The Effects of Dynamic Loading on Bone Fracture Healing Under Ilizarov Circular Fixators

Abstract

Early weight bearing appears to enhance bone fracture healing under Ilizarov circular fixators (ICFs). However, the role of early weight bearing in the healing process remains unclear. This study aims to provide insights into the effects of early weight bearing on healing of bone fractures stabilized with ICFs, with the aid of mathematical modeling. A computational model of fracture site was developed using poro-elastic formulation to simulate the transport of mesenchymal stem cells (MSCs), fibroblasts, chondrocytes, osteoblasts, osteogenic growth factor (OGF), and chondrogenic growth factor (CGF) and MSC differentiation during the early stage of healing, under various combinations of fracture gap sizes (GS), ICF wire pretension forces, and axial loads. 1 h of physiologically relevant cyclic axial loading followed by 23 h of rest in the post-inflammation phase (i.e., callus with granulation tissue) was simulated. The results show that physiologically relevant dynamic loading could significantly enhance cell and growth factor concentrations in the fracture site in a time and spatially dependent manner. 1 h cyclic loading (axial load with amplitude, PA, of 200 N at 1 Hz) increased the content of chondrocytes up to 37% (in all zones of callus), CGF up to 28% (in endosteal and periosteal callus) and OGF up to 50% (in endosteal and cortical callus) by the end of the 24 h period simulated. This suggests that the synergistic effect of dynamic loading-induced advective transport and mechanical stimuli due to early weight bearing is likely to enhance secondary healing. Furthermore, the study suggests that relatively higher PA values or lower ICF wire pretension forces or smaller GS could result in increased chondrocyte and GF content within the callus.