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.; Schlag, G; Claes, L.

doi:10.1016/s0021-9290(98)80247-9

Cited by 33 publications

(46 citation statements)

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“…The worst healing is predicted for cases 7 and 10. This was experimentally verified for case 7 [33], whereas the simulation for case 10 predicts worse healing than experimentally detected [36]. In general, but especially for cases 3, 4, 5 and 11, our model tends to predict slightly faster healing than experimentally measured [21], [37].…”

Section: Resultssupporting

confidence: 61%

Numerical Simulation of Callus Healing for Optimization of Fracture Fixation Stiffness

et al. 2014

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The stiffness of fracture fixation devices together with musculoskeletal loading defines the mechanical environment within a long bone fracture, and can be quantified by the interfragmentary movement. In vivo results suggested that this can have acceleratory or inhibitory influences, depending on direction and magnitude of motion, indicating that some complications in fracture treatment could be avoided by optimizing the fixation stiffness. However, general statements are difficult to make due to the limited number of experimental findings. The aim of this study was therefore to numerically investigate healing outcomes under various combinations of shear and axial fixation stiffness, and to detect the optimal configuration. A calibrated and established numerical model was used to predict fracture healing for numerous combinations of axial and shear fixation stiffness under physiological, superimposed, axial compressive and translational shear loading in sheep. Characteristic maps of healing outcome versus fixation stiffness (axial and shear) were created. The results suggest that delayed healing of 3 mm transversal fracture gaps will occur for highly flexible or very rigid axial fixation, which was corroborated by in vivo findings. The optimal fixation stiffness for ovine long bone fractures was predicted to be 1000–2500 N/mm in the axial and >300 N/mm in the shear direction. In summary, an optimized, moderate axial stiffness together with certain shear stiffness enhances fracture healing processes. The negative influence of one improper stiffness can be compensated by adjustment of the stiffness in the other direction.

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Section: Resultssupporting

confidence: 61%

Numerical Simulation of Callus Healing for Optimization of Fracture Fixation Stiffness

et al. 2014

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“…5 ¹Aª) und eine normale Gangaktivität aufwiesen. A = Keine Stimulation, B = 0,2 mm Stimulationsamplitude, C = 0,4 mm Stimulationsamplitude, D = 0,8 mm Stimulationsamplitude, Kontrolle = stabile Fixateur externe Montage trolleª) konnte ein deutlicherer Unterschied [28] nachgewiesen werden. 5 ¹Kon-Abb.…”

Section: Externe Stimulation Der Callusbildungunclassified

Mechanische Einflüsse auf die Callusheilung

Claes

Wolf

Augat

2000

Chirurg

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Interfragmentary movement and size of the fracture gap influence fracture healing. Limited movements promote callus formation and may result in increased mechanical stability. Although larger movements still promote callus formation, the bony consolidation of the fracture is hampered. Fracture healing is also hampered if the size of the fracture gap is too large. A combination of large movement and large gap bears the risk of non-union. Therefore, having in mind a minimally invasive surgical approach, one should strive for good reduction of the fracture ends and flexible yet stable osteosynthesis. Dynamization of the fracture by enabling axial movement will close the fracture gap, stimulate tissue differentiation and possibly accelerate the healing process. External mechanical stimulation, however, has not been shown to effectively enhance the healing process under flexible fixation or in load-bearing patients.

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“…15,18,24 This axial elasticity allows for controlled axial micromotion of the secured bone segments, which is purported to provide an environment conducive to bone healing. several studies [29][30][31] in sheep and humans have revealed that axial micromotion in the range of 0.5 to 1 mm has beneficial effects on bone healing. Measurements were obtained with the digitizing system before application of tension to fixation wires (pretensioning), after tensioning the fixation wires but prior to construct loading (preloading), during maximal axial load application in the 15th cycle (under load), after unloading for the 15th cycle (postloading), and after releasing the tension on fixation wires.…”

Section: Discussionmentioning

confidence: 99%

“…15,[25][26][27][28] The precise amount of axial micromotion that optimizes bone healing is not known, although Each construct was mounted on a custom fixture for testing; for each construct type, 5 replicates were evaluated (32 groups; total, 160 constructs). 30,31 Fixation wire tensioning is performed in circular and hybrid fixator constructs to increase construct stiffness and prevent excessive motion of the secured bone segments during weight bearing. No data were obtained for the 50-, 66-, and 84-mm-diameter incomplete ring constructs when tension on the fixation wires was increased to 90 kg because of ring failure (catastrophic plastic deformation).…”

Section: Discussionmentioning

confidence: 99%

Axial stiffness and ring deformation of complete and incomplete single ring circular external skeletal fixator constructs

Hudson¹,

Lewis²,

Cross³

et al. 2012

ajvr

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

Cited by 33 publications

References 0 publications

Numerical Simulation of Callus Healing for Optimization of Fracture Fixation Stiffness

Numerical Simulation of Callus Healing for Optimization of Fracture Fixation Stiffness

Mechanische Einflüsse auf die Callusheilung

Axial stiffness and ring deformation of complete and incomplete single ring circular external skeletal fixator constructs

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