title: The biomechanics of hybrid external fixation.
abstract: OBJECTIVE
  The objective of this study was to ascertain which factors determine the rigidity of a hybrid external fixation frame in a tibial periarticular fracture model.
  
  
  METHODS
  Laboratory investigation using a polyvinylchloride pipe periarticular tibia fracture model.
  
  
  METHODS
  Simulated periarticular tibia fractures were created in a tibia model. Instrumented specimens were tested in a biomaterials testing system.
  
  
  METHODS
  Groups of simulated periarticular tibia fractures were stabilized with one of nine different external fixation constructs with components from one manufacturer.
  
  
  METHODS
  Elastic stiffness was measured for each specimen in compression, torsion, flexion bending, extension bending, and varus and valgus bending.
  
  
  RESULTS
  The four-ring Ilizarov fixator was the stiffest in all modes of testing. There was a trend toward increasing stiffness with an increasing number of rings. Fixators constructed with multiple levels of fixation in the periarticular fragment were stiffer in all modes of testing. The additional spacing between wires gained by the use of a single thick carbon ring or the use of a drop wire three centimeters from a single ring did not increase stiffness in this model. Frame modifications intended to augment the bar-to-ring connection did not increase stiffness. The use of rings mounted with half-pins instead of a unilateral bar mounted with half-pins for diaphyseal fixation increased the stiffness of the frame only in torsional testing.
  
  
  CONCLUSIONS
  Although the ideal stiffness of an external fixator is unknown, our results show that the addition of more than one level of fixation in the periarticular fragment increases the stiffness of hybrid external fixators in this periarticular tibia fracture model. Augmentation of the ring-to-bar connection did not significantly affect the stiffness of the frame.
authors.affiliation: Department of Surgery, University of Kentucky, Lexington 40536-0284, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Pugh
authors.forename: P R
authors.initials: PR
authors.lastname: Wolinsky
authors.forename: J M
authors.initials: JM
authors.lastname: Dawson
authors.forename: G C
authors.initials: GC
authors.lastname: Stahlman
mesh_terms: D001696:Biomechanical Phenomena; D004867:Equipment Design; D016267:External Fixators; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*