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Title: The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation.
Epworth Authors: Richardson, Martin
Other Authors: Miramini, Saeed
Zhang, Lihai
Mendis, Priyan
Oloyede, Adekunle
Ebeling, Peter
Keywords: Mechanical Testing
Computer Simulation
Fracture Healing
Fracture Fixation
Cell Differentiation
Mesenchymal Stem Cells
Stem Cells, Mesenchymal
Fractures, Comminuted
Fractures, Malunited
Osteoporotic Fractures
Interfragmentary movement
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Mar-2016
Publisher: Springer
Citation: Australas Phys Eng Sci Med. 2016 Mar;39(1):123-33
Abstract: Interfragmentary movement (IFM) at the fracture site plays an important role in fracture healing, particularly during its early stage, via influencing the mechanical microenvironment of mesenchymal stem cells within the fracture callus. However, the effect of changes in IFM resulting from the changes in the configuration of locking plate fixation on cell differentiation has not yet been fully understood. In this study, mechanical experiments on surrogate tibia specimens, manufactured from specially formulated polyurethane, were conducted to investigate changes in IFM of fractures under various locking plate fixation configurations and loading magnitudes. The effect of the observed IFM on callus cell differentiation was then further studied using computational simulation. We found that during the early stage, cell differentiation in the fracture callus is highly influenced by fracture gap size and IFM, which in turn, is highly sensitive to locking plate fixation configuration. The computational model predicted that a small gap size (e.g. 1 mm) under a relatively flexible configuration of locking plate fixation (larger bone-plate distances and working lengths) could experience excessive strain and fluid flow within the fracture site, resulting in excessive fibrous tissue differentiation and delayed healing. By contrast, a relatively flexible configuration of locking plate fixation was predicted to improve cartilaginous callus formation and bone healing for a relatively larger gap size (e.g. 3 mm). If further confirmed by animal and human studies, the research outcome of this paper may have implications for orthopaedic surgeons in optimising the application of locking plate fixations for fractures in clinical practice.
DOI: 10.1007/s13246-015-0407-9
PubMed URL:
ISSN: 0158-9938
Journal Title: Australasian Physical and Engineering Sciences in Medicine
Type: Journal Article
Affiliated Organisations: Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
Biomedical Engineering and Medical Physics, Queensland University of Technology, Brisbane, Queensland, Australia.
Type of Clinical Study or Trial: Prospective Study
Appears in Collections:Musculoskeletal

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