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    The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation

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    21
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    Author
    Miramini, S; Zhang, L; Richardson, M; Mendis, P; Oloyede, A; Ebeling, P
    Date
    2016
    Source Title
    Australasian Physical & Engineering Sciences in Medicine
    Publisher
    Springer Netherlands
    University of Melbourne Author/s
    Zhang, Lihai; Miramini, Seyedsaeed; Mendis, Priyan; Ebeling, Peter; Richardson, Martin
    Affiliation
    Melbourne Medical School
    Clinical School (Royal Melbourne Hospital)
    Infrastructure Engineering
    Metadata
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    Document Type
    Journal Article
    Citations
    Miramini, S., Zhang, L., Richardson, M., Mendis, P., Oloyede, A. & Ebeling, P. (2016). The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation. Australasian Physical & Engineering Sciences in Medicine, 39 (1), pp.123-133. https://doi.org/10.1007/s13246-015-0407-9.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/217908
    DOI
    10.1007/s13246-015-0407-9
    Abstract
    Interfragmentary movement (IFM) at the fracture site plays an important role in fracture healing, particularly during its early stage, via influencing the mechanical microenvironment of mesenchymal stem cells within the fracture callus. However, the effect of changes in IFM resulting from the changes in the configuration of locking plate fixation on cell differentiation has not yet been fully understood. In this study, mechanical experiments on surrogate tibia specimens, manufactured from specially formulated polyurethane, were conducted to investigate changes in IFM of fractures under various locking plate fixation configurations and loading magnitudes. The effect of the observed IFM on callus cell differentiation was then further studied using computational simulation. We found that during the early stage, cell differentiation in the fracture callus is highly influenced by fracture gap size and IFM, which in turn, is highly sensitive to locking plate fixation configuration. The computational model predicted that a small gap size (e.g. 1 mm) under a relatively flexible configuration of locking plate fixation (larger bone-plate distances and working lengths) could experience excessive strain and fluid flow within the fracture site, resulting in excessive fibrous tissue differentiation and delayed healing. By contrast, a relatively flexible configuration of locking plate fixation was predicted to improve cartilaginous callus formation and bone healing for a relatively larger gap size (e.g. 3 mm). If further confirmed by animal and human studies, the research outcome of this paper may have implications for orthopaedic surgeons in optimising the application of locking plate fixations for fractures in clinical practice.

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