New Design Process for Anatomically Enhanced Osteosynthesis Plates

An anatomical artificial bone implant can improve three-dimensional correction accuracy in open-wedge high tibial osteotomy

BACKGROUND

An anatomical artificial bone implant inserted into the osteotomy gap might be useful for accurate alignment correction during open-wedge high tibial osteotomy (OWHTO). The aims of this study were to evaluate morphological variation in the osteotomy surface, identify an anatomical implant's shape, and verify its usefulness for accurate three-dimensional (3D) correction.

METHODS

Virtual OWHTO was performed with preoperative 3D computed tomography data from 100 knees. The tibial contour in the osteotomy plane was analyzed using principal component analysis to determine implant shape. An anatomical artificial bone implant with a 10° correction angle was made with a synthetic bone substitute. Coronal correction accuracy and changes in posterior tibial slope (PTS) and rotation were evaluated on eight cadaver knees that received the anatomical artificial bone implant and clinically on 85 in vivo knees that received conventional wedge-shaped spacers.

RESULTS

The single-shape anatomical artificial bone implant was designed to occupy a posteromedial 30 × 25 mm region and had high contour congruency (mean mismatch, 0.73 mm; mean contact area coverage, 97.5%). Gap opening angle with the anatomical artificial bone implant was precise, avoiding excessive PTS change (mean, 0.6°) and rotational change (mean, 0.5°). In contrast, both PTS and rotational change with conventional spacers increased by a mean of 2.9°.

CONCLUSIONS

An anatomical artificial bone implant derived from the mean shape of 100 knees had high and consistent contour congruency. The anatomical artificial bone implant inserted with 3D surgical guidance provided accurate gap opening, reducing PTS change to less than 1° during OWHTO.

Quantifying osteosynthesis plate prominence - mathematical definitions and case study on a clavicle plate

Hardware prominence remains a clinical challenge in focus for implant design in subcutaneous plate applications. Existing evaluation of hardware prominence relies on plate-to-bone distance at a single point or on average. A reproducible measure for plate prominence remains undefined. This study mathematically defines the plate prominence linked to the cross-sectional area change due to the plate presence on the bone. Two anatomical plate designs were fitted to 100 clavicles, and afterwards plate prominence parameters were evaluated and compared. This methodology enables the quantification of hardware prominence for different plate designs to inform the development of implants targeting low prominence.

Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures

Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.

Thermal, Mechanical and Chemical Analysis of Poly(vinyl alcohol) Multifilament and Braided Yarns

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.

EquiSim: An Open-Source Articulatable Statistical Model of the Equine Distal Limb

Most digital models of the equine distal limb that are available in the community are static and/or subject specific; hence, they have limited applications in veterinary research. In this paper, we present an articulatable model of the entire equine distal limb based on statistical shape modeling. The model describes the inter-subject variability in bone geometry while maintaining proper jointspace distances to support model articulation toward different poses. Shape variation modes are explained in terms of common biometrics in order to ease model interpretation from a veterinary point of view. The model is publicly available through a graphical user interface (https://github.com/jvhoutte/equisim) in order to facilitate future digitalization in veterinary research, such as computer-aided designs, three-dimensional printing of bone implants, bone fracture risk assessment through finite element methods, and data registration and segmentation problems for clinical practices.

Anatomical fitting of a plate shape directly derived from a 3D statistical bone model of the tibia

INTRODUCTION

Intra- and inter-population variations of bone morphology have made the process of designing an anatomically well-fitting fracture fixation plate challenging. Although statistical bone models have recently been used for analysing morphological variabilities, it is not known to what extent they would also provide the basis for the design of a new plate shape. This would be particularly valuable in the case where no existing plate shape is available to start the process of fit optimisation. Therefore, this study investigated the anatomical fitting of a plate shape (statistical plate) derived from the mean shape of a statistical 3D tibia bone model in comparison to results available from two other plate shapes.

METHODS

Forty-five 3D bone models of tibiae from Japanese cadaver specimens, as well as 3D models of the plate undersurface of both a commercial and shape optimised Medial Distal Tibia Plate, were utilised from earlier studies. The mean shape of the 3D statistical bone model was generated from the tibia models utilising the Statismo framework. With reverse engineering software, the plate undersurface of the statistical plate shape was derived directly from the mean surface of the statistical 3D bone model. Through an iterative process, the statistical plate model was placed at the correct surgical position on each bone model for fit assessment.

RESULTS

The statistical plate was fitting for 20% of the tibiae compared to 13% for the commercial and 67% for the optimised plate, respectively.

CONCLUSIONS

The plate shape derived directly from a statistical bone model was fitting better than the commercial plate, but considerably inferior to that of an optimised plate. However, the results do clearly indicate that this approach provides an appropriate and solid basis for commencing shape optimisation of the statistical plate. Studies of other anatomical regions are required to confirm whether these findings can be generalised.