Mechanistic study of the effect of flexible fixation and load‐bearing stress environment on fracture healing and shaping

Abstract Background The biomechanical environment created by suture‐button fixation Latarjet is conducive to the healing and shaping of the transplanted coracoid, but its mechanism remains unclear. The latest research has found that the absence of stem cell chemokine (CXCL12) impeded bone regeneration in Sonic Hedgehog (SHH)‐deficient animals. However, whether the biomechanical environment affects SHH and CXCL12 function has not been studied. Methods Rat fracture models were constructed to simulate stress environments under non‐load‐bearing and load‐bearing conditions. The fracture healing and shaping, as well as the expression levels of SHH and CXCL12, were assessed through gross viewing, micro‐computed tomography (micro‐CT), and histochemical staining. Results Under flexible fixation, the relative bone volume (BV/TV) of rats exposed to the load‐bearing stress environment was significantly higher than that of rats under a non‐load‐bearing stress environment (p ≤ 0.05). Adverse bone shaping was not observed in rats subjected to flexible fixation. The levels of SHH and CXCL12 in load‐bearing rats exhibited significant elevation (p ≤ 0.05). Under a load‐bearing stress environment, no significant difference was observed in the BV/TV between the flexible fixation group and the rigid fixation group (p ≥ 0.05), but there was excessive hyperplasia of the fracture callus in the rigid fixation group. The levels of SHH and CXCL12 in rats subjected to rigid fixation were significantly elevated (p ≤ 0.05). Conclusions Flexible fixation and load‐bearing stress environment may contribute to bone healing and shaping by influencing the levels of SHH and CXCL12, suggested that this mechanism may be relevant to the healing and shaping of the transplanted coracoid after suture‐button fixation Latarjet.