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Surgical widening of a stress fracture decreases local strains sufficiently to enable healing in a computational model

Fågelberg, Emil; Grassi, Lorenzo LU ; Aspenberg, Per and Isaksson, Hanna LU (2015) In International Biomechanics 2(1). p.12-21
Abstract
Stress fractures at the tibial diaphysis are prone to delayed union. We hypothesized that the interfragmentary strains in the gap tissue are of magnitudes that prohibit bone formation and healing. If so, a rational treatment would be to widen the fracture gap in order to decrease the strains. This could be achieved by replacing part of the fracture crack with a wide drilled hole. This study analyzes the biomechanical effects of this potential treatment through computational modeling. Poroelastic finite element models of an intact tibia, a tibia with a stress fracture, and a tibia with a drilled stress fracture were developed from clinical CT images. Loads corresponding to gait and stair climbing were simulated. Stresses, strains, and fluid... (More)
Stress fractures at the tibial diaphysis are prone to delayed union. We hypothesized that the interfragmentary strains in the gap tissue are of magnitudes that prohibit bone formation and healing. If so, a rational treatment would be to widen the fracture gap in order to decrease the strains. This could be achieved by replacing part of the fracture crack with a wide drilled hole. This study analyzes the biomechanical effects of this potential treatment through computational modeling. Poroelastic finite element models of an intact tibia, a tibia with a stress fracture, and a tibia with a drilled stress fracture were developed from clinical CT images. Loads corresponding to gait and stair climbing were simulated. Stresses, strains, and fluid velocities were evaluated for the bone in the tibia, and for the hypothetical soft tissue that fills the stress fracture. A minor decrease in the overall tibial stiffness (<9.9%) was noted as a result of drilling. The models predicted large interfragmentary strains in the soft gap tissue (max 35%) before drilling, which decreased substantially (<1%) after drilling. Thus, when comparing to current mechanobiological tissue differentiation theories, the authors believe that fracture gap widening by drilling a hole might facilitate healing of stress fractures. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
stress fracture, tibia, bone crack, finite element, surgical treatment
in
International Biomechanics
volume
2
issue
1
pages
12 - 21
publisher
Taylor & Francis
external identifiers
  • scopus:85006375131
ISSN
2333-5432
DOI
10.1080/23335432.2015.1014848
language
English
LU publication?
yes
id
f2704b9f-765c-4175-9dcc-097cf446532f (old id 5147206)
date added to LUP
2015-03-04 13:12:59
date last changed
2017-09-24 04:01:57
@article{f2704b9f-765c-4175-9dcc-097cf446532f,
  abstract     = {Stress fractures at the tibial diaphysis are prone to delayed union. We hypothesized that the interfragmentary strains in the gap tissue are of magnitudes that prohibit bone formation and healing. If so, a rational treatment would be to widen the fracture gap in order to decrease the strains. This could be achieved by replacing part of the fracture crack with a wide drilled hole. This study analyzes the biomechanical effects of this potential treatment through computational modeling. Poroelastic finite element models of an intact tibia, a tibia with a stress fracture, and a tibia with a drilled stress fracture were developed from clinical CT images. Loads corresponding to gait and stair climbing were simulated. Stresses, strains, and fluid velocities were evaluated for the bone in the tibia, and for the hypothetical soft tissue that fills the stress fracture. A minor decrease in the overall tibial stiffness (&lt;9.9%) was noted as a result of drilling. The models predicted large interfragmentary strains in the soft gap tissue (max 35%) before drilling, which decreased substantially (&lt;1%) after drilling. Thus, when comparing to current mechanobiological tissue differentiation theories, the authors believe that fracture gap widening by drilling a hole might facilitate healing of stress fractures.},
  author       = {Fågelberg, Emil and Grassi, Lorenzo and Aspenberg, Per and Isaksson, Hanna},
  issn         = {2333-5432},
  keyword      = {stress fracture,tibia,bone crack,finite element,surgical treatment},
  language     = {eng},
  number       = {1},
  pages        = {12--21},
  publisher    = {Taylor & Francis},
  series       = {International Biomechanics},
  title        = {Surgical widening of a stress fracture decreases local strains sufficiently to enable healing in a computational model},
  url          = {http://dx.doi.org/10.1080/23335432.2015.1014848},
  volume       = {2},
  year         = {2015},
}