Abstract
Introduction: Distraction osteogenesis has been used as a method of generating new bone in limb lengthening and deformity realignment; and is achieved in our unit though the use of the Sheffield Ring Fixator. The development of soft tissue tension creates an entirely different mechanical environment, and can often result in severe complications during treatment. Fixators must therefore be able to resist these forces. Furthermore, biomechanical modelling is very different from fracture and bone gap simulation.
The model developed in this study intended to look at linear distraction, i.e. lengthening.
Aims: To create a mechanical model that simulates the soft tissue effects during lengthening with an external fixator
To obtain a synthetic material with similar passive tensile properties to that measured in lengthened soft tissue
To measure the effect of tensioned synthetic soft tissue on osteotomy motion and multi-planar stiffness during cyclic loading.
Materials and Methods: A standard two 150mm ring frame was mounted on an acrylic rod, with a centrally placed osteotomy gap of 75mm. One ring was fixed with wires and the other with screws. An inter-fragmentary motion device was attached across the osteotomy, to measure axial, angular and shear deformation with both axial and off-axis loading.
Soft tissue tension was simulated with the use of neoprene rubber sheeting, attached to the nylon rod by Jubilee clips, with a gap anteriorly or medially. Extensive tensile testing was performed to determine the visco-elastic behaviour of the rubber, which showed it to be consistent and reliable. Tension of a similar magnitude to lengthened muscle (35–125N) was achieved, and could be accurately predicted for certain distraction lengths.
The stiffness of the frame was calculated from osteotomy motion with various distraction lengths both with the rubber attached and without.
Results: Tension in the soft tissues summates with the force applied in loading, with the effect of increasing the axial stiffness of the fixator by up to 70N, with a directly proportional relationship. It also acts as a restraint for shear and angulatory motion. In anterior and lateral loading positions however, the angulation stiffness remains low; this is thought to be due to the unequal distribution of soft tissues around the bony column, as seen in vivo. The stiffness of the frame is lowered by increasing the distance between rings; this effect can be counteracted by soft tissue tension in axial stiffness, but less so for angular and shear.
Conclusions: We conclude that osteotomy stability is dependent on soft tissue tension, and the magnitude of tension greatly alters the stiffness characteristics of the external fixator. This study highlights the important role of soft tissue tension in biomechanical modelling and clinical limb lengthening, and has exciting ramifications for future orthopaedic models.
Correspondence should be addressed to Carlos Widgerowitz, Honorary Secretary BORS, Division of Surgery and Oncology, Section of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Tort Centre, Dundee DD1 9SY, Scotland.
