Differentially loaded Radiostereometric Analysis (DLRSA) in Torsion Adds Essential Information in Diaphyseal Bone Healing: the Example of a Tibial Osteotomy

Background Clinical assessment and conventional imaging, which are currently used to monitor fracture healing, do not provide information on the mechanical properties of the healing construct. This limits their use in patient management decisions. Differentially loaded radiostereometric analysis (DLRSA) is a technique developed to assess the mechanical properties of healing fractures in vivo. DLRSA measures the relative micromotion of tantalum beads inserted into bone fracture fragments in response to load across the fracture site. To date, these loads have been applied axially, although in fractures fixed with devices which are highly resistant to axial loads, such as locked intramedullary nails, torsional testing may be more sensitive to healing. The aim of this study was to establish a method to investigate DLRSA using torsional loading for clinical application. Methods A device was designed and built to apply torsional loads to the tibia. The test case was an oblique plain corrective osteotomy of a tibial diaphysis stabilized with an intramedullary nail and with tantalum beads inserted into the two adjacent bone segments. Post surgical examinations were made at 2 weeks, 2, 4, and 6 months as well as 1 and 2 years. Healing was monitored with the use of plain film radiographs, computed tomography (CT) and DLRSA. Axial loads of 30kg and an external torsion of 5Nm were applied during DLRSA examinations and the resultant displacement and stiffness were calculated. Results Torsional DLRSA demonstrated progressive changes in angular displacements and torsional stiffness consistent with the fracture healing observed by CT. By contrast, axial DLRSA was not informative and was more reflective of the stability of the fixation than healing bone. Conclusion The addition of torsional assessments to DLRSA provides an important investigative option in assessing the biomechanical properties of bone healing in vivo .