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The problem of mismatched motion

As noted earlier, today most tibia fractures are treated with Internal Fixation (IF - typically Intramural Nail Surgery).  IF carries all the risks, costs, and discomfort of any major surgical procedure.

In theory, External Fixation (EF) could be a good alternative as it does not involve surgery or bone implants and so avoids many of these problems.  But EF has critical problems of its own.  Primary among them is poor overall results - EF involves very lengthy treatment with only mediocre outcomes at the end. 

The primary reason for EF's suboptimal performance is improper timing of immobilization versus motion.  (And that is what REF changes).

mismatched timing.png

Research has shown that axial motion is important for callus induction (ie, formation of new bone).  And callus induction occurs only within the first two to three weeks immediately following the fracture.  By contrast, bone motion is detrimental to callus ossification (ie, the hardening of newly formed bone).  And of course callus ossification starts only after callus induction.

What all this means is that in order to support the body's natural callus induction/ossification process, the fractured tibia should be kept mobile for the first 2 - 3 weeks, and then immobilized for the duration.  But this is exactly the opposite of what conventional EFs do.

Current EFs prevent motion when motion is beneficial  (i.e., the first weeks post fracture), and

they encourage motion when motion is detrimental (i.e., post week 3).

And EFs have numerous other problems too

In addition to mis-timed callus mobility (causing delayed or non-unions), a variety of other inherent shortcomings in current EFs also drive critical clinical and cost issues, including:

  • “Self-locking” – current EFs transfer weight/walking stresses to the bone-pin interface, leading to pin loosening and resultant bone infections (up to 85% incidence)

  • Non-weight bearing – current EFs do not enable weight-bearing for several weeks post surgery

  • Snowballing connectors – Current EFs require multiple intermediary connections (wires, clamps, jigs between the bone/pin interface) which add inventory and training complexity, cost, and significant additional per-procedure physician time.

  • No monitoring - Current EFs do not provide any information as to status of callus formation and fracture healing

The above problems all contribute to the limited use of EFs (despite their theoretical advantages versus internal fixation). 

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And the above problems are all solved by the Orthopedica REF.

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