Growth mixture model of distraction osteogenesis: effect of pre-traction stresses

In tensional studies of bone fragments during limb lengthening, it is usually assumed that the stress level in the gap tissue before each distraction step (pre-traction stress) is rather modest. However, during the process of distraction osteogenesis, a large interfragmentary gap is generated and these pre-traction stresses may be important. To date, to the authors’ knowledge, no computational study has been developed to assess the effect of stress accumulation during limb lengthening. In this work, we present a macroscopic growth mixture formulation to investigate the influence of pre-traction stresses on the outcome of this clinical procedure. In particular, the model is applied to the simulation of the regeneration of tibial defects by means of distraction osteogenesis. The evolution of pre-traction forces, post-traction forces and peak forces is evaluated and compared with experimental data. The results show that the inclusion of pre-traction stresses in the model affects the evolution of the regeneration process and the corresponding reaction forces.