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Roy D, Das MC, Dhason R, Roy S, Datta S. Effect of matrix material property on the composite tibia fracture plate: a biomechanical study. Biomed Phys Eng Express 2024; 10:035026. [PMID: 38547526 DOI: 10.1088/2057-1976/ad38c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
For the purpose of fixing tibia fractures, composite bone plates are suggested. Metal plates cause stress shielding, lessen the compression force at the fracture site, and have an impact on the healing process because they are significantly more rigid than bone. To prevent excessive shear strain and consequent instability at the fracture site, it is imperative to reduce stiffness in the axial direction without lowering stiffness in the transverse direction. Only a carefully crafted fiber reinforced composite with anisotropic properties will suffice to accomplish this. The purpose of the current study is to examine the impact of axial and shear movements at the fracture site on the fixing of metal and composite bone plates. After modeling the tibia with a 1 mm fracture gap, titanium plates, carbon/epoxy, carbon/PEEK, and carbon/UHMWPE composite bone plates were used to fix it. There are 6 holes on each of the 103 mm long plates. To determine the stresses and axial movement in the fracture site, anatomical 3D Finite Element (FE) models of the tibia with composite bone plates are built. The simulations that were run for various composite plate layouts and types give suggestions for selecting the best composite bone plate. Although the matrix material causes some variations in behaviors, most of the plates perform as well as or even better than metal plates. Thus, the appropriate composite combinations are recommended for a given fracture structure.
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Affiliation(s)
- Drupad Roy
- Department of Mechanical Engineering, MCKV Institute of Engineering, Liluah, Howrah 711204, West Bengal, India
| | - Manik Chandra Das
- Department of Industrial Engineering and Management, Maulana Abul Kalam Azad University of Technology, Haringhata, Nadia 741249, West Bengal, India
| | - Raja Dhason
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
| | - Sandipan Roy
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
| | - Shubhabrata Datta
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
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Minhas A, Berkay F, Ehlers CB, Froehle AW, Krishnamurthy AB. The statistical fragility of intramedullary reaming in tibial nail fixation: a systematic review. Eur J Trauma Emerg Surg 2023; 49:2347-2354. [PMID: 36879152 DOI: 10.1007/s00068-023-02254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To report the statistical stability of prospective clinical trials evaluating the effect of intramedullary reaming on rates of non-union in tibial fractures through calculation of the fragility metrics for non-union rates and all other dichotomous outcomes. METHODS Literature search was conducted for prospective clinical trials evaluating the effect of intramedullary reaming on non-union rates in tibial nailing. All dichotomous outcomes were extracted from the manuscripts. The fragility index (FI) and reverse fragility index (RFI) were calculated by determining the number of event reversals required for a statistically significant outcome to lose significance and vice-versa. The fragility quotient (FQ) and reverse fragility quotient (RFQ) were calculated by dividing the FI or RFI by the sample size, respectively. Outcomes were defined as "fragile" if the FI or RFI was found to be less than or equal to the number of patients lost to follow-up. RESULTS Literature search identified 579 results which produced ten studies meeting the criteria for review. There were 111 outcomes identified for analysis, of which 89 (80%) exhibited statistical fragility. For reported outcomes across the studies the median and mean FI was 2, the median FQ was 0.019, the mean FQ was 0.030, the median RFI was 4, the mean RFI was 3.95, the median RFQ was 0.045, and the mean RFQ was 0.030. Four studies reported outcomes which were found to have an FI of 0. CONCLUSIONS The studies evaluating the effect of intramedullary reaming on tibial nail fixation demonstrate considerable fragility. On average, two event reversals for significant findings, and four event reversals for insignificant findings are sufficient to alter statistical significance. LEVEL OF EVIDENCE Level II, systematic review of Level I and Level II studies.
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Affiliation(s)
- Arjun Minhas
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, 45409, USA.
- Department of Orthopaedic Surgery, Miami Valley Hospital, 30 E. Apple Street, Suite 2200, Dayton, OH, 45409, USA.
| | - Fehmi Berkay
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, 45409, USA
| | - Cooper B Ehlers
- Department of Orthopaedic Surgery, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, 45409, USA
| | - Anil B Krishnamurthy
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, 45409, USA
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Jones JK, Ngo D, Cardon M, Mullis BH, Weaver BA, Slaven JE, McCaskey M, Mir HR, Warner SJ, Achor TS, Natoli RM. High Nonunion and Amputations Rates With Either Early Intramedullary Nail Removal or Retention for Tibial Shaft Fracture-Related Infections. J Orthop Trauma 2023; 37:574. [PMID: 37448150 DOI: 10.1097/bot.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To compare debridement, antibiotics, and implant retention (DAIR) and intramedullary nail (IMN) removal with subsequent strategy for fracture stabilization in the treatment of tibia fracture-related infections (FRIs) occurring within 90 days of initial IMN placement. DESIGN Retrospective case-control. SETTING Four academic, Level 1 trauma centers. PATIENTS Sixty-six patients who subsequently received unplanned operative treatment for FRI diagnosed within 90 days of initial tibia IMN. INTERVENTION DAIR versus IMN removal pathways. MAIN OUTCOME MEASUREMENTS Fracture union. RESULTS Twenty-eight patients (42.4%) were treated with DAIR and 38 (57.6%) via IMN removal with subsequent strategy for fracture stabilization. Mean follow-up was 16.3 months. At final follow-up, ultimate bone healing was achieved in 75.8% (47/62), whereas 24.2% (15/62) had persistent nonunion or amputation. No significant difference was observed in ultimate bone healing ( P = 0.216) comparing DAIR and IMN removal. Factors associated with persistent nonunion or amputation were time from injury to initial IMN ( P < 0.001), McPherson systemic host grade B ( P = 0.046), and increasing open-fracture grade, with Gustilo-Anderson IIIB/IIIC fractures being the worst ( P = 0.009). Fewer surgeries after initial FRI treatment were positively associated with ultimate bone healing ( P = 0.029). CONCLUSIONS Treatment of FRI within 90 days of tibial IMN with DAIR or IMN removal with subsequent strategy for fracture stabilization results in a high rate, nearly 1 in 4, of persistent nonunion or amputation, with neither appearing superior for improving bone healing outcomes. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jenna K Jones
- Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN
| | - Daniel Ngo
- McGovern Medical School at UTHealth, Department of Orthopaedic Surgery, Houston, TX
| | - Morgan Cardon
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Brian H Mullis
- Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN
| | - Bree A Weaver
- Division of Infectious Disease, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN; and
| | - Meghan McCaskey
- University of South Florida, Florida Orthopaedic Institute, Tampa, FL
| | - Hassan R Mir
- University of South Florida, Florida Orthopaedic Institute, Tampa, FL
| | - Stephen J Warner
- McGovern Medical School at UTHealth, Department of Orthopaedic Surgery, Houston, TX
| | - Timothy S Achor
- McGovern Medical School at UTHealth, Department of Orthopaedic Surgery, Houston, TX
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN
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Cunningham D, LaRose M, Patel P, Zhang G, Morriss N, Paniagua A, Gage M. Regional anesthesia improves inpatient but not outpatient opioid demand in tibial shaft fracture surgery. Eur J Orthop Surg Traumatol 2023; 33:2921-2931. [PMID: 36912951 DOI: 10.1007/s00590-023-03504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients undergoing operative treatment of tibial shaft fractures have considerable pain largely managed with opioids. Regional anesthesia (RA) has been increasingly used to reduce perioperative opioid use. METHODS This was a retrospective study of 426 patients that underwent operative treatment of tibial shaft fractures with and without RA. Inpatient opioid consumption and 90-day outpatient opioid demand were measured. RESULTS RA significantly decreased inpatient opioid consumption for 48 h post-operatively (p = 0.008). Neither inpatient use after 48 h nor outpatient opioid demand differed in patients with RA (p > 0.05). CONCLUSIONS RA may help with inpatient pain control and reduce opioid use in tibial shaft fracture. LEVEL OF EVIDENCE Level III, retrospective, therapeutic cohort study.
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Affiliation(s)
- Daniel Cunningham
- Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC, 27710, USA
| | - Micaela LaRose
- Duke University School of Medicine, Duke University Medical Center, 3710, Durham, NC, 27710, USA
| | - Preet Patel
- Duke University School of Medicine, Duke University Medical Center, 3710, Durham, NC, 27710, USA
| | - Gloria Zhang
- Duke University School of Medicine, Duke University Medical Center, 3710, Durham, NC, 27710, USA
| | - Nicholas Morriss
- Duke University School of Medicine, Duke University Medical Center, 3710, Durham, NC, 27710, USA.
| | - Ariana Paniagua
- Duke University School of Medicine, Duke University Medical Center, 3710, Durham, NC, 27710, USA
| | - Mark Gage
- Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC, 27710, USA
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Chitnis A, Ray B, Sparks C, Grebenyuk Y, Vanderkarr M, Holy CE. Long bone fractures: treatment patterns and factors contributing to use of intramedullary nailing. Expert Rev Med Devices 2020; 17:731-738. [PMID: 32597254 DOI: 10.1080/17434440.2020.1779055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study evaluated treatment patterns for long bone fractures and factors that contribute to use of intramedullary nails (IMN). METHODS Patients from IBM MarketScan® Research Commercial and Medicare Databases with femoral/tibial/humeral fractures during inpatient admission between January 2016-July 2019 were identified. Patients were categorized by treatment (i.e., non-surgical/internal fixation [extramedullary internal fixation/plating]/IMN/external fixation). Four-year rates of IMN were reported by fracture type. Logistic regression evaluated factors contributing to IMN use. RESULTS 14,961 femoral, 14,101 tibial, and 7,059 humeral fracture patients were identified (mean[SD] age was 45.3[18.9], 42.0[16.3], and 39.8[21.6] years and % female 50.8%, 47.7%, and 55.3%, respectively). Mean(SD) lengths of stay were 6.7(9.2), 5.9(7.0), and 5.8(10.3) days, rates of surgical treatment were 74.3%, 84.0%, and 62.7%, and rates of IMN among surgical patients were 46.6%, 27.1%, and 6.7% for femoral, tibial, and humeral fractures, respectively. IMN was the predominant treatment for femoral fractures over the past 4 years. Factors contributing to IMN use included open/closed diaphyseal fractures, pathological fractures, diagnoses of cancer or AIDS/HIV, and alcohol abuse. CONCLUSIONS IMN was the predominant treatment for femoral fractures and use slightly increased for tibial/humeral fractures. Open/closed diaphyseal fractures, pathological fractures, cancer or AIDS/HIV, and alcohol abuse contributed to IMN use.
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Affiliation(s)
- Abhishek Chitnis
- Medical Devices Epidemiology,Real World Data Sciences, Johnson & Johnson , New Brunswick, NJ, USA
| | | | - Charisse Sparks
- Medical Affairs, DePuy Orthopedics, Inc , West Chester, PA, USA
| | - Yuriy Grebenyuk
- Medical Affairs, DePuy Orthopedics, Inc , West Chester, PA, USA
| | - Mollie Vanderkarr
- Health Economics and Market Access, DePuy Synthes , West Chester, PA, USA
| | - Chantal E Holy
- Medical Devices Epidemiology,Real World Data Sciences, Johnson & Johnson , New Brunswick, NJ, USA
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Konda SR, Dedhia N, Ganta A, Egol KA. Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Tibial Shaft and Plateau Fractures. J Orthop Trauma 2020; 34:539-44. [PMID: 32349026 DOI: 10.1097/BOT.0000000000001791] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether a validated trauma triage tool can identify the middle-aged and geriatric trauma patients with tibial shaft and plateau fractures who are at the risk for costly admissions and poorer hospital quality measures. DESIGN Prospective cohort study. SETTING Level-1 trauma center. PATIENTS/PARTICIPANTS Sixty-four patients older than 55 years hospitalized with isolated tibial shaft or plateau fractures. INTERVENTION Patients with either isolated tibial plateau fractures or tibial shaft fractures over a 3-year period were prospectively enrolled in an orthopedic trauma registry. Demographic information, injury severity, and comorbidities were assessed and incorporated into the Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) score, a validated trauma triage score that calculates inpatient mortality risk upon admission. Patients were then grouped into tertiles based on their STTGMA score. MAIN OUTCOME MEASURES Length of stay, complications, discharge location, and direct variable costs. RESULTS Sixty-four patients met inclusion criteria. Thirty-three patients (51.6%) presented with tibial plateau fractures and 31 (48.4%) with tibial shaft fractures. The mean age was 66.7 ± 10.2 years. Mean length of stay was significantly different between risk groups with a mean of 6.8 ± 4 days (P < 0.001). Although 19 (90.5%) of the minimal risk patients were discharged home, only 7 (33.3%) and 5 (22.7%) of moderate- and high-risk patients were discharged home, respectively (P < 0.001). Higher-risk patients experienced a significantly greater number of complications during hospitalization but had no differences in the need for intensive care unit-level care (P = 0.027 and P = 0.344, respectively). The total cost difference between the lowest- and highest-risk group was nearly 50% ($14,070 ± 8056 vs. $25,147 ± 14,471; mean difference, $11,077; P = 0.022). CONCLUSION Application of the STTGMA triage tool allows for the prediction of key hospital quality measures and cost of hospitalization that can improve clinical decision-making. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Lajevardi-khosh A, Stuart A, Ackerman M, Rothberg D, Kubiak E, Petelenz T, Hitchcock R. Characterization of compliance to weight-bearing protocols and patient weight-bearing behavior during the recovery period in lower extremity fractures: a pilot study. Current Orthopaedic Practice 2019; 30:395-402. [DOI: 10.1097/bco.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lajevardi-Khosh A, Tresco B, Stuart A, Sinclair S, Ackerman M, Kubiak E, Petelenz T, Hitchcock R. Development of a step counting algorithm using the ambulatory tibia load analysis system for tibia fracture patients. J Rehabil Assist Technol Eng 2019; 5:2055668318804974. [PMID: 31191958 PMCID: PMC6531803 DOI: 10.1177/2055668318804974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction: Ambulation can be used to monitor the healing of lower
extremity fractures. However, the ambulatory behavior of tibia fracture patients
remains unknown due to an inability to continuously quantify ambulation outside
of the clinic. The goal of this study was to design and validate an algorithm to
assess ambulation in tibia fracture patients using the ambulatory tibial load
analysis system during recovery, outside of the clinic.
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Affiliation(s)
| | - Ben Tresco
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Ami Stuart
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Sarina Sinclair
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Matt Ackerman
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Erik Kubiak
- Department of Orthopaedics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Tomasz Petelenz
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Christiano AV, Goch AM, Leucht P, Konda SR, Egol KA. Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion. J Clin Orthop Trauma 2019; 10:650-654. [PMID: 31316233 PMCID: PMC6611993 DOI: 10.1016/j.jcot.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the ability of preoperative and postoperative radiographic union scores for tibia fractures (RUST) to predict treatment success of tibia fracture nonunion. MATERIALS AND METHODS Patients presenting for operative treatment of tibia fracture nonunion were enrolled in a prospective data registry. Enrolled patients were followed at regular intervals for 12 months. Preoperative and 12 week postoperative radiographs were reviewed and scored using the RUST criteria. Postoperative time to union was determined by clinical and radiographic measures. Multivariate regressions were conducted to predict time to union using preoperative and postoperative RUST while controlling for treatment method. Receiver operating characteristic (ROC) curve was conducted to determine the accuracy of preoperative RUST in predicting failure of treatment. RESULTS Sixty-eight patients with aseptic tibia fracture nonunion treated operatively were identified. Sixty-one patients achieved union. Mean preoperative RUST was 7.5 (SD 1.4). Mean postoperative RUST was 9.2 (SD 1.4). Multivariate linear regressions demonstrated that preoperative (p = 0.043) and postoperative (p = 0.007) RUST are significant predictors of time to union after tibia fracture nonunion surgery. ROC curve demonstrated preoperative RUST below 7 was a good predictor of developing persistent tibia fracture nonunion (AUC = 0.83, Sensitivity = 1.000, Specificity = 0.745). CONCLUSIONS RUST preoperatively and postoperatively predicts outcome after nonunion surgery. RUST can be used as part of the complete clinical picture to shape patient expectations and guide treatment.
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Affiliation(s)
- Anthony V. Christiano
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author. 1 Gustave L Levy Pl, Box 1188, New York, NY, 10029, USA.
| | | | | | - Sanjit R. Konda
- NYU Hospital for Joint Diseases, New York, NY, USA,Jamaica Hospital Medical Center, New York, NY, USA
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McSweeney AL, Zani BG, Baird R, Stanley JR, Hayward A, Markham PM, Kopia GA, Edelman ER, Rabiner R. Biocompatibility, bone healing, and safety evaluation in rabbits with an IlluminOss bone stabilization system. J Orthop Res 2017; 35:2181-2190. [PMID: 28135014 PMCID: PMC5534392 DOI: 10.1002/jor.23532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/23/2017] [Indexed: 02/04/2023]
Abstract
Bone healing, biocompatibility, and safety employing the IlluminOss System (IS), comprised of an inflatable balloon filled with photopolymerizable liquid monomer, was evaluated in New Zealand white rabbits. Successful bone healing and callus remodeling over 6 months was demonstrated radiologically and histologically with IS implants in fenestrated femoral cortices. Biocompatibility was demonstrated with IS implants in brushed, flushed femoral intramedullary spaces, eliciting no adverse, local, or systemic responses and with similar biocompatibility to K-wires in contralateral femurs up to 1 year post-implant. Lastly simulated clinical failures demonstrated the safety of IS implants up to 1 year in the presence of liquid or polymerized polymer within the intramedullary space. Polymerized material displayed cortical bone and vasculature effects comparable to mechanical disruption of the endosteum. In the clinically unlikely scenario with no remediation or polymerization, a high dose monomer injection resulted in marked necrosis of cortical bone, as well as associated vasculature, endosteum, and bone marrow. Overall, when polymerized and hardened within bone intramedullary spaces, this light curable monomer system may provide a safe and effective method for fracture stabilization. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2181-2190, 2017.
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Affiliation(s)
- Amanda L. McSweeney
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421,Author to whom all correspondence should be addressed: Amanda L. McSweeney, BS, RLATG, SRS, CBSET, Inc., 500 Shire Way, Lexington, MA 02421, Phone: 781-541-5567,
| | - Brett G. Zani
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Rose Baird
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - James R.L. Stanley
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Alison Hayward
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Peter M. Markham
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | | | - Elazer R. Edelman
- Institute for Medical and Engineering Science, Massachusetts Institute of Technology, E25, 45 Carleton St., Cambridge, MA, 02139
| | - Robert Rabiner
- IlluminOss Medical Inc., 993 Waterman Ave., East Providence, RI 02914
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11
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Zani BG, Baird R, Stanley JRL, Markham PM, Wilke M, Zeiter S, Beck A, Nehrbass D, Kopia GA, Edelman ER, Rabiner R. Evaluation of an intramedullary bone stabilization system using a light-curable monomer in sheep. J Biomed Mater Res B Appl Biomater 2015; 104:291-9. [PMID: 25772144 DOI: 10.1002/jbm.b.33380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/28/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022]
Abstract
Percutaneous intramedullary fixation may provide an ideal method for stabilization of bone fractures, while avoiding the need for large tissue dissections. Tibiae in 18 sheep were treated with an intramedullary photodynamic bone stabilization system (PBSS) that comprised a polyethylene terephthalate (Dacron) balloon filled with a monomer, cured with visible light in situ, and then harvested at 30, 90, or 180 days. In additional 40 sheep, a midshaft tibial osteotomy was performed and stabilized with external fixators or external fixators combined with the PBSS and evaluated at 8, 12, and 26 weeks. Healing and biocompatibility were evaluated by radiographic analysis, micro-computed tomography, and histopathology. In nonfractured sheep tibiae, PBSS implants conformably filled the medullary canal, while active cortical bone remodeling and apposition of new periosteal and/or endosteal bone was observed with no significant macroscopic or microscopic observations. Fractured sheep tibiae exhibited increased bone formation inside the osteotomy gap, with no significant difference when fixation was augmented by PBSS implants. Periosteal callus size gradually decreased over time and was similar in both treatment groups. No inhibition of endosteal bone remodeling or vascularization was observed with PBSS implants. Intramedullary application of a light-curable PBSS is a biocompatible, feasible method for fracture fixation.
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Affiliation(s)
- Brett G Zani
- Department of Applied Sciences, CBSET, Inc., Lexington, Massachusetts, 02421
| | - Rose Baird
- Department of Applied Sciences, CBSET, Inc., Lexington, Massachusetts, 02421
| | - James R L Stanley
- Department of Pathology, CBSET, Inc., Lexington, Massachusetts, 02421
| | | | - Markus Wilke
- AO Research Institute Davos, 7270, Davos, Switzerland
| | | | - Aswin Beck
- AO Research Institute Davos, 7270, Davos, Switzerland
| | - Dirk Nehrbass
- AO Research Institute Davos, 7270, Davos, Switzerland
| | | | - Elazer R Edelman
- Institute for Medical and Engineering Science, Massachusetts Institute of Technology E25, Cambridge, Massachusetts, 02139
| | - Robert Rabiner
- IlluminOss Medical, Inc., East Providence, Rhode Island, 02914
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12
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Diotte B, Fallavollita P, Wang L, Weidert S, Euler E, Thaller P, Navab N. Multi-modal intra-operative navigation during distal locking of intramedullary nails. IEEE Trans Med Imaging 2015; 34:487-495. [PMID: 25296403 DOI: 10.1109/tmi.2014.2361155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The interlocking of intramedullary nails is a technically demanding procedure which involves a considerable amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure and fix screws into 4-6 mm distal holes of the nail. We propose to design an augmented radiolucent drill to assist surgeons in completing the distal locking procedure without any additional X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the augmented radiolucent drill and estimate its tip position in real-time. Consequently, the surgeons will be able to maintain the down the beam positioning required to drill the screws into the nail holes successfully. To evaluate the accuracy of the proposed augmented drill, we perform a preclinical study involving six surgeons and ask them to perform distal locking on dry bone phantoms. Surgeons completed distal locking 98.3% of the time using only a single X-ray image with an average navigation time of 1.4 ± 0.9 min per hole.
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14
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Abstract
BACKGROUND Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. METHODS We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date). RESULTS Among the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women. CONCLUSIONS Nonunions in TSF's are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.
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Abstract
The purpose of this review is to identify knowledge about the influence of chronic disease on major life changing decisions (MLCDs). This review was carried out in three stages: identification of key search terms; selection of databases and searching parameters; and evaluation of references. Only two articles matched the main search term 'major life changing decisions'. No article reviewed or measured the influence of chronic disease on major life changing decisions. However, 76 articles and various sections of seven books were identified that provided insight into this area and these are reviewed in detail. This literature review has brought together previously scattered information on chronic disease impact on important patient life decisions. These include decisions related to having children, marriage and divorce, job and career choice, social life, holidays, travelling and education. Lifestyle decisions viewed by patients as major decisions are also documented. The influence of cancer on life decisions is discussed, as are affected life decisions of other family members. Very little information is available about the long-term impact of chronic disease on patients' lives and methodology to assess long-term impact is incomplete. This review points to a novel dimension to health-related outcome research, the impact of chronic disease on major life changing decisions, and its possible implication for patients' future health.
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Affiliation(s)
- Zu Bhatti
- Centre for Socioeconomic Research, School of Pharmacy and Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, UK.
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Gkintzou V, Papablasopoulou T, Syrimpeis V, Sourla E, Tzimas G, Tsakalidis A. A Web and Smart Phone System for Tibia Open Fractures. In: Cruz-cunha MM, Varajão J, Powell P, Martinho R, editors. ENTERprise Information Systems. Berlin: Springer Berlin Heidelberg; 2011. pp. 413-22. [DOI: 10.1007/978-3-642-24352-3_43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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North K, Maass SD, Hitchcock RW. An insole sensor for recording weight bearing behavior during tibial fracture rehabilitation. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:1856-9. [PMID: 21095682 DOI: 10.1109/iembs.2010.5626006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Partial weight bearing prescriptions for tibial fracture care are made with little data to support their efficacy. To provide long term tibial load data that can be used to study, guide, and monitor partial weight bearing, we developed a novel load sensor that can record the load placed on an injured limb over a two-week period of time. The prototype load sensor demonstrated high linearity, low hysteresis and low static and dynamic drift. Preliminary human testing on the load sensor demonstrated the ability of the load sensor to capture load profile during underfoot recording. Presented are the bench testing and human testing data on the prototype load sensor verifying the design of an economic and durable system that allows for 2 weeks of recording of normal loads experienced by the tibia. This design motivates a next generation approach for use in clinical trials that will enable clinicians and researchers to improve current partial weight bearing prescriptions, thus improving tibial fracture outcomes.
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Affiliation(s)
- Kylee North
- Department of Bioengineering, University of Utah, Salt Lake City, 84112, USA.
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Smeltzer MD. Making a point about open fractures. Nursing 2010; 40:24-30; quiz 30-1. [PMID: 20234265 DOI: 10.1097/01.NURSE.0000369860.37315.c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Modin M, Ramos T, Stomberg MW. Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation. J Clin Nurs 2009; 18:3498-506. [PMID: 19732246 DOI: 10.1111/j.1365-2702.2009.02859.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of the impact of their health-related life situation on their daily life two and four weeks after primary fracture treatment with Ilizarov external fixation. BACKGROUND A few studies have been conducted postoperatively focussing on fracture treatment with Ilizarov fixation. DESIGN A prospective descriptive research design. METHOD Patients who had been treated for a proximal/distal tibial fracture were invited to participate in the study. Data were collected with a semi-structured questionnaire where 20 patients described in their own words their situation at home two and four weeks postoperatively. The process used when analysing the data was similar to content analysis. RESULTS Four key themes were identified: 'limitations in the home environment', 'limitations outside the home', 'limitations to social relations' and 'experience of having an Ilizarov fixation'. The patient's life situation was strongly affected during the first postoperative month. This took the form of clear limitations on activities outside the home and a degree of limitation on coping with household chores and personal hygiene. These limitations became less severe after between 2-4 weeks and were very much a consequence of using crutches. CONCLUSION This study points to limitations in the patient's daily life situation in the home. The results from the study make it obvious that the information given to patients prior to discharge, concerning the value of putting weight on the leg, had not been clear or that the patients had not understood it. This had a negative impact on the patient's daily life after discharge. Further data are needed to uncover the extent of the issue to be able to optimise patient outcomes. RELEVANCE TO CLINICAL PRACTICE There is a need for clearer and more active information from the nurse before discharge but also a need to follow up how the information given is understood.
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Affiliation(s)
- Marina Modin
- Department of Surgery, Central Hospital, Skövde, Sweden.
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Murphy S, Conway C, McGrath NB, Leary BO, P. O’Sullivan M, Powell A. A journey taken when developing a new neurovascular assessment tool. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.joon.2008.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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