Can changing the mechanical environment increase the speed of fracture healing? A pilot study in tibial fractures

We hypothesed that fracture healing could be speeded up by changing the mechanical environment from initial rigidity followed by micromovements (dynamization) to initial macromovement followed by rigidity. We based this hypothesis on two tenets. Firstly, callus requires movement for its formation and its production is limited to the first few weeks after fracture. Secondly, that callus would mature faster in the absence of movement (based on theoretical reasoning and supported by a prior rabbit experiment). An external fixator was built that would allow axial macromovements (up to 5 mm) and then compression to produce a rigid configuration. Permission from the Helsinki Ethical Committee was obtained for a pilot trial. 15 patients with an isolated closed (12 patients) or open grade 1 (3 patients) tibial fracture were treated. The average time of removal of the fixator was 11 weeks (range seven to 15.4 weeks) which was faster than other comparable series. This trial indicates that it is possible to speed up the healing of tibial fractures by changing the mechanical regimes used today of initial rigidity followed by dynamization to one of initial macromovement followed by rigidity.