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Wang M, Deng Y, Xie P, Tan J, Yang Y, Ouyang H, Zhao D, Huang G, Huang W. Optimal Design and Biomechanical Analysis of a Biomimetic Lightweight Design Plate for Distal Tibial Fractures: A Finite Element Analysis. Front Bioeng Biotechnol 2022; 10:820921. [PMID: 35265599 PMCID: PMC8901108 DOI: 10.3389/fbioe.2022.820921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
The treatment of fractures of the distal tibia can be problematic due to the insubstantial soft-tissue covering this part of the anatomy. This study investigates a novel strategy for minimally invasive plate osteosynthesis of distal tibia fractures called bionic lightweight design plating. Following the structure of the animal trabecular bone, we utilized topological mathematical methods to redesign the material layout of the internal fixation device to fulfill the desired lightweight design within given boundary conditions. The results showed that this method can maintain the same stability of the construct as the original plate after a reduction in the original volume by 30%, and the differences in strain energy of plates and maximum node displacement of constructs between the constructs [RP construct vs. LP construct] were not statistically significant (p > 0.05). In the safety assessment of the constructs, the peak stress of plates between constructs was found to not be statistically significantly different under a doubled physiological load (p > 0.05). The average stress of the plates’ elements exceeding the allowable stress was analyzed, and no statistically significant differences were found between the two constructs under axial compression stress conditions (p > 0.05). The average stress of the plates’ elements in the redesigned plating construct under torsional stress conditions was 3.08% less than that of the locked plating construct (p < 0.05). Under the double physiological load condition, 89% of the elements of the plate in the redesigned plating construct and 85% of the elements of the plate in the locked plating construct were lower than the maximum safe stress of the plate, which was 410 MPa (secondary allowable stresses). That reminds us the topology optimization offer a possible way to improve the capacity of soft tissue protection while ensuring the safety of the RP construct by reducing the volume of the implants.
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Affiliation(s)
- Mian Wang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Pusheng Xie
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Medical Innovation Platform for Translation of 3D Printing Application, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yang Yang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Hanbin Ouyang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Dongliang Zhao
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Drug Discovery Center, State Key Laboratory of Chemical Oncogenomics, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, China
| | - Gang Huang
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Gang Huang, ; Wenhua Huang,
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Guangdong Medical Innovation Platform for Translation of 3D Printing Application, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Gang Huang, ; Wenhua Huang,
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Kent M, Mumith A, McEwan J, Hancock N. The service impact of failed locking plate fixation of distal tibial fractures: a service and financial evaluation at a major trauma centre. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1333-42. [PMID: 26429344 DOI: 10.1007/s00590-015-1706-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 09/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The surgical treatment of distal tibial fractures is challenging and controversial. Recently, locking plate fixation has become popular, but the outcomes of this treatment are mixed with complication rates as high as 50 % in the published literature. There are no reports specifically relating to the financial and resource costs of failed treatment in the literature. METHOD Retrospective service analysis of patients who had undergone locking plate fixation of a distal third tibial fracture between 2008 and 2011 with at least 12 months follow-up. Rates of readmission, reoperation, bony union and infection were ascertained. The financial and resource (hospital stay and number of outpatient appointments) implications of failed treatment were calculated. RESULTS Forty-two patients were identified. There were 31 type A fractures, one type B fracture and 10 type C fractures. Three injuries were open. Twenty patients were treated with minimally invasive percutaneous osteosynthesis (MIPO). The readmission and reoperation rates were 26 % (n = 11) and 19 % (n = 8), respectively. A total of 89 % of readmissions were due to infection. All patients had received appropriate antibiotic regimens. The average costs of successful and failed treatment were £ 5538 and £ 18,335, respectively. The average time to union was 24.5 weeks. The rate of non-union was 21 % (n = 9). The rate of infection was 28 % (n = 12), with all patients with open fracture incurring an infection. Tourniquet time had no effect on the incidence of complications. Smokers were more likely to incur a complication (p < 0.05), and non-union was lower in the MIPO group (p < 0.05). The length and total cost of inpatient care were significantly lower in the MIPO group (p < 0.05). MIPO patients were five times less likely to incur readmission or reoperation. Failed treatment was three times more expensive and four times longer than successful treatment. CONCLUSION The study identified a large burden to the service following failure of locking plate treatment of these fractures, but the outcomes were similar to series published in the literature. Readmission rates were high following these injuries, and failed treatment was costly and had a significant impact on hospital resources. The implementation of major trauma networks and centralised subspecialised units should improve quality and value for money.
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Affiliation(s)
- Michael Kent
- Department of Trauma and Orthopaedics, University Hospital Southampton, Tremona Road, Southampton, Hants, SO166YD, England, UK. .,Department of Orthopaedics, Fremantle Hospital, Alma Street, Fremantle, 6160, Australia.
| | - Aadil Mumith
- Department of Trauma and Orthopaedics, University Hospital Southampton, Tremona Road, Southampton, Hants, SO166YD, England, UK
| | - Jo McEwan
- Department of Trauma and Orthopaedics, University Hospital Southampton, Tremona Road, Southampton, Hants, SO166YD, England, UK
| | - Nicholas Hancock
- Department of Trauma and Orthopaedics, University Hospital Southampton, Tremona Road, Southampton, Hants, SO166YD, England, UK
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Are locking plates better than non-locking plates for treating distal tibial fractures? Foot Ankle Surg 2014; 20:115-9. [PMID: 24796830 DOI: 10.1016/j.fas.2013.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/03/2013] [Accepted: 12/23/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Locking and non-locking plates has been used for distal tibia fracture osteosynthesis. Sufficient evidence to favor one implant over the other is lacking in the current literature. Our aim is to compare them in terms of fracture healing, alignment, functional outcome, complications. METHODS Sixty-eight patients operated on using a percutaneous plate were retrospectively reviewed. They were divided into two groups: in group 1 (28 patients) a 4.5mm narrow conventional dynamic compression plate (DCP) was used. In group 2 (40 patients) a titanium locked compression plate (LCP) was used. RESULTS Mean time to union was 16.2 and 15.4 weeks for group 1 and 2, respectively (p=0.618). 11 patients (39.3%) in group 1 and 4 patients (10%) in group 2 showed malalignment (p=0.016). AOFAS scores at follow up were 89 and 88 in groups 1 and 2, respectively. Implant removal was necessary in 9 cases (32.1%) and 4 cases (10%) in group 1 and group 2, respectively (p=0.042). Three patients (10.7%) in group 1 and three patients (7.5%) in group 2 had an infection. CONCLUSIONS Both plating systems have similar results in terms of time to union, infection, and AOFAS scores. The LCP seems superior with respect to alignment and the need for implant removal.
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