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Dias LGGG, Rocha TASS, Malta CAS, Minto BW, Carrera ALC. A Novel Dynamic Compression Angle-Stable Interlocking Intramedullary Nail: Description, Validation, and Model Evaluation. Vet Med Int 2025; 2025:7875699. [PMID: 40255609 PMCID: PMC12006711 DOI: 10.1155/vmi/7875699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 03/14/2025] [Indexed: 04/22/2025] Open
Abstract
The stabilization of long-bone fractures using intramedullary nails offers significant biological advantages for bone healing. Nevertheless, the mechanical stability of the implant-bone interface remains suboptimal due to the absence of models capable of generating interfragmentary compression at the fracture site. To address these limitations, this study aims to describe and evaluate a novel dynamic compression angle-stable interlocking intramedullary nail (DCASIN), designed for use in conjunction with a compression device (CD). Its performance was compared with conventional and angle-stable interlocking intramedullary nails. Implantation was demonstrated using a tube-based bone model with transverse fractures. Compression was achieved in the proximal aspect of the DCASIN through an oblong hole that allowed the insertion of a Steinmann pin, which was then subjected to the thrust of the CD's primary screw (PS). To evaluate dynamic compression, a load cell connected to the Arduino/Genuíno Uno software was utilized. Three groups of interlocking nails were assessed: G1 (conventional), G2 (angle-stable), and G3 (DCASIN), with measurements taken at four time points (M1: prelocking, M2: after the first screw or PS for the DCASIN, M3: after the second implant, and M4: one-minute post-M3). No statistically significant differences in compression forces were observed for G1 and G2 across the measured time points. In contrast, G3 exhibited significantly higher compression at M2 than at M3 and M4, and its compression forces at M2, M3, and M4 were significantly greater than those in G1 and G2. Finite element analysis revealed no significant deformation in G3 during compression. In conclusion, the DCASIN combined with the CD achieved and sustained superior compression forces compared to conventional and angle-stable nails, thereby offering a promising alternative for the internal fixation of long bones.
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Affiliation(s)
- Luís Gustavo Gosuen Gonçalves Dias
- Department of Veterinary Clinics and Surgery, School of Agricultural and Veterinarian Sciences of the São Paulo State University (FCAV UNESP), Jaboticabal, State of São Paulo, Brazil
| | | | - Caio Afonso Santos Malta
- Department of Veterinary Clinics and Surgery, School of Agricultural and Veterinarian Sciences of the São Paulo State University (FCAV UNESP), Jaboticabal, State of São Paulo, Brazil
| | - Bruno Watanabe Minto
- Department of Veterinary Clinics and Surgery, School of Agricultural and Veterinarian Sciences of the São Paulo State University (FCAV UNESP), Jaboticabal, State of São Paulo, Brazil
| | - Alefe Luiz Caliani Carrera
- Department of Veterinary Clinics and Surgery, School of Agricultural and Veterinarian Sciences of the São Paulo State University (FCAV UNESP), Jaboticabal, State of São Paulo, Brazil
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Takata K, Yugami M, Karata S, Karasugi T, Uehara Y, Masuda T, Nakamura T, Tokunaga T, Hisanaga S, Sugimoto K, Yonemitsu R, Ideo K, Fukuma Y, Uragami M, Arima T, Kawakami J, Maeda K, Yoshimura N, Matsunaga H, Kai Y, Tanimura S, Shimada M, Shibata Y, Tateyama M, Takata S, Goshogawa H, Yumoto M, Takashima Y, Inoue S, Ueno S, Kubo R, Tajiri R, Tian X, Honma F, Kawamura Y, Miyamoto T. Plates made from magnesium alloy with a long period stacking ordered structure promote bone formation in a rabbit fracture model. Sci Rep 2025; 15:12210. [PMID: 40204858 PMCID: PMC11982537 DOI: 10.1038/s41598-025-96853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 04/01/2025] [Indexed: 04/11/2025] Open
Abstract
Operative treatment is an option for fractures when the fracture is unstable or the patient wishes to return early to daily life or social activities. Metal plates such as titanium and stainless steel are often used in fracture surgery, but the metal plate lacks bone-healing activity and is not bioabsorbable, requiring a second surgery to remove it after bone union. Here we show that a magnesium (Mg) plate made from an alloy of yttrium, zinc, and aluminum with magnesium as the main component in a long-period stacking ordered structure promotes bone formation in a rabbit tibia fracture model and is also bioabsorbable. We show that the Mg plate significantly promoted bone and callus formation compared to a titanium plate in the rabbit tibia fracture model. Moreover, the Mg plate was mostly bioabsorbed once bone union was achieved, but rabbits showed no evidence of biotoxic effects, such as weight loss or increased blood magnesium levels. We also demonstrate that treatment with exogenous magnesium significantly enhanced calcium deposition in an in vitro osteoblast culture system. Magnesium is an essential element, and its radiolucency facilitates observation of the fracture site during Mg plate fixation, while its lack of magnetic properties allows its use in patients who require MRI scans. Accordingly, we propose that a use of a Mg plate could be beneficial in treating bone fracture.
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Affiliation(s)
- Kosei Takata
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Yugami
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Soichiro Karata
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsuki Karasugi
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yusuke Uehara
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tetsuro Masuda
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takayuki Nakamura
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takuya Tokunaga
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Satoshi Hisanaga
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kazuki Sugimoto
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryuji Yonemitsu
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Katsumasa Ideo
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuko Fukuma
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaru Uragami
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takahiro Arima
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Jyunki Kawakami
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kazuya Maeda
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoto Yoshimura
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideto Matsunaga
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Kai
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shuntaro Tanimura
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Shimada
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuto Shibata
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Makoto Tateyama
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shu Takata
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hikaru Goshogawa
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Mizuho Yumoto
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yusuke Takashima
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shinichi Inoue
- Magnesium Research Center & Department of Material Science, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-85565, Japan
| | - Syotaro Ueno
- Magnesium Research Center & Department of Material Science, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-85565, Japan
| | - Ryuta Kubo
- Department of Oral and Maxillofacial Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Rui Tajiri
- Department of Oral and Maxillofacial Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Xiao Tian
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Fuka Honma
- Department of Oral and Maxillofacial Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshihito Kawamura
- Magnesium Research Center & Department of Material Science, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-85565, Japan
| | - Takeshi Miyamoto
- Faculty of Life Sciences, Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Basci O, Aydemir S, Acan AE, Gursan O, Uzun B, Erduran M. The effect of screw hole inserts for the unused screw holes on the strength of a plate. J Orthop Surg Res 2025; 20:312. [PMID: 40128861 PMCID: PMC11934671 DOI: 10.1186/s13018-025-05686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 03/06/2025] [Indexed: 03/26/2025] Open
Abstract
INTRODUCTION The purpose of this study was to determine if the use of specially designed screw hole inserts in empty locking screw holes improves the strength and failure characteristics of locking plates. METHODS Forty-two 7-hole locking LC/DCP plates were mounted on cylindric UHMW Polyethylene blocks with a 1-cm gap between blocks, simulating a fracture with comminution and bone loss. 21 plates had a screw hole insert placed in the center hole (centered over the simulated fracture), while 21 of the plates remained empty in the center hole. The plate-block constructs were placed in a mechanical testing machine and subjected to loading conditions. The axial, bending, and torsional stiffness and displacements needed for the failure of each plate-block construct were calculated. The statistical analysis was performed using the Mann-Whitney U test for independent variables. RESULTS All plates were then loaded to failure. There were significant differences in the axial load to failure (p = 0.017), bending load to failure (p < 0.01), and bending displacements (p < 0.01) of the test groups favoring the screw hole insert group as higher mechanical strength. DISCUSSION/CONCLUSION In conclusion, the study demonstrates that the addition of the specially designed locking screw hole insert does significantly change the strength of the locking LC/DCP plates and might be suggested in the clinical application.
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Affiliation(s)
- Onur Basci
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
| | - Selahaddin Aydemir
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey.
| | - Ahmet Emrah Acan
- Department of Orthopaedics and Traumatology, Balıkesir University, Balıkesir, Turkey
| | - Onur Gursan
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
| | - Bora Uzun
- Department of Biomechanics, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Erduran
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
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Tseng TH, Hung CC, Yen HK, Chen HM, Wang CY, Tzeng SC, Fu SH. Higher nonunion rates with locking plates compared to dynamic compression plates in forearm diaphyseal fractures: a multicenter study. J Orthop Traumatol 2025; 26:10. [PMID: 39984810 PMCID: PMC11845636 DOI: 10.1186/s10195-025-00823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 02/02/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Dynamic compression plate (DCP) osteosynthesis is the gold standard for treating forearm diaphyseal fractures, providing stability and promoting healing. Locking plates (LPs) are increasingly used in modern fracture management but may increase the risk of nonunion if applied with excessive rigidity and without proper fracture site compression. The purpose of this study is to compare the nonunion rate between LPs and DCPs. MATERIALS AND METHODS We conducted a retrospective study by reviewing the medical records and radiographs of 515 patients diagnosed with radial and/or ulnar shaft fractures at three trauma centers between 2014 and 2019. Inclusion criteria were patients treated with locking plates (LPs), locking compression plates (LCPs), or dynamic compression plates (DCPs) who had at least 9 months of outpatient follow-up and imaging assessments. Exclusion criteria included treatment with other methods, hospitalization for pathological fractures or implant removal, or incomplete surgical records. Data on patient demographics, injury details, and surgical outcomes were collected to compare nonunion rates, as well as early and late complications, between the LP and DCP groups. RESULTS A total of 368 patients were included in the analysis. Among them, 132 (35.9%) had isolated radial shaft fractures, 116 (31.5%) had isolated ulnar shaft fractures, and 120 (32.6%) had both-bone fractures. Of these, 124 patients received LP implants, 98 were treated with LCPs, and 146 were treated with DCPs. Early complications were comparable among the groups; however, the nonunion rate was significantly higher in the LP group (18.5% versus 11.2% versus 6.2%, p < 0.007). Logistic regression identified LP use [odds ratio (OR): 3.05, 95% confidence interval (CI) 1.24-7.53] as a significant predictor of nonunion. Notably, LPs lacking dynamic compression functionality were associated with markedly higher odds of nonunion in radial shaft fractures (OR: 26.94, 95% CI 3.52-206.15). These findings collectively indicate that LPs increase the nonunion rate in forearm fractures. CONCLUSIONS Using LPs without compression functionality to treat forearm diaphyseal fractures increases the nonunion rate, particularly in radial shaft fractures. Therefore, we recommend using LCPs or DCPs for forearm diaphyseal fractures to ensure adequate compression at the fracture site during fixation, thereby promoting optimal bone healing rates. LEVEL OF EVIDENCE Level III: retrospective comparative therapeutic study.
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Affiliation(s)
- Tzu-Hao Tseng
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7 Chungsan South Road, Taipei, 10002, Taiwan
| | - Chih-Chien Hung
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Yunlin County 632, Douliu, Taiwan
| | - Hung-Kuan Yen
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7 Chungsan South Road, Taipei, 10002, Taiwan
| | - Ho-Min Chen
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Shi-Chien Tzeng
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7 Chungsan South Road, Taipei, 10002, Taiwan.
| | - Shau-Huai Fu
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7 Chungsan South Road, Taipei, 10002, Taiwan.
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Yunlin County 632, Douliu, Taiwan.
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Cho SM, Yang BE, Kim WH, Park SY, On SW, Lee JH, Byun SH. Biomechanical stability of magnesium plate and screw fixation systems in LeFort I osteotomy: a three-dimensional finite element analysis. Maxillofac Plast Reconstr Surg 2024; 46:40. [PMID: 39692988 DOI: 10.1186/s40902-024-00451-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 11/25/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND Titanium (Ti-6Al-4 V) is used for fixation in LeFort I osteotomy, a procedure for treating midface deformities. This study assessed the biomechanical stabilities of two Mg alloys (WE43 and ZK60) as biodegradable alternatives and compared them against Ti using finite element analyses. The LeFort I osteotomy procedure was simulated, and various plate and screw configurations were tested. The maximum principal and peak von Mises stresses in the metal plates and bone screws were measured under four load conditions, and the stability was evaluated. RESULTS The holes in the Mg screws, as compared with the Ti counterparts, exhibited higher and lower stress levels in the cortical and cancellous bones, respectively. The Mg screws also exhibited a higher fracture risk. The ZK60 plate, as compared with the Ti and WE43 plates, exhibited a lower fracture risk under all load conditions. ZK60 exhibited higher biomechanical stability in terms of maintaining the gap between osteotomy surfaces and lower fracture risk; the osteotomy surfaces with Ti im-plants underwent bone impaction, resulting in gap closure. CONCLUSIONS Although the Mg implants exhibited better stress distribution, their screw strength requires improvement. Appropriate improvements can promote the use of Mg alloys in bone fixation applications.
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Affiliation(s)
- Su-Min Cho
- Department of Prosthodontics, Hallym University Sacred Heart Hospital, Anyang, 14066, Republic of Korea
- Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Byoung-Eun Yang
- Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Republic of Korea
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang, 14066, Republic of Korea
| | - Won-Hyeon Kim
- Dental Life Science Research Institute/Innovation Research & Support Center for Dental Science, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang, 14066, Republic of Korea
- Institute of Clinical Dentistry, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Sung-Woon On
- Graduate School of Clinical Dentistry, Hallym University, Chuncheon, 24252, Republic of Korea
- Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 18450, Republic of Korea
| | - Jong-Ho Lee
- Oral Oncology Clinic, Research Institute & Hospital, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang, 14066, Republic of Korea.
- Dental Robotic Center, Hallym University Sacred Heart Hospital, Anyang, 14066, Republic of Korea.
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Liu C, Sha D, Zhao L, Zhou C, Sun L, Liu C, Yuan Y. Design and Improvement of Bone Adhesive in response to Clinical Needs. Adv Healthc Mater 2024; 13:e2401687. [PMID: 39375984 DOI: 10.1002/adhm.202401687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/21/2024] [Indexed: 10/09/2024]
Abstract
Fracture represents one of the most common diagnoses in contemporary medical practice, with the majority of cases traditionally addressed through metallic device fixation. However, this approach is marred by several drawbacks, including prolonged operative durations, considerable expenses, suboptimal applicability to comminuted fractures, increased infection risks, and the inevitable requirement for secondary surgery. The inherent advantages of bone adhesives in these fields have garnered the attention of orthopedic surgeons, who have commenced utilizing biocompatible and biodegradable bone adhesives to bond and stabilize bone fragments. Regrettably, the current bone adhesives generally exhibit insufficient adhesive strength in vivo environments, and it is desirable for them to possess effective osteogenesis to facilitate fracture healing. Consequently, aligning bone adhesives with practical clinical demands remains a significant hurdle, which has catalyzed a surge in research endeavors. Within this review, the conceptual framework, characteristics, and design ideas of bone adhesives based on clinical needs are delineated. Recent advancements in this domain, specifically focusing on the enhancement of two pivotal characteristics-adhesive strength and osteogenic potential are also reviewed. Finally, a prospective analysis of the future advancements in bone adhesives, offering new insights into solutions for diverse clinical problems is presented.
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Affiliation(s)
- Chenyu Liu
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Dongyong Sha
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Lingfei Zhao
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Chuanwei Zhou
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Lili Sun
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Changsheng Liu
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
| | - Yuan Yuan
- Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P.R. China
- Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P.R. China
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Akkad DT, Phull SS, Towler MR. Evaluating the physico-chemical properties of water-based and 2% lidocaine hydrochloride-based aluminum-free glass polyalkenoate cements for distal radius fixation. J Biomater Appl 2024; 39:343-354. [PMID: 39079098 DOI: 10.1177/08853282241268669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Lidocaine hydrochloride is used as an anesthetic for clinical applications. This study considers the effects of the substitution of 2% lidocaine hydrochloride for deionized (DI) water on the rheological, mechanical, ion release, pH and injectable properties of two formulations of aluminum-free glass polyalkenoate cements (GPCs) using two distinct poly(acrylic) acids (PAA), E9 and E11, which have different molecular weights (Mw). The substitution of 2% lidocaine hydrochloride demonstrated increased injectability, but did not affect mechanical properties. The mechanical properties increased with time, as expected, and, in general, E9-based GPCs displayed significantly higher strengths over E11-based GPCs. With respect to ion release, which includes calcium (Ca), strontium (Sr), zinc (Zn) and silicon (Si); all ions displayed a steady and consistent increased release over time. Ca and Sr showed similar ion release patterns, whereby the GPC made with E11 PAA and lidocaine hydrochloride released significantly more ions than all other compositions likely due to similar chemical kinetics. However, Zn is also divalent in nature, but displayed only one significant difference across the GPC series at all time points, which was attributed to its higher electronegativity allowing for increased participation in the setting reaction. Finally, an analysis of the pH confirmed an increase in pH with time, suggesting that H+ ions were attacking the glass structure to allow for ion release. After 1 and 7 days, water-based GPCs environments achieved a higher pH than lidocaine hydrochloride-based GPCs, indicating that the lidocaine hydrochloride may be releasing additional protons upon bond formation with PAA.
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Affiliation(s)
- Danny T Akkad
- Department of Mechanical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sunjeev S Phull
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - Mark R Towler
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, USA
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Jeon YD, Jung KH, Kim MS, Kim H, Yoon DK, Park KB. Clinical validation of artificial intelligence-based preoperative virtual reduction for Neer 3- or 4-part proximal humerus fractures. BMC Musculoskelet Disord 2024; 25:669. [PMID: 39192203 DOI: 10.1186/s12891-024-07798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND If reduction images of fractures can be provided in advance with artificial-intelligence (AI)-based technology, it can assist with preoperative surgical planning. Recently, we developed the AI-based preoperative virtual reduction model for orthopedic trauma, which can provide an automatic segmentation and reduction of fractured fragments. The purpose of this study was to validate a quality of reduction model of Neer 3- or 4-part proximal humerus fractures established by AI-based technology. METHODS To develop the AI-based preoperative virtual reduction model, deep learning performed the segmentation of fracture fragments, and a Monte Carlo simulation completed the virtual reduction to determine the best model. A total of 20 pre/postoperative three-dimensional computed tomography (CT) scans of proximal humerus fracture were prepared. The preoperative CT scans were employed as the input of AI-based automated reduction (AI-R) to deduce the reduction models of fracture fragments, meanwhile, the manual reduction (MR) was conducted using the same CT images. Dice similarity coefficient (DSC) and intersection over union (IoU) between the reduction model from the AI-R/MR and postoperative CT scans were evaluated. Working times were compared between the two groups. Clinical validity agreement (CVA) and reduction quality score (RQS) were investigated for clinical validation outcomes by 20 orthopedic surgeons. RESULTS The mean DSC and IoU were better when using AI-R that when using MR (0.78 ± 0.13 vs. 0.69 ± 0.16, p < 0.001 and 0.65 ± 0.16 vs. 0.55 ± 0.18, p < 0.001, respectively). The working time of AI-R was, on average, 1.41% of that of MR. The mean CVA of all cases was 81%±14.7% (AI-R, 82.25%±14.27%; MR, 76.75%±14.17%, p = 0.06). The mean RQS was significantly higher when AI-R compared with MR was used (91.47 ± 1.12 vs. 89.30 ± 1.62, p = 0.045). CONCLUSION The AI-based preoperative virtual reduction model showed good performance in the reduction model in proximal humerus fractures with faster working times. Beyond diagnosis, classification, and outcome prediction, the AI-based technology can change the paradigm of preoperative surgical planning in orthopedic surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Young Dae Jeon
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, 25, Daehakbyeongwon-ro, Dong-Gu, Ulsan, 44033, Republic of Korea
| | - Kwang-Hwan Jung
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, 25, Daehakbyeongwon-ro, Dong-Gu, Ulsan, 44033, Republic of Korea
| | - Moo-Sub Kim
- Industrial R&D Center, KAVILAB Co. Ltd, Seoul, Republic of Korea
| | - Hyeonjoo Kim
- Industrial R&D Center, KAVILAB Co. Ltd, Seoul, Republic of Korea
| | - Do-Kun Yoon
- Industrial R&D Center, KAVILAB Co. Ltd, Seoul, Republic of Korea
| | - Ki-Bong Park
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, 25, Daehakbyeongwon-ro, Dong-Gu, Ulsan, 44033, Republic of Korea.
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9
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Bowers KM, Anderson DE. Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review. Bioengineering (Basel) 2024; 11:525. [PMID: 38927761 PMCID: PMC11201148 DOI: 10.3390/bioengineering11060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.
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Affiliation(s)
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996-4550, USA;
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10
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Foppiani JA, Taritsa IC, Foster L, Patel A, Hernandez Alvarez A, Lee D, Lin GJ, Lee TC, Gavlasova D, Escobar-Domingo MJ, Kaplan DL, Lin SJ. Redefining Surgical Materials: Applications of Silk Fibroin in Osteofixation and Fracture Repair. Biomimetics (Basel) 2024; 9:286. [PMID: 38786496 PMCID: PMC11118403 DOI: 10.3390/biomimetics9050286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
Silk and silk derivatives have emerged as a possible alternative in surgical device development, offering mechanical strength, biocompatibility, and environmental sustainability. Through a systematic review following PRISMA guidelines, this study evaluated silk fibroin's application across pre-clinical and clinical settings, focusing on its role as screws and plates for osteofixation. A comprehensive search yielded 245 studies, with 33 subjected to full-text review and 15 ultimately included for qualitative analysis. The findings underscore silk fibroin's superior properties, including its tunable degradation rates and ability to be functionalized with therapeutic agents. In vivo and in vitro studies demonstrated its efficacy in enhancing bone healing, offering improved outcomes in osteofixation, particularly for craniofacial defects. Silk fibroin's remarkable attributes in biodegradation and drug release capabilities underscore its potential to enhance patient care. Ultimately, silk fibroin's integration into surgical practices promises a revolution in patient outcomes and environmental sustainability. Its versatility, coupled with the continuous progress in fabrication techniques, signals a promising horizon for its widespread acceptance in the medical field, potentially establishing a new benchmark in surgical treatment. Further research is expected to solidify the transition of silk products from basic science to patient care, paving the way for widespread use in various surgical applications.
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Affiliation(s)
- Jose A. Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
| | - Iulianna C. Taritsa
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
| | - Lacey Foster
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Armaan Patel
- Department of Biomedical Engineering, Tufts University, Boston, MA 02155, USA; (A.P.)
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
| | - Daniela Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
| | - Gavin J. Lin
- Nobles and Greenough School, Dedham, MA 02026, USA
| | | | - Dominika Gavlasova
- Institute of Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Maria J. Escobar-Domingo
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Boston, MA 02155, USA; (A.P.)
| | - Samuel J. Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (D.L.)
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11
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Wee H, Spence Reid J, Lewis GS. Finite element modeling of fracture compression by compression plates. J Orthop Res 2024; 42:1123-1133. [PMID: 38053299 PMCID: PMC11009078 DOI: 10.1002/jor.25759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Dynamic compression plating is a common type of fracture fixation used to compress between bone fragments. The quality of compression across the fracture is important for postoperative stability and primary bone healing. Compression quality may be affected by surgical variations in plate prebend, screw location, screw torque, fracture gap, and implant material. Computational modeling provides a tool for systematically examining these factors, and for visualizing the mechanisms involved. The purpose of this study was to develop a finite element model of dynamic compression plating that includes screw insertion under torque control, establish model credibility through sensitivity analyses and experimental validation, and use the model to examine the effects of surgical variables on fracture compression and postoperative stability. Model-predicted compressive pressures had good agreement with corresponding synthetic bones experiments under a variety of conditions. Models demonstrated that introducing a 1.5 or 3 mm plate prebend (using a 4.5 mm narrow LCP plate) eliminated gapping at the far cortex, which is consistent with clinical recommendations. However, models also revealed that plate prebend led to sharp decreases in fracture compressive force, exceeding 80% in some cases. A 1.5 mm plate prebend resulted in the most uniform pressures across the fracture. Testing of a simplified model form used in previous computational modeling studies showed large inaccuracies for constructs with plate prebend. This study provides the first experimentally validated computational models of dynamic compression plate fracture fixation, and reveals important effects of plate prebend and fracture gap on fracture compression quality.
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Affiliation(s)
- Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - John Spence Reid
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
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12
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Wee H, Staub J, Koroneos Z, Kunselman A, Reid JS, Lewis GS. Mechanics of dynamic compression plate application in fracture fixation. Clin Biomech (Bristol, Avon) 2024; 113:106209. [PMID: 38401319 PMCID: PMC11091841 DOI: 10.1016/j.clinbiomech.2024.106209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Dynamic compression plating is a fundamental type of bone fracture fixation used to generate interfragmentary compression. The goal of this study was to investigate the mechanics of the surgical application of these plates, specifically how plate prebend, screw location, fracture gap, and applied torque influence the resulting compressive pressures. METHODS Synthetic bones with transverse fractures were fixed with locking compression plates. One side of the fracture was fixed with locking screws. On the other side of the fracture, a nonlocking screw was inserted eccentrically to induce interfragmentary compression. A pressure mapping sensor within the fracture gap was used to record the resulting pressure distribution. Plate prebends of 0 mm, 1.5 mm, and 3 mm were tested. Three locations of the eccentric screw, four levels of screw torque, and two initial fracture gap conditions also were tested. FINDINGS With increasing plate prebend, fracture compression pressures shifted significantly toward the far cortex; however, compression force decreased (P < 0.05). The 1.5 mm prebend plate resulted in the greatest contact area. Increasing screw torque generally resulted in greater fracture compression force. The introduction of a 1 mm fracture gap at the far cortex prior to dynamic compression resulted in little or no fracture compression. INTERPRETATION The model showed that increasing plate prebend results in an increasing shift of fracture compression pressures toward the far cortex; however, this is accompanied by decreases in compressive force. Initial fracture gaps at the far cortex can result in little or no compression.
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Affiliation(s)
- Hwabok Wee
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Jacob Staub
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Zachary Koroneos
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - J Spence Reid
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Gregory S Lewis
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
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13
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Assink N, Oldhoff MGE, Ten Duis K, Kraeima J, Doornberg JN, Witjes MJH, de Vries JPPM, Meesters AML, IJpma FFA. Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery. Eur J Trauma Emerg Surg 2024; 50:11-19. [PMID: 37391531 PMCID: PMC10924019 DOI: 10.1007/s00068-023-02313-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A substantial proportion of conventional tibial plateau plates have a poor fit, which may result in suboptimal fracture reduction due to applied -uncontrolled- compression on the bone. This study aimed to assess whether patient-specific osteosyntheses could facilitate proper fracture reduction in medial tibial plateau fractures. METHODS In three Thiel embalmed human cadavers, a total of six tibial plateau fractures (three Schatzker 4, and three Schatzker 6) were created and CT scans were made. A 3D surgical plan was created and a patient-specific implant was designed and fabricated for each fracture. Drilling guides that fitted on top of the customized plates were designed and 3D printed in order to assist the surgeon in positioning the plate and steering the screws in the preplanned direction. After surgery, a postoperative CT scan was obtained and outcome was compared with the preoperative planning in terms of articular reduction, plate positioning, and screw direction. RESULTS A total of six patient-specific implants including 41 screws were used to operate six tibial plateau fractures. Three fractures were treated with single plating, and three fractures with dual plating. The median intra-articular gap was reduced from 6.0 (IQR 4.5-9.5) to 0.9 mm (IQR 0.2-1.4), whereas the median step-off was reduced from 4.8 (IQR 4.1-5.3) to 1.3 mm (IQR 0.9-1.5). The median Euclidean distance between the centre of gravity of the planned and actual implant was 3.0 mm (IQR: 2.8-3.7). The lengths of the screws were according to the predetermined plan. None of the screws led to screw penetration. The median difference between the planned and actual screw direction was 3.3° (IQR: 2.5-5.1). CONCLUSION This feasibility study described the development and implementation of a patient-specific workflow for medial tibial plateau fracture surgery that facilitates proper fracture reduction, tibial alignment and accurately placed screws by using custom-made osteosynthesis plates with drilling guides.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joep Kraeima
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Max J H Witjes
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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14
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Mischler D, Gueorguiev B, Windolf M, Varga P. On the importance of accurate elasto-plastic material properties in simulating plate osteosynthesis failure. Front Bioeng Biotechnol 2023; 11:1268787. [PMID: 38107614 PMCID: PMC10725216 DOI: 10.3389/fbioe.2023.1268787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background: Plate osteosynthesis is a widely used technique for bone fracture fixation; however, complications such as plate bending remain a significant clinical concern. A better understanding of the failure mechanisms behind plate osteosynthesis is crucial for improving treatment outcomes. This study aimed to develop finite element (FE) models to predict plate bending failure and validate these against in vitro experiments using literature-based and experimentally determined implant material properties. Methods: Plate fixations of seven cadaveric tibia shaft fractures were tested to failure in a biomechanical setup with various implant configurations. FE models of the bone-implant constructs were developed from computed tomography (CT) scans. Elasto-plastic implant material properties were assigned using either literature data or the experimentally derived data. The predictive capability of these two FE modelling approaches was assessed based on the experimental ground truth. Results: The FE simulations provided quantitatively correct prediction of the in vitro cadaveric experiments in terms of construct stiffness [concordance correlation coefficient (CCC) = 0.97, standard error of estimate (SEE) = 23.66, relative standard error (RSE) = 10.3%], yield load (CCC = 0.97, SEE = 41.21N, RSE = 7.7%), and maximum force (CCC = 0.96, SEE = 35.04, RSE = 9.3%), when including the experimentally determined material properties. Literature-based properties led to inferior accuracies for both stiffness (CCC = 0.92, SEE = 27.62, RSE = 19.6%), yield load (CCC = 0.83, SEE = 46.53N, RSE = 21.4%), and maximum force (CCC = 0.86, SEE = 57.71, RSE = 14.4%). Conclusion: The validated FE model allows for accurate prediction of plate osteosynthesis construct behaviour beyond the elastic regime but only when using experimentally determined implant material properties. Literature-based material properties led to inferior predictability. These validated models have the potential to be utilized for assessing the loads leading to plastic deformation in vivo, as well as aiding in preoperative planning and postoperative rehabilitation protocols.
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Affiliation(s)
- Dominic Mischler
- AO Research Institute Davos, Davos, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | | | | | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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15
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Bowers KM, Terrones LD, Sun X, Rifkin R, Croy E, Adair HS, Mulon PY, Hecht S, Anderson DE. Changes in tibial cortical dimensions and density associated with long-term locking plate fixation in goats. J Exp Orthop 2023; 10:111. [PMID: 37934300 PMCID: PMC10634227 DOI: 10.1186/s40634-023-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Cortical porosis, secondary to either vascular injury or stress-shielding, is a comorbidity of fracture fixation using compression bone plating. Locking plate constructs have unique mechanics of load transmission and lack of reliance on contact pressures for fixation stability, so secondary cortical porosis adjacent to the plate has not been widely investigated. Therefore, this study aimed to assess the effects of long-term locking plate fixation on cortical dimensions and density in a caprine tibial segmental ostectomy model. METHODS Data was acquired from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over periods of 3, 6, 9, and 12 months. Quantitative data included tibial cortical width measurements and three-dimensionally reconstructed slab density measurements, both assessed using computed tomographic examinations performed at the time of plate removal. Additional surgical and demographic variables were analyzed for effect on cortical widths and density, and all cis-cortex measurements were compared to both the trans-cortex and to the contralateral limbs. RESULTS The tibial cis-cortex was significantly wider and more irregular than the trans-cortex at the same level. This width asymmetry differed in both magnitude and direction from the contralateral limb. The bone underlying the plate was significantly less dense than the trans-cortex, and this cortical density difference was significantly greater than that of the contralateral limb. These cortical changes were independent of both duration of fixation and degree of ostectomy bone healing. CONCLUSIONS This study provides evidence that cortical bone loss consistent with cortical porosity is a comorbidity of locking plate fixation in a caprine tibial ostectomy model. Further research is necessary to identify risk factors for locking-plate-associated bone loss and to inform clinical decisions in cases necessitating long-term locking plate fixation.
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Affiliation(s)
- Kristin M Bowers
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA.
| | - Lori D Terrones
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, USA
| | - Rebecca Rifkin
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Elizabeth Croy
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Henry S Adair
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Silke Hecht
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - David E Anderson
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
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16
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Antoniac I, Manescu (Paltanea) V, Antoniac A, Paltanea G. Magnesium-based alloys with adapted interfaces for bone implants and tissue engineering. Regen Biomater 2023; 10:rbad095. [PMID: 38020233 PMCID: PMC10664085 DOI: 10.1093/rb/rbad095] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Magnesium and its alloys are one of the most used materials for bone implants and tissue engineering. They are characterized by numerous advantages such as biodegradability, high biocompatibility and mechanical properties with values close to the human bone. Unfortunately, the implant surface must be adequately tuned, or Mg-based alloys must be alloyed with other chemical elements due to their increased corrosion effect in physiological media. This article reviews the clinical challenges related to bone repair and regeneration, classifying bone defects and presenting some of the most used and modern therapies for bone injuries, such as Ilizarov or Masquelet techniques or stem cell treatments. The implant interface challenges are related to new bone formation and fracture healing, implant degradation and hydrogen release. A detailed analysis of mechanical properties during implant degradation is extensively described based on different literature studies that included in vitro and in vivo tests correlated with material properties' characterization. Mg-based trauma implants such as plates and screws, intramedullary nails, Herbert screws, spine cages, rings for joint treatment and regenerative scaffolds are presented, taking into consideration their manufacturing technology, the implant geometrical dimensions and shape, the type of in vivo or in vitro studies and fracture localization. Modern technologies that modify or adapt the Mg-based implant interfaces are described by presenting the main surface microstructural modifications, physical deposition and chemical conversion coatings. The last part of the article provides some recommendations from a translational perspective, identifies the challenges associated with Mg-based implants and presents some future opportunities. This review outlines the available literature on trauma and regenerative bone implants and describes the main techniques used to control the alloy corrosion rate and the cellular environment of the implant.
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Affiliation(s)
- Iulian Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
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Josephson TO, Morgan EF. Harnessing mechanical cues in the cellular microenvironment for bone regeneration. Front Physiol 2023; 14:1232698. [PMID: 37877097 PMCID: PMC10591087 DOI: 10.3389/fphys.2023.1232698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
At the macroscale, bones experience a variety of compressive and tensile loads, and these loads cause deformations of the cortical and trabecular microstructure. These deformations produce a variety of stimuli in the cellular microenvironment that can influence the differentiation of marrow stromal cells (MSCs) and the activity of cells of the MSC lineage, including osteoblasts, osteocytes, and chondrocytes. Mechanotransduction, or conversion of mechanical stimuli to biochemical and biological signals, is thus part of a multiscale mechanobiological process that drives bone modeling, remodeling, fracture healing, and implant osseointegration. Despite strong evidence of the influence of a variety of mechanical cues, and multiple paradigms proposed to explain the influence of these cues on tissue growth and differentiation, even a working understanding of how skeletal cells respond to the complex combinations of stimuli in their microenvironments remains elusive. This review covers the current understanding of what types of microenvironmental mechanical cues MSCs respond to and what is known about how they respond in the presence of multiple such cues. We argue that in order to realize the vast potential for harnessing the cellular microenvironment for the enhancement of bone regeneration, additional investigations of how combinations of mechanical cues influence bone regeneration are needed.
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Affiliation(s)
- Timothy O. Josephson
- Biomedical Engineering, Boston University, Boston, MA, United States
- Center for Multiscale and Translational Mechanobiology, Boston University, Boston, MA, United States
| | - Elise F. Morgan
- Biomedical Engineering, Boston University, Boston, MA, United States
- Center for Multiscale and Translational Mechanobiology, Boston University, Boston, MA, United States
- Mechanical Engineering, Boston University, Boston, MA, United States
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18
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Barcik J, Ernst M, Buchholz T, Constant C, Mys K, Epari DR, Zeiter S, Windolf M. The absence of immediate stimulation delays bone healing. Bone 2023; 175:116834. [PMID: 37385428 DOI: 10.1016/j.bone.2023.116834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
AIM Secondary bone healing requires an adequate level of mechanical stimulation expressed by the extent of interfragmentary motion in the fracture. However, there is no consensus about when the mechanical stimulation should be initiated to ensure a timely healing response. Therefore, this study aims to compare the effect of the immediate and delayed application of mechanical stimulation in a large animal model. METHODS Twelve Swiss White Alpine sheep underwent partial osteotomy of a tibia that was stabilised with an active fixator inducing well-controlled mechanical stimulation. Animals were randomly assigned into two groups with different stimulation protocols. The immediate group received daily stimulation (1000 cycles/day) from the first day post-operation, while in the delayed group, stimulation began only on the 22nd day post-operation. Healing progression was evaluated daily by measuring the in vivo stiffness of the repair tissue and by quantifying callus area on weekly radiographs. All animals were euthanised five weeks post-op. Post-mortem callus volume was determined from high-resolution computer tomography (HRCT). RESULTS Fracture stiffness (p < 0.05) and callus area (p < 0.01) were significantly larger for the immediate group compared to the delayed stimulation group. In addition, the callus volume measured on the post-mortem HRCT showed 319 % greater callus volume for the immediate stimulation group (p < 0.01). CONCLUSIONS This study demonstrates that a delay in the onset of mechanical stimulation retards fracture callus development and that mechanical stimulation already applied in the early post-op phase promotes bone healing.
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Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Tim Buchholz
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Caroline Constant
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Karen Mys
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Devakara R Epari
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, George Street 2, Brisbane, QLD 4000, Australia
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
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19
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von Rüden C, Rehme-Röhrl J, Augat P, Friederichs J, Hackl S, Stuby F, Trapp O. Evidence on treatment of clavicle fractures. Injury 2023; 54 Suppl 5:110818. [PMID: 37217399 DOI: 10.1016/j.injury.2023.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
Depending on the severity of the injury and the involvement of the soft tissue envelope, clavicle fractures can be treated operatively or non-operatively. In the past, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the rate of nonunion following non-operative treatment seems to be higher than previously reported. In addition, publications reporting better functional outcomes following operative treatment are increasing. In recent years this has led to a paradigm shift towards an increase of operative fracture treatment. The aim of this review article was to summarize the currently available evidence on the treatment of clavicle fractures. Classifications, indications, and treatment options for different fracture patterns of the medial, midshaft, and lateral clavicles are presented and discussed.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Weiden Medical Center, Weiden/ Oberpfalz, Germany; Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
| | - Julia Rehme-Röhrl
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Simon Hackl
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Fabian Stuby
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Oliver Trapp
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
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20
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Abdullah M, Mubashar A, Uddin E. Structural optimization of orthopedic hip implant using parametric and non-parametric optimization techniques. Biomed Phys Eng Express 2023; 9:055026. [PMID: 37536305 DOI: 10.1088/2057-1976/aced0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/03/2023] [Indexed: 08/05/2023]
Abstract
This research investigates the reduction in weight of hip implant by the application of parametric and non-parametric optimization techniques. Orthopaedic hip implants can be made from metals, ceramics, composites, or metallic alloys and are generally solid structures. The stiffness of orthopaedic hip implant is a pertaining problem when implanted in the human body as Hip implant are stiffer than bone material and causes stress shielding. This results in bone weakening which causes osteoporosis. Reduction in mass of femur stem results in stiffness reduction of femur stem. Non-Parametric topology optimization results in 34.9% mass reduction and parametric optimization based on Central Composite Design technique in Design of Experiments (DoE) uses hole diameters as parameters and performs structural optimization that results in 22% mass reduction.
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Affiliation(s)
- Muhammad Abdullah
- Post Graduate Student at the School of Mechanical & Manufacturing Engineering, (SMME), National University of Science and Technology (NUST), Islamabad, Pakistan
| | - Aamir Mubashar
- School of Mechanical & Manufacturing Engineering, (SMME), National University of Science and Technology (NUST), Islamabad, Pakistan
| | - Emad Uddin
- School of Mechanical & Manufacturing Engineering, (SMME), National University of Science and Technology (NUST), Islamabad, Pakistan
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21
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Subasi O, Karaismailoglu B, Ashkani-Esfahani S, Lazoglu I. Investigation of lattice infill parameters for additively manufactured bone fracture plates to reduce stress shielding. Comput Biol Med 2023; 161:107062. [PMID: 37235944 DOI: 10.1016/j.compbiomed.2023.107062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stress shielding is a detrimental phenomenon caused by the stiffness mismatch between metallic bone plates and bone tissue, which can hamper fracture healing. Additively manufactured plates can decrease plate stiffness and alleviate the stress shielding effect. METHODS Rectilinear lattice plates with varying cell sizes, wall thicknesses, and orientations are computationally generated. Finite element analysis is used to calculate the four-point bending stiffness and strength of the plates. The mechanical behaviors of three different lattice plates are also simulated under a simple diaphyseal fracture fixation scenario. RESULTS The study shows that with different combinations of lattice infill parameters, plates with up to 68% decrease in stiffness compared to the 100% infill plate can be created. Moreover, in the fixation simulations, the least stiff lattice plate displays 53% more average stress distribution at the healing callus region compared to the 100% infill plate. CONCLUSIONS Using computational techniques, it has been demonstrated that additively manufactured stiffness-reduced bone plates can successfully address stress shielding with the strategic modulation of lattice infill parameters. Lattice plates with design versatility have the potential for use in various fracture fixation scenarios.
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Affiliation(s)
- Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Manufacturing and Automation Research Center, Koc University, Istanbul, 34450, Turkey.
| | - Bedri Karaismailoglu
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey; CAST (Cerrahpasa Research Simulation and Design) Laboratory, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| | - Ismail Lazoglu
- Manufacturing and Automation Research Center, Koc University, Istanbul, 34450, Turkey
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22
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Zhang Y, Cao J, Jian M, Zhou Z, Anwar N, Xiao L, Ma Y, Zhang D, Zhang J, Wang X. Fabrication of Interleukin-4 Encapsulated Bioactive Microdroplets for Regulating Inflammation and Promoting Osteogenesis. Int J Nanomedicine 2023; 18:2019-2035. [PMID: 37155503 PMCID: PMC10122853 DOI: 10.2147/ijn.s397359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
Background Despite the inherent regenerative ability of bone, large bone defect regeneration remains a major clinical challenge for orthopedic surgery. Therapeutic strategies medicated by M2 phenotypic macrophages or M2 macrophage inducer have been widely used to promote tissue remodeling. In this study, ultrasound-responsive bioactive microdroplets (MDs) encapsulated with bioactive molecule interleukin-4 (IL4, hereafter designated MDs-IL4) were fabricated to regulate macrophage polarization and potentiate the osteogenic differentiation of human mesenchymal stem cells (hBMSCs). Materials and Methods The MTT assay, live and dead staining, and phalloidin/DAPI dual staining were used to evaluate biocompatibility in vitro. H&E staining was used to evaluate biocompatibility in vivo. Inflammatory macrophages were further induced via lipopolysaccharide (LPS) stimulation to mimic the pro-inflammatory condition. The immunoregulatory role of the MDs-IL4 was tested via macrophage phenotypic marker gene expression, pro-inflammatory cytokine level, cell morphological analysis, and immunofluorescence staining, etc. The immune-osteogenic response of hBMSCs via macrophages and hBMSCs interactions was further investigated in vitro. Results The bioactive MDs-IL4 scaffold showed good cytocompatibility in RAW 264.7 macrophages and hBMSCs. The results confirmed that the bioactive MDs-IL4 scaffold could reduce inflammatory phenotypic macrophages, as evidenced by changing in morphological features, reduction in pro-inflammatory marker gene expression, increase of M2 phenotypic marker genes, and inhibition of pro-inflammatory cytokine secretion. Additionally, our results indicate that the bioactive MDs-IL4 could significantly enhance the osteogenic differentiation of hBMSCs via its potential immunomodulatory properties. Conclusion Our results demonstrate that the bioactive MDs-IL4 scaffold could be used as novel carrier system for other pro-osteogenic molecules, thus having potential applications in bone tissue regeneration.
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Affiliation(s)
- Yi Zhang
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
| | - Jin Cao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Minghui Jian
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
| | - Zhixiao Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Nadia Anwar
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Lan Xiao
- School of Mechanical, Medical and Process Engineering, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Yaping Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Dingmei Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Jun Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Xin Wang
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
- School of Mechanical, Medical and Process Engineering, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Correspondence: Xin Wang, Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China, Tel +86 136 3928 8558, Fax +86-851-2860 8903, Email
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23
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Liu X, Tang B, Li Q, Xiao W, Wang X, Xiao H, Zheng Z. Hydrophilic competent and enhanced wet-bond strength castor oil-based bioadhesive for bone repair. Colloids Surf B Biointerfaces 2022; 219:112835. [PMID: 36113225 DOI: 10.1016/j.colsurfb.2022.112835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 10/31/2022]
Abstract
Bone adhesive has been proved to be a promising alternative in the clinical treatment of bone repairs. However, the problems of unsatisfying bone-bonding strength, especially the bonding of cortical bone in vivo, and blocked bone tissue recovery remain barriers to clinical reparation. Benefit from dopamine-modified castor oil synthesized by an epoxy-modification method, a porous and two-component polyurethane adhesive (PUA) was prepared to overcome the current challenges encountered. The tailored surface morphology and open porosity of the adhesive layer can be obtained to meet the requirements of bone repair by tuning the fraction of the formulation. Furthermore, the incorporation of nano-hydroxyapatite improved the mechanical properties and osteocompatibility of the material. Compared with PUA without catechol groups, the introduction of catechol groups not only increased the adhesive strength from 0.28 ± 0.05 MPa to 0.58 ± 0.06 MPa under wet conditions but also enabled the enrichment of Ca2+ on the adhesive surface to promote bone regeneration. Besides, the cell culture experiments also indicated that PUAs show good biocompatibility and excellent adhesion to stem cells. Given its excellent wet adhesive strength and biocompatibility, this system demonstrated potential applications in orthopedic treatment.
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Affiliation(s)
- Xinchang Liu
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Bo Tang
- The Third Clinical Medical College of Southern Medical University, Guangzhou 510630, China; Department of Orthopedics, Central Hospital of Fengxian District, Sixth People's Hospital of Shanghai, Shanghai 201400, China
| | - Qiang Li
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Wei Xiao
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xinling Wang
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Haijun Xiao
- The Third Clinical Medical College of Southern Medical University, Guangzhou 510630, China; Department of Orthopedics, Central Hospital of Fengxian District, Sixth People's Hospital of Shanghai, Shanghai 201400, China.
| | - Zhen Zheng
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
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24
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Zhang S, Patel D, Brady M, Gambill S, Theivendran K, Deshmukh S, Swadener J, Junaid S, Leslie LJ. Experimental testing of fracture fixation plates: A review. Proc Inst Mech Eng H 2022; 236:1253-1272. [PMID: 35920401 PMCID: PMC9449446 DOI: 10.1177/09544119221108540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Metal and its alloys have been predominantly used in fracture fixation for
centuries, but new materials such as composites and polymers have begun to see
clinical use for fracture fixation during the past couple of decades. Along with
the emerging of new materials, tribological issues, especially debris, have
become a growing concern for fracture fixation plates. This article for the
first time systematically reviews the most recent biomechanical research, with a
focus on experimental testing, of those plates within ScienceDirect and PubMed
databases. Based on the search criteria, a total of 5449 papers were retrieved,
which were then further filtered to exclude nonrelevant, duplicate or
non-accessible full article papers. In the end, a total of 83 papers were
reviewed. In experimental testing plates, screws and simulated bones or cadaver
bones are employed to build a fixation construct in order to test the strength
and stability of different plate and screw configurations. The test set-up
conditions and conclusions are well documented and summarised here, including
fracture gap size, types of bones deployed, as well as the applied load, test
speed and test ending criteria. However, research on long term plate usage was
very limited. It is also discovered that there is very limited experimental
research around the tribological behaviour particularly on the debris’
generation, collection and characterisation. In addition, there is no identified
standard studying debris of fracture fixation plate. Therefore, the authors
suggested the generation of a suite of tribological testing standards on
fracture fixation plate and screws in the aim to answer key questions around the
debris from fracture fixation plate of new materials or new design and
ultimately to provide an insight on how to reduce the risks of debris-related
osteolysis, inflammation and aseptic loosening.
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Affiliation(s)
- Shiling Zhang
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Dharmesh Patel
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Mark Brady
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Sherri Gambill
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | | | - Subodh Deshmukh
- Sandwell and West Birmingham Hospital NHS Trust, Birmingham, UK
| | - John Swadener
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Sarah Junaid
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Laura Jane Leslie
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
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25
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Hu J, Peng Y, Li J, Li M, Xiong Y, Xiao J, Zhang L, Tang P. Spatial Bridge Locking Fixator versus Traditional Locking Plates in Treating AO/OTA 32-A3.2 Fracture: Finite Element Analysis and Biomechanical Evaluation. Orthop Surg 2022; 14:1638-1648. [PMID: 35733286 PMCID: PMC9363740 DOI: 10.1111/os.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the biomechanical behaviors of the spatial bridge locking fixator (SBLF), single locking plate (SP), and double locking plate (DP) for AO/OTA 32‐A3.2 fractures using finite element analysis and biomechanical tests. Methods Axial loading of 700 N was conducted on the AO/OTA 32‐A3.2 model via finite element analysis. The von Mises stress and the interfragmentary movement (IFM) were comparatively analyzed in the three configurations above. On the mechanical tester, axial and torsional loading of 30 synthetic femurs (five specimens of each configuration for each test at random) was performed, and the interfragmentary movement, torsion angle, stiffness, and ultimate load were recorded and analyzed. Results The finite element analysis (FEA) results showed that the von Mises stress of the spatial bridge locking fixator (SBLF) was lower than that of the single locking plate (SP) and higher than that of the double locking plate (DP). At 700 N, the axial IFMs were 0.15–0.38 mm (SBLF), 0.03–0.84 mm (SP), and 0.02–0.07 mm (DP). The biomechanical experiment indicated that the axial interfragmentary movements (IFMs) were 0.44 ± 0.23 mm (SBLF), 1.02 ± 0.40 mm (SP), and 0.07 ± 0.07 mm (DP) (p < 0.001). The axial IFM of the SBLF group had the highest probability (79.26%) of falling within the ideal range (0.2–0.8 mm), and the SP and DP groups had probabilities of 27.10% and 3.14%, respectively. The axial stiffness in the SBLF group (1586 ± 130 N/mm) was significantly lower than that in the DP group (10,264 ± 2671 N/mm) (p < 0.001) but greater than that in the SP group (725 ± 178 N/mm) (p = 0.396). The range of axial loads to ultimate failure was 3385–4527 N (SBLF), 3377–4664 N (SP), and 3780–4804 N (DP). The shear motion of the fracture end was 0.35 ± 0.14 mm (SBLF), 0.16 ± 0.10 mm (SP), and 0.08 ± 0.04 mm (DP) (p < 0.001). The torsional stiffness was 1.68 ± 0.14 Nm/degree (SBLF), 2.32 ± 0.29 Nm/degree (SP) (SBLF&SP, p < 0.001), and 3.53 ± 0.73 Nm/degree (DP) (SBLF&DP, p < 0.001). Conclusions The SBLF structure may exhibit a better biomechanical performance compared with the SP and DP in providing the best quantity and more symmetrical interfragmentary movement for AO/OTA 32‐A3.2 fractures.
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Affiliation(s)
- Jianwei Hu
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, China
| | - Ye Peng
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Jiantao Li
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Ming Li
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Ying Xiong
- Department of Orthopaedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jiayu Xiao
- Department of Orthopaedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Licheng Zhang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Peifu Tang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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26
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Arthroscopic Latarjet Procedure Using FiberTape Cerclage With a Simplified Technique for Suture Passage and Coracoid Fixation. Arthrosc Tech 2022; 11:e1277-e1287. [PMID: 35936836 PMCID: PMC9353334 DOI: 10.1016/j.eats.2022.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic Latarjet has evolved as a reproducible procedure to address significant anterior glenoid bone loss in recurrent anterior instability of the shoulder joint. While arthroscopic Bankart procedure for anterior shoulder instability has changed from metal anchors to absorbable or soft all-suture anchors to avoid metal-ware and subsequent abrasion in cases of osteolysis or backout, Latarjet procedure, until recently couple of titanium screws were used to fix the coracoid bone to the anterior glenoid. Arthroscopic techniques for Latarjet procedure of coracoid bone transfer have shown results similar to the open technique in many recent studies. We use an all-arthroscopic technique that is different and easier from the currently described technique using FiberTape cerclage loops, with 2 ultrabraid tapes fixing the coracoid bone to the prepared anteroinferior glenoid surface. The repair is completed using all-suture anchors to fix the anterior capsule over the attached coracoid, thus exteriorizing the transferred bone and preventing contact with the moving humeral head.
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27
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Spronk T, Kraff O, Kreutner J, Schaefers G, Quick HH. Development and evaluation of a numerical simulation approach to predict metal artifacts from passive implants in MRI. MAGMA (NEW YORK, N.Y.) 2022; 35:485-497. [PMID: 34655346 PMCID: PMC9188622 DOI: 10.1007/s10334-021-00966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study presents the development and evaluation of a numerical approach to simulate artifacts of metallic implants in an MR environment that can be applied to improve the testing procedure for MR image artifacts in medical implants according to ASTM F2119. METHODS The numerical approach is validated by comparing simulations and measurements of two metallic test objects made of titanium and stainless steel at three different field strengths (1.5T, 3T and 7T). The difference in artifact size and shape between the simulated and measured artifacts were evaluated. A trend analysis of the artifact sizes in relation to the field strength was performed. RESULTS The numerical simulation approach shows high similarity (between 75% and 84%) of simulated and measured artifact sizes of metallic implants. Simulated and measured artifact sizes in relation to the field strength resulted in a calculation guideline to determine and predict the artifact size at one field strength (e.g., 3T or 7T) based on a measurement that was obtained at another field strength only (e.g. 1.5T). CONCLUSION This work presents a novel tool to improve the MR image artifact testing procedure of passive medical implants. With the help of this tool detailed artifact investigations can be performed, which would otherwise only be possible with substantial measurement effort on different MRI systems and field strengths.
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Affiliation(s)
- Tobias Spronk
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany.
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- MRI-STaR Magnetic Resonance Institute for Safety, Technology and Research GmbH, Gelsenkirchen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
| | - Jakob Kreutner
- MRI-STaR Magnetic Resonance Institute for Safety, Technology and Research GmbH, Gelsenkirchen, Germany
- MR:Comp GmbH, Testing Services for MR Safety and Compatibility, Gelsenkirchen, Germany
| | - Gregor Schaefers
- MRI-STaR Magnetic Resonance Institute for Safety, Technology and Research GmbH, Gelsenkirchen, Germany
- MR:Comp GmbH, Testing Services for MR Safety and Compatibility, Gelsenkirchen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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28
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Siqueira RC, Rahal SC, Mesquita LR, Voorwald FA, Fernandes MF, Tosati M, Ribeiro CR, Scorsato PS. Influence of the Near-Cortical Over-Drilling Technique on the Mechanical Behaviour of Locking Plate Constructs Applied in Maned Wolf's Femur. Vet Comp Orthop Traumatol 2022; 35:246-254. [PMID: 35609873 DOI: 10.1055/s-0042-1748859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of near-cortical over-drilling holes on the mechanical behaviour of locking plate constructs applied in maned wolf's femur by using mechanical testing and finite element method (FEM). STUDY DESIGN Seven pairs of adult maned wolves (Chrysocyon brachyurus) femur bones were randomly distributed into four groups. In all groups, a 3.5 mm locking compression plate, designed with 12 combi-holes and one locked, was applied to the lateral surface of the femur. G1 (n = 4) received bicortical locking screws placed in holes 1, 3, 5, 8, 10 and 12. In G2 (n = 5), the plate was applied as used in G1, but the application of the locked screws involved the near-cortical over-drilling technique. In G3 (n = 4), the plate was applied as used in G2, but the size of the near-cortical over-drilling was larger. The combi-holes 6 and 7 were maintained over a 10 mm fracture gap without screws. All constructs were tested for failure in the axial load. The axial load was applied eccentrically to the femoral head. RESULTS Statistical differences were observed in the maximum load with G3 > G1 and G3 > G2, and in the deflection with G2 > G1 and G2 > G3. The FEM showed the lowest total displacement of the bone-plate constructs as well as of the plate in G1 compared with G2 and G3. CONCLUSION The near-cortical over-drilling technique used in unstable fractures induced in the maned wolf's femur showed by static axial compression test that maximum load and deflection are dependent on drill hole size induced in the near-cortex. Based on FEM, the lowest total displacement of the bone-plate constructs was observed in Group 1.
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Affiliation(s)
- Rafael C Siqueira
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Sheila C Rahal
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Luciana R Mesquita
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Fabiana A Voorwald
- Department of Veterinary Surgery, Federal University of Viçosa, MG, Brazil
| | - Martin F Fernandes
- Department of Materials and Technology, São Paulo State University (UNESP), Guaratinguetá, São Paulo, Brazil
| | - Marcos Tosati
- Solution Engineering Manager at SAMT - Structural Solutions for Finite Elements, Bauru, Brazil
| | - Celso R Ribeiro
- Mechanical and Metallography Testing Laboratory - LEMM, Jaú, SP, Rua Luiz Pengo 150, Brazil
| | - Paulo S Scorsato
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, University of Marília (UNIMAR), Marília, SP, Brazil
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Wang Y, Wang J, Tu S, Li S, Yi J, Zhao H, Qiao H, Yan K, Liao B. Biomechanical Evaluation of an Oblique Lateral Locking Plate System for Oblique Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurg 2022; 160:e126-e141. [PMID: 35031519 DOI: 10.1016/j.wneu.2021.12.105] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The oblique lateral locking plate system (OLLPS) is a novel internal fixation with a locking and reverse pedicle track screw configuration designed for oblique lumbar interbody fusion (OLIF). The OLLPS is placed in a single position through the oblique lateral surgical corridor to reduce operative time and complications associated with prolonged anesthesia and prone positioning. The purpose of this study was to verify the biomechanical effect of the OLLPS. METHODS An intact finite element model of L1-S1 (intact) was established based on computed tomography images of a healthy male volunteer. The L4-L5 intervertebral space was selected as the surgical segment. The surgical models were established separately based on OLIF surgical procedures and different internal fixations: 1) stand-alone OLIF (SA); 2) OLIF with a 2-screw lateral plate; 3) OLIF with a 4-screw lateral plate; 4) OLIF with OLLPS; and 5) OLIF with bilateral pedicle screw fixation (BPS). After validation of the intact model, physiologic loads were applied to the superior surface of L1 to simulate motions such as flexion, extension, left bending, right bending, left rotation, and right rotation. The evaluation indices included the L4/5 range of motion, the L4 maximum displacement, and the maximum stresses of the superior and inferior end plates, the cage, and the supplemental fixation. RESULTS During OLIF surgery, the OLLPS provided multiplanar stability similar to that provided by BPS. Compared with 2-screw lateral plate and 4-screw lateral plate, OLLPS had better biomechanical properties in terms of enhancing the instant stability of the surgical segment, reducing the stress on the superior and inferior end plates of the surgical segment, and decreasing the risk of cage subsidence. CONCLUSIONS With a minimally invasive background, the OLLPS can be used as an alternative to BPS in OLIF and it has better prospects for clinical promotions and applications.
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Affiliation(s)
- Yinge Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China; Department of Orthopedics, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Jiajia Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Sha Tu
- Department of Nutrition, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Shuang Li
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Jiangpu Yi
- 3D Printing Research Center, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Haien Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Huanhuan Qiao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Kang Yan
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
| | - Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
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Kong LP, Yang JJ, Wang F, Liu FX, Yang YL. Minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure. World J Clin Cases 2022; 10:117-127. [PMID: 35071511 PMCID: PMC8727274 DOI: 10.12998/wjcc.v10.i1.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/04/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis. The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation, suture anchor fixation, and plate fixation, all of which have treatment-associated complications. To decrease surgical complications, we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus. AIM To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures. METHODS Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively. All were followed up by clinical examination and radiographs at 3 and 6 wk, 3, 6 and 12 mo after surgery, and thereafter every 6 mo. Outcomes were assessed preoperatively and postoperatively by a visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeon score (ASES), and range of motion (ROM) for shoulders. RESULTS Seven men and nine women, with an average age of 44.94 years, were evaluated. The time between injury and surgery was 1-2 d, with an average of 1.75 d. The mean operation time was 103.1 ± 7.23 min. All patients achieved bone union within 3 mo after surgery. VAS scores were significantly decreased (P = 0.002), and the mean degrees of forward elevation (P = 0.047), mean degrees of abduction (P = 0.035), ASES score (P = 0.092) were increased at 3 wk. The UCLA score was increased at 6 wk (P = 0.029) after surgery. The average degrees of external rotation and internal rotation both improved at 3 mo after surgery (P = 0.012 and P = 0.007, respectively). No procedure-related deaths or incision-related superficial or deep tissue infections occurred. CONCLUSION Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures, was easier to perform, and had fewer implants than other procedures.
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Affiliation(s)
- Ling-Peng Kong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Juan-Juan Yang
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
| | - Fu Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Fan-Xiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yong-Liang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate. Arch Orthop Trauma Surg 2022; 142:1539-1546. [PMID: 33760940 PMCID: PMC9217777 DOI: 10.1007/s00402-021-03867-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. PATIENTS AND METHODS A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. RESULTS Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. CONCLUSION A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.
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Uliana CS, Nakahashi ER, Silva LHP, Freitas A, Giordano V. No clinical advantage of locking over nonlocking plate fixation of symphyseal disruptions. Rev Col Bras Cir 2021; 48:e20213122. [PMID: 34932737 PMCID: PMC10683429 DOI: 10.1590/0100-6991e-20213122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE although locking plates have led to important changes in fracture management, becoming important tools in the orthopedic surgeon's arsenal, the benefits of locking plates for traumatic diastasis of the pubic symphysis have not been established. This study was conducted to assess the quality of life in its different domains among patients with traumatic diastasis of the pubic symphysis managed either with locking or nonlocking plate. METHODS a prospective cohort study was undertaken at 3 level 1 trauma centres in Brazil. Patients presenting traumatic diastasis of the pubic symphysis treated with plate fixation with a minimum follow-up of 12 months were eligible for inclusion. Through a Pfannenstiel approach, the pubic symphysis was reduced and fixed with a superiorly positioned 4.5mm four to six hole reconstruction locked plate or 3.5mm four to six hole reconstruction nonlocked plate. Posterior injury was managed during the same procedure. Outcome measures were adequate healing of the pelvic injuries, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. Complications and modes of failure were summarized and reviewed. Bivariate linear regression was used to assess individual factors affecting patients' health-related quality of life. A p value of <5% was considered significant. RESULTS a total of 31 adult patients (29 males and 2 females) were eligible for the study. Thirteen patients were managed with a reconstruction locked plate and 18 patients with a nonlocked reconstruction plate. Average postoperative follow-up time was 24 months. Adequate healing of the pelvic injuries was achieved in 61.5% of patients treated with locking plates and 94.4% of patients treated with nonlocking plates (p=0.003). Radiographic failure of fixation with minor complications occurred in 46.1% of patients after locked plating versus 11.1% of patients in the nonlocking plate group (p=0.0003). In bivariate analysis, abnormal gait (p=0.007) was associated with a reduced long-term quality of life as measured with the EQ-5D-3L. CONCLUSION internal fixation of traumatic diastasis of the pubic symphysis with locking plates has no clinical advantage when compared to nonlocked plating. Mechanical failure and inadequate healing are significantly increased after locked plating of the pubic symphysis. Therefore, we do not recommend routine use of locking plates for managing patients presenting traumatic diastasis of the pubic symphysis. LEVEL OF EVIDENCE II (prospective, cohort study).
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Affiliation(s)
| | - Eiji Rafael Nakahashi
- - Hospital do Trabalhador, Universidade Federal do Paraná, Ortopedia - Curitiba - PR - Brasil
| | | | - Anderson Freitas
- - Hospital de Ortopedia e Medicina Especializada (HOME), Instituto de Pesquisa e Ensino - Brasília - DF - Brasil
- - Hospital Regional do Gama, Ortopedia - Brasília - DF - Brasil
| | - Vincenzo Giordano
- - Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
- - Clínica São Vicente, Rede D'or São Luiz, Ortopedia - Rio de Janeiro - RJ - Brasil
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Mohandes Y, Tahani M, Rouhi G. Osteosynthesis of diaphyseal tibia fracture with locking compression plates: A numerical investigation using Taguchi and ANOVA. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3528. [PMID: 34486240 DOI: 10.1002/cnm.3528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
Performance of the locking compression plate (LCP) is a multifactorial function. The control parameters of plating, such as geometries, material properties, and physical constraints of the LCP components, affect basic functions associated with the bone fixation, including the extent of stress shielding and subsequent bone remodeling, strength and stability of the bone-LCP construct, and performance of secondary bone healing. The main objectives of this research were as follows: (1) to find the appropriate values of control parameters of an LCP construct to achieve the optimized performance throughout bone healing; and (2) to unravel relationships between LCP parameters and the LCP's performance. Different values for the plate/screw modulus of elasticity (E), plate width (W), plate thickness (T), screw diameter (D), bone-plate offset (O), and screw configuration (C), as six control parameters, were considered at five different levels. Taguchi method was adopted to create trial combinations of control parameters and determining the best set of parameters, which can optimize the overall performance of the LCP. All design cases were analyzed using the finite element method. The optimal set of control parameters consisting of 150 GPa, 12 mm, 4 mm, 5.5 mm, 2 mm, and 123,678 were determined for E, W, T, D, O, and C, respectively. Furthermore, ANOVA was used to rank the most influential parameters on each function of the LCP fixation. In the overall performance of the LCP fixation, E, D, T, C, W, and O showed a contribution percentage of 46%, 22%, 10%, 11%, 8%, and 3%, respectively.
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Affiliation(s)
- Yousof Mohandes
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Masoud Tahani
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Gholamreza Rouhi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Freire TF, Quinaz T, Fertuzinhos A, Quyền NT, de Moura MFSM, Martins M, Zille A, Dourado N. Thermal, Mechanical and Chemical Analysis of Poly(vinyl alcohol) Multifilament and Braided Yarns. Polymers (Basel) 2021; 13:polym13213644. [PMID: 34771201 PMCID: PMC8588446 DOI: 10.3390/polym13213644] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
Poly(vinyl alcohol) (PVA) in multifilament and braided yarns (BY) forms presents great potential for the design of numerous applications. However, such solutions fail to accomplish their requirements if the chemical and thermomechanical behaviour is not sufficiently known. Hence, a comprehensive characterisation of PVA multifilament and three BY architectures (6, 8, and 10 yarns) was performed involving the application of several techniques to evaluate the morphological, chemical, thermal, and mechanical features of those structures. Scanning electron microscopy (SEM) was used to reveal structural and morphological information. Differential thermal analysis (DTA) pointed out the glass transition temperature of PVA at 76 °C and the corresponding crystalline melting point at 210 °C. PVA BY exhibited higher tensile strength under monotonic quasi-static loading in comparison to their multifilament forms. Creep tests demonstrated that 6BY structures present the most deformable behaviour, while 8BY structures are the least deformable. Relaxation tests showed that 8BY architecture presents a more expressive variation of tensile stress, while 10BY offered the least. Dynamic mechanical analysis (DMA) revealed storage and loss moduli curves with similar transition peaks for the tested structures, except for the 10BY. Storage modulus is always four to six times higher than the loss modulus.
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Affiliation(s)
- Tania F. Freire
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (T.F.F.); (T.Q.); (A.F.); (M.M.)
| | - Tiago Quinaz
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (T.F.F.); (T.Q.); (A.F.); (M.M.)
| | - Aureliano Fertuzinhos
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (T.F.F.); (T.Q.); (A.F.); (M.M.)
| | - Nguyễn T. Quyền
- 2C2T-Centro de Ciência e Tecnologia Têxtil, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (N.T.Q.); (A.Z.)
| | - Marcelo F. S. M. de Moura
- Departamento de Engenharia Mecânica, Faculdade de Engenharia da Universidade do Porto, 4200-464 Porto, Portugal;
| | - Marcos Martins
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (T.F.F.); (T.Q.); (A.F.); (M.M.)
| | - Andrea Zille
- 2C2T-Centro de Ciência e Tecnologia Têxtil, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (N.T.Q.); (A.Z.)
| | - Nuno Dourado
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Campus de Azurém, Universidade do Minho, 4804-533 Guimarães, Portugal; (T.F.F.); (T.Q.); (A.F.); (M.M.)
- Correspondence:
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Eskelinen EV, Suhonen AP, Virolainen JV, Liska WD. Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study. Vet Comp Orthop Traumatol 2021; 35:96-104. [PMID: 34634824 DOI: 10.1055/s-0041-1736217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin). METHODS Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure. RESULTS Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study. CLINICAL SIGNIFICANCE Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.
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Affiliation(s)
- Esa V Eskelinen
- Tammisto Animal Hospital, Evidensia Eläinlääkäripalvelut Oy, Finland
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In silico analysis of modular bone plates. J Mech Behav Biomed Mater 2021; 124:104847. [PMID: 34555620 DOI: 10.1016/j.jmbbm.2021.104847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inventory management or immediate availability of fracture plates can be problematic since for each surgical intervention a specific plate of varying size and functionality must be ordered. Modularization of the standard monolithic plate is proposed to address this issue. METHODS The effects of four different unit module design parameters (type, degree of modularization, connector screw diameter, sandwich ratio) on the plate bending stiffness and failure are investigated in a finite element four-point-bending analysis. A chosen, best-performing modular plate is then tested in silico for a simple diaphyseal tibial fracture scenario under anatomical compressional, torsional, and bending loads. RESULTS A modularization strategy is proposed to match the monolithic plate bending properties as closely as possible. With the best combination of design parameters, a fully modularized equivalent length plate with a 42.3% decrease in stiffness and 46.2% decrease in strength could be assembled. The chosen modular plate also displayed sufficient mechanical performance under the fracture fixation scenarios for a potentially successful osteosynthesis. CONCLUSIONS Via computational methods, the viability of the modularization strategy as an alternate to the traditional monolithic plate is demonstrated. As a further realized advantage, the modular plates can alleviate stress shielding thanks to the reduced stiffness.
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The advances of topology optimization techniques in orthopedic implants: A review. Med Biol Eng Comput 2021; 59:1673-1689. [PMID: 34363576 DOI: 10.1007/s11517-021-02361-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/05/2021] [Indexed: 10/20/2022]
Abstract
Metal implants are widely used in the treatment of orthopedic diseases. However, owing to the mismatched elastic modulus of the bone and implants, stress shielding often occurs clinically which can result in failure of the implant or fractures around the implant. Topology optimization (TO) is a technique that can provide more efficient material distribution according to the objective function under the special load and boundary conditions. Several researchers have paid close attention to TO for optimal design of orthopedic implants. Thanks to the development of additive manufacturing (AM), the complex structure of the TO design can be fabricated. This article mainly focuses on the current stage of TO technique with respect to the global layout and hierarchical structure in orthopedic implants. In each aspect, diverse implants in different orthopedic fields related to TO design are discussed. The characteristics of implants, methods of TO, validation methods of the newly designed implants, and limitations of current research have been summarized. The review concludes with future challenges and directions for research. Wang TO design of global layout and local structure of implants in diverse fields of orthopedic.
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Terzini M, Sicuranza S, Alberghina F, Ravera L, Aloj DC, Bignardi C. Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
External fixation is an osteosynthesis technique particularly useful in trauma surgery and Damage Control Orthopedics (DCO). However, complications, such as pin loosening and pin tract infections, are fairly common. For reducing thermal damage and infection rates, monocortical pins have been proposed as an alternative to the most used bicortical pins. However, there is a lack of studies regarding their mechanical properties.
Objective:
The aim of the study is to assess the static and dynamic stability of a unilateral external fixator experimentally when applied through monocortical pins for the reduction of femur and tibia fractures.
Methods:
A modular unilateral external fixator was used and a total number of 6 pins were used per test. The static tests were performed in displacement control by applying a vertical displacement to the upper fixture at 1 mm/min until a tension load of 380 N was reached. The dynamic tests were performed by applying a sinusoidal displacement. During each test, forces and crosshead displacements were acquired. Two different stiffness indexes were assessed.
Results:
By comparing the two anatomic regions, it was found that the fixator behaves stiffer when mounted on the femur, regardless of the pins used, while stiffnesses comparable to the femur ones are reached by the tibia when 4 mm diameter pins are used. Static analysis revealed excellent fixator stability when implanted with 4 mm diameter monocortical pins on both anatomic regions. On the contrary, two tibia and one femur samples showed failures at the bone-pin interface when 3 mm diameter pins were used.
Conclusion:
Dynamic analysis showed no substantial difference between the tested configurations and confirmed the fixator's ability to sustain cyclic loading without further damage to the sample.
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Strategies to Improve Bone Healing: Innovative Surgical Implants Meet Nano-/Micro-Topography of Bone Scaffolds. Biomedicines 2021; 9:biomedicines9070746. [PMID: 34203437 PMCID: PMC8301359 DOI: 10.3390/biomedicines9070746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022] Open
Abstract
Successful fracture healing is dependent on an optimal mechanical and biological environment at the fracture site. Disturbances in fracture healing (non-union) or even critical size bone defects, where void volume is larger than the self-healing capacity of bone tissue, are great challenges for orthopedic surgeons. To address these challenges, new surgical implant concepts have been recently developed to optimize mechanical conditions. First, this review article discusses the mechanical environment on bone and fracture healing. In this context, a new implant concept, variable fixation technology, is introduced. This implant has the unique ability to change its mechanical properties from “rigid” to “dynamic” over the time of fracture healing. This leads to increased callus formation, a more homogeneous callus distribution and thus improved fracture healing. Second, recent advances in the nano- and micro-topography of bone scaffolds for guiding osteoinduction will be reviewed, particularly emphasizing the mimicry of natural bone. We summarize that an optimal scaffold should comprise micropores of 50–150 µm diameter allowing vascularization and migration of stem cells as well as nanotopographical osteoinductive cues, preferably pores of 30 nm diameter. Next to osteoinduction, such nano- and micro-topographical cues may also reduce inflammation and possess an antibacterial activity to further promote bone regeneration.
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Marcondes GDM, Paretsis NF, Souza AFD, Ruivo MRBA, Rego MAF, Nóbrega FS, Cortopassi SRG, De Zoppa ALDV. Locking compression plate fixation of critical-sized bone defects in sheep. Development of a model for veterinary bone tissue engineering. Acta Cir Bras 2021; 36:e360601. [PMID: 34190837 PMCID: PMC8232063 DOI: 10.1590/acb360601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To develop a segmental tibial bone defect model for tissue engineering studies in veterinary orthopedics using single locking compression plate (LCP) fixation and cast immobilization. METHODS A 3-cm bone defect was created in the right tibia of 18 adult Suffolk sheep. A 10-hole, 4.5-mm LCP was applied to the dorsomedial aspect of the bone. Four locking screws were inserted into the proximal and three into the distal bone fragment. Operated limbs were immobilized with casts. Animals were submitted to stall rest, but were allowed to bear weight on the operated limb. During the recovery period, animals were checked daily for physiological parameters, behavior and lameness. Follow-up radiographs were taken monthly. RESULTS Surgical procedures and postoperative recovery were uneventful. Animals adapted quickly to casts and were able to bear weight on the operated limb with no signs of discomfort or distress. No clinical or radiographic complications were detected over a 90-day follow-up period. CONCLUSIONS Surgical creation of tibial segmental bone defects followed by fixation with single LCP and cast immobilization was deemed a feasible and appropriate model for veterinary orthopedic research in tissue engineering.
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Madry H, Grässel S, Nöth U, Relja B, Bernstein A, Docheva D, Kauther MD, Katthagen JC, Bader R, van Griensven M, Wirtz DC, Raschke MJ, Huber-Lang M. The future of basic science in orthopaedics and traumatology: Cassandra or Prometheus? Eur J Med Res 2021; 26:56. [PMID: 34127057 PMCID: PMC8200553 DOI: 10.1186/s40001-021-00521-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Orthopaedic and trauma research is a gateway to better health and mobility, reflecting the ever-increasing and complex burden of musculoskeletal diseases and injuries in Germany, Europe and worldwide. Basic science in orthopaedics and traumatology addresses the complete organism down to the molecule among an entire life of musculoskeletal mobility. Reflecting the complex and intertwined underlying mechanisms, cooperative research in this field has discovered important mechanisms on the molecular, cellular and organ levels, which subsequently led to innovative diagnostic and therapeutic strategies that reduced individual suffering as well as the burden on the society. However, research efforts are considerably threatened by economical pressures on clinicians and scientists, growing obstacles for urgently needed translational animal research, and insufficient funding. Although sophisticated science is feasible and realized in ever more individual research groups, a main goal of the multidisciplinary members of the Basic Science Section of the German Society for Orthopaedics and Trauma Surgery is to generate overarching structures and networks to answer to the growing clinical needs. The future of basic science in orthopaedics and traumatology can only be managed by an even more intensified exchange between basic scientists and clinicians while fuelling enthusiasm of talented junior scientists and clinicians. Prioritized future projects will master a broad range of opportunities from artificial intelligence, gene- and nano-technologies to large-scale, multi-centre clinical studies. Like Prometheus in the ancient Greek myth, transferring the elucidating knowledge from basic science to the real (clinical) world will reduce the individual suffering from orthopaedic diseases and trauma as well as their socio-economic impact.
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Affiliation(s)
- Henning Madry
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg, Germany
| | - Susanne Grässel
- Experimental Orthopedics, Department of Orthopedic Surgery, University of Regensburg, Regensburg, Germany
| | - Ulrich Nöth
- Department of Orthopaedics and Trauma Surgery, Evangelisches Waldkrankenhaus Berlin Spandau, Berlin, Germany
| | - Borna Relja
- Experimental Radiology, University Clinic for Radiology and Nuclear Medicine, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Anke Bernstein
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisgau, Germany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Max Daniel Kauther
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Jan Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Rainer Bader
- Department of Orthopaedics, Research Lab for Biomechanics and Implant Technology, Rostock University Medical Center, Rostock, Germany
| | - Martijn van Griensven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN-Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Dieter C Wirtz
- Department of Orthopaedics and Trauma Surgery, University Hopsital Bonn, Bonn, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma-Immunology (ITI), University Hospital Ulm, Helmholzstr. 8/1, Ulm, Germany.
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Augat P, Hollensteiner M, von Rüden C. The role of mechanical stimulation in the enhancement of bone healing. Injury 2021; 52 Suppl 2:S78-S83. [PMID: 33041020 DOI: 10.1016/j.injury.2020.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
The biomechanical environment plays a dominant role in the process of fracture repair. Mechanical signals control biological activities at the fracture site, regulate the formation and proliferation of different cell types, and are responsible for the formation of connective tissues and the consolidation of the fractured bone. The mechanobiology at the fracture site can be easily manipulated by the design and configuration of the fracture fixation construct and by the loading of the extremity (weight-bearing prescription). Depending on the choice of fracture fixation, the healing response can be directed towards direct healing or towards indirect healing through callus formation. This manuscript summarizes the evidence from experimental studies and clinical observations on the effect of mechanical manipulation on the healing response. Parameters like fracture gap size, interfragmentary movement, interfragmentary strain, and axial and shear deformation will be explored with respect to their respective effects on fracture repair. Also, the role of externally applied movement on the potential enhancement on the fracture repair process will be explored. Factors like fracture gap size, type and amplitude of the mechanical deformation as well as the loading history and its timing will be discussed.
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Affiliation(s)
- Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Marianne Hollensteiner
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian von Rüden
- Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
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Alcântara B, Minto B, Franco G, Lucena D, Dias L. Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.
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Affiliation(s)
| | | | - G.G. Franco
- Universidade Federal do Espírito Santo, Brazil
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Bassanino J, Kaczmarek J, Boursier JF, Mindner J, Paton R, Bedu AS, Unger M, Scharvogel S, Meiler D, Leperlier D. Radiographically confirmed outcomes after fracture repair with a PLS polyaxial locking system in 40 dogs and cats. Vet Surg 2021; 50:571-578. [PMID: 33480076 DOI: 10.1111/vsu.13578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report radiographic findings and complications after fracture repair with a new polyaxial locking plate system (PLS polyaxial locking system; Aesculap/B Braun, Tuttlingen, Germany) in dogs and cats. STUDY DESIGN Retrospective case review from four veterinary practices. SAMPLE POPULATION Twenty-six dogs and 14 cats (40 long bone fractures). METHODS Medical and radiographic records of dogs and cats with long bone fractures treated with the PLS were reviewed. Cases were included when operative records were complete and included documentation of radiographic union or complications. Phone interviews of owners were performed for long-term follow-up. Ancillary methods of fracture fixation and associated complications were recorded. RESULTS Only two complications were recorded, one of which required a revision surgery. Radiographic follow-up was performed for all fractures. Radiographic union without complications was achieved in 38 of 40 (95%) fractures. Radiographic union was documented before 60 days in 19 of 40 (47.5%) fractures, between 61 and 90 days in 15 of 40 (37.5%) fractures, and after 90 days in six of 40 (15%) fractures. A functional union was observed at a mean time ± SD of 70.8 ± 38.9 days (range, 32-182). One or more ancillary fixation methods were used in 27 of 40 (67.5%) fractures. CONCLUSION The PLS polyaxial locking system was often used with adjunct fixation in this series, and radiographically confirmed healing without complications was documented in most cases. CLINICAL SIGNIFICANCE Use of the PLS can result in high success rates for fracture repair in dogs and cats, but ancillary fixation should be strongly considered.
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Affiliation(s)
| | | | | | | | | | | | - Martin Unger
- AniCura Kleintierspezialisten, Augsburg, Germany
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Lambert S, Mischler D, Windolf M, Regazzoni P, Dell'Oca AF, Gueorguiev B, Varga P. From creative thinking to scientific principles in clinical practice. Injury 2021; 52:32-36. [PMID: 33004202 DOI: 10.1016/j.injury.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 02/02/2023]
Abstract
Stephan Perren's contributions to the understanding and application of the principles of bone pathobiology, healing, and fracture fixation to clinical care remain as a lasting legacy of a great creative mind. Less well appreciated perhaps were his important contributions to the dissemination and practical application of those principles through the use of technology as applied to the learning environment. This paper describes and pays tribute to a series of initiatives in which Perren was a leading mentor and collaborator in the development of methods and instruments through which the principles of bone mechano-pathobiology could be translated through active learning environments into the practical world of clinical musculoskeletal traumatology.
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Affiliation(s)
- Simon Lambert
- Department of Trauma and Orthopaedics, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK.
| | | | | | - Pietro Regazzoni
- AO Research Institute, Davos, Switzerland; AO Research Institute Davos, Lugano, Switzerland
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HURİ G. Adjustable bone plate: state of art. Turk J Med Sci 2020; 50:1723-1727. [PMID: 32222126 PMCID: PMC7672350 DOI: 10.3906/sag-2002-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/22/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim The success of treatment of bone fracture and defects are based on a proper contact and compression between the bone fracture fragments. Intraoperative manipulations such as bone compression or distractions are generally done in order to achieve this. However, none of the bone plates currently in routine use allow these manipulations after fixation to the bone, requiring refixation and repeated drilling, and screwing operations. Based on this shortcoming, we designed a novel adjustable bone plate (ABP) system which allows bone shortening and lengthening even after fixation to the bone surface. The aim of the paper is to clarify the unique properties of the novel bone plate. Materials and methods In this paper, the new generation adjustable bone plate applicability, design, indication, and new characteristics in addition to conventional bone plates with review of the literature were discussed and surgical technique was demonstrated in a saw bone model. Results This novel design allows for compression and distraction at the fracture ends post fixation as well as bone segment transfers. Conclusions The potential of the new generation ABP plate for use in bone compression, distraction, and the segmental bone transfer is a promising invention for clinical applications in the future.
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Affiliation(s)
- Gazi HURİ
- Department of Orthopaedics and Traumatology, Hacettepe University, AnkaraTurkey
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Supplemental cerclage wiring in angle stable plate fixation of distal tibial spiral fractures enables immediate post-operative full weight-bearing: a biomechanical analysis. Eur J Trauma Emerg Surg 2020; 48:621-628. [PMID: 32989509 PMCID: PMC8825397 DOI: 10.1007/s00068-020-01503-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022]
Abstract
Purpose Distal tibial fractures generally require post-operative weight-bearing restrictions. Especially geriatric patients are unable to follow these recommendations. To increase post-operative implant stability and enable early weight-bearing, augmentation of the primary osteosynthesis by cerclage is desirable. The purpose of this study was to identify the stabilizing effects of a supplemental cable cerclage following plate fixation of distal tibial spiral fractures compared to solitary plate osteosynthesis. Methods In eight synthetic tibiae, a reproducible spiral fracture (AO/OTA 42-A1.1c) was stabilized by angle stable plate fixation. Each specimen was statically loaded under combined axial and torsional loads to simulate partial (200 N, 2 Nm) and full (750 N, 7 Nm) weight-bearing. Tests were repeated with supplemental cable cerclage looped around the fracture zone. In a subsequent stepwise increased dynamic load scenario, construct stiffness and interfragmentary movements were analyzed. Results With supplemental cable cerclage, construct stiffness almost tripled compared to solitary plate osteosynthesis (2882 ± 739 N/mm vs. 983 ± 355 N/mm; p < 0.001). Under full weight-bearing static loads, a supplemental cerclage revealed reduced axial (− 55%; p = 0.001) and shear movement (− 83%; p < 0.001), and also lowered shear movement (− 42%; p = 0.001) compared to a solitary plate under partial weight-bearing. Under dynamic loads supplemental cerclage significantly reduced axial (p = 0.005) as well as shear movements (p < 0.001). Conclusion Supplemental cable cerclage significantly increases fixation stiffness and reduces shear movement in distal tibial spiral fractures. This stabilizing effect enables from a biomechanical point of view immediate mobilization without any weight-bearing restrictions, which may improve the quality of care of orthopedic patients and may trigger a change towards early weight-bearing regimes, especially geriatric patients would benefit from.
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Sallent I, Capella-Monsonís H, Procter P, Bozo IY, Deev RV, Zubov D, Vasyliev R, Perale G, Pertici G, Baker J, Gingras P, Bayon Y, Zeugolis DI. The Few Who Made It: Commercially and Clinically Successful Innovative Bone Grafts. Front Bioeng Biotechnol 2020; 8:952. [PMID: 32984269 PMCID: PMC7490292 DOI: 10.3389/fbioe.2020.00952] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Bone reconstruction techniques are mainly based on the use of tissue grafts and artificial scaffolds. The former presents well-known limitations, such as restricted graft availability and donor site morbidity, while the latter commonly results in poor graft integration and fixation in the bone, which leads to the unbalanced distribution of loads, impaired bone formation, increased pain perception, and risk of fracture, ultimately leading to recurrent surgeries. In the past decade, research efforts have been focused on the development of innovative bone substitutes that not only provide immediate mechanical support, but also ensure appropriate graft anchoring by, for example, promoting de novo bone tissue formation. From the countless studies that aimed in this direction, only few have made the big jump from the benchtop to the bedside, whilst most have perished along the challenging path of clinical translation. Herein, we describe some clinically successful cases of bone device development, including biological glues, stem cell-seeded scaffolds, and gene-functionalized bone substitutes. We also discuss the ventures that these technologies went through, the hindrances they faced and the common grounds among them, which might have been key for their success. The ultimate objective of this perspective article is to highlight the important aspects of the clinical translation of an innovative idea in the field of bone grafting, with the aim of commercially and clinically informing new research approaches in the sector.
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Affiliation(s)
- Ignacio Sallent
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Héctor Capella-Monsonís
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Philip Procter
- Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
- GPBio Ltd., Shannon, Ireland
| | - Ilia Y. Bozo
- Histograft LLC, Moscow, Russia
- Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
| | - Roman V. Deev
- Histograft LLC, Moscow, Russia
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
| | - Dimitri Zubov
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | - Roman Vasyliev
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | | | | | - Justin Baker
- Viscus Biologics LLC, Cleveland, OH, United States
| | | | - Yves Bayon
- Sofradim Production, A Medtronic Company, Trévoux, France
| | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
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Feasibility of the Inner-Side-Out Use of the LC-DCP for Periprosthetic Femoral Fracture in Total Hip Arthroplasty. Indian J Orthop 2020; 54:879-884. [PMID: 33133411 PMCID: PMC7572970 DOI: 10.1007/s43465-020-00200-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal technique for plate fixation to treat type B and C periprosthetic femoral fractures (PFFs) is unclear. The purpose of this study is to evaluate the radiographic results of inner-side-out limited contact dynamic compression plate (LC-DCP) to treat PFFs during or after total hip arthroplasty (THA). METHODS This retrospective study comprised of four men and six women with an average age of 64.7 years who underwent open reduction and internal fixation with an inner-side-out LC-DCP technique to treat PFFs; the reduction was maintained preliminary with the use of contoured plate and cables, and the grooves on the undersurface of LC-DCP for limited contact was used to hold and prevent the cables from slippage during tightening the cables. There were five intraoperative and five postoperative PFFs after THA. According to the Vancouver classification, the intraoperative PFFs included type B2 in two, B3 in one and C3 in two patients while postoperative PFFs were categorized into type B1 in one, type B2 in two and type C in two patients. The mean follow-up duration was 5.9 years (range 1-10.4). We evaluated radiographic union and complications after index operation. RESULTS All patients demonstrated radiographic bone union at an average follow-up duration of 4.4 months (range 3-8). Two patients showed stem subsidence after revision THA and one patient demonstrated a subsequent peri-implant fracture around the distal end of plate after union of the initial PPF; one patient underwent re-revision THA for stem loosening while another patient went through refixation for the peri-implant fracture. There was no nonunion, infection, nerve injury, or dislocation. CONCLUSION The inner-side-out LC-DCP technique showed satisfactory radiographic outcome. In certain situations where locking plates are not available, this technique might be a useful alternative for treating type B and C PFFs.
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Charbonnier B, Manassero M, Bourguignon M, Decambron A, El-Hafci H, Morin C, Leon D, Bensidoum M, Corsia S, Petite H, Marchat D, Potier E. Custom-made macroporous bioceramic implants based on triply-periodic minimal surfaces for bone defects in load-bearing sites. Acta Biomater 2020; 109:254-266. [PMID: 32194263 DOI: 10.1016/j.actbio.2020.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022]
Abstract
The architectural features of synthetic bone grafts are key parameters for regulating cell functions and tissue formation for the successful repair of bone defects. In this regard, macroporous structures based on triply-periodic minimal surfaces (TPMS) are considered to have untapped potential. In the present study, custom-made implants based on a gyroid structure, with (GPRC) and without (GP) a cortical-like reinforcement, were specifically designed to fit an intended bone defect in rat femurs. Sintered hydroxyapatite implants were produced using a dedicated additive manufacturing technology and their morphological, physico-chemical and mechanical features were characterized. The implants' integrity and ability to support bone ingrowth were assessed after 4, 6 and 8 weeks of implantation in a 3-mm-long, femoral defect in Lewis rats. GP and GPRC implants were manufactured with comparable macro- to nano-architectures. Cortical-like reinforcement significantly improved implant effective stiffness and resistance to fracture after implantation. This cortical-like reinforcement also concentrated new bone formation in the core of the GPRC implants, without affecting newly formed bone quantity or maturity. This study showed, for the first time, that custom-made TPMS-based bioceramic implants could be produced and successfully implanted in load-bearing sites. Adding a cortical-like reinforcement (GPRC implants) was a relevant solution to improve implant mechanical resistance, and changed osteogenic mechanism compared to the GP implants. STATEMENT OF SIGNIFICANCE: Architectural features are known to be key parameters for successful bone repair using synthetic bioceramic bone graft. So far, conventional manufacturing techniques, lacking reproducibility and complete control of the implant macro-architecture, impeded the exploration of complex architectures, such as triply periodic minimal surfaces (TPMS), which are foreseen to have an unrivaled potential for bone repair. Using a new additive manufacturing process, macroporous TPMS-based bioceramics implants were produced in calcium phosphate, characterized and implanted in a femoral defect in rats. The results showed, for the first time, that such macroporous implants can be successfully implanted in anatomical load-bearing sites when a cortical-like outer shell is added. This outer shell also concentrated new bone formation in the implant center, without affecting new bone quantity or maturity.
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