The Biology of Fracture Repair and the Role of Dynamization

  • J. Kenwright
  • J. B. Richardson


External skeletal fixation is used widely and the indications for selecting this method of treatment are nearly always clear. There is, however, controversy regarding its place in the treatment of diaphyseal fractures, particularly in the leg. There is concern that healing may be inhibited, and that this may be associated with the treatment method itself; there is, however, no evidence in the literature that healing is delayed in groups of fractures where external fixation has been employed. When used by advocates of the method, very high rates of rapid fracture healing are recorded; both De Bastiani and his co-workers1 and Checketts2 have shown very low non-union rates when large groups of tibial diaphyseal fractures have been treated by external skeletal fixation. How can such high success rates be achieved?


Fracture Healing Fracture Site Tibial Fracture Fracture Repair Diaphyseal Fracture 
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  1. 1.
    De Bastiani G, Aldegheri R and Renzi Brivio L, ‘The treatment of fractures with a dynamic axial fixator’ J Bone Joint Surg [Br] 1984; 66-B: 538–545.Google Scholar
  2. 2.
    Checketts RG, Moran CG, Jennings AG, ‘134 Tibial shaft frac¬tures managed with dynamic axial fixation’ Acta Orthop Scand 1995; 66:71–74.Google Scholar
  3. 3.
    Nicoll EA, ‘Fractures of the tibial shaft’ J Bone Joint Surg [Br] 1964; 46B: 373–387.Google Scholar
  4. 4.
    Wolff J, (1892) Das Gesetz der Transformation der Knochen A. Hirschwald: Berlin.Google Scholar
  5. 5.
    Lanyon LE, Goodship AE, Pye CJ and MacFie JH, ‘Mechanically adaptive bone remodelling’ J Biomech 1982; 15: 141–54.Google Scholar
  6. 6.
    Aro HT, Chao EYS, ‘Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression’ Clin Orthop 1993; 293: 8–17.PubMedGoogle Scholar
  7. 7.
    McKibbin B, ‘The biology of fracture healing in long bones’ J Bone Joint Surg [Br] 1978; 60B: 150–162.Google Scholar
  8. 8.
    Goodship AE, Cunningham JL and Kenwright J, ‘Strain rate and timing of stimulation in mechanical modulation of fracture healing’ Clin Orthop 335 (Suppl) 1998; 105–115.Google Scholar
  9. 9.
    Goodship AE, Kenwright J, The influence of induced micromovement upon the healing of experimental fractures, J Bone Joint Surg [Br] 1985; 67B: 650–655.Google Scholar
  10. 10.
    Kenwright J, Gardner T, ‘Mechanical influences on tibial frac¬ture healing’ Clin Orthop 1998; 335: 179–190.Google Scholar
  11. 11.
    Lindholm RV, Lindholm TS, Toikkanen S and Leino R, ‘The effect of forced inter-fragmentary movements on the healing of tibial fractures in rats’ Acta Orthop Scand 1970; 40: 721–8.Google Scholar
  12. 12.
    Apley AG, Solomon L Apley’s System of Orthopaedics and Fractures 1990; Butterworths: London.Google Scholar
  13. 13.
    Lippert FG, ‘Three dimensional measurement of tibia fracture motion by photogrammetry’ Clin Orthop 1974; 105: 130–143.PubMedGoogle Scholar
  14. 14.
    Sarmiento A, Gersten LM and Sobol PA, ‘Tibial shaft fractures treated with functional braces. Experience with 780 fractures’ J Bone Joint Surg [Br] 1989; 71B: 602–609.Google Scholar
  15. 15.
    Sarmiento A, Latta LL, Functional Fracture Bracing 1995; Springer: Heidelberg.Google Scholar
  16. 16.
    Yamagishi M, Yoshimura Y, ‘The biomechanics of fracture healing’ J Bone Joint Surg [Am] 1955; 37A: 1035–1068.Google Scholar
  17. 17.
    Park S-Y, O’Connor K, McKellop H and Sarmiento A, The influence of active shear or compressive motion on fracture-healing. J Bone Joint Surg [Am] 1998; 80A: 868–78.Google Scholar
  18. 18.
    Wolf JW, White AA, Punjabi MM and Southwick WO, ‘Com¬parison of cyclic loading versus compression in the treatment of long bone fractures in rabbits’ J Bone Joint Surg [Am] 1981; 63A: 805–810.Google Scholar
  19. 19.
    Claes L, Wilke H-J, Rübenacker S, ‘Interfragmentary strain and bone healing: an experimental study’ Trans Orthop Res Soc 1989; 14: 568.Google Scholar
  20. 20.
    Richardson JB, Gardner TN, Hardy JRW et al ‘Dynamisation and tibial fractures’ J Bone Joint Surg [Br] 1995; 77B: 412–6.Google Scholar
  21. 21.
    Perren SM, ‘Physical and biological aspects of fracture healing with special reference to internal fixation’ Clin Orthop 1970; 136:175–196.Google Scholar
  22. 22.
    Goodship AE, Watkins PE, Rigby HS and Kenwright J, ’The role of fixator frame stiffness in the control of fracture healing: An experimental study’ J Biomech 1993; 26: 1027–35.Google Scholar
  23. 23.
    Kershaw CJ, Cunningham JL and Kenwright J, ‘Tibial external fixation, weight bearing, and fracture movement’ Clin Orthop 1993; 293: 28–36.PubMedGoogle Scholar
  24. 24.
    Gardner TN, Evans M, Simpson AHRW, Turner—Smith A, ‘3-dimensional movement at externally-fixated tibial fractures and osteotomies during normal patient function’ J Clin Biochem 1994; 9:51–59.Google Scholar
  25. 25.
    Burny FL, ‘Elastic External Fixation of Tibial Fractures: Study of 1421 Cases’ in Brooker Jr AF, Edwards C (eds), External Fixa¬tion: The Current State of the Art. Proceedings of the Sixth Inter¬national Conference on Hoffman External Fixation 1979; Williams & Wilkins: Baltimore, p 55–73.Google Scholar
  26. 26.
    Kenwright J, Richardson JB, Cunningham JL, White SH, Goodship AE, Adams MA, Magnussen PA and Newman JH ‘Axial movement and tibial fractures’ J Bone Joint Surg 1991; [Br] 73B: 654–659.Google Scholar
  27. 27.
    Behrens F, Searls K, ‘External fixation of the tibia: basic concepts and prospective evaluation’ J Bone Joint Surg [Br] 1986; 68B: 246–254.Google Scholar
  28. 28.
    Lazo-Zbikowski J, Aguilar F, Mozo F, Gonzalez-Buendia R and Lazo JM, ‘Biocompression external fixation’ Clin Orthop 1986; 206: 169–84.Google Scholar
  29. 29.
    Gardner TN, Evans M, Hardy J, Kenwright J, ‘Dynamic interfragmentary motion in fractures during routine patient activity’. Clin Orthop 1997; 336: 216–25.PubMedCrossRefGoogle Scholar
  30. 30.
    Richardson JB, Cunningham JL, Goodship AE, O’Connor BT and Kenwright J, ‘Measuring stiffness can define healing of tibial fractures’ J Bone Joint Surg [Br] 1994; 76B: 389–394.Google Scholar
  31. 31.
    Kay PR, Ross ERS and Powell ES, ‘Development and clinical application of an external fixator monitoring system’ J Biomed Eng 1989; 11:240–244.PubMedCrossRefGoogle Scholar
  32. 32.
    Richardson JB, ‘The mechanics of fracture healing’ 1989; MD Thesis, University of Aberdeen.Google Scholar

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© Springer-Verlag London Limited 2000

Authors and Affiliations

  • J. Kenwright
  • J. B. Richardson

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