Measuring Orthopedic Plate Strain to Track Bone Healing Using a Fluidic Sensor Read via Plain Radiography.

ABSTRACT

OBJECTIVE: We describe a fluidic X-ray visualized strain indicator under applied load (X-VISUAL) to quantify orthopedic plate strain and inform rehabilitative care. METHODS: The sensor comprises a polymeric device with a fluidic reservoir filled with a radio-dense fluid (cesium acetate) and an adjoining capillary wherein the liquid level is measured. A stainless-steel lever attaches to the plate and presses upon the acrylic bulb with a displacement proportional to plate bending strain. The sensor was attached to a plate in a Sawbones composite tibia mimic and a human cadaveric tibia. An osteotomy model (5 mm gap) was used to simulate an unstable fracture, and allograft repair to simulate a stiffer healed fracture. The cadaveric and Sawbones tibia were cyclically loaded five times (0-400 N) using a mechanical test stand, and fluid displacement was measured from plain radiographs. RESULTS: The sensor displayed reversible and repeatable behavior with a slope of 0.096 mm/kg and fluid level noise of 50-80 micrometer (equivalent to 5-10 N). The allograft-repaired composite fracture was 13 times stiffer than the unstable fracture. CONCLUSION: An analysis of prior external fracture fixation studies and fatigue curves for internal plates indicates that the threshold for safe weight bearing should be 1/5th-1/10th of the initial bending for an unstable fracture. The precision of our device (<2% body weight) should thus be sufficient to track fracture healing from unstable through safe weight bearing. SIGNIFICANCE: The X-VISUAL fluidic sensor enables orthopedic plate strain quantification to monitor facture healing via X-ray imaging.