Influence of muscle loading on early-stage bone fracture healing

Journal article


Miramini, Saeed, Ganadhiepan, Ganesharajah, Lin, Yi-Chung, Patel, Minoo, Richardson, Martin, Pandy, Marcus and Zhang, Lihai. (2023). Influence of muscle loading on early-stage bone fracture healing. Journal of the Mechanical Behavior of Biomedical Materials. 138, p. Article 105621. https://doi.org/10.1016/j.jmbbm.2022.105621
AuthorsMiramini, Saeed, Ganadhiepan, Ganesharajah, Lin, Yi-Chung, Patel, Minoo, Richardson, Martin, Pandy, Marcus and Zhang, Lihai
Abstract

Designing weight-bearing exercises for patients with lower-limb bone fractures is challenging and requires a systematic approach that accounts for patient-specific loading conditions. However, ‘trial-and-error’ approaches are commonplace in clinical settings due to the lack of a fundamental understanding of the effect of weight-bearing exercises on the bone healing process. Whilst computational modelling has the potential to assist clinicians in designing effective patient-specific weight-bearing exercises, current models do not explicitly account for the effects of muscle loading, which could play an important role in mediating the mechanical microenvironment of a fracture site. We combined a fracture healing model involving a tibial fracture stabilised with a locking compression plate (LCP) with a detailed musculoskeletal model of the lower limb to determine interfragmentary strains in the vicinity of the fracture site during both full weight-bearing (100% body weight) and partial weight-bearing (50% body weight) standing. We found that muscle loading significantly altered model predictions of interfragmentary strains. For a fractured bone with a standard LCP configuration (bone-plate distance = 2 mm, working length = 30 mm) subject to full weight-bearing, the predicted strains at the near and far cortices were 23% and 11% higher when muscle loading was included compared to the case when muscle loading was omitted. The knee and ankle muscles accounted for 38% of the contact force exerted at the knee joint during quiet standing and contributed significantly to the strains calculated at the fracture site. Thus, models of bone fracture healing ought to account explicitly for the effects of muscle loading. Furthermore, the study indicated that LCP configuration parameters play a crucial role in influencing the fracture site microenvironment. The results highlighted the dominance of working length over bone-plate distance in controlling the flexibility of fracture sites stabilised with LCP devices.

Keywordsmusculoskeletal analysis; muscle loading; weight-bearing; locking compression plate; treatment planning
Year2023
JournalJournal of the Mechanical Behavior of Biomedical Materials
Journal citation138, p. Article 105621
PublisherElsevier Ltd
ISSN1751-6161
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jmbbm.2022.105621
PubMed ID36549248
Scopus EID2-s2.0-85145666382
Page range1-9
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online17 Dec 2022
Publication process dates
Accepted11 Dec 2022
Deposited06 Mar 2023
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