Timely Fracture-Healing Requires Optimization of Axial Fixation Stability

Epari, Devakara R.; Schell, Hanna; Duda, Georg N.; Kassi, Jean-Pierre

doi:10.2106/00004623-200707000-00022

Cited by 120 publications

(92 citation statements)

References 21 publications

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“…In an in vivo study Epari et al found torsional and sheer stresses to have negative influence on fracture healing [16]. Therefore angle-stable locking is an option to reduce risk of delayed union and, because of the increased stability, of secondary loss of reduction.…”

Section: Discussionmentioning

confidence: 99%

The primary stability of angle-stable versus conventional locked intramedullary nails

Wähnert

Stolarczyk

Hoffmeier

et al. 2011

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare the initial biomechanical characteristics of the angle-stable locking system for intramedullary nails using the new biodegradable sleeve with conventional locking in the treatment of unstable distal tibial fractures. Methods Eight pairs of fresh, frozen porcine tibiae were used for this study. The expert tibial nail (Synthes) was equipped with either conventional locking screws (CL) or the angle-stable locking system (AS). This system consists of a special ASLS screw with a biodegradable sleeve. For this investigation distal tibias (5.5 cm) were used and the nails were locked with three screws in both groups. Biomechanical testing included non-destructive torsional and axial loading. Results The AS group showed a significantly higher torsional stiffness (70%) compared to the CL group. The range of motion was 0.5 times smaller for the AS constructs. The neutral zone was eight times higher in the CL group (p<0.001). In axial loading the AS group also showed a 10% higher axial stiffness and a 12% lower range of motion (p<0.001). Conclusion The angle-stable locking system (ASLS) using a special screw and sleeve locking for intramedullary nails provides a significantly higher primary stability. The differences determined in this study may have clinical relevance particularly for torsional loads. For the new biodegradable angle-stable sleeve we found a comparable stability to the PEEK-based sleeve system. This system has the potential to decrease complications such as secondary loss of reduction and mal-/non-union.

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Section: Discussionmentioning

confidence: 99%

The primary stability of angle-stable versus conventional locked intramedullary nails

Wähnert

Stolarczyk

Hoffmeier

et al. 2011

International Orthopaedics (SICOT)

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“…Several studies in small [26] and large [15,16] animals suggest decreased fixation stiffness results in decreased flexural or torsional rigidity of the healing bone. Histologically, larger IFM leads to the predominance of endochondral ossification with a prolonged chondral phase and later bone formation [16,22,23,25,36,43] and may cause bone resorption at the fragment ends [31].…”

Section: Introductionmentioning

confidence: 99%

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

Willie

Blakytny

Glöckelmann

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Dynamization involves a reduction in fixation construct stiffness during bone healing, allowing increased interfragmentary movement of the fracture through physiologic weightbearing and muscle contraction. Within some optimal range, interfragmentary movement stimulates healing, but this range likely varies across stages of bone healing. Questions/purposes How does the time of dynamization affect the cartilage formation, bony bridging, and bone resorption in a rat fracture-healing model? Methods Unilateral external fixators, stabilizing a 1-mm gap, were dynamized at 1 (D1 group, n = 10), 3 (D3 group, n = 11), or 4 (D4 group, n = 11) weeks postoperatively. Continuously 5 weeks stiff (S group, n = 10) and flexible (F group, n = 11) fixation were included for comparison. After 5 weeks, healing was evaluated by histomorphometric methods.

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“…Following protocols developed by other investigators (Augat et al, 2008, Epari et al, 2007, Kaspar et al, 2005, Penzkofer et al, 2009 and applied by ourselves previously for characterisation of tibial IM nailing stability , Dailey et al, 2013, we carried out testing in axial tension/compression, anteroposterior ( …”

Section: Biomechanical Testingmentioning

confidence: 99%

Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

Galbraith

Daly

Harty

et al. 2016

Clinical Biomechanics

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Timely Fracture-Healing Requires Optimization of Axial Fixation Stability

Cited by 120 publications

References 21 publications

The primary stability of angle-stable versus conventional locked intramedullary nails

The primary stability of angle-stable versus conventional locked intramedullary nails

Temporal Variation in Fixation Stiffness Affects Healing by Differential Cartilage Formation in a Rat Osteotomy Model

Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

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