The role of soft-tissue traction forces in bone segment transport for callus distraction
Konstantin Horas, Reinhard Schnettler, Gerrit Maier, Gaby Schneider, Uwe Horas
Keywords :
Traction force measurement, Soft tissues, Callus distraction system, Intramedullary, Distraction osteogenesis, Bone defect treatment
Citation Information :
Horas K, Schnettler R, Maier G, Schneider G, Horas U. The role of soft-tissue traction forces in bone segment transport for callus distraction. 2015; 10 (1):21-26.
Callus distraction using bone segment transport systems is an applied process in the treatment of bone defects. However, complications such as muscle contractures, axial deviation and pin track infections occur in the treatment process using the currently available devices. Since successful treatment is influenced by the applied distraction force, knowledge of the biomechanical properties of the involved soft tissues is essential to improve clinical outcome and treatment strategies. To date, little data on distraction forces and the role of soft-tissue traction forces are available. The aim of this study was to assess traction forces generated by soft tissues during bone segment transport using a novel intramedullary callus distraction system on eight human femora. For traction force measurements, bone segment transport over 60-mm femoral defects was conducted under constant load measurement using 40- and 60-mm bone segments. The required traction forces for 60-mm bone segments were higher than forces for 40-mm bone segments. This study demonstrates that soft tissues are of relevance biomechanically in bone segment transport. The size of the bone segment and the selection of the region for osteotomy are of utmost importance in defining the treatment procedure.
Wiedemann M (1996) Callus distraction: a new method? A historical review of limb lengthening. Clin Orthop Related Res 327:291-304
Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Related Res 238:249-281
Hankemeier S, Pape HC, Gosling T, Hufner T, Richter M, Krettek C (2004) Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor. Principles and preliminary clinical experiences. Arch Orthop Trauma Surg 124(2):129-133
Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am 85-A(5):838-848
Betz A, Baumgart R, Schweiberer L (1990) First fully implantable intramedullary system for callus distraction—intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results. Chirurg 61(8):605-609
Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ et al (2011) Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Joint Surg Br 93(6):782-787
Schiedel FM, Pip S, Wacker S, Popping J, Tretow H, Leidinger B et al (2011) Intramedullary limb lengthening with the Intramedullary Skeletal Kinetic Distractor in the lower limb. J Bone Joint Surg Br 93(6):788-792
Burghardt RD, Herzenberg JE, Specht SC, Paley D (2011) Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening. J Bone Joint Surg Br 93(5):639-643
Gardner TN, Evans M, Simpson H, Kenwright J (1998) Forcedisplacement behaviour of biological tissue during distraction osteogenesis. Med Eng Phys 20(9):708-715
Aronson J, Harp JH (1994) Mechanical forces as predictors of healing during tibial lengthening by distraction osteogenesis. Clin Orthop Relat Res (301):73-79
Simpson AH, Cunningham JL, Kenwright J (1996) The forces which develop in the tissues during leg lengthening. A clinical study. J Bone Joint Surg Br 78(6):979-983
Younger AS, Mackenzie WG, Morrison JB (1994) Femoral forces during limb lengthening in children. Clin Orthop Related Res 301:55-63
Brunner UH, Cordey J, Schweiberer L, Perren SM (1994) Force required for bone segment transport in the treatment of large bone defects using medullary nail fixation. Clin Orthop Related Res 301:147-155
Forriol F, Goenaga I, Mora G, Vinolas J, Canadell J (1997) Measurement of bone lengthening forces; an experimental model in the lamb. Clin Biomech 12(1):17-21
Leong JC, Ma RY, Clark JA, Cornish LS, Yau AC (1979) Viscoelastic behavior of tissue in leg lengthening by distraction. Clin Orthop Related Res 139:102-109
Baumgart R, Kuhn V, Hinterwimmer S, Krammer M, Mutschler W (2004) Tractive force measurement in bone transport—an in vivo investigation in humans. Biomed Tech 49(9):248-256
Aro HT, Chao EY (1993) Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Related Res 293:8-17
Horas U (2006) A novel internal callus distraction system. In: Leung KTG, Schnettler R, Alt V, Haarman H (eds) Practice of intramedullary locked nails. Springer, Berlin, pp 199-210
Wolfson N, Hearn TC, Thomason JJ, Armstrong PF (1990) Force and stiffness changes during Ilizarov leg lengthening. Clin Orthop Related Res 250:58-60
