The relation between fracture activity and bone healing with special reference to the early healing phase – A preclinical study

Windolf, Markus; Ernst, Manuela; Schwyn, Ronald; Arens, Daniel; Zeiter, Stephan

doi:10.1016/j.injury.2020.10.050

Cited by 17 publications

(11 citation statements)

References 22 publications

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“…After tibial osteotomy, maximum axial displacement and implant load were observed within the first 2 to 3 weeks. 34 35 From the third week on, the displacement and implant load decreased to reach minimum 8 weeks postoperatively. Because the forces acting on some long bones are equivalent to twice the body weight, 36 activity restriction after surgery is required to avoid failure of osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model

Palierne

Blondel

Swider

et al. 2022

Vet Comp Orthop Traumatol

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Objectives The aim of this study was to measure and compare the stiffness and cyclic fatigue of two plate-bone model constructs, with either two or three locking screws per fragment, under cyclic compression. Methods A 10-hole 3.5 mm stainless steel locking compression plate (LCP) was fixed 1 mm from a synthetic bone model in which the fracture gap was 47 mm. Two groups of 10 constructs, prepared with either two or three bicortical locking screws placed at the extremities of each fragment, were tested in a load-controlled compression test until failure. Results The three-screw constructs were stiffer than the two-screw constructs (196.75 ± 50.48 N/mm and 102.43 ± 22.93 N/mm, respectively) and the actuator displacements of the two-screw constructs were higher (18.02 ± 1.07 mm) than those of the three-screw constructs (14.48 ± 2.25 mm). The number of cycles to failure of the two-screw constructs was significantly lower (38,337.50 ± 2,196.98) than the that of the three-screw constructs (44,224.00 ± 1,515.24). Load at irreversible deformation was significantly lower in the two-screw constructs (140.93 ± 13.39 N) than in the three-screw constructs (184.27 ± 13.17 N). All constructs failed by plate bending at the gap between the two cylinders. Clinical Significance Omission of the third innermost locking screw during bridging osteosynthesis subjected to compression forces led to a 13.3% reduction in the number of cycles to failure and a 23.5% reduction of the load withstood by the plate before plastic deformation occurred.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model

Palierne

Blondel

Swider

et al. 2022

Vet Comp Orthop Traumatol

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show abstract

“…In addition to potentially affecting function, different weight-bearing strategies might have other implications although data concerning distal femur fractures specifically is limited. From other studies it is, however, known that loading has a positive effect on fracture healing, 17 and muscle disuse has been found to cause rapid muscle atrophy and potentially loss of functional health. 49 , 50 Studies on hip fractures have found that early weight-bearing decreases mortality 15 , 16 and the occurrence of complications such as pneumonia 51 and pressure ulcers 15 while non-weight-bearing status compromises functional level.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly patients with distal femur fractures are frail, as emphasized by their high 1-year mortality rate 13 and restricted weight-bearing might increase mortality and harm bone healing and post-rehabilitation mobility. [14][15][16][17] Elderly patients often cannot restrict weightbearing consistently. [18][19][20][21] It is, therefore, not clear that restricting weight-bearing is the most suitable postoperative rehabilitation strategy for elderly patients following a distal femur fracture.…”

Section: Introductionmentioning

confidence: 99%

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

Ekholm

Jonsson

Rolfson

2021

Geriatr Orthop Surg Rehabil

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Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

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“…Bone union following non-union correction is dependent on stable fixation, mechanical alignment, and early functional rehabilitation (Ferreira and Marais 2015 , Windolf et al. 2020 ). In the technique described the tibial implant is fixed to the proximal segment with surface cementing and to the distal segment with an uncemented splined stem.…”

Section: Discussionmentioning

confidence: 99%

1-stage total knee arthroplasty and proximal tibial non-union correction using 3-D planning and custom-made cutting guide

2021

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The relation between fracture activity and bone healing with special reference to the early healing phase – A preclinical study

Cited by 17 publications

References 22 publications

Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model

Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

1-stage total knee arthroplasty and proximal tibial non-union correction using 3-D planning and custom-made cutting guide

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