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The Journal of Bone and Joint Surgery, Vol 59, Issue 2 188-192, Copyright © 1977 by Journal of Bone and Joint Surgery, Inc
The four biomechanical stages of fracture repair
AA White, MM Panjabi and WO Southwick
Based on analysis of the torque-angle curves and roentgenographic findings
in fifty-three healing tibial fractures in rabbits tested in torsion to
failure, four biomechanical stages of fracture healing were defined, as
follows: Stage I--failure through original fracture site, with low
stiffness; Stage II--failure through original fracture site, with high
stiffness; Stage III--failure partially through original fracture site and
partially through intact bone, with high stiffness; and Stage IV--failure
entirely through intact bone, with high stiffness. These stages correlated
with the progressive increases in the average torque and energy absorption
to failure as healing progressed and also with the average times since the
original experimental fracture. It is hoped that this system of staging
will provide both a standard by which important variables related to
ultimate strength of healing fractures can be correlated and an objective
way to predict delayed unions and non-unions and to determine the level of
activity that is safe for patients with a healing fracture.
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