Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA.
UC Davis Medical Center, Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 1700, Sacramento, CA, 95817, USA.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3299-3305. doi: 10.1007/s00590-023-03605-y. Epub 2023 Jun 7.
Interfragmentary strain influences whether a fracture will undergo direct and indirect fracture healing. Orthopedic trauma surgeons modulate strain and create optimal biomechanical environments for specific fracture patterns using fixation constructs. However, objective intraoperative interfragmentary strain measurement does not currently inform fixation strategy in common practice. This review identifies potential methods and technologies to enable intraoperative strain measurement for guiding optimal fracture fixation strategies.
PubMed, Scopus, and Web of Science were methodologically queried for manuscripts containing terms related to "bone fracture," "strain," "measurement," and "intraoperative." Manuscripts were systematically screened for relevance and adjudicated by three reviewers. Relevant articles describing methods to measure interfragmentary strain intraoperatively were summarized.
After removing duplicates, 1404 records were screened initially. There were 49 manuscripts meeting criteria for in-depth review. Of these, four reports were included in this study that described methods applicable to measuring interfragmentary strain intraoperatively. Two of these reports described a method using instrumented staples, one described optical tracking of Kirschner wires, and one described using a digital linear variable displacement transducer with a custom external fixator.
The four reports identified by this review describe potential methods to quantify interfragmentary strain after fixation. However, further studies are needed to confirm the precision and accuracy of these measurements across a range of fractures and fixation methods. Additionally, described methods require the insertion and likely removal of additional implants into the bone. Ideally, innovations that measure interfragmentary strain intraoperatively would provide dynamic biomechanical feedback for the surgeon to proactively modulate construct stability.
骨碎片间的应变会影响骨折是直接愈合还是间接愈合。矫形创伤外科医生通过固定结构来调节应变并为特定的骨折模式创造最佳的生物力学环境。然而，目前在常规实践中，并没有通过客观的术中骨碎片间应变测量来为固定策略提供信息。本综述确定了潜在的方法和技术，以实现术中应变测量，从而指导最佳的骨折固定策略。
通过对包含“骨骨折”、“应变”、“测量”和“术中”等术语的文献进行系统检索，对 PubMed、Scopus 和 Web of Science 进行了方法学查询。通过三名评审员对文献进行系统筛选和评估，以确定其相关性。总结了描述术中测量骨碎片间应变的相关方法。
在去除重复项后，最初筛选了 1404 条记录。有 49 篇符合深入审查标准的手稿。其中，有 4 篇报道包含了适用于术中测量骨碎片间应变的方法，被纳入本研究。其中 2 篇报道描述了一种使用带仪器的缝合钉的方法，1 篇报道描述了克氏针的光学跟踪，还有 1 篇报道描述了使用带有定制外固定器的数字线性可变位移传感器。
本综述确定的 4 篇报道描述了用于在固定后量化骨碎片间应变的潜在方法。然而，需要进一步的研究来确认这些测量方法在一系列骨折和固定方法中的精度和准确性。此外，所描述的方法需要将额外的植入物插入到骨中，并且可能需要移除。理想情况下，术中测量骨碎片间应变的创新技术将为外科医生提供动态生物力学反馈，以便主动调节结构稳定性。
