the author and publisher. As the journal is fully open access, the authors will sign an exclusive license agreement.
The authors have the right to:
- Share their article in the same ways permitted to third parties under the relevant user license.
- Retain copyright, patent, trademark and other intellectual property rights including research data.
- Proper attribution and credit for the published work.
For the open access article, the publisher is granted to the following right.
- The non-exclusive right to publish the article and grant right to others.
- For the published article, the publisher applied for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
