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Pause Insertions During Cyclic In Vivo Loading Affect Bone Healing

  • Original Article
  • Trauma or Fracture
  • Published:
Clinical Orthopaedics and Related Research

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Abstract

Fracture repair is influenced by the mechanical environment, particularly when cyclic loads are applied across the fracture site. However, the specific mechanical loading parameters that accelerate fracture healing are unknown. Intact bone adaptation studies show enhanced bone formation with pauses inserted between loading cycles. We hypothesized pause-inserted noninvasive external loading to mouse tibial fractures would lead to accelerated healing. Eighty mice underwent tibial osteotomies with intramedullary stabilization and were divided into four loading protocol groups: (1) repetitive loading (100 cycles, 1 Hz); (2) pause/time-equivalent (10 cycles, 0.1 Hz); (3) pause/cycle-equivalent (100 cycles, 0.1 Hz); and (4) no load control. Loading was applied daily for 2 weeks. Healing was assessed using histology, biomechanical bending tests, and microcomputed tomography. The pause-inserted, cycle-equivalent group had a greater percentage of osteoid present in the callus cross-sectional area compared with no-load controls, indicating more advanced early healing. The pause-inserted, cycle-equivalent group had a failure moment and stiffness that were 37% and 31% higher than the controls, respectively. All three loaded groups had smaller overall mineralized callus volumes than the control group, also indicating more advanced healing. At an early stage of fracture healing, pause-inserted loading led to more histologically advanced healing.

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Acknowledgments

We thank Jonathan Zelken, Alexia Hernandez, and Xu Yang for technical assistance.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Harborview Medical Center, 325 9th Ave, Box 359798, Seattle, WA, 98104, USA

    Michael J. Gardner MD

  2. Laboratory for Biomedical Mechanics and Materials, Hospital for Special Surgery, New York, NY, USA

    Benjamin F. Ricciardi BS & Timothy M. Wright PhD

  3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Mathias P. Bostrom MD

  4. Department of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA

    Marjolein C. H. van der Meulen PhD

Authors
  1. Michael J. Gardner MD
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  2. Benjamin F. Ricciardi BS
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  3. Timothy M. Wright PhD
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  4. Mathias P. Bostrom MD
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  5. Marjolein C. H. van der Meulen PhD
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Corresponding author

Correspondence to Michael J. Gardner MD.

Additional information

One or more of the authors have received funding from the Orthopaedic Trauma Association (MJG), the Orthopaedic Research and Education Foundation (MJG), and NIH Musculoskeletal Core Center P30AR046121 (TMW, MCHvdM).

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Gardner, M.J., Ricciardi, B.F., Wright, T.M. et al. Pause Insertions During Cyclic In Vivo Loading Affect Bone Healing . Clin Orthop Relat Res 466, 1232–1238 (2008). https://doi.org/10.1007/s11999-008-0155-1

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  • DOI: https://doi.org/10.1007/s11999-008-0155-1

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