Die Tibiaschaftfraktur ist eine häufig auftretende Verletzung. Der Fixateur externe findet bei der Versorgung von Tibiafrakturen große Verwendung. Die Variabilität und Anpassung an die individuelle Patientensituation stellen den Vorteil der Osteosynthese dar. Gleichzeitig ist unklar, ob und inwiefern die Montageebene die Frakturheilung beeinflusst. Interfragmentäre Bewegungen (IFM) bestimmen die Quantität und Qualität der Kallusbildung. IFM werden wiederum durch die Fixateurmontageebene bedingt. Diese Studie wurde vorgelegt, um den Einfluss der Montageebene auf die Frakturheilung zu bestimmen. Zwei identisch konfigurierte monolaterale Fixateurs externes mit medialer und anteromedialer Montageebene wurden bezüglich ihres Heilungspotentials an der Schafstibia verglichen. IFM und Bodenreaktionsparameter wurden während des neunwöchigen Heilungsverlaufs in vivo ermittelt. Die Knochenkonsolidierung wurde radiologisch und biomechanisch evaluiert. Allein die Änderung der Montageebene führte zu einer Modifikation der IFM. Der Unterschied der IFM war nur in der initialen Heilungsphase signifikant. Diese initialen Unterschiede beeinflussten jedoch bei nicht signifikant unterschiedlicher Gewichtsbelastung die Kallusbildung. Die Gruppe mit anteromedial montierten Fixateur zeigte initial höhere IFM und bewirkte einen radiologisch größeren Kallusdurchmesser und eine biomechanisch größere Kallussteifigkeit im Sinne einer weiter fortgeschrittenen Heilungsphase. Diese erzielten Heilungsergebnisse demonstrieren die Sensitivität der Montageebene und die Bedeutung der initialen biomechanischen Bedingungen, die den Kurs der Frakturheilung beeinflussen. Darum sollte der Montageebene und der dadurch bedingten initialen mechanischen Osteosynthesestabilität in der klinischen Frakturversorgung mehr Beachtung geschenkt werden. / Fractures of the tibia are commonly encountered problems. One of the most common osteosyntheses used to stabilise tibial fractures are external fixators. The fixator allows great freedom in configuration, especially with regard to its mounting plane. Whether and how the mounting plane influences the healing process is still unclear. Interfragmentary movements (IFM) affect the quality and quantity of callus formation. The mounting plane of monolateral external fixators may give direction to those movements. The presented study aimed to determine the influence of the fixator mounting plane on fracture healing. Identically configured fixators were mounted either medially or anteromedially on a standardised ovine tibial diastasis model with regard to their fracture healing potential. IFM and ground reaction forces were evaluated in vivo during a nine week period. Biomechanical and radiological parameters described the bone healing process. Changing only the mounting plane led to a modification of IFM in the initial healing phase. The difference in IFM between the groups was only significant during the first post-operative period. However, these initial differences in mechanical conditions influenced callus tissue formation. The group with the anteromedially mounted fixator, initially showing significantly more IFM, ended up with a radiologically bigger callus diameter and a biomechanically higher callus stiffness as a result of advanced fracture healing. This demonstrates that the initial phase of healing is sensitive to mechanical conditions and influences the course of healing. Therefore, initial mechanical stability of an osteosynthesis should be considered an important factor in clinical fracture treatment.

Orientadora: Prof.ª Dr.ª Léia Bernardi Bagesteiro / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Engenharia Biomédica, 2015. / A osteotomia proximal da tibia (OPT) com cunha medial aberta e uma intervencao cirurgica utilizada para o tratamento de osteoartrite no condilo medial. Basicamente consiste na realizacao de um corte parcial da tibia e na abertura em formato de cunha em um angulo pre-determinado. Apos a abertura e necessaria a fixacao de um implante ortopedico. Os dispositivos ortopedicos utilizados para estabilizar a fratura devem suportar as cargas biomecanicas e gerar um ambiente mecanico capaz de permitir a consolidacao ossea. O objetivo deste estudo e analisar as tensoes de um novo implante (NPO) para osteotomia, previamente projetado pelo autor e colaboradores, bem como os deslocamentos relativos da cunha apos a aplicacao de cargas estaticas, atraves do metodo dos elementos finitos. Baseados em imagens medicas geradas a partir de tomografias computadorizadas, tres modelos distintos de elementos finitos da tibia com abertura em cunha foram simulados e fixados com: (1) uma nova placa para osteotomia (NPO), (2) uma placa gTh reta (PTR) e (3) uma placa gTh curva (PTC). Em cada avaliacao foram consideradas duas condicoes de carga em pos-operatorio: (1) primeira semana e (2) sexta semana. A tensao maxima observada na NPO (362,62 MPa) foi 57,08% maior que a PTR (230,85 MPa) e 23,47% (293,70 MPa) maior que a PTC. O deslocamento da configuracao NPO (1,37 mm) foi similar a tibia intacta e a PTC e a PTR, que apresentaram deslocamentos do tecido osseo de 1,35 mm e 1,30 mm, respectivamente. Para o caso da primeira semana do pos-operatorio a NPO apresentou movimento relativo interfragmentar (MRI) axial minimo e maximo de 169,58 ¿Êm e 218,14 ¿Êm, respectivamente. E MRI cisalhante minimo e maximo de 1,21 ¿Êm e 0,96 ¿Êm, respectivamente. Estes valores foram inferiores e superiores a 0,2 mm. Segundo PLECKO et al. (2013) valores acima de 0,2 mm aumentam a proliferacao de calo ossificado. No caso da sexta semana o MRI axial minimo da cunha foi de 165,20 ¿Êm e o maximo de 284,01 ¿Êm. Enquanto que o MRI cisalhante minimo foi de 47,52 ¿Êm e o maximo de 50,82 ¿Êm. A PTR apresentou valores de MRI axial entre 153,39 ¿Êm e 233,68 ¿Êm na primeira semana e 136,92 ¿Êm e 314,47 ¿Êm na sexta semana. E MRI de cisalhamento entre 1,12 ¿Êm e 1,95 ¿Êm na primeira semana e 87,49 ¿Êm e 92,89 ¿Êm na sexta semana. A PTC apresentou valores de MRI axial entre 158,92 ¿Êm e 233,70 ¿Êm (primeira semana) e 154,33 ¿Êm e 310,31 ¿Êm (sexta semana). E MRI cisalhante entre 0,94 ¿Êm e 1,66 ¿Êm (primeira semana) e 77,67 ¿Êm e 78,40 ¿Êm (sexta semana). Portanto, a analise valida a utilizacao do novo implante para osteotomia proximal da tibia e sugere a reducao de material nas regioes de baixa tensao equivalente de von Mises. Todos os implantes apresentaram valores de tensoes menores que o limite de escoamento da liga de titanio (Ti-6Al-4V) e permitiram o deslocamento da tibia com osteotomia proximo ao deslocamento da tibia intacta. A cunha apresentou regioes de micromovimento e microdeformacao que permitem a cicatrizacao ossea em ambas condicoes de carga. / IOpen wedge high tibial osteomy is a surgical intervention used to treat medial compartment osteoarthritis. The technique consists of tibial partial cut and an opening wedge with a pre-defined angle. Once opened, the orthopedic implant¿s fixation is required. The orthopedic devices used to stabilize the fracture should support the biomechanical loads and create an optimal mechanical environment to allow the fracture healing. The aim of this study is to analyze the stress level and displacements for the new implant of the osteotomy wedge under static loads using the finite element method. Using CT-based images, three tibia¿s distinct finite element models with open wedge were simulated and fixed: (1) the new implant osteotomy, (2) a straight T plate (STP) and (3) a curved T plate (CTP). On each evaluation two load conditions were considered: (1) the first week post-operative and (2) the sixth week post-operative. The maximum stress observed for the new implant (362.62MPa) was 57.08% higher than STP (230.85MPa) and 23.47% higher than CTP (293.70MPa). The highest displacement of the bone tissue was showed by the new implant (1.37mm), follow by STP (1.35mm) and CTP (1.30mm). For the first week condition, the wedge with the new implant showed minimum and maximum axial interfragmentary relative micromotion (IRM) of 169.58ìm and 218.14ìm. And shear IRM minimum and maximum of 1.21ìm e 0.96ìm, respectively. These values were inferior and superior to 0.2 mm. According to PLECKO et al. (2013), values larger than 0.2 mm increases the proliferation of callus ossified. For the sixth week, the minimum and maximum axial IRM were 165.20ìm and 284.01ìm. And shear IRM minimum and maximum of 47.52ìm and 50.82ìm, respectively. The STP showed IRM between 153.39ìm and 233.68ìm in the first week, and 136.92ìm and 314.47ìm for the sixth week. And shear IRM between 1.12ìm e 1.95ìm in the first week and 87.49ìm and 92.89ìm in the sixth week. The CTP showed IRM between 158.92ìm and 233.70ìm (first week), and 154.33ìm and 310.31ìm (sixth week). And shear IRM between 0.94ìm e 1.66ìm (first week) and 77.67ìm and 78.40ìm in the sixth week. Therefore, the analysis validates the use of the new implant for proximal tibial osteotomy and suggests the material's reduce in the regions with lower von Mises equivalent stress. All implants showed stress levels lower than the yield strength of the titanium alloy (Ti-6Al-4V) and the displacement of the fractured tibia was similar to the intact tibia. The wedge showed regions of micromotion (mm) and strain (%) that allowed the fracture healing in both loads conditions.