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By Geoffrey Bourne (Eds.)

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37) it is strikingly evident that the periosteal circulation, in the same area, is not able to produce the vascular proliferation and osseous porosity which should accompany fracture healing. Subsequent experiments with tightly fitting medullary nails will further elucidate this matter. 2. Regenerative Ability of Medullary Circulation The tremendous ability of the medullary circulation to regenerate after obliteration by an intramedullary nail is demonstrated by Fig. 38, a cross-sectional microangiogram of an ulna in a 7-week osteotomy experi- 2.

One end of the plate has become loosened and elevated (arrow). Blood vessels stream through the space provided by a loosened screw. Note the vascularity of cortex beneath the loose portion of the plate and the avascularity beneath the tight portion ( X 3 . 5 ) . in this experiment suggest that the blood supply of this area of compact bone is through-and-through where flow is concerned—in a centrifugal direction, from medulla to periosteum. This agrees with the conclusions of Brookes quoted in Section III, C above.

27. Histologic enlargement from central area of vascular congestion at site of osteotomy shown in Fig. 26. Note the beginnings of a pseudarthrotic cavity (Η & Ε, X 5 2 . 5 ) . Histologic enlargement of the healing area (Fig. 27) confirms the impression that there is no osseous or cartilaginous union. The increased local blood supply, observed in the microangiogram, has led to a more rapid invasion of dead bone than is usual at this stage, with the result that the smooth cortical ends, burned by the power saw, have mostly been removed.

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