Subscribe to RSS
DOI: 10.1055/a-0755-6202
Knochenbruchheilung und klinische Belastungsstabilität
Stability and Fracture HealingPublication History
Publication Date:
17 January 2019 (online)
Zusammenfassung
Der umgangssprachlich oft verwendete Begriff „Stabilität“ wird im Zusammenhang mit Osteosynthesen und Frakturheilung genutzt, um den mechanischen Begriff der Steifigkeit zu umschreiben. Die Steifigkeit einer Osteosynthese hat neben Frakturmorphologie und biologischen Voraussetzungen erheblichen Einfluss auf die Heilungrate und -geschwindigkeit der Fraktur, sowie die biomechanischen Eigenschaften des Frakturkallus. Durch die unterschiedlichen verfügbaren Osteosyntheseverfahren ist in Hinblick auf Fraktur und physiologische Beanspruchung und Belastung des betroffenen Knochens eine Osteosynthese anzustreben, welche die Frakturheilung durch ihre biomechanischem Eigenschaften unterstützt. Dieser Artikel gibt eine Einführung in mechanische einflüsse auf die Frakturheilung sowie Eigenschaften der häufigsten Osteosyntheseverfahren.
Abstract
The term stability is commonly used to describe the mechanical concept of stiffness, when referencing an osteosynthesis and fracture healing. In addition to fracture morphology and biological conditions, the stiffness of an osteosynthesis has a significant influence on the healing rate and time of the fracture, as well as the biomechanical properties of the fracture callus. When choosing the method of osteosynthesis both fracture pattern and physiological stress and strain of the affected bone should be considered, in order to enhance fracture healing. This article provides an overview of mechanical influences on fracture healing and properties of the most common osteosynthetic procedures.
-
Literatur
- 1 Willie BM, Petersen A, Schmidt-Bleek K. et al. Designing biomimetic scaffolds for bone regeneration: why aim for a copy of mature tissue properties if nature uses a different approach?. Soft Matter 2010; 6: 4976-4987 doi:10.1039/c0sm00262c
- 2 Hernigou P. Plaster of Paris: the orthopaedic surgeon heritage. Int Orthop 2016; 40: 1767-1779 doi:10.1007/s00264-016-3179-2
- 3 Mathijsen A. New method for application of plaster-of-Paris bandage. 1852. Clin Orthop Relat Res 2007; 458: 59-62 doi:10.1097/BLO.0b013e31803def0c
- 4 Knothe U, Knothe Tate ML, Perren SM. 300 Years of Intramedullary Fixation – from Aztec Practice to Standard Treatment Modality. Eur J Trauma 2000; 5: 217-225
- 5 Augat P, von Rüden C. Evolution of fracture treatment with bone plates. Injury 2018; 49: S2-S7 doi:10.1016/s0020-1383(18)30294-8
- 6 Danis R. Treatment of fractures. Lancet 1947; 2: 520
- 7 Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: The diamond concept. Injury 2007; 38: S3-S6 doi:10.1016/s0020-1383(08)70003-2
- 8 Giannoudis PV, Einhorn TA, Schmidmaier G. et al. The diamond concept – open questions. Injury 2008; 39: S5-S8 doi:10.1016/s0020-1383(08)70010-x
- 9 Thompson WR, Rubin CT, Rubin J. Mechanical regulation of signaling pathways in bone. Gene 2012; 503: 179-193 doi:10.1016/j.gene.2012.04.076
- 10 Epker BN, Frost HM. Periosteal Appositional Bone Growth from Age Two to Age Seventy in Man. Anat Rec 1966; 154: 573-578
- 11 Frost HM. Bone “Mass” and the “Mechanostat”: A Proposal. Anat Rec 1987; 219: 1-9
- 12 Duncan RL, Turner CH. Mechanotransduction and the Functional Response of Bone to Mechanical Strain. Calcif Tissue Int 1995; 57: 344-358
- 13 Hadid A, Epstein Y, Shabshin N. et al. Biomechanical Model for Stress Fracture-related Factors in Athletes and Soldiers. Med Sci Sports Exerc 2018; 50: 1827-1836 doi:10.1249/mss.0000000000001628
- 14 Glatt V, Evans CH, Tetsworth K. A Concert between Biology and Biomechanics: The Influence of the Mechanical Environment on Bone Healing. Front Physiol 2016; 7: 678 doi:10.3389/fphys.2016.00678
- 15 Kenwright J, Goodship AE. Controlled Mechanical Stimulation in the Treatment of Tibial Fractures. Clin Orthop Relat Res 1989; 241: 36-47
- 16 Claes L, Haegele CA. Magnitudes of local stress and strain along bony surfaces predict the course and type of fracture healing. J Biomech 1999; 32: 255-266
- 17 Checa S, Prendergast PJ. A mechanobiological model for tissue differentiation that includes angiogenesis: a lattice-based modeling approach. Ann Biomed Eng 2009; 37: 129-145 doi:10.1007/s10439-008-9594-9
- 18 Checa S, Prendergast PJ. Effect of cell seeding and mechanical loading on vascularization and tissue formation inside a scaffold: a mechano-biological model using a lattice approach to simulate cell activity. J Biomech 2010; 43: 961-968
- 19 Checa S, Rausch MK, Petersen A. et al. The emergence of extracellular matrix mechanics and cell traction forces as important regulators of cellular self-organization. Biomech Model Mechanobiol 2015; 14: 1-13 doi:10.1007/s10237-014-0581-9
- 20 Epari DR, Lienau J, Schell H. et al. Pressure, oxygen tension and temperature in the periosteal callus during bone healing–an in vivo study in sheep. Bone 2008; 43: 734-739 doi:10.1016/j.bone.2008.06.007
- 21 Epari DR, Kassi JP, Schell H. et al. Timely fracture-healing requires optimization of axial fixation stability. J Bone Joint Surg Am 2007; 89: 1575-1585 doi:10.2106/JBJS.F.00247
- 22 Mardian S, Schaser KD, Duda GN. et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon) 2015; 30: 391-396 doi:10.1016/j.clinbiomech.2015.02.006
- 23 Mardian S, Schmolz W, Schaser KD. et al. Interfragmentary lag screw fixation in locking plate constructs increases stiffness in simple fracture patterns. Clin Biomech (Bristol, Avon) 2015; 30: 814-819 doi:10.1016/j.clinbiomech.2015.06.008
- 24 Oh JK, Hwang JH, Lee SJ. et al. Dynamization of locked plating on distal femur fracture. Arch Orthop Trauma Surg 2011; 131: 535-539 doi:10.1007/s00402-010-1202-4
- 25 Claes L, Augat P, Suger G. et al. Influence of Size and Stability of the Osteotomy Gap on the Success of Fracture Healing. J Orthop Res 1997; 15: 577-584
- 26 Claes L, Eckert-Hubner K, Augat P. The fracture gap size influences the local vascularization and tissue differentiation in callus healing. Langenbecks Arch Surg 2003; 388: 316-322 doi:10.1007/s00423-003-0396-0
- 27 MacLeod AR, Pankaj P. Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations. Injury 2018; 49: S12-S18 doi:10.1016/s0020-1383(18)30296-1
- 28 Heyland M, Duda GN, Mardian S. et al. [Steel or titanium for osteosynthesis : A mechanobiological perspective]. Unfallchirurg 2017; 120: 103-109 doi:10.1007/s00113-016-0289-7
- 29 MacLeod AR, Simpson AH, Pankaj P. Age-related optimization of screw placement for reduced loosening risk in locked plating. J Orthop Res 2016; 34: 1856-1864 doi:10.1002/jor.23193
- 30 Ahmad M, Nanda R, Bajwa AS. et al. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability?. Injury 2007; 38: 358-364 doi:10.1016/j.injury.2006.08.058
- 31 Henschel J, Tsai S, Fitzpatrick DC. et al. Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion. J Orthop Trauma 2017; 31: 531-537 doi:10.1097/BOT.0000000000000879
- 32 Heyland M, Duda GN, Haas NP. et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury 2015; 46 (Suppl. 04) S24-S32 doi:10.1016/s0020-1383(15)30015-2
- 33 Roderer G, Gebhard F, Duerselen L. et al. Delayed bone healing following high tibial osteotomy related to increased implant stiffness in locked plating. Injury 2014; 45: 1648-1652 doi:10.1016/j.injury.2014.04.018
- 34 Augat P, Margevicius K, Wolf S. et al. Local Tissue Properties in Bone Healing: Influence of Size and Stability of the Osteotomy Gap. J Orthop Res 1998; 16: 475-481
- 35 Harvin WH, Oladeji LO, Della Rocca GJ. et al. Working length and proximal screw constructs in plate osteosynthesis of distal femur fractures. Injury 2017; 48: 2597-2601 doi:10.1016/j.injury.2017.08.064
- 36 Strauss EJ, Schwarzkopf R, Kummer F. et al. The Current Status of Locked Plating: The Good, the Bad, and the Ugly. J Orthop Trauma 2008; 22: 479-486
- 37 Giannoudis PV, Gudipati S, Harwood P. et al. Long bone non-unions treated with the diamond concept: a case series of 64 patients. Injury 2015; 46 (Suppl. 08) S48-S54 doi:10.1016/s0020-1383(15)30055-3