Optimum loading mode for axial stiffness testing in limb lengthening.

The axial stiffness of the regenerate is an indicator of bone healing after fracture or distraction osteogenesis. The axial stiffness may be assessed clinically by measuring the sharing of load between fixator and limb during loading. The aim of this study was to find out how to perform the stiffness test in order to minimize the influence of confounding factors to the test result. We investigated whether the test score was influenced by two factors: 1) the magnitude of the external load applied to the limb during the test; and 2) the patient's position during the test. The problem was approached by both a clinical study and by theoretical calculations. Thirty-three patients undergoing leg lengthening were tested regularly during the consolidation period. The stiffness test was executed with both high and low load, and in a standing and sitting position. There were significant differences in results between both the tests with high and low load, and between the standing and sitting tests. This indicated that both the magnitude of force and patient position during the test influenced the test result. Accordingly, these factors represent sources of error and must be taken into consideration when performing an axial stiffness test. The result of the theoretical calculations confirmed the result. We recommend performing the test while the patient is sitting, and to apply no more than 20% of the individual's body weight. It is also recommended that the same load be used in every test, when testing a patient several times during the treatment period.