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External fixator
Implants
(e.g for the distal femur)
Screws
patient, female, 37 y.: distal femoral fracture type B2
caused by a fall down the stairs ; treated with 3 screws
Implants
(e.g for the distal femur)
Conventional plate systems:
Intramedullar
nails
patient, male, 40 y.: A1 distal femoral fracture type
A1 caused by a car accident ; treated with an
intramedullary nail
Implants
(e.g for the distal femur)
Angular stable internal fixators with
locked screws
patient, female, 18 y.: distal femoral fracture type
C3 caused by a car accident ; treated with an angular stable
internal fixator
….and now let‘s have a
closer look on internal
fixators or implants with
locked screws or angular
stable implants
How to define
angular stability ?
conventional
plate-
osteosynthesis
internal plate
fixator
Why do we need internal fixators?
Multidirectional,
bicortical screw
positioning and contact
betweeen bone and
plate without pressure
Different Implants
Less invasive stabilisation System (LISS)
•Unidirectional,
monocortical screws
Multidirectional internal plate fixators
Pressure-Plate-Fixator
(PPF)
Titanium Internal-Fixateur (TiFix)
`87 `93
Bony consolidation in
9/1993
Minimal invasive osteosynthesis
of the femur by a PPF
Second solution to produce a
locked screw-plate interface
Plate: „softer“ Material (e.g. titanium grade 1 )
Screw: „harder“ material (e.g. titanium grade 4
or 5, titanium alloy) 1992
Thread-miller
TiFix 1st generation
The angle
between screw
and plate can be
choosen freely up
to 45° to each
direction !
TiFix 2nd Generation
„lip-construction“
No thread-miller
needed!
History of the development of multi-
directional internal plate fixators
1985 PPF lumbar and thoracic
spine
1991 PPF cervical spine
1993 PPF femur
1997 TiFix tibia
1998 TiFix calcaneus and
distal femur
1999 TiFix humeral head,
forearm and tibial head
First problem
Second problem
Solution?
Unilateral osteosynthesis of
tibial head by angular stable
butress plate
Biomechanical Study design
Comparison of unilateral osteosynthesis of tibial
head fractures by butress plate in angular stable
and conventional technique in fresh human
cadaveric tibial heads by biomechanical testing on
a servohydraulic material test machine.
European spine
phantom
Implant
Material testing machine
Biaxial, servohydraulic
material testing
machine MTS Typ
Bionix 858.2
Standardized preparation
X-ray controlled osteosynthesis
Testing assembly
LVDT
LVDT
X-Y-table
Testing protocol
preload 10N
sinus shaped, cyclic, force-induced load,
frequence 4 Hz
initial axial load 100 N
increase of load by 50 N every 2000
cycles until failure of the construct or 700 N
are reached (maximum 26000 cycles)
Results I
number bone density failure (at load in N )
(mg HA/cm³) angular stable conventional
1 146.8 600 350
2 63.1 >700 300
3 78.1 550 200
4 60.4 600 400
5 118.7 650 450
median 600 350
¾ Locked Implant
¾ DMS Sensors
¾ Microelektronic/Telemetry
¾ Encapsulation
Telemetry
Energy
µC based
RF-Interface transponder
Data
Transponder
Power
coil
Display
Sensor
Application
PC with custom-designed
software
300
F4
F5
F6
200 F7
F8
F9
F10
F11
100
F12
F13
F14
F15
F16
µV/V
0
F17
0 100 200 300 400 500 600 700 800 900
F18
F19
F20
F21
-100
F22
F23
F24
F25
E1
-200
E5
E6
-300
New ton
In-vivo testing in sheep
Korrelation Fixateurbelastung vs. Kraft
y = 2,4677x + 35,171
(8 Kraftzyklen) 2
R = 0,9532
Steifigkeit: 0,41 N/(µm/m)
200,0
175,0
150,0
Fixateurbelastung (Dehnung [µm/m]
125,0
100,0
75,0
50,0
25,0
0,0
0,0 5,0 10,0 15,0 20,0 25,0 30,0 35,0 40,0 45,0 50,0
Externe Kraft [N]
Bluetooth-Readout
In-vivo use in Patients
Patient 2, 11.08.05, postop
600,0
500,0
400,0
Measured data
300,0
200,0
100,0
0,0
0,000 50,000 100,000 150,000 200,000
Time [s]
Kraft [N] Fixateur (A/D Code [dez])
Physiotherapy
500%
400%
Prozent
300%
200%
100%
0%
Implantatbelastung unter 10kg max. Anspannung der OS- Anheben des Beines in KG-Übungen mit
axial Muskulatur Rückenlage Torsionskomponente
Outlook
¾ Routine Use
¾ Telemedical Patient Supervision
¾ Optimisation of postop. treatment regime
Future of External Fixation ?
08/2003 R.L.
Motor Driven Fixator
08/2003 R.L.
3-Dimensional Load Measurements
30
1 A3
25 2 A3
3 A3
Mxy (Nmm/N)
20 4 A3
bone 15
10
0
callus 2 4 8
Zeit (Wochen)
12 M
30
5 A2
6 A2
25
7 A2
fixator 8 B2
Mxy (Nmm/N)
20 9 C3
15
10
0
Fground 2 4 8
Zeit (Wochen)
12 M
30
25
20
Mxy (Nmm/N)
15
10 Patient A: delayed
fracture healing
5
0 Patient B: normal
fracture healing
2 4 8 12
time ( weeks )
Summary
Universal and precise 3-dimensional bone movements
Path of reduction / correction can be modified at any time
To be applied with different fixator systems
Painless fracture reduction