The effect of head trauma on fracture healing: biomechanical testing and finite element analysis.

OBJECTIVES We aimed to evaluate the effect of head trauma on fracture healing with biomechanical testing, to compare the results obtained from a femur model created by finite element analysis with experimental data, and to develop a finite element model that can be employed in femoral fractures. METHODS Twenty-two Wistar albino rats were randomized into two groups. The control group was subjected to femoral fracture followed by intramedullary fixation, whereas the head trauma group was subjected to femoral fracture followed by intramedullary fixation along with closed blunt head trauma. Bone sections obtained with computed tomography from rat femurs were transferred into a computer and a 3D mathematical model of femur was created. At the end of week 4, femurs were examined by biomechanical testing and finite element analysis. RESULTS The mean maximum fracture load was significantly higher in the head trauma group than in control group (p<0.05). Maximum strain values were also significantly high in the head trauma group (p<0.05). There was no significant difference between the groups with regard to maximum deformation (p>0.05). The head trauma group had significantly higher mean bending rigidity than the control group (p<0.05). The head trauma group showed no significant difference from the control group in terms of strain energy and elasticity module (p>0.05). There was no significant difference between experimental biomechanical test and finite element analysis (p>0.05). CONCLUSION Noninvasive methods such as finite element analysis are useful in examination of the mechanical structure of bones. Experimental biomechanical test and finite element analysis methods suggest that head trauma contributes to fracture healing.

[1]  R. Waters,et al.  Femoral fractures in head-injuries adults. , 1982, Clinical orthopaedics and related research.

[2]  A. Skirving,et al.  Callus formation and the rate of healing of femoral fractures in patients with head injuries. , 1987, The Journal of bone and joint surgery. British volume.

[3]  A. Ekeland,et al.  Methods for testing the mechanical properties of the rat femur. , 1978, Acta orthopaedica Scandinavica.

[4]  A. Yildiz,et al.  [Determining the biomechanical quality of normal and osteoporotic bones in rat femora through biomechanical test and finite element analysis]. , 2007, Acta orthopaedica et traumatologica turcica.

[5]  M. Kurer,et al.  Human osteoblast stimulation by sera from paraplegic patients with heterotopic ossification , 1992, Paraplegia.

[6]  S. Hoerstrup,et al.  Influence of brain injury on early posttraumatic bone metabolism , 2005, Critical care medicine.

[7]  L. Filgueira,et al.  Humoral factors enhance fracture-healing and callus formation in patients with traumatic brain injury. , 2009, The Journal of bone and joint surgery. American volume.

[8]  N. Lebwohl,et al.  Evaluation of Serum Osteoblast Mitogenic Activity in Spinal Cord and Head Injury Patients With Acute Heterotopic Ossification , 1994, Spine.

[9]  D. Carter,et al.  Geometric, elastic, and structural properties of maturing rat femora , 1986, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  R. Spencer The effect of head injury on fracture healing. A quantitative assessment. , 1987, The Journal of bone and joint surgery. British volume.

[11]  A. Boskey,et al.  The mineral and mechanical properties of bone in chronic experimental diabetes , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  A. Marmarou,et al.  A new model of diffuse brain injury in rats. Part II: Morphological characterization. , 1994, Journal of neurosurgery.

[13]  R. Smith Head injury, fracture healing and callus. , 1987, The Journal of bone and joint surgery. British volume.

[14]  M. Stone,et al.  Accelerated fracture union in association with severe head injury. , 1987, Injury.

[15]  J. G. Kennedy,et al.  Long bone torsion: I. Effects of heterogeneity, anisotropy and geometric irregularity. , 1985, Journal of biomechanical engineering.

[16]  S. Kakar,et al.  Osteogenic effects of traumatic brain injury on experimental fracture-healing. , 2006, The Journal of bone and joint surgery. American volume.

[17]  D. Garland,et al.  Forearm fractures in the head-injured adult. , 1983, Clinical orthopaedics and related research.

[18]  D. Zukor,et al.  Evidence for a humoral mechanism for enhanced osteogenesis after head injury. , 1990, The Journal of bone and joint surgery. American volume.

[19]  P. Giannoudis,et al.  Does traumatic brain injury result in accelerated fracture healing? , 2005, Injury.

[20]  D. Garland,et al.  Fractures of the tibial diaphysis in adults with head injuries. , 1980, Clinical orthopaedics and related research.

[21]  R. Zernicke,et al.  Effects of severe diabetes and insulin on the femoral neck of the immature rat , 1993, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[22]  P. Mahy,et al.  Experimental heterotopic bone formation induced by bone morphogenetic protein and recombinant human interleukin-1B. , 1988, Clinical orthopaedics and related research.

[23]  Zheng-Cheng Zhong,et al.  Finite element analysis of the lumbar spine with a new cage using a topology optimization method. , 2006, Medical engineering & physics.

[24]  G. Tanriover,et al.  Modified experimental mild traumatic brain injury model. , 2006, The Journal of trauma.

[25]  G. Beaupré,et al.  Improved method for analysis of whole bone torsion tests , 1994, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[26]  C. Turner Biomechanics of Bone: Determinants of Skeletal Fragility and Bone Quality , 2002, Osteoporosis International.

[27]  A. Marmarou,et al.  A new model of diffuse brain injury in rats. Part I: Pathophysiology and biomechanics. , 1994, Journal of neurosurgery.

[28]  A. Ekeland,et al.  Mechanical properties of fractured and intact rat femora evaluated by bending, torsional and tensile tests. , 1981, Acta orthopaedica Scandinavica.

[29]  M. Waisman,et al.  Experimental study on healing of bone fractures using L-dopa. , 1979, Clinical orthopaedics and related research.

[30]  T A Einhorn,et al.  Enhancement of fracture-healing. , 1995, The Journal of bone and joint surgery. American volume.

[31]  S. Ersözlü,et al.  [The effect of bone marrow ablation on regional biomechanical properties of rat tibia]. , 2006, Acta orthopaedica et traumatologica turcica.

[32]  M. Boulet,et al.  Precipitation of calcium phosphates from solutions at near physiological concentrations , 1961 .