Tim Wehner
Research interests
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InterestsFracture Healing, Numerical Simulation, optimization of fracture fixations, Mechanobiology
Publications
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3.11Impact points
Optimization of intramedullary nailing by numerical simulation of fracture healing.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 04/2012; 30(4):569-73.
Due to the annular gap between intramedullary (IM) nails and the endosteal surface, high interfragmentary movement can occur under loading. This could prolong the healing time, particularly for thin IM nails that are often used for unreamed IM nailing. The aims of our study were to determine the inf... [more] Due to the annular gap between intramedullary (IM) nails and the endosteal surface, high interfragmentary movement can occur under loading. This could prolong the healing time, particularly for thin IM nails that are often used for unreamed IM nailing. The aims of our study were to determine the influence of the nail diameter on the healing time of human tibial shaft fractures and to investigate whether the healing time could be shortened by increasing the stiffness of the implant material. Therefore, a corroborated numerical model for simulating the fracture healing process in humans was used to simulate the healing process of human tibial fractures treated with IM nails. The calculated healing time (up to 71 weeks) was longest for transverse fractures treated with thin IM nails made of titanium. That the healing time was disproportionately long depended on the nail diameter, and could be greatly reduced by using a thicker nail or using steel instead of titanium. To avoid a prolonged healing time, the nail should be thick, and the annular gap should be as narrow as possible. Alternatively, using steel instead of titanium may also help to avoid a prolonged healing time. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:569-573, 2012.
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3.11Impact points
C5aR-antagonist significantly reduces the deleterious effect of a blunt chest trauma on fracture healing.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 09/2011; 30(4):581-6.
Confirming clinical evidence, we recently demonstrated that a blunt chest trauma considerably impaired fracture healing in rats, possibly via the interaction of posttraumatic systemic inflammation with local healing processes, the underlying mechanisms being unknown. An important trigger of systemic... [more] Confirming clinical evidence, we recently demonstrated that a blunt chest trauma considerably impaired fracture healing in rats, possibly via the interaction of posttraumatic systemic inflammation with local healing processes, the underlying mechanisms being unknown. An important trigger of systemic inflammation is the complement system, with the potent anaphylatoxin C5a. Therefore, we investigated whether the impairment of fracture healing by a severe trauma resulted from systemically activated complement. Rats received a blunt chest trauma and a femur osteotomy stabilized with an external fixator. To inhibit the C5a-dependent posttraumatic systemic inflammation, half of the rats received a C5aR-antagonist intravenously immediately and 12 h after the thoracic trauma. Compared to the controls (control peptide), the treatment with the C5aR-antagonist led to a significantly increased flexural rigidity (three-point-bending test), an improved bony bridging of the fracture gap, and a slightly larger and qualitatively improved callus (µCT, histomorphometry) after 35 days. In conclusion, immunomodulation by a C5aR-antagonist could abolish the deleterious effects of a thoracic trauma on fracture healing, possibly by influencing the function of inflammatory and bone cells locally at the fracture site. C5a could possibly represent a target to prevent delayed bone healing in patients with severe trauma. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:581-586, 2012.
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4.09Impact points
Small animal bone healing models: standards, tips, and pitfalls results of a consensus meeting.
Bone. 07/2011; 49(4):591-9.
Small animal fracture models have gained increasing interest in fracture healing studies. To achieve standardized and defined study conditions, various variables must be carefully controlled when designing fracture healing experiments in mice or rats. The strain, age and sex of the animals may influ... [more] Small animal fracture models have gained increasing interest in fracture healing studies. To achieve standardized and defined study conditions, various variables must be carefully controlled when designing fracture healing experiments in mice or rats. The strain, age and sex of the animals may influence the process of fracture healing. Furthermore, the choice of the fracture fixation technique depends on the questions addressed, whereby intra- and extramedullary implants as well as open and closed surgical approaches may be considered. During the last few years, a variety of different, highly sophisticated implants for fracture fixation in small animals have been developed. Rigid fixation with locking plates or external fixators results in predominantly intramembranous healing in both mice and rats. Locking plates, external fixators, intramedullary screws, the locking nail and the pin-clip device allow different degrees of stability resulting in various amounts of endochondral and intramembranous healing. The use of common pins that do not provide rotational and axial stability during fracture stabilization should be discouraged in the future. Analyses should include at least biomechanical and histological evaluations, even if the focus of the study is directed towards the elucidation of molecular mechanisms of fracture healing using the largely available spectrum of antibodies and gene-targeted animals to study molecular mechanisms of fracture healing. This review discusses distinct requirements for the experimental setups as well as the advantages and pitfalls of the different fixation techniques in rats and mice.
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3.11Impact points
Experimental blunt chest trauma impairs fracture healing in rats.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 05/2011; 29(5):734-9.
In poly-traumatic patients a blunt chest trauma is an important trigger of the posttraumatic systemic inflammatory response. There is clinical evidence that fracture healing is delayed in such patients, however, experimental data are lacking. Therefore, we investigated the influence of a thoracic tr... [more] In poly-traumatic patients a blunt chest trauma is an important trigger of the posttraumatic systemic inflammatory response. There is clinical evidence that fracture healing is delayed in such patients, however, experimental data are lacking. Therefore, we investigated the influence of a thoracic trauma on fracture healing in a rat model. Male Wistar rats received either a blunt chest trauma combined with a femur osteotomy or an isolated osteotomy. A more rigid or a more flexible external fixator was used for fracture stabilization to analyze whether the thoracic trauma influences regular healing and mechanically induced delayed bone healing differently. The blunt chest trauma induced a significant increase of IL-6 serum levels after 6 and 24 h, suggesting the induction of a systemic inflammation, whereas the isolated fracture had no effect. Under a more rigid fixation the thoracic trauma considerably impaired fracture healing after 35 days, reflected by a significantly reduced flexural rigidity (three-point-bending test), as well as a significantly diminished callus volume, moment of inertia, and relative bone surface (µCT analysis). In confirming the clinical evidence, this study reports for the first time that a blunt chest trauma considerably impaired bone healing, possibly via the interaction of the induced systemic inflammation with local inflammatory processes.
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2.66Impact points
Effect of the fixator stiffness on the young regenerate bone after bone transport: computational approach.
Journal of biomechanics. 12/2010; 44(5):917-23.
Bone transport is a well accepted technique for the treatment of large bony defects. This process is mechanically driven, where mechanical forces play a central role in the development of tissues within the distracted gap. One of the most important mechanical factors that conditions the success of b... [more] Bone transport is a well accepted technique for the treatment of large bony defects. This process is mechanically driven, where mechanical forces play a central role in the development of tissues within the distracted gap. One of the most important mechanical factors that conditions the success of bone regeneration during distraction osteogenesis is the fixator stiffness not only during the distraction phase but also during the consolidation phase. Therefore, the aim of the present work is to evaluate the effect of the stiffness of the fixator device on the interfragmentary movements and the tissue outcome during the consolidation phase. A previous differentiation model (Claes and Heigele, 1999) is extended in order to take into account the different behaviors of the tissues in tension and compression. The numerical results that were computed concur with experimental findings; a stiff fixator promotes bone formation while the excessive motion induced by extremely flexible fixators is adverse for bony bridging. Experimental interfragmentary movement is similar to that computed numerically.
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3.11Impact points
Fracture healing in mice under controlled rigid and flexible conditions using an adjustable external fixator.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 11/2010; 28(11):1456-62.
Mice are increasingly used to investigate mechanobiology in fracture healing. The need exists for standardized models allowing for adjustment of the mechanical conditions in the fracture gap. We introduced such a model using rigid and flexible external fixators with considerably different stiffness ... [more] Mice are increasingly used to investigate mechanobiology in fracture healing. The need exists for standardized models allowing for adjustment of the mechanical conditions in the fracture gap. We introduced such a model using rigid and flexible external fixators with considerably different stiffness (axial stiffnesses of 18.1 and 0.82 N/mm, respectively). Both fixators were used to stabilize a 0.5 mm osteotomy gap in the femur of C57BL/6 mice (each n = 8). Three-point bending tests, µCT, and histomorphometry demonstrated a different healing pattern after 21 days. Both fixations induced callus formation with a mixture of intramembranous and enchondral ossification. Under flexible conditions, the bending stiffness of the callus was significantly reduced, and a larger but qualitatively inferior callus with a significantly lower fraction of bone but a higher fraction of cartilage and soft tissue was formed. Monitoring of the animal movement and the ground reaction forces demonstrated physiological loading with no significant differences between the groups, suggesting that the differences in healing were not based on a different loading behavior. In summary, flexible external fracture fixation of the mouse femur led to delayed fracture healing in comparison to a more rigid situation.
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1.76Impact points
Improvement of the shear fixation stability of intramedullary nailing.
Clinical biomechanics (Bristol, Avon). 10/2010; 26(2):147-51.
The healing outcome of long bone fractures is strongly influenced by the mechanical environment. High interfragmentary movement at the fracture site is detrimental to the fracture healing process. Long bone fractures stabilized with thin intramedullary nails commonly used for unreamed intramedullary... [more] The healing outcome of long bone fractures is strongly influenced by the mechanical environment. High interfragmentary movement at the fracture site is detrimental to the fracture healing process. Long bone fractures stabilized with thin intramedullary nails commonly used for unreamed intramedullary nailing might be very flexible in shear direction and therefore critical for the fracture healing outcome. The aims of this study were to simulate the shear interfragmentary movement during gait for a human tibia treated with intramedullary nailing and to investigate if this movement could be lowered by implant design modifications. The shear movement was calculated with a 3D finite element model based on computer tomograph images of a cadaver bone-implant complex of a transverse tibia fracture treated with a Stryker T2 Standard Tibial Nail. This model was validated through in vitro test results under pure shear, axial, bending and torsional loading. High shear movements of approximately 4mm were calculated during gait. These shear movements could be reduced by approximately 30% either by implant modifications or the use of a 1mm thicker nail. Combining the implant modifications with a 1mm thicker nail, the shear movements could be reduced by 54%. The increase of the fixation stiffness by using an implant material with a high Young's modulus in combination with an angle-stable nail-screw fixation helps to reduce the shear movement during gait and possibly to lower the risk of a prolonged healing time with unreamed intramedullary nailing.
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2.66Impact points
Internal forces and moments in the femur of the rat during gait.
Journal of biomechanics. 09/2010; 43(13):2473-9.
The rat is of increasing importance for experimental studies on fracture healing. The healing outcome of long bone fractures is strongly influenced by mechanical factors, such as the interfragmentary movement. This movement depends on the stability of the fracture fixation and the musculoskeletal lo... [more] The rat is of increasing importance for experimental studies on fracture healing. The healing outcome of long bone fractures is strongly influenced by mechanical factors, such as the interfragmentary movement. This movement depends on the stability of the fracture fixation and the musculoskeletal loads. However, little is known about these loads in rats. The musculoskeletal loads during gait were estimated using an inverse-dynamic musculoskeletal model of the right hindlimb of the rat. This model was based on a micro-CT scan of the lower extremities and an anatomical study using 15 rat cadavers. Kinematics were reconstructed from X-ray movies, taken simultaneously from two perpendicular directions during a gait cycle. The ground reaction forces were taken from the literature. The muscle forces were calculated using an optimization procedure. The internal forces and moments varied over the gait cycle and along the femoral axis. The greatest internal force (up to 7 times bodyweight) acted in the longitudinal direction. The greatest internal moment (up to 13.8 bodyweight times millimeter) acted in the sagittal plane of the femur. The validity of the model was corroborated by comparing the estimated strains caused by the calculated loads on the surface of the femoral mid-shaft with those from the literature. Knowledge of the internal loads in the femur of the rat allows adjustment of the biomechanical properties of fixation devices in fracture healing studies to the desired interfragmentary movement.
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3.11Impact points
Metaphyseal fracture healing follows similar biomechanical rules as diaphyseal healing.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 09/2010; 29(3):425-32.
It is generally supposed that the pattern of fracture healing in trabecular metaphyseal bone differs from that of diaphyseal fractures. However, few experimental studies to date have been performed, even though clinically many fractures occur in metaphyseal bone. Particularly, the influence of biome... [more] It is generally supposed that the pattern of fracture healing in trabecular metaphyseal bone differs from that of diaphyseal fractures. However, few experimental studies to date have been performed, even though clinically many fractures occur in metaphyseal bone. Particularly, the influence of biomechanical factors has not yet been investigated under standardized conditions. Our aim was to correlate the interfragmentary strain (IFS) with the bone-healing outcome in a controlled metaphyseal fracture model in sheep. Twelve sheep received a partial osteotomy in the distal femoral condyle close to the trochlea. The determination of the IFS by in vivo X-ray analyses and a finite element model revealed that the deflection of the osteotomy gap by the patello-femoral force during walking provoked increasing strains of up to 40%. Bone healing was evaluated after 8 weeks by the assessment of the bone mineral density and by histomorphometry in regions of interest that displayed differing magnitudes of IFS. In areas with strains below 5% significantly less bone formation occurred compared to areas with higher strains (6-20%). For strains larger than 20% fibrocartilage layers were observed. Low IFS (<5%) led to intramembranous bone formation, whereas higher strains additionally provoked endochondral ossification or fibrocartilage formation. It is therefore proposed that metaphyseal bone healing follows similar biomechanical principles as diaphyseal healing.
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1.76Impact points
Influence of the fixation stability on the healing time--a numerical study of a patient-specific fracture healing process.
Clinical biomechanics (Bristol, Avon). 07/2010; 25(6):606-12.
The healing outcome of long bone fractures is strongly influenced by the interfragmentary movement of the bone fragments. This depends on the fixation stability, the optimum value of which is still not known. The aim of this study was to simulate a patient-specific human healing process using a nume... [more] The healing outcome of long bone fractures is strongly influenced by the interfragmentary movement of the bone fragments. This depends on the fixation stability, the optimum value of which is still not known. The aim of this study was to simulate a patient-specific human healing process using a numerical algorithm and to retrospectively analyse the influence of the fixation stability on the healing time. The healing simulation was processed as an initial value problem. This was iteratively solved based on two mechanical (invariants of the strain tensor, calculated through a finite element analysis) and five biological state variables (local tissue composition and blood perfusion) using a previously published fuzzy logic algorithm. For validation purposes, the calculated interfragmentary movement was compared to in vivo measurements of this patient. By changing clinically adjustable parameters of the fixation device, the influence of the fixation stability on the healing time was analysed. The time course showed good agreement of the interfragmentary movement compared with the in vivo measurements. The predicted healing time was strongly influenced by the fixation stability, i.e. by changing the parameters of the fixation device, it was possible to significantly reduce the healing time. The time to heal could be greatly reduced by modification of the fixator design, i.e. increasing the fixation stiffness. When using external fixation devices, this could be achieved by decreasing the free bending length of the pins, using a stiff fixation body and a stiff connection between the pins and the body.
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2.66Impact points
Simulation of the nutrient supply in fracture healing.
Journal of biomechanics. 09/2009;
The healing process for bone fractures is sensitive to mechanical stability and blood supply at the fracture site. Most currently available mechanobiological algorithms of bone healing are based solely on mechanical stimuli, while the explicit analysis of revascularization and its influences on the ... [more] The healing process for bone fractures is sensitive to mechanical stability and blood supply at the fracture site. Most currently available mechanobiological algorithms of bone healing are based solely on mechanical stimuli, while the explicit analysis of revascularization and its influences on the healing process have not been thoroughly investigated in the literature. In this paper, revascularization was described by two separate processes: angiogenesis and nutrition supply. The mathematical models for angiogenesis and nutrition supply have been proposed and integrated into an existing fuzzy algorithm of fracture healing. The computational algorithm of fracture healing, consisting of stress analysis, analyses of angiogenesis and nutrient supply, and tissue differentiation, has been tested on and compared with animal experimental results published previously. The simulation results showed that, for a small and medium-sized fracture gap, the nutrient supply is sufficient for bone healing, for a large fracture gap, non-union may be induced either by deficient nutrient supply or inadequate mechanical conditions. The comparisons with experimental results demonstrated that the improved computational algorithm is able to simulate a broad spectrum of fracture healing cases and to predict and explain delayed unions and non-union induced by large gap sizes and different mechanical conditions. The new algorithm will allow the simulation of more realistic clinical fracture healing cases with various fracture gaps and geometries and may be helpful to optimise implants and methods for fracture fixation.
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2.66Impact points
Discretization error when using finite element models: Analysis and evaluation of an underestimated problem.
Journal of biomechanics. 07/2009;
Mesh convergence tests are often insufficiently performed in finite element analyses. There are many parameters which may have an effect on the mesh convergence behavior. The aim of this study was to identify the influence of different parameters on the mesh convergence behavior. For this purpose we... [more] Mesh convergence tests are often insufficiently performed in finite element analyses. There are many parameters which may have an effect on the mesh convergence behavior. The aim of this study was to identify the influence of different parameters on the mesh convergence behavior. For this purpose we used a simplified axis-symmetrical model of a single pedicle screw flank with surrounding bone to simulate a pull-out test. In parameter studies, the flank radii and the contact conditions at the bone-screw interface were varied. These parameter studies were carried out using an implicit and explicit solver. Thereby, the convergence criteria and the number of the substeps for the implicit nonlinear iteration process as well as the velocity and the material density for the explicit approach were considered. The mesh convergence behavior was influenced by varying the flank radii and the contact conditions. The implicit calculations led to a reaction force, which converged rapidly to a certain value with increasing mesh density, whereas the maximum von-Mises stress showed substantial convergence problems. The number of substeps and the convergence criteria of the iteration process strongly influenced the implicit solutions. In contrast, the maximum von-Mises stresses resulting from explicit calculations converged to a certain value after only a few refinement steps. Different pull-out velocities substantially affected the mesh convergence behavior, while the material density showed only a negligible influence. The results indicated the need to perform an appropriate mesh convergence test when using finite element methods. We were able to show that different parameters strongly influence the mesh convergence behavior and we demonstrated that convergence tests do not always lead to a satisfactory or acceptable solution.
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1.76Impact points
Internal loads in the human tibia during gait.
Clinical biomechanics (Bristol, Avon). 02/2009;
BACKGROUND: Internal loads in long bones are of special interest, for testing and optimization of current implant designs for fracture treatment. Inverse dynamic musculoskeletal models were successfully used to determine the muscle forces in the lower extremities, however the internal loads expresse... [more] BACKGROUND: Internal loads in long bones are of special interest, for testing and optimization of current implant designs for fracture treatment. Inverse dynamic musculoskeletal models were successfully used to determine the muscle forces in the lower extremities, however the internal loads expressed as forces and moments along the human tibia during gait have not been reported. METHODS: A musculoskeletal model of the lower extremities, developed and provided under public domain from the AnyBody research group (www.anybody.aau.dk), was modified to determine the three-dimensional internal loads along the tibial axis during gait. To corroborate this numerical model, the calculated resultant hip contact force as well as the axial force on the tibial plateau were compared to in vivo data from the literature. FINDINGS: The highest internal loads were the axial force with up to 4.7 bodyweight and the bending moment in the sagittal plane with up to 71.6 bodyweight times millimetre in the late stance phase. The extreme values of the internal loads along the tibial axis varied up to 1.5 bodyweight and 85.7 bodyweight times millimetre. In the distal part of the tibia, the axial force dominated the three-dimensional internal load case, whereas the internal moments became more significant with increasing distance from the ankle joint. INTERPRETATION: This study provides for the first time the three-dimensional internal loads, expressed as forces and moments along the human tibia during normal gait. The results of this study could be used to improve the mechanical behaviour of current implant designs for the treatment of tibial fractures to avoid implant failures under in vivo loading conditions.
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2.19Impact points
Poly(vinyl alcohol) membranes for adhesion prevention.
Journal of biomedical materials research. Part B, Applied biomaterials. 09/2004; 70(2):191-202.
The abnormal joining of anatomic structures after abdominal and pelvic surgery can lead to such major complications as bowel obstruction or infertility. Poly(vinyl alcohol) (PVA) membranes and hydrogels were placed over the injured tissue to act as a physical barrier and prevent such adhesions from ... [more] The abnormal joining of anatomic structures after abdominal and pelvic surgery can lead to such major complications as bowel obstruction or infertility. Poly(vinyl alcohol) (PVA) membranes and hydrogels were placed over the injured tissue to act as a physical barrier and prevent such adhesions from occurring in a rabbit sidewall model. The membranes were sutured into place to prevent their slipping or curling on the moist tissue. Various in vitro experiments (including testing for swelling and mechanical strength) were conducted in order to better understand the behavior of these membranes in the wound. The results showed that both the PVA membranes and PVA hydrogels significantly reduced the number and severity of adhesions in the rabbit sidewall model, and even indicated a distinct improvement over SEPRAFILM as antiadhesion barriers. Contact-angle measurements were taken in order to evaluate the surface properties of the membranes and hydrogels. Three approaches were taken to render the membranes more bioadhesive, and forego the need for future additional suturing: imprinting a texture onto the membrane, coating the membrane with carboxy methyl cellulose (CMC), and producing bi-layered, porous PVA membranes through a process of lyophilization. Though the surface of the PVA hydrogels is more hydrophilic than the surface of the PVA membranes, neither would adhere untreated to moist tissue. However, all three approaches aimed at improving their bioadhesion yielded excellent results and demonstrated that PVA could indeed be considered a viable method of adhesion prevention.
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Simulation der Frakturheilung beim Fixateur Externe und bei intramedullärem Nagel
Experimentelle und klinische Studien zur Frakturheilung an langen Röhrenknochen zeigten einen engen Zusammenhang zwischen den mechanischen Bedingungen während der Heilung und dem Heilungsergebnis. Hohe Lasten, hohe interfragmentäre Bewegungen und hohe Frakturspaltbreiten führen zu einer Heilungsverz... [more] Experimentelle und klinische Studien zur Frakturheilung an langen Röhrenknochen zeigten einen engen Zusammenhang zwischen den mechanischen Bedingungen während der Heilung und dem Heilungsergebnis. Hohe Lasten, hohe interfragmentäre Bewegungen und hohe Frakturspaltbreiten führen zu einer Heilungsverzögerung, jedoch ist über den genauen Zusammenhang zwischen gängigen Osteosyntheseverfahren beim Menschen und dem Heilungsergebnis wenig bekannt. Dieser Zusammenhang wurde in dieser Arbeit anhand von numerischen Modellen näher analysiert. Durch Verwendung von Finite-Elemente-Modellen wurde zunächst das komplexe 3D-Nachgiebigkeitsverhalten gängiger Osteosyntheseverfahren (Fixateur Externe und intramedullärer Nagel) zur operativen Behandlung von Tibiaschaftfrakturen bestimmt. Ein physiologischer Belastungszustand wurde mittels eines numerischen muskuloskelettalen Modells berechnet. Die Heilungssimulation erfolgte anschließend durch Vorhersage der mechanisch induzierten Gewebedifferenzierung anhand eines weiteren numerischen Modells (Finite-Elemente-Analyse und Fuzzy-Logik). Anhand der Heilungssimulationen konnten Querfrakturen mit großem Frakturspalt, Frakturen mit offenem Weichteilschaden und eine geringe Stabilität der Osteosynthese als besonders kritisch für die Heilung identifiziert werden. Diese Fälle werden durch Ergebnisse aus klinischen Studien bestätigt. Bei der operativen Behandlung von Tibiaschaftfrakturen sollten große Frakturspaltbreiten und Osteosynthesen mit hoher Nachgiebigkeit unbedingt vermieden werden. Die aufgebohrte Marknagelung ist aus mechanischer Sicht für die Behandlung von Tibiaschaftfrakturen besser geeignet als die unaufgebohrte Nagelung, da sie eine Reduzierung des Ringspalts (Abstand vom Marknagel zum Endost) ermöglicht. Die entwickelten Verfahren sollen zukünftig zur Identifikation weiterer kritischer Fälle sowie zur Abschätzung des Einflusses von Designänderungen der Osteosynthese auf das Heilungsergebnis verwendet werden.
Following (5)
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Uwe Wolfram
Universität Bern -
Frank Niemeyer
Universität Ulm -
Ronny Bindl
Universität Ulm -
Lutz Claes
Universität Ulm -
Andreas Hoess
Uppsala University
