REDUCING MOTION IN UNSTABLE SAGITTAL PLANE FRACTURES - PRELIMINARY RESULTS

Abstract

Experience has shown that oblique fractures can be slow to heal and this has been attributed to excess shear at the fracture site. We routinely treat fractures with hybrid external fixation. In previous studies, olive wires placed through the fracture site reduced shear and this has improved healing times. When the fracture is oblique in the sagittal plane, anatomical constraints prevent the use of olive wires and a new solution is required.

A sawbone tibia with a distal sagittal plane oblique fracture (70° obliquity) was stabilised with a Sheffield Hybrid Fixator. In a pilot study various methods of fixation were tested and six were chosen for further testing. Since the pull-out strength of threads in the plastic bone was poor, olive wires cut behind the olive were used as a mechanically equivalent model for the push-pull system. Seventy degree steerage pins could not be used so 25° pins were tested instead. Cyclic compressive forces (at 10mm/min) of up to 200N axially and in four off-axis positions were applied using a universal testing machine. Fracture site linear motion in three dimensions was measured using an inter-fragmentary motion device, sampled at 100Hz. A standard frame was tested before and after each adaptation and all six methods were applied sequentially to each model.

The results suggest that: I) Arched wires are effective especially under greater bends, 2) Push-pull wires are effective and provide a minimally disruptive solution, 3) Steerage pins are effective especially at steeper obliquities but this may not always be practical, and 4) Placing a half pin in the distal fragment is beneficial but less effective than the use of 2 transverse half pins acting in a compression system (Hutson technique).