Measurements of Stability of Crural Fractures Treated with Hoffmann Osteotaxis: 4.<i>The complicated, terminal phase of healing of crural fractures</i>

Jørgensen, Torben Ejsing

doi:10.3109/17453677208991266

Cited by 10 publications

(5 citation statements)

References 3 publications

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“…For a direct measurement of callus stiffness, the most accurate method to determine the stiffness of the fracture callus is the measurement of the deflection of the healing bone under loading with all the fixation devices removed [21,23,24,32]. In principle, this is only really possible for patients who are treated by external fixators or by cast.…”

Section: Principles Of Mechanical Measurements Of Callus Stiffnessmentioning

confidence: 99%

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: Principles Of Mechanical Measurements Of Callus Stiffnessmentioning

confidence: 99%

Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

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“…54,55 Conversely, fracture callus stiffness can provide an objective assessment of fracture healing and direct measurement of callus stiffness with instrumented external fixation has been achieved in tibia fractures. [13][14][15]56 However, previous attempts to measure stiffness with internal fixation have been cumbersome, requiring percutaneous connections, telemetry systems, or significant implant modifications which are prohibitive for clinical implementation. 16,[19][20][21][22] The purpose of this study was to use a smart fracture plate to distinguish between phases of fracture healing by measuring forces transmitted through the plate.…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative radiographic assessment of callus mineralization has been attempted but the relationship to union remains unclear 54,55 . Conversely, fracture callus stiffness can provide an objective assessment of fracture healing and direct measurement of callus stiffness with instrumented external fixation has been achieved in tibia fractures 13–15,56 . However, previous attempts to measure stiffness with internal fixation have been cumbersome, requiring percutaneous connections, telemetry systems, or significant implant modifications which are prohibitive for clinical implementation 16,19–22 …”

Section: Discussionmentioning

confidence: 99%

“…Measurement of callus stiffness can provide an objective quantitative assessment of the progress of fracture healing 12 . This has been demonstrated by instrumenting external fixators with strain gauge transducers 13–15 . Biomechanically, the fixator is loaded in parallel with the fracture, thus measuring forces in the fixator can be used as an indication of callus stiffness.…”

Section: Introductionmentioning

confidence: 99%

“…12 This has been demonstrated by instrumenting external fixators with strain gauge transducers. [13][14][15] Biomechanically, the fixator is loaded in parallel with the fracture, thus measuring forces in the fixator can be used as an indication of callus stiffness.…”

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confidence: 99%

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Smart fracture plate for quantifying fracture healing: Preliminary efficacy in a biomechanical model

Ledet

Caparaso

Stout

et al. 2022

Journal Orthopaedic Research

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The diagnosis of fracture nonunion following plate osteosynthesis is subjective and frequently ambiguous. Initially following osteosynthesis, loads applied to the bone are primarily transmitted through the plate. However, as callus stiffness increases, the callus is able to bear load proportional to its stiffness while forces through the plate decrease. The purpose of this study was to use a “smart” fracture plate to distinguish between phases of fracture healing by measuring forces transmitted through the plate. A wireless force sensor and small adapter were placed on the outside of a distal femoral locking plate. The adapter converts the slight bending of the plate under axial load into a transverse force which is measurable by the sensor. An osteotomy was created and then plated in the distal femur of biomechanical Sawbones. Specimens were loaded to simulate single‐leg stance first with the osteotomy defect empty (acute healing), then sequentially filled with silicone (early callus) and then polymethyl methacrylate (hard callus). There was a strong correlation between applied axial load and force measured by the “smart” plate. Data demonstrate statistically significant differences between each phase of healing with as little as 150 N of axial load applied to the femur. Forces measured in the plate were significantly different between acute (100%), early callus (66.4%), and hard callus (29.5%). This study demonstrates the potential of a “smart” fracture plate to distinguish between phases of healing. These objective data may enable early diagnosis of nonunion and enhance outcomes for patients.

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