1. Mitchell Peterson, SPT Ashley Sundstrom, SPT Akeila Thompson, SPT Lauren Trail, SPT Jason Wheeler, SPT and Edilberto Raynes, MD, PhD (c) Department of Physical Therapy Pedal Your Way to New Bone

2. Introduction Complete fracture Incomplete fracture http://www.eorthopod.com/si tes/default/files/images/adult _femur_fx_anatomy04.jpg

4. Summary of Long Bone Fracture Biomechanics (McKinnis, 2010) Fracture Pattern Appearance Mechanism of Injury Location of Soft- Tissue Hinge* Energy TransverseBendingConcavityLow SpiralTorsion Vertical segment Low Oblique-transverse or butterfly Compression + bending Concavity or side of butterfly Mod Oblique Compression + bending + torsion Concavity (often destroyed) Mod ComminutedVariableDestroyedHigh Metaphyseal compression CompressionVariableVariable

5. Epidemiology of Femoral Shaft Fracture (citation) 3x more common between the ages of 25-65 1 per 10,000 people Average of 107 days of inability to participate in daily activities

6. Physiology of Bone (Peer, 2004) Bone is made up of: – Type 1 collagen – Proteins – Water – Osteoblasts – Osteoclasts – Osteocytes – Calcium – Hydroxyapatite

7. Mechanism of Bone Healing (cite) Bone is constantly turning over and responding to various factors. – Stress/Strain – Other osteogenic factors

8. Stages of Bone Healing (citation) Stage 1First 72 hoursHematoma formation Stage 23 days to 2 weeks Osteoblasts and fibroblasts migrate to the fracture site Stage 32 weeks to 6 weeksMaturation of the granulation tissue Stage 43 weeks to 6 months Reunion and ossification of the fracture site Stage 56 weeks to 1 yearConsolidation and remodeling

9. Research Gap The effect of cycling in relation to bone has been explored and examined. However, there has been no evidence-based studies that correlate resistive cycling as an intervention with transverse femoral fracture healing rates.

10. Research Question Does resistive cycling increase the rate of healing in a complete transverse femoral fracture?

11. Cycling as an Intervention (cite) Cycling is currently incorporated in the acute phase of fracture healing. – The goal of rehabilitation should be to implement weight bearing as soon as possible. – Full weight bearing is permitted once the bone has fully healed. – 30-45 minutes of pain free cycling on a flat surface is recommended.

12. Methodology

13. Results AuthorsTitleLOEDateResults Wilks,Gilliver, and Rittweger Forearm and Tibial Bone Measures of Distance- and Sprint- Trained 22009 Comparison of bone mineral density (BMD) in male sprint-trained cyclists between the ages of 30-82 was greater compared to controls that did not participate in physical fitness activities Warner, Shaw, and Dalsky Bone Mineral Density of Competitive Male Mountain and Road Cyclists 22002 Mountain cyclists had significantly greater BMD than road cyclists and controls due to more ground-induced loads Barry And Kohrt BMD Decreases Over the Course of A Year in Competitive Male Cylists 12008 Barry and Kohrt found that BMD significantly decreased in the femur in road cycling over the course of one year Compared the results of BMD of cycling with the results of various sports from power combat lifting to ballet and swimming and controls, showing that increased rate of strain and intensity magnify BMD.

14. Conclusion Based on our findings, we conclude that resistive cycling does increase the healing rate of transverse femoral fractures.

15. Considerations for Future Research Peer (cite other sources) Obesity increases the incidence of complications post fracture Femoral fractures fixated with intramedullary nails allow the patient to attend physical therapy earlier In order to achieve the benefits of osteoprotective exercise, professionals suggest weight bearing, physical activity 3- 5x/week.

16. Thank you!