Fracture stiffness measurement in the assessment and management of tibial fractures

Richardson, JB; Kenwright, J; Cunningham, J L

doi:10.1016/0268-0033(92)90018-y

Cited by 62 publications

(44 citation statements)

References 18 publications

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“…Pin-site loosening did not affect our results because the technique puts very little force through the pin sites, unlike indirect methods of measuring stiffness (Richardson and O'Connor 1993). When loose pins caused concern, the pretensioning of the pins against each other by an elastic band effectively eliminated artefactual movements produced by soft-tissue deformation.…”

Section: Discussionmentioning

confidence: 84%

Stiffness Measurements to Assess Healing During Leg Lengthening

Dwyer

Owen

Evans

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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We describe a technique for measuring the stiffness of regenerate bone after leg lengthening. This allows early identification of slow healing by reference to normal patterns. We determined the time of removal of the fixator from clinical and radiological information independent of the stiffness result.In a series of 30 leg lengthenings there were no refractures when the tibial stiffness had reached 15 Nm/° or the femoral stiffness 20 Nm/°. Three refractures occurred at lower stiffness values. The technique is simple to perform, will allow a reduction in plain radiography and is recommended for routine postoperative management.

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Section: Discussionmentioning

confidence: 84%

Stiffness Measurements to Assess Healing During Leg Lengthening

Dwyer

Owen

Evans

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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“…This choice is based on the results of Richardson et al [44] who observed an exponential increase in stiffness during tibial fracture healing. The period of 75 days was chosen based on an average of times reported for the consolidation and the calcification of the fracture callus [13,27].…”

Section: Discussionmentioning

confidence: 99%

Tissue differentiation and bone regeneration in an osteotomized mandible: a computational analysis of the latency period

Boccaccio

Prendergast

Pappalettere

et al. 2007

Med Biol Eng Comput

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Mandibular symphyseal distraction osteogenesis is a common clinical procedure to modify the geometrical shape of the mandible for correcting problems of dental overcrowding and arch shrinkage. In spite of consolidated clinical use, questions remain concerning the optimal latency period and the influence of mastication loading on osteogenesis within the callus prior to the first distraction of the mandible. This work utilized a mechano-regulation model to assess bone regeneration within the callus of an osteotomized mandible. A 3D model of the mandible was reconstructed from CT scan data and meshed using poroelastic finite elements. The stimulus regulating tissue differentiation within the callus was hypothesized to be a function of the strain and fluid flow computed by the finite element model. This model was then used to analyse tissue differentiation during a fifteen day latency period, defined as the time between the day of the osteotomy and the day when the first distraction is given to the device. The following predictions are made: (i) the mastication forces generated during the latency period support osteogenesis in certain regions of the callus, and that during the latency period the percentage of progenitor cells differentiating into osteoblasts increases; (ii) reducing the mastication load by 70% during the latency period increases the number of progenitor cells differentiating into osteoblasts; (iii) the stiffness of new tissue increases at a slower rate on the side of bone callus next to the occlusion of the mandibular ramus which could cause asymmetries in the bone tissue formation with respect to the middle sagittal plane. Although the model predicts that the mastication loading generates such asymmetries, their effects on the spatial distribution of callus mechanical properties are insignificant for typical latency periods used clinically. It is also predicted that a latency period of longer than a week will increase the risk of premature bone union across the callus.

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“…In contrast to this indirect measurement of fracture stiffness, other groups have removed the fixator for each measurement and measured the fracture stiffness by applying a load to the bone, measuring the deflection [8] and calculating the stiffness. They found that no refracture or angulation occurs when the fracture stiffness exceeds 10 Nm/degree [8] and proposed a bending stiffness of 15 Nm/degree as a safe threshold value at which the fixator can be removed and the leg functionally loaded. However, this measurement technique is time-consuming, not possible in the first weeks after fracture, and impractical under routine clinical conditions.…”

Section: Introductionmentioning

confidence: 99%