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2.1 Absolute Stability

The document outlines the principles of absolute stability in fracture healing, emphasizing that it requires no micro-motion at the fracture site and is best achieved through interfragmentary compression techniques such as lag screw fixation. It discusses the biological effects of stability on healing, indicating that absolute stability leads to direct bone healing with minimal callus formation. Clinical indications for employing absolute stability include articular and simple diaphyseal fractures, highlighting the importance of anatomical reduction and vascularity preservation.

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Asma Adel
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39 views20 pages

2.1 Absolute Stability

The document outlines the principles of absolute stability in fracture healing, emphasizing that it requires no micro-motion at the fracture site and is best achieved through interfragmentary compression techniques such as lag screw fixation. It discusses the biological effects of stability on healing, indicating that absolute stability leads to direct bone healing with minimal callus formation. Clinical indications for employing absolute stability include articular and simple diaphyseal fractures, highlighting the importance of anatomical reduction and vascularity preservation.

Uploaded by

Asma Adel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Absolute stability: biomechanics,

techniques, and fracture healing

AO Trauma Basic Principles Course


Learning objectives

• Define absolute stability

• Describe how the biological behavior of fractured bone is affected


by absolute stability

• Define indications for selection of absolute stability according to


AO principles

• Explain techniques for achieving absolute stability

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Bone fracture

• Intact cortical bone is strong and stiff

• Intact cortical bone can deform only


2% before it breaks

• When stiffness is lost, instability occurs


Fractured bone is designed to heal

• When left alone, a fractured bone


will heal on its own

• As a bone heals, the natural


response to interfragmentary
movement is callus formation

• However, deformity may occur


resulting in:
• Shortening
• Angulation
• Rotation
Aim of fracture treatment

• Obtain and maintain reduction

• Restore stiffness (stability) for


healing

• Decrease pain

• Promote healing

• Return of function
Degree of stability will determine the
type of bone healing
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How stability affects healing

• Internal fixation of fractures alters the biology of fracture healing


• Method of bone healing depends on:
• Type of fracture (simple or complex)
• Type of reduction (anatomical or functional)
• Type of stability achieved (absolute or relative)
• Type of implant chosen (providing absolute or relative
stability)
Cascade of events in fracture healing
Acute fracture

Hematoma formation

Microvascular ingrowth
granulation tissue

Cell differentiation to bone


Method of healing
depends on the type of
stability you can Intervention with stabilization
produce with internal
fixation
Absolute stability Relative stability

Direct bone healing Indirect bone healing


Definition of absolute stability

• Absolute stability means that there is no micro-motion at the


fracture site under normal physiological loads
• This requires open reduction
• This requires anatomical reduction of the fracture

• Best method to produce absolute stability is with interfragmentary


compression

• Absolute stability usually leads to direct bone healing

8
Results of absolute stability
Photomicrograph of fracture healing with
Direct bone healing absolute stability

• Formerly called primary bone


healing
• Occurs by internal (osteonal)
remodeling
• Direct contact is needed
between fracture ends
• Requires anatomical reduction • Anatomical reduction
• No motion between fragments • Absolute stability
• Osteons growing across fracture
• Little or no callus forms
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Effect of stability on blood supply

Absolute stability has a positive effect on revascularization of the


healing bone
Implants that produce absolute stability

• Lag screw fixation (interfragmentary compression)


• Axial compression with compression plate
• Buttress plate

Lag screw Axial compression plate Buttress plate


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Lag screw fixation

• Lag screw is a technique, not a type of screw

• Any screw can function as a lag screw to provide


interfragmentary compression if it is inserted properly

• Shaft screw is the only screw that is designed as a lag screw to


provide interfragmentary compression

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Interfragmentary compression

• Lag screw technique

• Other methods:
• Compression plate
• Buttress plate
Axial compression with compression plate

• Transverse fractures

• Lag screw not possible

• Axial compression from DCP or


LC-DCP can produce absolute
stability

• Requires anatomical reduction

• Axial compression with plate

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Axial compression with a plate

Dynamic compression holes allow axial compression through the


plate

15
Clinical indications for absolute stability

• Articular fractures
• Simple diaphyseal fractures, especially in forearm
• Some simple (Type A) metaphyseal fractures
• Osteotomies
• Utmost care for the vascularity of soft tissues, periosteum, and bone

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Principles of the lag screw technique

• It is a technique of insertion, not a type of screw

• Any screw can function as a lag screw

• A lag screw produces interfragmentary compression

• A lag screw can produce up to 2,500–3,000 Newtons of force

• Lag screw fixation will result in absolute stability


Conditions—interfragmentary compression

• Screw must glide through near cortex

• Threads hold only in far cortex

• Screw head stops at near cortex

• Best compression when screw is perpendicular to fracture line


Axiom

Any time a screw crosses a fracture line it must be inserted as a lag


screw to provide interfragmentary compression
Take-home messages

• Absolute stability implies there is no motion between fracture


fragments with normal functional loads

• The best method to achieve absolute stability is with


interfragmentary compression (lag screw technique)

• Absolute stability is indicated for articular fractures and simple


diaphyseal fractures

• Fractures treated with absolute stability can be expected to


heal with direct bone healing with no callus
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