title: Load-displacement behavior in a distal radial fracture model. The effect of simulated healing on motion.
abstract: External fixation of fractures of the distal end of the radius neutralizes external forces and maintains axial alignment during healing. As far as we know, there have been no biomechanical studies of the effects of early removal of the fixator in a partially healed fracture model. The purpose of the present study was to observe the load-displacement behavior of a distal radial fracture model in which we had simulated partial healing by injection of butyl-rubber caulk and augmented this simulated healing with Kirschner-wire fixation. Sixteen fresh-frozen hand-wrist-forearm specimens from cadavera were mounted in mid-rotation in resin pots, and a load was applied. An osteotomy was used to simulate the fracture. Relative motion at the site of the osteotomy was compared, with use of a three-dimensional Optotrak kinematic device, during physiological loading of six constructs with Kirschner-wire transfixion or outrigger fixation. In the experimental group, partial healing was simulated by injection of butyl-rubber caulk into the site of the osteotomy and testing with simulated muscle-loading was performed through a full range of motion of the wrist. No difference could be detected between the relative motion at the osteotomy sites that had been treated with standard fully augmented external fixation and that in the experimental group (p > 0.05). T test analysis revealed that motion was equivalent regardless of whether Kirschner-wire transfixion or outrigger fixation had been used (p = 0.62) and that all of the augmented constructs had significantly less relative motion than all of the nonaugmented constructs (p < 0.001).
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520-8071, USA. scott.wolfe@yale.edu
authors.forename: S W
authors.initials: SW
authors.lastname: Wolfe
authors.forename: M D
authors.initials: MD
authors.lastname: Lorenze
authors.forename: G
authors.initials: G
authors.lastname: Austin
authors.forename: C R
authors.initials: CR
authors.lastname: Swigart
authors.forename: M M
authors.initials: MM
authors.lastname: Panjabi
mesh_terms: D001864:Bone Wires; D002102:Cadaver; D003100:Colles' Fracture / Q000503:physiopathology* / Q000601:surgery; D016267:External Fixators; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D008954:Models, Biological; D010027:Osteotomy; D016059:Range of Motion, Articular / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology; D014955:Wrist Joint / Q000503:physiopathology*