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Mitchell C, Emami K, Emami A, Hosseinzadeh S, Shore B, Novais EN, Kiapour AM. Effects of joint loading on the development of capital femoral epiphysis morphology. Arch Orthop Trauma Surg 2023; 143:5457-5466. [PMID: 36856839 DOI: 10.1007/s00402-023-04795-0] [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: 09/20/2022] [Accepted: 01/22/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION The deleterious influence of increased mechanical forces on capital femoral epiphysis development is well established; however, the growth of the physis in the absence of such forces remains unclear. The hips of non-ambulatory cerebral palsy (CP) patients provide a weight-restricted (partial weightbearing) model which can elucidate the influence of decreased mechanical forces on the development of physis morphology, including features related to development of slipped capital femoral epiphysis (SCFE). Here we used 3D image analysis to compare the physis morphology of children with non-ambulatory CP, as a model for abnormal hip loading, with age-matched native hips. MATERIALS AND METHODS CT images of 98 non-ambulatory CP hips (8-15 years) and 80 age-matched native control hips were used to measure height, width, and length of the tubercle, depth, width, and length of the metaphyseal fossa, and cupping height across different epiphyseal regions. The impact of age on morphology was assessed using Pearson correlations. Mixed linear model was used to compare the quantified morphological features between partial weightbearing hips and full weightbearing controls. RESULTS In partial weightbearing hips, tubercle height and length along with fossa depth and length significantly decreased with age, while peripheral cupping height increased with age (r > 0.2, P < 0.04). Compared to normally loaded (full weightbearing) hips and across all age groups, partially weightbearing hips' epiphyseal tubercle height and length were smaller (P < .05), metaphyseal fossa depth was larger (P < .01), and posterior, inferior, and anterior peripheral cupping heights were smaller (P < .01). CONCLUSIONS Smaller epiphyseal tubercle and peripheral cupping with greater metaphyseal fossa size in partial weightbearing hips suggests that the growing capital femoral epiphysis requires mechanical stimulus to adequately develop epiphyseal stabilizers. Deposit low prevalence and relevance of SCFE in CP, these findings highlight both the role of normal joint loading in proper physis development and how chronic abnormal loading may contribute to various pathomorphological changes of the proximal femur (i.e., capital femoral epiphysis).
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Affiliation(s)
- Charles Mitchell
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Koroush Emami
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Alex Emami
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Benjamin Shore
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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Hinz N, Dehoust J, Münch M, Seide K, Barth T, Schulz AP, Frosch KH, Hartel MJ. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg 2022; 48:3541-3560. [PMID: 35305114 PMCID: PMC9532317 DOI: 10.1007/s00068-022-01936-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01936-9.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Arndt-Peter Schulz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Test-Retest Reliability of Functional Electromechanical Dynamometer on Five Sit-to-Stand Measures in Healthy Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136829. [PMID: 34202138 PMCID: PMC8297007 DOI: 10.3390/ijerph18136829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022]
Abstract
Background: The purpose of this study was to determine the reliability for the strength and movement velocity of the concentric phase from the five Sit-to-Stand (5STS), using three incremental loads measured by a functional electromechanical dynamometer (FEMD) in healthy young adults. Methods: The average and peak strength and velocity values of sixteen healthy adults (mean ± standard deviation (SD): age = 22.81 ± 2.13 years) were recorded at 5, 10 and 15 kg. To evaluate the reliability of FEMD, the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and coefficient of variation (CV) were obtained. Results: Reliability was high for the 10 kg (CV range: 3.70–4.18%, ICC range: 0.95–0.98) and 15 kg conditions (CV range: 1.64–3.02%, ICC: 0.99) at average and peak strength, and reliability was high for the 5 kg (CV range: 1.71–2.84%, ICC range: 0.96–0.99), 10 kg (CV range: 0.74–1.84%, ICC range: 0.99–1.00) and 15 kg conditions (CV range: 0.79–3.11%, ICC range: 0.99–1.00) at average and peak velocity. Conclusions: The findings of this study demonstrate that FEMD is a reliable instrument to measure the average and peak strength and velocity values during the five STS in healthy young adults.
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Le Quang H, Schmoelz W, Lindtner RA, Schwendinger P, Blauth M, Krappinger D. Biomechanical comparison of fixation techniques for transverse acetabular fractures - Single-leg stance vs. sit-to-stand loading. Injury 2020; 51:2158-2164. [PMID: 32646647 DOI: 10.1016/j.injury.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To biomechanically compare five different fixation techniques for transverse acetabular fractures using both the single-leg stance (SLS) and the sit-to-stand (STS) loading protocols and to directly compare fracture gap motion (FGM) and relative interfragmentary rotation (RIFR). METHODS Transtectal transverse acetabular fractures were created on fourth-generation composite hemipelves in a reproducible manner. Five different fixation techniques were biomechanically assessed using both an SLS and STS loading protocol: anterior plate (AP) only, posterior plate (PP) only, anterior plate plus posterior column screw (AP+PCS), posterior plate plus anterior column screw (PP+ACS) and anterior plus posterior plate (AP+PP). After preconditioning, the specimens were loaded from 50 to 750 N with a ramp of 100 N/s. FGM and RIFR under loads of 750 N were measured using an optical 3D measurement system. RESULTS In the three groups of fixation techniques addressing both columns, STS loading resulted in higher mean FGM and in RIFR than SLS loading. No construct failure was observed. In the single plate groups (AP only and PP only), STS loading resulted in failure of all specimens before reaching loads of 750 N, while no failure occurred after SLS loading. No significant differences in FGM and RIFR were found between the double plate (AP+PP) and the single plate plus column screw (AP+PCS and PP+ACS) techniques. CONCLUSION SLS loading appeared to overestimate the strength of acetabular fracture fixation constructs and STS loading may be more appropriate to provide clinically relevant biomechanical data. Internal fixation of a single column might not provide adequate stability for transverse fractures, while strength of single plate plus column screw fixation and double plate fixation was comparable.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Lazennec JY, Kim Y, Folinais D, Pour AE. Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA. Arthroplast Today 2020; 6:672-681. [PMID: 32875018 PMCID: PMC7451919 DOI: 10.1016/j.artd.2020.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/04/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Sagittal spinopelvic translation (SSPT) is the horizontal distance from the hip center to the C7 plumb line (C7PL). SSPT is an important variable showing the overall patient balance in different functional positions which could affect the rate of hip instability. This study investigates the SSPT modification in patients who underwent total hip arthroplasty (THA). Methods A total of 120 patients were assessed preoperatively and postoperatively on standing and sitting acquisitions (primary unilateral THA without complication). SSPT is zero when the C7PL goes through the center of the femoral heads and positive when the C7PL is posterior to the hips’ center (negative if anterior). Three subgroups were defined based on the pelvic incidence (PI): low PI <45°, 45°< normal PI <65°, or high PI >65°. Results The overall mean preoperative SSPT change from standing to sitting was 2.2 cm ([-7.2 to 17.4]) (P < .05). The overall mean postoperative SSPT change from standing to sitting was 1.2 cm ([-14.2 to 22.4]) (P < .05). In low- and normal-PI groups, standing to sitting SSPT and preoperative to postoperative changes in standing SSPT were increased significantly after surgery with the C7PL behind the hips’ center (P < .05). In the high-PI group, standing to sitting SSPT was increased postoperatively (P = .034) (no significant changes from preoperative to postoperative status in standing and sitting). Conclusions Adaptation from standing to sitting positions combines pelvic tilt and anteroposterior pelvic translation. THA implantation induces significant changes in SSPT mainly for low- and standard-PI patients. This is an important variable to consider when investigating the causes of THA subluxation or dislocation.
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Affiliation(s)
- Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France.,Anatomy Department Faculté Pitié-Salpêtrière, Médecine Sorbonne Université, Paris, France.,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Dominique Folinais
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France.,Anatomy Department Faculté Pitié-Salpêtrière, Médecine Sorbonne Université, Paris, France.,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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