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Numerical Simulation of Callus Healing for Optimization of Fracture Fixation Stiffness
Open accessAbstract
The stiffness of fracture fixation devices together with musculoskeletal loading defines the mechanical environment within a long bone fracture, and can be quantified by the interfragmentary movement. In vivo results suggested that this can have acceleratory or inhibitory influences, depending on direction and magnitude of motion, indicating that some complications in fracture treatment could be avoided by optimizing the fixation stiffness. However, general statements are difficult to make due to the limited number of experimental findings. The aim of this study was therefore to numerically investigate healing outcomes under various combinations of shear and axial fixation stiffness, and to detect the optimal configuration. A calibrated and established numerical model was used to predict fracture healing for numerous combinations of axial and shear fixation stiffness under physiological, superimposed, axial compressive and translational shear loading in sheep. Characteristic maps of healing outcome versus fixation stiffness (axial and shear) were created. The results suggest that delayed healing of 3 mm transversal fracture gaps will occur for highly flexible or very rigid axial fixation, which was corroborated by in vivo findings. The optimal fixation stiffness for ovine long bone fractures was predicted to be 1000-2500 N/mm in the axial and >300 N/mm in the shear direction. In summary, an optimized, moderate axial stiffness together with certain shear stiffness enhances fracture healing processes. The negative influence of one improper stiffness can be compensated by adjustment of the stiffness in the other direction.
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Smaller fracture gaps require stiffer fixation and a lower IFM.
“Smaller fracture gaps require stiffer fixation and a lower IFM (31).”
From Methods to accelerate fracture healing – a narrative review from a clinical perspective (2024) · cites this paper as [31]
The Results report that very high fixation rigidity gave the best healing outcome for the simulated 1 mm gap, and the Discussion links direct ossification of small gaps to minimal IFM. But the Discussion also says small gaps healed desirably almost independently of fixation stiffness, so the claim that they require stiffer fixation and lower IFM is too absolute. (LLM, conf=0.87)
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Metadata
- Authors
- Steiner, M., Claes, L., Ignatius, A., Simon, U., & Wehner, T.
- Affiliations
- Universität Ulm (DE)
- Corresponding author
- Steiner, Malte
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-07-03
- Volume
- 9
- Issue
- 7
- Pages
- e101370
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4081589
- OpenAlex
- W2090313174
- Cited by
- 58
- References
- 56
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 11 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 6 · 2014: 2
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Universität Ulm
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone fractures and treatments
- Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- fracture healing, interfragmentary motion, axial stiffness, shear stiffness, long bone fractures, callus formation, sheep model, fracture fixation devices
- MeSH terms
- Animals, Bony Callus, Fracture Fixation, Models, Biological, Sheep, Tibial Fractures, Poisson Distribution, Fracture Healing, Elastic Modulus
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