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Review
. 2021 Jun 18;9(6):691.
doi: 10.3390/biomedicines9060691.

Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Jan Barcik  1   2 , Devakara R Epari  3
Affiliations
Review

Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Jan Barcik et al. Biomedicines. .

Abstract

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

Keywords: bone repair; fracture healing; implants; mechanobiology; rehabilitation.

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Conflict of interest statement

The authors declare no conflict of interest. The authors are not compensated and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this work unless clearly documented and disclosed.

Figures

Figure 1
Figure 1
Pictorial representation of standard healing curve. After the initially slow increase of stiffness, the curve deflects and the rate at which stiffness increases accelerates. Bridging occurs when the fracture stiffness reaches the level of stiffness that allows for unrestricted functional loading of the bone (dashed line).
Figure 2
Figure 2
1. Halting the motion during the consolidation phase increases the rate of stiffness increase. 2. Increasing the rest periods during proliferation increases the rate of tissue formation and shortens the time to consolidation; 1. and 2. combined to shorten the overall time for bridging (3.).
Figure 3
Figure 3
Hypothesized benefit of the optimized stimulation protocol in reducing healing time in comparison to current clinical practice.
Figure 4
Figure 4
The protocol designed to test the hypothesis of the optimum delivery of mechanical stimulation.
See this image and copyright information in PMC

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