Dynamic Stabilization of Simple Fractures With Active Plates Delivers Stronger Healing Than Conventional Compression Plating

Bottlang, Michael; Tsai, Stanley; Bliven, Emily; Rechenberg, Brigitte von; Kindt, Philipp H.; Augat, Peter; Henschel, Julia; Fitzpatrick, Daniel; Madey, Steven M.

doi:10.1097/bot.0000000000000732

Cited by 34 publications

(25 citation statements)

References 27 publications

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“…1 ): replacing diaphyseal locking screws with nonlocking screws (NONLOCKED group); bridge dynamization (BRIDGE group) by increasing the bridging span with locked screws in the diaphysis 19 ; screw dynamization with FCL screws (FCL group) 8 ; and plate dynamization with active locking plates (ACTIVE group). 10 , 20 Construct stiffness was characterized by measuring the construct deformation in response to quasi-physiologic loading. Dynamization of the fracture site was characterized by measuring the interfragmentary motion in axial and shear direction.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Henschel

Tsai

Fitzpatrick

et al. 2017

Journal of Orthopaedic Trauma

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Section: Methodsmentioning

confidence: 99%

“… 3 , 7 – 9 Conversely, research over the past 50 years has consistently demonstrated that controlled axial dynamization can improve the speed and strength of fracture healing by dynamically stimulating natural bone healing through callus formation. 7 , 10 – 15 …”

Section: Introductionmentioning

confidence: 99%

Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Henschel

Tsai

Fitzpatrick

et al. 2017

Journal of Orthopaedic Trauma

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“…Fig. (6) summarizes the total angle variation experienced by the two anatomic regions, confirming the higher stabilizing effect of the 4 mm diameter monocortical pins.…”

Section: Static Characterizationmentioning

confidence: 52%

Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

Terzini¹,

Sicuranza²,

Alberghina³

et al. 2021

TOBEJ

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Background: External fixation is an osteosynthesis technique particularly useful in trauma surgery and Damage Control Orthopedics (DCO). However, complications, such as pin loosening and pin tract infections, are fairly common. For reducing thermal damage and infection rates, monocortical pins have been proposed as an alternative to the most used bicortical pins. However, there is a lack of studies regarding their mechanical properties. Objective: The aim of the study is to assess the static and dynamic stability of a unilateral external fixator experimentally when applied through monocortical pins for the reduction of femur and tibia fractures. Methods: A modular unilateral external fixator was used and a total number of 6 pins were used per test. The static tests were performed in displacement control by applying a vertical displacement to the upper fixture at 1 mm/min until a tension load of 380 N was reached. The dynamic tests were performed by applying a sinusoidal displacement. During each test, forces and crosshead displacements were acquired. Two different stiffness indexes were assessed. Results: By comparing the two anatomic regions, it was found that the fixator behaves stiffer when mounted on the femur, regardless of the pins used, while stiffnesses comparable to the femur ones are reached by the tibia when 4 mm diameter pins are used. Static analysis revealed excellent fixator stability when implanted with 4 mm diameter monocortical pins on both anatomic regions. On the contrary, two tibia and one femur samples showed failures at the bone-pin interface when 3 mm diameter pins were used. Conclusion: Dynamic analysis showed no substantial difference between the tested configurations and confirmed the fixator's ability to sustain cyclic loading without further damage to the sample.

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“…Even though HTO demands an intricate surgical procedure compared to trauma fractures, it favours the locking plate over the compression plate as fixation which allows inter-fragmentary motion, thus more efficient secondary healing via both healing methods (Röderer et al, 2014). To dynamise bone plates and facilitate the micromotion required to stimulate option healing, current solutions incorporate various mechanics that revolve around increasing the motion around the fixation of the screw to the bone (Bottlang et al, 2009(Bottlang et al, , 2017Döbele et al, 2010). The stiffness modulation of orthopaedic implants and has been broached only once, by varying the lattice design of a hip implant (Burton et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Design Principles to Increase the Patient Specificity of High Tibial Osteotomy Fixation Devices

Kanagalingam

Shepherd

Fernández-Vicente

et al. 2019

Proc. Int. Conf. Eng. Des.

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High stiffness fracture fixation devices inducing absolute stability, activate inefficient primary healing and stress shielding. Taking High Tibial Osteotomy as a representative example, review of the clinical literature and mapping the fracture healing process revealed two physically contradicting requirements, which are only partially met by current techniques. Stiffness of the fixation is required immediately after fracture, however in the remodelling phase this can cause stress shielding. Stability is required immediately after fracture, however in the ossification phase less stability is required to stimulate secondary (and more efficient) healing. This study evaluates the use of the TRIZ Inventive Design Principles to overcome these physical contradictions. Six designs concepts were evaluated, of which the Macro-Geometry stiffness modulated design was ranked the highest. This was achieved through spatial decomposition of the problem utilising the Inventive Principles of Asymmetry, Extraction and Local Quality. This study offer perspectives on how to increase the patient specificity of fixation utilising the increased topology freedom of design for additive manufacture (AM).

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Dynamic Stabilization of Simple Fractures With Active Plates Delivers Stronger Healing Than Conventional Compression Plating

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 34 publications

References 27 publications

Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

Design Principles to Increase the Patient Specificity of High Tibial Osteotomy Fixation Devices

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