CLINICAL APPLICATION OF AXIAL LOAD MECHANICAL TESTING IN REMOVING EXTERNAL FIXATOR AFTER TIBIA AND FIBULA FRACTURES SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUQingwei ¹ ,  WANChunyou ² , ZHANGTao ² , WANGXiaowei ¹ , LIUYanshi ³ , MAJihai ¹

1. Graduate School of Tianjin Traditional Chinese Medicine University, Tianjin, 300193, P. R. China;
2. No.1 Ward of Limb Orthopedics, Tianjin Hospital;
3. Graduate School of Tianjin Medical University;

Corresponding?author：

WANChunyou, Email: wanchunyouxs@163.com

Keywords：

Axial load; External fixator; Mechanical test; Tibia and fibula fractures

DOI：

10.7507/1002-1892.20160221

Video：

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Objective To explore the efficacy and safety of the axial load mechanical testing for removing external fixator. Methods Between January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years (range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. Results At 21-85 weeks after external fixation (mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. Conclusion External fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.

Citation： LUQingwei, WANChunyou, ZHANGTao, WANGXiaowei, LIUYanshi, MAJihai. CLINICAL APPLICATION OF AXIAL LOAD MECHANICAL TESTING IN REMOVING EXTERNAL FIXATOR AFTER TIBIA AND FIBULA FRACTURES SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1085-1088. doi: 10.7507/1002-1892.20160221 Copy

1.	?Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection:a randomized controlled trial. Clin Orthop Relat Res, 2012, 470(2):610-615.
2.	Kocaoglu M, Eralp L, Kilicoglu O, et al. Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg (Am), 2004, 86-A(11):2406-2411.
3.	Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Joint Surg (Br), 2000, 82(5):659-665.
4.	Saran N, Hamdy RC. DEXA as a predictor of fixator removal in distraction osteogenesis. Clin Orthop Relat Res, 2008, 466(12):2955-2961.
5.	Chachan S, Tudu B, Sahu B. Ultrasound monitoring of fracture healing:is this the end of radiography in fracture follow-ups? J Orthop Trauma, 2015, 29(3):e133-138.
6.	Lowet G, Van der Perre G. Ultrasound velocity measurement in long bones:measurement method and simulation of ultrasound wave propagation. J Biomech, 1996, 29(10):1255-1262.
7.	De Backer AI, Mortelé KJ, De Keulenaer BL. Picture archiving and communication system-Part one:filmless radiology and distance radiology. JBR-BTR, 2004, 87(5):234-241.
8.	Aarnes GT, Steen H, Ludvigsen P, et al. In vivo assessment of regenerate axial stiffness in distraction osteogenesis. J Orthop Res, 2005, 23(2):494-498.
9.	郭占社, 房遠勇, 梁向黨, 等.骨科生物力學參數測試理論及方法研究進展.中國醫療器械雜志, 2010, 34(5):350-354.
10.	Donnan LT, Saleh M, Rigby AS, et al. Radiographic assessment of bone formation in tibia during distraction osteogenesis. J Pediatr Orthop, 2002, 22(5):645-651.
11.	Zhao L, Fan Q, Venkatesh KP, et al. Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio:a pilot study. Clin Orthop Relat Res, 2009, 467(12):3321-3326.
12.	馬信龍, 馬劍雄, 徐衛國, 等.骨科生物力學研究的測量方法學專家共識.中國骨質疏松雜志, 2014, 20(9):1039-1054.
13.	鄭誠功.骨科生物力學的進展.中華創傷骨科雜志, 2005, 7(10):901-902.
14.	李躍飛, 田賀, 張文泰.中西醫結合治療四肢骨折.長春中醫藥大學學報, 2015, 31(2):316-317.
15.	許志宇, 孟和.由"動靜結合、筋骨并重"談孟氏學術理念.西部中醫藥, 2016, 29(1):58-60.
16.	夏和桃.外固定器剛度對骨折愈合的影響.中華創傷骨科雜志, 2007, 9(12):1170-1172.
17.	秦泗河.骨外固定技術的發展與創新.中醫正骨, 2012, 24(9):643-647.
18.	Arora J, Malik AC. External fixation in comminuted, displaced intra-articular fractures of the distal radius:is it sufficient? Arch Orthop Trauma Surg, 2005, 125(8):536-540.

1. ?Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection:a randomized controlled trial. Clin Orthop Relat Res, 2012, 470(2):610-615.
2. Kocaoglu M, Eralp L, Kilicoglu O, et al. Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg (Am), 2004, 86-A(11):2406-2411.
3. Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Joint Surg (Br), 2000, 82(5):659-665.
4. Saran N, Hamdy RC. DEXA as a predictor of fixator removal in distraction osteogenesis. Clin Orthop Relat Res, 2008, 466(12):2955-2961.
5. Chachan S, Tudu B, Sahu B. Ultrasound monitoring of fracture healing:is this the end of radiography in fracture follow-ups? J Orthop Trauma, 2015, 29(3):e133-138.
6. Lowet G, Van der Perre G. Ultrasound velocity measurement in long bones:measurement method and simulation of ultrasound wave propagation. J Biomech, 1996, 29(10):1255-1262.
7. De Backer AI, Mortelé KJ, De Keulenaer BL. Picture archiving and communication system-Part one:filmless radiology and distance radiology. JBR-BTR, 2004, 87(5):234-241.
8. Aarnes GT, Steen H, Ludvigsen P, et al. In vivo assessment of regenerate axial stiffness in distraction osteogenesis. J Orthop Res, 2005, 23(2):494-498.
9. 郭占社, 房遠勇, 梁向黨, 等.骨科生物力學參數測試理論及方法研究進展.中國醫療器械雜志, 2010, 34(5):350-354.
10. Donnan LT, Saleh M, Rigby AS, et al. Radiographic assessment of bone formation in tibia during distraction osteogenesis. J Pediatr Orthop, 2002, 22(5):645-651.
11. Zhao L, Fan Q, Venkatesh KP, et al. Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio:a pilot study. Clin Orthop Relat Res, 2009, 467(12):3321-3326.
12. 馬信龍, 馬劍雄, 徐衛國, 等.骨科生物力學研究的測量方法學專家共識.中國骨質疏松雜志, 2014, 20(9):1039-1054.
13. 鄭誠功.骨科生物力學的進展.中華創傷骨科雜志, 2005, 7(10):901-902.
14. 李躍飛, 田賀, 張文泰.中西醫結合治療四肢骨折.長春中醫藥大學學報, 2015, 31(2):316-317.
15. 許志宇, 孟和.由"動靜結合、筋骨并重"談孟氏學術理念.西部中醫藥, 2016, 29(1):58-60.
16. 夏和桃.外固定器剛度對骨折愈合的影響.中華創傷骨科雜志, 2007, 9(12):1170-1172.
17. 秦泗河.骨外固定技術的發展與創新.中醫正骨, 2012, 24(9):643-647.
18. Arora J, Malik AC. External fixation in comminuted, displaced intra-articular fractures of the distal radius:is it sufficient? Arch Orthop Trauma Surg, 2005, 125(8):536-540.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF AXIAL LOAD MECHANICAL TESTING IN REMOVING EXTERNAL FIXATOR AFTER TIBIA AND FIBULA FRACTURES SURGERY

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