Axial movement and tibial fractures. A controlled randomised trial of treatment

Kenwright, J; Richardson, JB; Cunningham, J L; White, SH; Goodship, AE; Adams, MA; Magnussen, P.; Newman, JH

doi:10.1302/0301-620x.73b4.2071654

Cited by 261 publications

(120 citation statements)

References 19 publications

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“…The main aim of such studies is to determine when the external fixation device can be removed without risk of a refracture or angulation and when an increased loading of the fracture can be recommended to the patient. Most of the studies [8,21,25,32,43] provided a good and objective database to inform this decision. Decisions about reoperations or additional operations, which might be necessary, could be supported by the data achieved from these measurements.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, there are only a few studies [4,8,21,23,25,32,41] which monitored the stiffness of healing fractures in a sufficiently large number of patients to be able to draw conclusions from the results. The largest study of direct measurement of bone stiffness was presented by Richardson et al [32] on 212 patients with tibial fractures treated by external fixation.…”

Section: Clinical Studies Using Bone Stiffness Measurementsmentioning

confidence: 99%

“…Kenwright et al [25] used indirect measurement of fracture stiffness as a method of comparing two different treatment modalities in 80 patients treated with external fixation for a tibial diaphyseal fracture. In one group the fixator was modified to allow for 1 mm of axial movement on the application of a low load (12 N) while in the other group the fixator remained rigid.…”

Section: Indirect Measurementmentioning

confidence: 99%

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Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

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Fracture healing is normally assessed through an interpretation of radiographs, clinical evaluation, including pain on weight bearing, and a manual assessment of the mobility of the fracture. These assessments are subjective and their accuracy in determining when a fracture has healed has been questioned. Viewed in mechanical terms, fracture healing represents a steady increase in strength and stiffness of a broken bone and it is only when these values are sufficiently high to support unrestricted weight bearing that a fracture can be said to be healed. Information on the rate of increase of the mechanical properties of a healing bone is therefore valuable in determining both the rate at which a fracture will heal and in helping to define an objective and measurable endpoint of healing. A number of techniques have been developed to quantify bone healing in mechanical terms and these are described and discussed in detail. Clinical studies, in which measurements of fracture stiffness have been used to identify a quantifiable end point of healing, compare different treatment methods, predictably determine whether a fracture will heal, and identify factors which most influence healing, are reviewed and discussed.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Studies Using Bone Stiffness Measurementsmentioning

confidence: 99%

Section: Indirect Measurementmentioning

confidence: 99%

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Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

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“…While many of the genetic mechanism regulating fetal skeletogenesis also play a role in adult skeletal regeneration (Vortkamp et al, 1998;Ferguson et al, 1999), the mechanical environment is known to play a key role in regulating the outcomes of fracture repair (Goodship and Kenwright 1985;Kenwright and Goodship 1989;Kenwright et al, 1991;Chao et al, 1998;Goodship et al, 1998;Goodship et al, 2009). A number of hypotheses have been proposed for how MSC differentiation is regulated by the mechanical environment during events such as fracture repair.…”

Section: Repairmentioning

confidence: 99%

The role of mechanical signals in regulating chondrogenesis and osteogenesis of mesenchymal stem cells

Kelly

Jacobs

2010

Birth Defects Research Pt C

216

152

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It is becoming increasingly clear that Mesenchymal Stem Cell (MSC) differentiation is regulated by mechanical signals. Mechanical forces generated intrinsically within the cell in response to its extracellular environment, and extrinsic mechanical signals imposed upon the cell by the extracellular environment, play a central role in determining MSC fate. This paper reviews chondrogenesis and osteogenesis during skeletogenesis, and then considers the role of mechanics in regulating limb development and regenerative events such as fracture repair. However, observing skeletal changes under altered loading conditions can only partially explain the role of mechanics in controlling MSC differentiation. Increasingly, understanding how epigenetic factors such as the mechanical environment regulate stem cell fate is undertaken using tightly controlled in vitro models. Factors such as bio-engineered surfaces, substrates and bioreactor systems are used to control the mechanical forces imposed upon, and generated within, MSCs. From these studies, a clearer picture of how osteogenesis and chondrogenesis of MSCs is regulated by mechanical signals is beginning to emerge. Understanding the response of MSCs to such regulatory factors is a key step towards understanding their role in disease and regeneration.3

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“…Many authors have demonstrated that although compression is necessary during the early stages of fracture healing 5,8,11 loading must be cyclic at a later stage, a principle applied not only to fractures but also to non-unions, as demonstrated by Ilizarov. 4 External fixation not only responds to the first requirements but it is the only aid which allows a mechanical modulation of the healing process.…”

Section: Introductionmentioning

confidence: 99%