The effect of rigidity on fracture healing in external fixation

Knowledge of the basic biomechanics of external fixation is necessary to obtain the full benefits of the technique for bone fracture treatment. The rigidity of external fixation, including pin-bone interface stresses, is discussed and bone healing and remodeling under different fixation stiffnesses and fracture gap conditions are described. The rigidity of fixation ultimately depends on the biomechanical characteristics of the fracture, the accuracy of reduction, and the amount of physiologic loading. Comparative experiments using a canine tibial fracture model have suggested that fixation rigidity is important in early bone healing and in the prevention of pin loosening. Bone union can be achieved under external fixation through different pathways, ranging from callus-free gap healing under a rigid neutralization configuration to direct-contact healing with periosteal new bone formation under axially dynamized stable fixation. Cortical reconstruction by secondary osteons seems to be important for the ultimate strength of the bone union.