The Ilizarov external fixator: What remains of the wire pretension after dynamic loading?

Background. Maintenance of wire pretension in an Ilizarov external fixator is dependent on the torque applied to the fixation bolts. We therefore measured immediately after surgery the clinically applied torques. The median value was only 10 N m (range 8–14 N m). We wondered whether this value is appropriate to maintain the wire pretension and thereby to achieve sufficient fracture stability during dynamic loading of the device for a longer period. Methods. A material testing machine dynamically loaded one wire mounted on one ring. Several configurations were tested. Results. A quick decrease in wire tension to a steady state situation was seen. In the most stable configuration (20 N m wire fixation torque) 50% of the initial 90 kg wire pretension remained after dynamic loading with 200 N. In the least stable configuration (10 N m torque) considerable wire slippage occurred even without loading and no tension remained after loading! No plastic deformation of the wires was observed so loss of wire tension was due to slippage of the wires through the fixation bolts. Interpretation. With the small fixation torques used in clinical practice considerable wire tension is lost even after a few loading cycles. Further research should address the question whether preservation of a higher wire tension during long term loading promotes faster fracture healing.