Monitoring and healing analysis of 100 tibial shaft fractures

Claes, Lutz; Grass, R.; Schmickal, Thomas; Kisse, B; Eggers, C.; Gerngroß, H.; Mutschler, Wolf; Arand, M.; Wintermeyer, T; Wentzensen, Andreas

doi:10.1007/s00423-002-0306-x

Cited by 122 publications

(94 citation statements)

References 11 publications

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“…One of the first surgeons who used strain-gauge-equipped fixators to analyze the increase in bone stiffness was Burny [3]. In the following years several measuring devices were developed, which detected mainly the deflection of the fixation pins or the bending of the fixator body [2,4,7,8,10,26]. As the fixator is eccentrically arranged to the load axis of the bone, the deformation of the fixator is a complex deformation, which is usually different in the three translations and rotations.…”

Section: Principles Of Mechanical Measurements Of Callus Stiffnessmentioning

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%

“…Claes et al [8] performed another study measuring the deformation of the bone screws of external fixators under axial or bending loads. This clinical multicenter study was carried out on 100 tibial fractures stabilized by various types of external fixators and monitored for healing up to 28 weeks postoperatively.…”

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: Principles Of Mechanical Measurements Of Callus Stiffnessmentioning

confidence: 99%

Section: Clinical Studies Using Bone Stiffness Measurementsmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

View full text Add to dashboard Cite

show abstract

“…Most require specialized equipment that is not available in fracture clinics and are not applicable to many common fractures or fracture treatment methods. For example, fracture stiffness [4,5,20,26] and acoustic emission [12] measurements can only be performed in those cases treated with external fixators and the fractured bone must be subcutaneous to enable testing using vibration or ultrasonic measurements [1,7,15,18,23].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Fracture Healing from Radiographs Using the Maximum Callus Index

Eastaugh-Waring

Joslin

Hardy

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…In most healthy adults immobility associated with fracture healing does not significantly impact quality of life of the patient, but in elderly patients the period of convalescence required for fracture repair is a significant cause of post-trauma morbidity and mortality [12,20]. Although there is some disagreement [25], clinicians have suggested that advanced age might delay fracture healing [7,13], which could further hinder recovery in the elderly. Understanding how the potential of fracture repair changes with age will identify novel therapeutic targets that can be exploited to improve fracture healing in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Cellular basis for age-related changes in fracture repair

Miclau

et al. 2005

J. Orthop. Res.

191

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The goal of this work was to define cellular and molecular changes that occur during fracture healing as animals age. We compared the molecular, cellular, and histological progression of skeletal repair in juvenile (4 weeks old), middle-aged (6 months old), and elderly (18 months old) mice at 3, 5, 7, 10, 14,21,28, and 35 days post-fracture, using a non-stabilized tibia fracturqmodel. Our histological and molecular analyses demonstrated that there was a sharp decline in fracture healing potential between juvenile and middle-aged animals, while a more subtle decrease in healing potential was apparent between middle-aged and elderly mice. By three days after fracture, chondrocytes expressing Collagen type ZZ, and osteoblasts expressing osteocalcin, were present in calluses of juvenile, but not middle-aged or elderly, mice. At day 5 immature chondrocytes and osteoblasts were observed in calluses of middle-aged and elderly mice. While at this time, chondrocytes in juvenile mice were expressing Collagen type X (ColX) indicating that chondrocyte maturation was already underway. At day 7, chondrocytes expressing ColX were abundant in middle-aged mice while a small domain of ColX-positive chondrocytes were observed in elderly mice. Further, in juvenile and middle-aged mice, but not elderly mice, vascular invasion of the cartilage was underway by day 7. Juvenile mice had replaced nearly all of the cartilage by day 14, while cartilage was still present in the callus of middle-aged mice at day 21 and in elderly mice at day 28. In addition to these delays, histomorphometry revealed that elderly and middle-aged mice formed less bone than juveniles (p < 0.001), while cartilage production was unaffected (p > 0.22). Collectively, these data suggest that enhancing cell differentiation, improving osteoblast function, and accelerating endochondral ossification may significantly benefit the elderly.

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Monitoring and healing analysis of 100 tibial shaft fractures

Abstract: The measurement of fracture stiffness allows the detection of patients at risk for nonunions. The healing time increased with increasing fracture gap size and was less in patients with younger age, less complex fractures, and lesser degrees of soft tissue damage.

Cited by 122 publications

References 11 publications

Monitoring the Mechanical Properties of Healing Bone

Monitoring the Mechanical Properties of Healing Bone

Quantification of Fracture Healing from Radiographs Using the Maximum Callus Index

Cellular basis for age-related changes in fracture repair

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