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Stahl oder Titan bei der Osteosynthese

Eine mechanobiologische Perspektive

Steel or titanium for osteosynthesis

A mechanobiological perspective

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Zusammenfassung

Hintergrund

Wird ein Implantat für die Stabilisierung einer Fraktur eingesetzt, entsteht ein mechanisches Konstrukt, das unmittelbaren Einfluss auf die Biologie der Knochenheilung nimmt. Dabei stellt die Stabilisierung von Frakturen hohe mechanische Anforderungen an Implantate, weshalb momentan fast ausschließlich Stahl oder Titan als Material verwendet wird.

Ziel der Arbeit

Der mögliche Bereich der erreichbaren mechanobiologischen Stimulation als Mechanotherapie in Abhängigkeit von der Plattensteifigkeit durch die Wahl des Plattenmaterials sowie die physikalisch-mechanischen Eigenschaften der Materialoptionen sollen hier erörtert werden.

Material und Methoden

Ein Überblick über die Materialeigenschaften von Stahl und Titan wird gegeben. Am Beispiel dynamisch fixierter Frakturen langer Röhrenknochen wird die Plattenschwingstrecke (PSS; frakturnahe Schraubenkonfiguration) für verschiedene Finite-Elemente-Modelle der Plattenosteosynthese (Stahl/Titan) variiert. Die interfragmentäre Bewegung (IFB) als Maß der mechanobiologischen Stimulation wird ausgewertet.

Ergebnisse

Die Stimulation in Form der IFB variiert über den Frakturspalt und auch in Abhängigkeit vom Osteosynthesematerial und der -konfiguration. Der Einfluss des Materials erscheint dabei deutlich kleiner als der Einfluss der PSS, aber beides verliert seinen Einfluss weitgehend für eine überbrückte Fraktursituation (Kontakt). Mit einer flexibleren Titanplatte und großer PSS kann eine größere mechanobiologische Stimulation erzeugt werden.

Diskussion

Eine Voraussetzung für die sekundäre Frakturheilung ist eine angemessene mechanobiologische Umgebung, welche durch das Osteosynthesematerial und die -konfiguration gesteuert werden kann, aber auch durch die Art der Fraktur und Belastung beeinflusst wird.

Abstract

Background

An implant used for stabilizing a fracture creates a mechanical construct, which directly determines the biology of bone healing. The stabilization of fractures places high mechanical demands on implants and therefore steel and titanium are currently almost exclusively used as the materials of choice.

Objectives

The possible range of attainable mechanobiological stimulation for mechanotherapy as a function of plate stiffness depending on the selection of the plate material and the physical and mechanical properties of the material options are discussed.

Material and methods

An overview of the material properties of steel and titanium is given. For dynamically fixed long bone fractures as examples, various finite element models of plate osteosynthesis (steel/titanium) are created and the plate working length (PWL, screw configuration close to fracture) is varied. The interfragmentary movement (IFM) as a measure of mechanobiological stimulation is evaluated.

Results

Stimulation in the form of IFM varies across the fracture and also as a function of the osteosynthesis material and the configuration. The influence of the material appears to be notably smaller than the influence of PWL but both lose their influence largely over a bridged fracture situation (contact). With a flexible titanium plate and large PSS, a greater mechanobiological stimulation is produced.

Conclusion

An essential prerequisite for the secondary fracture healing is an appropriate mechanobiological environment, which can be controlled by the osteosynthesis material and the configuration and is also affected by the type of fracture and load.

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Author information

Authors and Affiliations

  1. Julius Wolff Institut, Campus-Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Institutsgebäude Süd, 13353, Berlin, Deutschland

    M. Heyland & G. N. Duda

  2. CMSC – Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    S. Märdian & M. Schütz

  3. AO Forschungsinstitut Davos, Davos, Schweiz

    M. Windolf

Authors
  1. M. Heyland
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  2. G. N. Duda
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  3. S. Märdian
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  4. M. Schütz
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  5. M. Windolf
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Corresponding author

Correspondence to G. N. Duda.

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Interessenkonflikt

M. Heyland, G.N. Duda, S. Märdian, M. Schütz und M. Windolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

D.G. Höntzsch, Tübingen

W. Mutschler, München

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Heyland, M., Duda, G.N., Märdian, S. et al. Stahl oder Titan bei der Osteosynthese. Unfallchirurg 120, 103–109 (2017). https://doi.org/10.1007/s00113-016-0289-7

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  • DOI: https://doi.org/10.1007/s00113-016-0289-7

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