Strategies in Trauma and Limb Reconstruction

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VOLUME 16 , ISSUE 3 ( September-December, 2021 ) > List of Articles

ORIGINAL RESEARCH

Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs

Carl Fenton, Daniel Henderson, Mikhail Samchukov, Alexander Cherkashin, Hemant Sharma

Keywords : Biomechanical analysis, Biomechanical study, Biomechanics, Circular external fixation, Circular frame, Taylor spatial frame

Citation Information : Fenton C, Henderson D, Samchukov M, Cherkashin A, Sharma H. Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs. 2021; 16 (3):138-143.

DOI: 10.5005/jp-journals-10080-1539

License: CC BY-NC-SA 4.0

Published Online: 15-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: The Ilizarov method and fixator are clinically recognised for the treatment of fractures, limb salvage and deformity correction. There have been extensive studies determining the basic mechanism for fracture healing using this technique. It is generally accepted that circular frames optimise the mechanical environment by reducing shear strain across the fracture while maintaining axial micromotion so as to promote fracture healing. There have been several new hexapod-type frames introduced into the market over the past 20 years with little comparative research into their biomechanical properties and resultant effects on the fracture environment. Questions/purposes: To investigate the biomechanical behaviours of the TrueLok-Hex (TL-HEX) and Taylor spatial frame (TSF) hexapod-type circular external fixators with comparison to traditional Ilizarov-type (TL-Ilizarov and TSF-Ilizarov) constructs and potential performance in vivo. Methods: Testing was performed on standardised four-ring TSF and TL-HEX constructs matched by identical frames using Ilizarov threaded rod constructs for each set of components. All frames were tested under physiological levels of axial, bending and torsional loading. Load-deformation properties for each construct under each mode of loading were calculated and analysed statistically using ANOVA. Results: Under axial loading, the Ilizarov construct utilising TL-HEX components demonstrated the greatest rigidity followed by the Ilizarov construct using TSF components. Under bending loads, the difference in rigidity between constructs was similar but less marked. Under torsional loading, both hexapod frames were seen to be significantly more rigid than the Ilizarov constructs. Overall deformation around neutral loading was much higher in the TSF frame due to an observed significant “toe-in” laxity in the strut universal joints. The remaining deformation of both hexapod frames was similar with a higher level of TL-HEX rigidity in axial loading and a higher level of TSF rigidity in bending and torsion. Conclusion: In conclusion, both hexapod frame constructs were less rigid under axial loading but more rigid under bending and torsional loads than their comparative Ilizarov constructs. As a result of their Cardan universal joints, the TSF demonstrated greater overall planar strain due to the observed “toe-in” laxity around neutral loading while the TL-HEX, with ball-and-socket universal joints, demonstrated a minimal level of laxity. Beyond the initial deformation due to the preloaded laxity, both hexapod frames responded to loading in a similar manner. There were significant differences in the frames’ mechanical behaviour under different loading conditions but further research is required to determine whether these translate in vivo into clinical significance.


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  1. Henderson DJ, Barron E, Hadland Y, et al. Functional outcomes after tibial shaft fractures treated using the Taylor spatial frame. J Orthop Trauma 2015;29(2):e54–e59. DOI: 10.1097/BOT.0000000000000192.
  2. Glatt V, Evans CH, Tetsworth K. A concert between biology and biomechanics: the influence of the mechanical environment on bone healing. Front Physiol 2016;7:678. DOI: 10.3389/fphys.2016.00678.
  3. Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res 1979;(138):175–196. PMID: 376198.
  4. Claes L, Augat P, Suger G, et al. Influence of size and stability of the osteotomy gap on the success of fracture healing. J Orthop Res 1997;15(4):577–584. DOI: 10.1002/jor.1100150414.
  5. Aro HT, Chao EY. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993;(293):8–17. PMID: 8339513.
  6. Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg Br 1985;67(4):650–655. DOI: 10.1302/0301-620X.67B4.4030869.
  7. Carter DR, Beaupre GS, Giori NJ, et al. Mechanobiology of skeletal regeneration. Clin Orthop Relat Res 1998;(355 Suppl):S41–S55. DOI: 10.1097/00003086-199810001-00006.
  8. Claes L, Wolf S, Augat P. [Mechanical modification of callus healing]. Chirurg 2000;71(9):989–994. DOI: 10.1007/s001040051172.
  9. Bishop NE, van Rhijn M, Tami I, et al. Shear does not necessarily inhibit bone healing. Clin Orthop Relat Res 2006;443:307–314. DOI: 10.1097/01.blo.0000191272.34786.09.
  10. Park SH, O'Connor K, McKellop H, et al. The influence of active shear or compressive motion on fracture-healing. J Bone Joint Surg Am 1998;80(6):868–878. DOI: 10.2106/00004623-199806000-00011.
  11. Augat P, Burger J, Schorlemmer S, et al. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res 2003;21(6):1011–1017. DOI: 10.1016/S0736-0266(03)00098-6.
  12. Steiner M, Claes L, Ignatius A, et al. Disadvantages of interfragmentary shear on fracture healing--mechanical insights through numerical simulation. J Orthop Res 2014;32:865–872. DOI: 10.1002/jor.22617.
  13. Board TN, Yang L, Saleh M. Why fine-wire fixators work: an analysis of pressure distribution at the wire-bone interface. J Biomech 2007;40:20–25. DOI: 10.1016/j.jbiomech.2005.12.005.
  14. Henderson DJ, Rushbrook JL, Stewart TD, et al. What are the biomechanical effects of half-pin and fine-wire configurations on fracture site movement in circular frames? Clin Orthop 2016;474(4):1041–1049. DOI: 10.1007/s11999-015-4652-8.
  15. Gessmann J, Citak M, Jettkant B, et al. The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: tensioned wires vs half-pins. J Orthop Surg 2011;6:61. DOI: 10.1186/1749-799X-6-61.
  16. Calhoun JH, Li F, Bauford WL, et al. Rigidity of half-pins for the Ilizarov external fixator. Bull Hosp Joint Dis 1992;52(1):21–26. PMID: 1422438.
  17. Seide K, Weinrich N, Wenzl ME, et al. Three-dimensional load measurements in an external fixator. J Biomech 2004;37(9):1361–1369. DOI: 10.1016/j.jbiomech.2003.12.025.
  18. Kold S. CORR insights®: what are the biomechanical properties of the Taylor Spatial Frame™? Clin Orthop 2017;475(5):1483–1485. DOI: 10.1007/s11999-016-5212-6.
  19. Henderson ER, Feldman DS, Lusk C, et al. Conformational instability of the taylor spatial frame: a case report and biomechanical study. J Pediatr Orthop 2008;28(4):471–477. DOI: 10.1097/BPO.0b013e318173ecb1.
  20. Samchukov M, Chiaramonti B, Pierce W, et al. Comparative conformational instability of different hexapod frames. 2015.
  21. Henderson DJ, Rushbrook JL, Harwood PJ, et al. What are the biomechanical properties of the taylor spatial frame™? Clin Orthop 2017;475(5):1472–1482. DOI: 10.1007/s11999-016-5182-8.
  22. Larsson S, Kim W, Caja VL, et al. Effect of early axial dynamization on tibial bone healing: a study in dogs. Clin Orthop Relat Res 2001;388:240–251. DOI: 10.1097/00003086-200107000-00033.
  23. Lacroix D and Prendergast PJ. A mechano-regulation model for tissue differentiation during fracture healing: analysis of gap size and loading. J Biomech 2002;35(9):1163–1171. DOI: 10.1016/s0021-9290(02)00086-6.
  24. Gardner TN, Hardy J, Evans M, et al. Temporal changes in dynamic inter fragmentary motion and callus formation in fractures. J Biomech 1997;30(4):315–321. DOI: 10.1016/s0021-9290(96)00156-x.
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