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The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation

  • Saeed MiraminiEmail author
  • Lihai Zhang
  • Martin Richardson
  • Priyan Mendis
  • Adekunle Oloyede
  • Peter Ebeling
Scientific Paper

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.

Keywords

Fracture healing Mesenchymal stem cell differentiation Locking plate fixation Mechanical testing Computational simulation Osteoporosis 

Notes

Acknowledgments

The authors would like to thank AOTRAUMA Asia Pacific (AOTAP14-02), DePuy Synthes, Victorian Orthopaedic Research Trust (2014–2015), Epworth HealthCare and the University of Melbourne for their support.

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Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2015

Authors and Affiliations

  1. 1.Department of Infrastructure EngineeringThe University of MelbourneParkvilleAustralia
  2. 2.The Epworth HospitalRichmondAustralia
  3. 3.Biomedical Engineering and Medical PhysicsQueensland University of TechnologyBrisbaneAustralia
  4. 4.Department of MedicineMonash UniversityClaytonAustralia

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