Influence of high-frequency cyclical stimulation on the bone fracture-healing process: mathematical and experimental models

• Published in: Philosophical transactions of the Royal Society of London. Series A: Mathematical, physical, and engineering sciences physical, and engineering sciences, 2011-11, Vol.369 (1954), p.4278-4294
• Main Authors: Gómez-Benito, María José, González-Torres, Libardo Andrés, Reina-Romo, Esther, Grasa, Jorge, Seral, Belén, García-Aznar, José Manuel
• Format: Article
• Language: English
• Subjects: Animals; Biomechanical Phenomena; Bone and Bones - pathology; Bone Density; Bone formation; Bone fractures; Bone Healing; Bones; Callus; Cell Differentiation; External fixators; Female; Fracture Healing; Fracture mechanics; Fractures, Bone - therapy; Healing; Humans; Low-Magnitude High-Frequency Mechanical Stimulation; Mathematical models; Mechano-Biological Model; Mechanotransduction, Cellular; Modeling; Models, Theoretical; Osteogenesis, Distraction; Shear Strength; Sheep; Stress, Mechanical; Tibia - pathology
• ISSN: 1364-503X; 1471-2962
• DOI: 10.1098/rsta.2011.0153

Mechanical stimulation affects the evolution of healthy and fractured bone. However, the effect of applying cyclical mechanical stimuli on bone healing has not yet been fully clarified. The aim of the present study was to determine the influence of a high-frequency and low-magnitude cyclical displacement of the fractured fragments on the bone-healing process. This subject is studied experimentally and computationally for a sheep long bone. On the one hand, the mathematical computational study indicates that mechanical stimulation at high frequencies can stimulate and accelerate the process of chondrogenesis and endochondral ossification and consequently the bony union of the fracture. This is probably achieved by the interstitial fluid flow, which can move nutrients and waste from one place to another in the callus. This movement of fluid modifies the mechanical stimulus on the cells attached to the extracellular matrix. On the other hand, the experimental study was carried out using two sheep groups. In the first group, static fixators were implanted, while, in the second one, identical devices were used, but with an additional vibrator. This vibrator allowed a cyclic displacement with low magnitude and high frequency (LMHF) to be applied to the fractured zone every day; the frequency of stimulation was chosen from mechano-biological model predictions. Analysing the results obtained for the control and stimulated groups, we observed improvements in the bone-healing process in the stimulated group. Therefore, in this study, we show the potential of computer mechano-biological models to guide and define better mechanical conditions for experiments in order to improve bone fracture healing. In fact, both experimental and computational studies indicated improvements in the healing process in the LMHF mechanically stimulated fractures. In both studies, these improvements could be associated with the promotion of endochondral ossification and an increase in the rate of cell proliferation and tissue synthesis.