Externalized Locked Plating With Monitoring of Fracture Healing Progression Using an Implant Load Sensor in Combination With Ground Reaction Force Measurements: A Clinical Case Series

Externalized locked plating (ELP) provides an alternative minimally invasive approach for treatment of unstable proximal and distal meta-diaphyseal tibia fractures with severe soft tissue damage. In a previous prospective clinical study including a virtual biomechanical analysis, 18 ELP patients were followed up to evaluate the clinical and functional outcomes. A recently developed sensor-based system enables continuous monitoring of implant load, providing objective and quantitative measures to improve fracture healing assessment. The aim of this clinical case series is to evaluate fracture healing progression and activity in ELB patients utilizing the implant load sensor (ILS) data alongside ground reaction force measurements. The ILS is externally mounted on several ELP patients, suffering unstable proximal or distal meta-diaphyseal tibia fractures with severe soft tissue damage. Its continuously acquired data is downloaded at monthly follow-up visits. In addition, directly postoperative and at the monthly follow-up visits, quasi-static loading sessions with incrementally increasing load levels ranging from 5 kg to 35 kg are recorded simultaneously by the ILS and a force plate system for ground reaction force measurement. Initial data demonstrates a good relation between the implant load and ground reaction force. The combination of ILS data evaluation and ground reaction force analysis offers a promising method for objective monitoring of fracture healing and rehabilitation progression in ELP patients.