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Lower-limb internal loading and potential consequences for fracture healing
Introduction: Mechanical loading is known to determine the course of bone fracture healing. We hypothesise that lower limb long bone loading differs with knee flexion angle during walking and frontal knee alignment, which affects fracture healing success. Materials and methods: Using our musculoskel...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602681/ https://www.ncbi.nlm.nih.gov/pubmed/37901836 http://dx.doi.org/10.3389/fbioe.2023.1284091 |
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author | Heyland, Mark Deppe, Dominik Reisener, Marie Jacqueline Damm, Philipp Taylor, William R. Reinke, Simon Duda, Georg N. Trepczynski, Adam |
author_facet | Heyland, Mark Deppe, Dominik Reisener, Marie Jacqueline Damm, Philipp Taylor, William R. Reinke, Simon Duda, Georg N. Trepczynski, Adam |
author_sort | Heyland, Mark |
collection | PubMed |
description | Introduction: Mechanical loading is known to determine the course of bone fracture healing. We hypothesise that lower limb long bone loading differs with knee flexion angle during walking and frontal knee alignment, which affects fracture healing success. Materials and methods: Using our musculoskeletal in silico modelling constrained against in vivo data from patients with instrumented knee implants allowed us to assess internal loads in femur and tibia. These internal forces were associated with the clinical outcome of fracture healing in a relevant cohort of 178 extra-articular femur and tibia fractures in patients using a retrospective approach. Results: Mean peak forces differed with femoral compression (1,330–1,936 N at mid-shaft) amounting to about half of tibial compression (2,299–5,224 N). Mean peak bending moments in the frontal plane were greater in the femur (71–130 Nm) than in the tibia (from 26 to 43 Nm), each increasing proximally. Bending in the sagittal plane showed smaller mean peak bending moments in the femur (−38 to 43 Nm) reaching substantially higher values in the tibia (−63 to −175 Nm) with a peak proximally. Peak torsional moments had opposite directions for the femur (−13 to −40 Nm) versus tibia (15–48 Nm) with an increase towards the proximal end in both. Femoral fractures showed significantly lower scores in the modified Radiological Union Scale for Tibia (mRUST) at last follow-up (p < 0.001) compared to tibial fractures. Specifically, compression (r = 0.304), sagittal bending (r = 0.259), and frontal bending (r = −0.318) showed strong associations (p < 0.001) to mRUST at last follow-up. This was not the case for age, body weight, or localisation alone. Discussion: This study showed that moments in femur and tibia tend to decrease towards their distal ends. Tibial load components were influenced by knee flexion angle, especially at push-off, while static frontal alignment played a smaller role. Our results indicate that femur and tibia are loaded differently and thus require adapted fracture fixation considering load components rather than just overall load level. |
format | Online Article Text |
id | pubmed-10602681 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106026812023-10-27 Lower-limb internal loading and potential consequences for fracture healing Heyland, Mark Deppe, Dominik Reisener, Marie Jacqueline Damm, Philipp Taylor, William R. Reinke, Simon Duda, Georg N. Trepczynski, Adam Front Bioeng Biotechnol Bioengineering and Biotechnology Introduction: Mechanical loading is known to determine the course of bone fracture healing. We hypothesise that lower limb long bone loading differs with knee flexion angle during walking and frontal knee alignment, which affects fracture healing success. Materials and methods: Using our musculoskeletal in silico modelling constrained against in vivo data from patients with instrumented knee implants allowed us to assess internal loads in femur and tibia. These internal forces were associated with the clinical outcome of fracture healing in a relevant cohort of 178 extra-articular femur and tibia fractures in patients using a retrospective approach. Results: Mean peak forces differed with femoral compression (1,330–1,936 N at mid-shaft) amounting to about half of tibial compression (2,299–5,224 N). Mean peak bending moments in the frontal plane were greater in the femur (71–130 Nm) than in the tibia (from 26 to 43 Nm), each increasing proximally. Bending in the sagittal plane showed smaller mean peak bending moments in the femur (−38 to 43 Nm) reaching substantially higher values in the tibia (−63 to −175 Nm) with a peak proximally. Peak torsional moments had opposite directions for the femur (−13 to −40 Nm) versus tibia (15–48 Nm) with an increase towards the proximal end in both. Femoral fractures showed significantly lower scores in the modified Radiological Union Scale for Tibia (mRUST) at last follow-up (p < 0.001) compared to tibial fractures. Specifically, compression (r = 0.304), sagittal bending (r = 0.259), and frontal bending (r = −0.318) showed strong associations (p < 0.001) to mRUST at last follow-up. This was not the case for age, body weight, or localisation alone. Discussion: This study showed that moments in femur and tibia tend to decrease towards their distal ends. Tibial load components were influenced by knee flexion angle, especially at push-off, while static frontal alignment played a smaller role. Our results indicate that femur and tibia are loaded differently and thus require adapted fracture fixation considering load components rather than just overall load level. Frontiers Media S.A. 2023-10-12 /pmc/articles/PMC10602681/ /pubmed/37901836 http://dx.doi.org/10.3389/fbioe.2023.1284091 Text en Copyright © 2023 Heyland, Deppe, Reisener, Damm, Taylor, Reinke, Duda and Trepczynski. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Bioengineering and Biotechnology Heyland, Mark Deppe, Dominik Reisener, Marie Jacqueline Damm, Philipp Taylor, William R. Reinke, Simon Duda, Georg N. Trepczynski, Adam Lower-limb internal loading and potential consequences for fracture healing |
title | Lower-limb internal loading and potential consequences for fracture healing |
title_full | Lower-limb internal loading and potential consequences for fracture healing |
title_fullStr | Lower-limb internal loading and potential consequences for fracture healing |
title_full_unstemmed | Lower-limb internal loading and potential consequences for fracture healing |
title_short | Lower-limb internal loading and potential consequences for fracture healing |
title_sort | lower-limb internal loading and potential consequences for fracture healing |
topic | Bioengineering and Biotechnology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602681/ https://www.ncbi.nlm.nih.gov/pubmed/37901836 http://dx.doi.org/10.3389/fbioe.2023.1284091 |
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