Altering the course of fracture healing monitoring

Abstract

Effective detection of delayed union and non-union related to bone fracture healing can reduce the individual and social burdens associated with fracture management. Despite bone fracture is recognized as a global public health issue, incidences of worldwide fracture non-union exceeding 10% are still reported. Conventional monitoring of bone healing is still based on imaging methods, although their low measurement accuracy, high cost and inability of daily clinical follow-up. This study summarizes, for the first time, major breakthroughs carried out in the scope of non-imaging and alternative methodologies and technologies already proposed to monitor bone fracture healing, as well as their performances and experimental validation. A total of twelve methods and twenty-three technologies were already proposed to provide bone healing monitoring in external fixation systems and osteosynthesis plate systems. Technologies were categorized into six methodologies: vibrometry, electrical impedance, electric charge, electromagnetic radiation, magnetic induction and mechanical displacement. Research efforts have been mainly focused on electrical impedance and vibrometry approaches. Although most technologies are noninvasive and are able to monitor the callus evolution, they are not able to follow-up the fracture healing in multiple target regions, their operation requires extracorporeal excitations and they are not able to provide high specificity concerning the fracture healing states. The same conclusion is also true for the most sophisticated monitoring systems already developed to perform autonomous, remote and continuous monitoring. Future research directions are proposed in the scope of smart multifunctional bone implants.

Keywords

• Sensors for medical devices
• Physiological measurement
• Bone fracture healing
• Healing monitoring
• Instrumented implant
• Smart medical device