The effects of external mechanical stimulation on the healing of diaphyseal osteotomies fixed by flexible external fixation

Wolf, Steffen; Janousek, A.; Pfeil, Joachim; Veith, W.; Haas, F.; Duda, Georg N.; Claes, Lutz

doi:10.1016/s0268-0033(98)00097-7

Cited by 112 publications

(49 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The range of optimal interfragmentary movement has only been partially described. Initial axial interfragmentary movement of 0.2-1 mm for gap sizes of 3 mm are believed to give the best healing results [3,21,28]. However, animal experiments and measurements on human patients have shown that interfragmentary movements are multidirectional [6].…”

Section: Introductionmentioning

confidence: 99%

The course of bone healing is influenced by the initial shear fixation stability

Schell

Epari

Kassi

et al. 2005

Journal Orthopaedic Research

192

119

View full text Add to dashboard Cite

Fracture healing is influenced by fixation stability and experimental evidence suggests that the initial mechanical conditions may determine the healing outcome.We hypothesised that mechanical conditions influence not only the healing outcome, but also the early phase of fracture healing. Additionally, it was hypothesised that decreased fixation stability characterised by an increased shear interfragmentary movement results in a delay in healing. Sixty-four sheep underwent a mid-shaft tibia1 osteotomy which was treated with either a rigid or a semirigid external fixator. Animals were sacrificed at 2 , 3 , 6 and 9 weeks postoperatively and the fracture callus was analysed using radiological, biomechanical and histological techniques.The tibia treated with semi-rigid fixation showed inferior callus stiffness and quality after 6 weeks. At 9 weeks, the calluses were no longer distinguishable in their mechanical competence. The calluses at 9 weeks produced under rigid fixation were smaller and consisted of a reduced fibrous tissue component. These results demonstrate that the callus formation over the course of healing differed both morphologically and in the rate of development.In this study, we provide evidence that the course of healing is influenced by the initial fixation stability. The semi-rigid fixator did not result in delayed healing, but a less optimal healing path was taken. An upper limit of stability required for successful healing remains unknown, however a limit by which healing is less optimal has been determined.

show abstract

Section: Introductionmentioning

confidence: 99%

The course of bone healing is influenced by the initial shear fixation stability

Schell

Epari

Kassi

et al. 2005

Journal Orthopaedic Research

192

119

View full text Add to dashboard Cite

show abstract

“…Based on our data, the 100-cycle/1-Hz repetitive loading protocol may not saturate the mechanosensitivity of the healing tissue. Superimposing externally applied load on routine weightbearing, as was the case in this study, also may lessen the effect of load augmentation [36].…”

Section: Discussionmentioning

confidence: 69%

Pause Insertions During Cyclic In Vivo Loading Affect Bone Healing

Gardner

Ricciardi

Wright

et al. 2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Fracture repair is influenced by the mechanical environment, particularly when cyclic loads are applied across the fracture site. However, the specific mechanical loading parameters that accelerate fracture healing are unknown. Intact bone adaptation studies show enhanced bone formation with pauses inserted between loading cycles. We hypothesized pause-inserted noninvasive external loading to mouse tibial fractures would lead to accelerated healing. Eighty mice underwent tibial osteotomies with intramedullary stabilization and were divided into four loading protocol groups: (1) repetitive loading (100 cycles, 1 Hz); (2) pause/time-equivalent (10 cycles, 0

show abstract

“…Augat et al [2] showed in an externally fixated ovine model that delayed weight-bearing or decreased micromotion increased the percentage of bone in the callus whereas the amount of cartilage was increased by early weight bearing or increased micromotion. Wolf et al [21] reported that the area of callus was significantly greater with increasing interfragmentary motion; however the greatest biomechanical stability and bone mineral density were demonstrated in callus that had undergone lower interfragmentary motion. Claes et al [7] demonstrated, in a sheep osteotomy model, that increasing interfragmentary motion stimulated callus formation but not tissue quality.…”

Section: Mechanical Testingmentioning

confidence: 99%

A reliable externally fixated murine femoral fracture model that accounts for variation in movement between animals

Connolly

Bunn

et al. 2003

Journal Orthopaedic Research

View full text Add to dashboard Cite

Fifty-two CFLP mice had an open femoral diaphyseal osteotomy held in compression by a four-pin external fixator. The movement of 34 of the mice in their cages was quantified before and after operation, until sacrifice at 4, 8, 16 or 24 days. Thirty-three specimens underwent histomorphometric analysis and 19 specimens underwent torsional stiffness measurement. The expected combination of intramembranous and endochondral bone formation was observed, and the model was shown to be reliable in that variation in the histological parameters of healing was small between animals at the same time point, compared to the variation between time-points. There was surprisingly large individual variation in the amount of animal movement about the cage, which correlated with both histomorphometric and mechanical measures of healing. Animals that moved more had larger external calluses containing more cartilage and demonstrated lower torsional stiffness at the same time point. Assuming that movement of the whole animal predicts, at least to some extent, movement at the fracture site, this correlation is what would be expected in a model that involves similar processes to those in human fracture healing. Models such as this, employed to determine the effect of experimental interventions, will yield more information if the natural variation in animal motion is measured and included in the analysis.

show abstract

The effects of external mechanical stimulation on the healing of diaphyseal osteotomies fixed by flexible external fixation

Cited by 112 publications

References 14 publications

The course of bone healing is influenced by the initial shear fixation stability

The course of bone healing is influenced by the initial shear fixation stability

Pause Insertions During Cyclic In Vivo Loading Affect Bone Healing

A reliable externally fixated murine femoral fracture model that accounts for variation in movement between animals

Contact Info

Product

Resources

About