In vivo impact testing on a lengthened femur with external fixation: a future option for the non-invasive monitoring of fracture healing?

J R Soc Interface. 2018 May;15(142):20180068. doi: 10.1098/rsif.2018.0068.


Non-invasive methods for assessing fracture healing are crucial for biomedical engineers. An approach based on mechanical vibrations was tried out in the 1990s, but was soon abandoned due to insufficiently advanced technologies. The same approach is re-proposed in the present study in order to monitor the healing process of a lengthened femur with an external fixator. The pins screwed into the bone were exploited for the impact testing (IT) to excite the bone and capture its response. Transmission through the soft tissues was thus prevented, and the quality of the signals was improved. Impact tests were performed every three to four weeks for five months. Unfortunately, after seven weeks, some pins were removed due to infection, and thus, the system was modified. Two different configurations were considered: before and after pin removal. An additional configuration was examined in the last two sessions, when the fixator body was removed, while four pins were left in the femur. The evolution of the frequency response function and of the resonant frequencies of the system were analysed for the duration of the monitoring period. The IT results were compared to the indications provided by X-ray images. During the evolution of the callus from the soft phase to the woven bone, the resonant frequencies of the system were found to increase by approximately 2-3% per week. The largest increase (approx. 22%) was observed for the first resonant frequency. After formation of the woven bone, the vibratory response remained almost the same, suggesting that the healing assessment could be related to the relative variation in the resonant frequencies. The results presented support the application of the IT approach for fracture healing assessment.

Keywords: biomechanics; bone lengthening; external fixation; fracture healing; non-invasive monitoring; vibration analysis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bone Nails*
  • External Fixators*
  • Female
  • Femoral Fractures* / pathology
  • Femoral Fractures* / physiopathology
  • Femoral Fractures* / therapy
  • Femur* / pathology
  • Femur* / physiopathology
  • Fracture Healing*
  • Humans
  • Vibration / therapeutic use*