Wähnert Dirk, Miersbach Marco, Colcuc Christian, Brianza Stefano, Vordemvenne Thomas, Plecko Michael, Schwarz Angelika
Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Bielefeld, Germany.
Biomech Innovations AG, Nidau, Switzerland.
Front Surg. 2024 May 2;11:1376441. doi: 10.3389/fsurg.2024.1376441. eCollection 2024.
Delayed union and non-union of fractures continue to be a major problem in trauma and orthopedic surgery. These cases are challenging for the surgeon. In addition, these patients suffer from multiple surgeries, pain and disability. Furthermore, these cases are a major burden on healthcare systems. The scientific community widely agrees that the stability of fixation plays a crucial role in determining the outcome of osteosynthesis. The extent of stabilization affects factors like fracture gap strain and fluid flow, which, in turn, influence the regenerative processes positively or negatively. Nonetheless, a growing body of literature suggests that during the fracture healing process, there exists a critical time frame where intervention can stimulate the bone's return to its original form and function. This article provides a summary of existing evidence in the literature regarding the impact of different levels of fixation stability on the strain experienced by newly forming tissues. We will also discuss the timing and nature of this "window of opportunity" and explore how current knowledge is driving the development of new technologies with design enhancements rooted in mechanobiological principles.
骨折的延迟愈合和不愈合仍然是创伤和骨科手术中的一个主要问题。这些病例对外科医生来说具有挑战性。此外，这些患者要接受多次手术，遭受疼痛和残疾之苦。此外，这些病例给医疗系统带来了沉重负担。科学界普遍认为，固定的稳定性在决定骨合成的结果方面起着关键作用。稳定程度会影响诸如骨折间隙应变和流体流动等因素，而这些因素又会对再生过程产生积极或消极的影响。尽管如此，越来越多的文献表明，在骨折愈合过程中，存在一个关键的时间框架，在此期间进行干预可以刺激骨骼恢复其原始形态和功能。本文总结了文献中关于不同固定稳定性水平对新形成组织所经历应变的影响的现有证据。我们还将讨论这个“机会之窗”的时间和性质，并探讨当前的知识是如何推动基于机械生物学原理进行设计改进的新技术的发展的。
