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Wang B, Wang W, Li J, Li J. Zinc finger protein 36 like 2-histone deacetylase 1 axis is involved in the bone responses to mechanical stress. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167162. [PMID: 38604490 DOI: 10.1016/j.bbadis.2024.167162] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
The molecular mechanism underlying the promotion of fracture healing by mechanical stimuli remains unclear. The present study aimed to investigate the role of zinc finger protein 36 like 2 (ZFP36L2)-histone deacetylase 1 (HDAC1) axis on the osteogenic responses to moderate mechanical stimulation. Appropriate stimulation of fluid shear stress (FSS) was performed on MC3T3-E1 cells transduced with ZFP36L2 and HDAC1 recombinant adenoviruses, aiming to validate the influence of mechanical stress on the expression of ZFP36L2-HDAC1 and the osteogenic differentiation and mineralization. The results showed that moderate FSS stimulation significantly upregulated the expression of ZFP36L2 in MC3T3-E1 cells (p < 0.01). The overexpression of ZFP36L1 markedly enhanced the levels of osteogenic differentiation markers, including bone morphogenetic protein 2 (BMP2), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), Osterix, and collagen type I alpha 1 (COL1A1) (p < 0.01). ZFP36L2 accelerated the degradation of HDAC1 by specifically binding to its 3' UTR region, thereby fulfilling its function at the post-transcriptional regulatory gene level and promoting the osteogenic differentiation and mineralization fate of cells. Mechanical unloading notably diminished/elevated the expression of ZFP36L2/HDAC1, decreased bone mineral density and bone volume fraction, hindered the release of osteogenic-related factors and vascular endothelial growth factor in callus tissue (p < 0.01), and was detrimental to fracture healing. Collectively, proper stress stimulation plays a crucial role in facilitating osteogenesis through the promotion of ZFP36L2 and subsequent degradation of HDAC1. Targeting ZFP36L2-HDAC1 axis may provide promising insights to enhance bone defect healing.
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Affiliation(s)
- Bin Wang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Jingyu Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China.
| | - Jianjun Li
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China.
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Kujur MS, Venkatraman Krishnan A, Manakari V, Parande G, Dieringa H, Mallick A, Gupta M. Scope of magnesium ceria nanocomposites for mandibular reconstruction: Degradation and biomechanical evaluation using a 3-dimensional finite element analysis approach. J Mech Behav Biomed Mater 2024; 152:106424. [PMID: 38290392 DOI: 10.1016/j.jmbbm.2024.106424] [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: 11/13/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
Magnesium/Ceria nanocomposites (Mg/xCeO2 NCs (x = 0.5 %, 1 % and 1.5 %)) prepared by using powder metallurgy and microwave sintering method are assessed for their corrosion rate for a period of 28 days. As per the immersion tests results, the addition of ceria nanoparticles to pure Mg, brought about a noteworthy improvement to corrosion resistance. A corrosion rate of approximately 0.84 mm/year for Mg/0.5CeO2 and 0.99 mm/year for Mg/1.0CeO2 nanocomposites were observed. Another aspect of the study involves employing the simulation method i.e. finite element analysis (FEA) to compare the stress distribution in magnesium-ceria nanocomposite based screws and circular bars especially for Mg/0.5CeO2 and Mg/1.0CeO2. Further, the simulation also gives a perception of the impact of masticatory forces, the biting force and shear stress exerted on the Mg/0.5CeO2 and Mg/1.0CeO2 based screws. The simulations results show that the screws showed an acceptable level of stresses for a biting force up to 300 N. The circular bar as well kept its stresses at acceptable levels for the same load of 300N. The shear stress results indicated that a biting force up to 602 N can be safely absorbed by Mg/0.5CeO2 screw. The comprehensive approach allows for a better understanding of the corrosion behavior, stress distribution, and mechanical properties of the Mg/CeO2 nanocomposites, enabling the development of effective temporary implants for craniofacial trauma fixation that can withstand normal physiological forces during mastication. The study reported in this paper aims to target Mg/xCeO2 NCs for temporary implants for craniofacial trauma fixation.
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Affiliation(s)
- Milli Suchita Kujur
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, India; Department of Mechanical Engineering, National University of Singapore, Singapore; Institute of Material and Process Design, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany.
| | | | - Vyasaraj Manakari
- Department of Mechanical Engineering, National University of Singapore, Singapore; Magloy Tech Pte. Ltd., Singapore.
| | - Gururaj Parande
- Department of Mechanical Engineering, National University of Singapore, Singapore; Magloy Tech Pte. Ltd., Singapore.
| | - Hajo Dieringa
- Institute of Material and Process Design, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany.
| | - Ashis Mallick
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, India.
| | - Manoj Gupta
- Department of Mechanical Engineering, National University of Singapore, Singapore.
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Li Z, Pollard S, Smith G, Deshmukh S, Ding Z. Biomechanical analysis of combi-hole locking compression plate during fracture healing: A numerical study of screw configuration. Proc Inst Mech Eng H 2024; 238:313-323. [PMID: 38372206 PMCID: PMC10941711 DOI: 10.1177/09544119241229157] [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: 07/20/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
Locking compression plates (LCPs) have become a widely used option for treating femur bone fractures. However, the optimal screw configuration with combi-holes remains a subject of debate. The study aims to create a time-dependent finite element (FE) model to assess the impacts of different screw configurations on LCP fixation stiffness and healing efficiency across four healing stages during a complete fracture healing process. To simulate the healing process, we integrated a time-dependent callus formation mechanism into a FE model of the LCP with combi-holes. Three screw configuration parameters, namely working length, screw number, and screw position, were investigated. Increasing the working length negatively affected axial stiffness and healing efficiency (p < 0.001), while screw number or position had no significant impact (p > 0.01). The time-dependent model displayed a moderate correlation with the conventional time-independent model for axial stiffness and healing efficiency (ρ ≥ 0.733, p ≤ 0.025). The highest healing efficiency (95.2%) was observed in screw configuration C125 during the 4-8-week period. The results provide insights into managing fractures using LCPs with combi-holes over an extended duration. Under axial compressive loading conditions, the use of the C125 screw configuration can enhance callus formation during the 4-12-week period for transverse fractures. When employing the C12345 configuration, it becomes crucial to avoid overconstraint during the 4-8-week period.
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Affiliation(s)
- Zeyang Li
- School of Engineering, Cardiff University, Cardiff, UK
| | - Stuart Pollard
- School of Engineering, University of Birmingham, Birmingham, UK
| | | | | | - Ziyun Ding
- School of Engineering, University of Birmingham, Birmingham, UK
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Ogura H, Nakamura T, Ishii T, Saito A, Onodera S, Yamaguchi A, Nishii Y, Azuma T. Mechanical stress-induced FGF-2 promotes proliferation and consequently induces osteoblast differentiation in mesenchymal stem cells. Biochem Biophys Res Commun 2023; 684:149145. [PMID: 37913587 DOI: 10.1016/j.bbrc.2023.149145] [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: 08/29/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Mechanical stimuli serve as crucial regulators of bone mass, promoting bone formation. However, the molecular mechanisms governing how mesenchymal stem cells (MSCs) respond to mechanical cues during their differentiation into osteogenic cells remain elusive. In this study, we found that cyclic stretching enhances MSC proliferation but does not increase the expression of osteoblast-related genes. We further revealed that this proliferative effect is mediated by fibroblast growth factor 2 (FGF-2), synthesized by MSCs in response to mechanical stress. Cell proliferation induced by cyclic stretching was inhibited upon the addition of either U0126, an inhibitor of mitogen-activated protein kinase kinase (MEK), or early growth response 1 (EGR1)-targeting small-hairpin RNA (shRNA), indicating the involvement of the extracellular signal-regulated kinase (ERK)/EGR1 signaling pathway. Osteoblast differentiation, evaluated through ALP activity, osteoblast-related gene expression, and mineralization, was stimulated by recombinant human FGF-2 (rhFGF-2) when applied during the proliferation phase, but not when applied during the differentiation stage alone. Our results suggest that FGF-2 indirectly promotes osteoblast differentiation as a downstream effect of stimulating cell proliferation. For the first time, we demonstrate that cyclic stretching induces MSCs to produce FGF-2, which in turn encourages cell proliferation through an autocrine/paracrine mechanism, consequently leading to osteoblast differentiation.
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Affiliation(s)
- Hiroyuki Ogura
- Department of Orthodontics, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Takashi Nakamura
- Department of Biochemistry, Tokyo Dental College, Tokyo, 101-0061, Japan; Oral Health Science Center, Tokyo Dental College, Tokyo, 101-0061, Japan.
| | - Takenobu Ishii
- Department of Orthodontics, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Akiko Saito
- Department of Biochemistry, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Shoko Onodera
- Department of Biochemistry, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Akira Yamaguchi
- Oral Health Science Center, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Yasushi Nishii
- Department of Orthodontics, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Toshifumi Azuma
- Department of Biochemistry, Tokyo Dental College, Tokyo, 101-0061, Japan; Oral Health Science Center, Tokyo Dental College, Tokyo, 101-0061, Japan
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Ferringo CRA, Diggs G, Lewis DD, Banks SA. An assessment of the fixin tplo jig to generate effective compression using a transverse fracture model. PLoS One 2023; 18:e0286937. [PMID: 37831702 PMCID: PMC10575488 DOI: 10.1371/journal.pone.0286937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The objective of this study was to determine compressive loads that could be generated using a tibial plateau leveling osteotomy (TPLO) jig with a tensioned strand of 18-gauge stainless steel orthopedic wire in a simulated transverse fracture model. The wire was sequentially tensioned using heavy needle holders or an AO wire tightener. Recorded loads were subsequently compared to loads generated by applying a 3.5 mm limited contact-dynamic compression plate (LC-DCP) as a compression plate. Two segments of 2 cm diameter Delrin rod were placed in a testing apparatus and used to simulate a transverse fracture. A load cell was interposed between the two segments to measure the compressive loads generated during the application of the TPLO jig or the LC-DCP. Compression was generated by sequential tensioning a strand of 18-gauge wire secured through the base of the arms of the TPLO jig or by placing one or two load screws in the LC-DCP. Wires were tensioned using heavy needle holders or an AO wire tightener. Eight replicates of each construct were tested. Recorded loads were compared using a one-way repeated measures ANOVA and Tukey Honestly Significant Difference test. The wire being tensioned broke while attempting a second quarter rotation of the needle holders and when the crank handle of the AO wire tightener was advanced beyond two rotations. The mean + SD peak compressive loads recorded when tensioning the wire using the heavy needle holders and AO wire tightener was 148 ± 7 N and 217 ± 16 N, respectfully. The mean ± SD load recorded after placement of the first and second load screw in the LC-DCP was 131 ± 39 N and 296 ± 49 N, respectively. The compression generated by placing two load screws in the LC-DCP was superior to the compression generated using the jig. The maximum load recorded by tensioning the wire secured through the TPLO jig using the AO wire tightener was superior to the compression generated by placing a single load screw and tensioning the wire using needle holders. Our results demonstrate that the TPLO jig allows surgeons to compress transverse fractures or osteotomies effectively. Tensioning the AO wire tightener allows for sequential tensioning and generates superior compressive loads than tensioning wires with heavy needle holders.
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Affiliation(s)
- Cassio Ricardo Auada Ferringo
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States of America
| | - George Diggs
- Department of Mechanical and Aerospace Engineering, College of Engineering, University of Florida, Gainesville, FL United States of America
| | - Daniel D. Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, College of Engineering, University of Florida, Gainesville, FL United States of America
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Manfredi JN, Schick S, Paul KD, Elphingstone JW, Sowell J, Lameka M, Brabston EW, Momaya AM, Ponce BA. A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs. Orthop J Sports Med 2023; 11:23259671231186429. [PMID: 37840899 PMCID: PMC10571685 DOI: 10.1177/23259671231186429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Glenohumeral dislocations often lead to glenoid bone loss and recurrent instability, warranting bony augmentation. While numerous biomechanical studies have investigated fixation methods to secure a graft to the glenoid, a review of available constructs has yet to be performed. Purpose To synthesize the literature and compare the biomechanics of screw and suture button constructs for anterior glenoid bony augmentation. Study Design Systematic review. Methods A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 2 independent reviewers who performed a literature search using the PubMed, Embase, and Google Scholar databases of studies published between 1950 and 2020. Studies were included that compared the biomechanical outcomes of fixation for the treatment of anterior shoulder instability with glenoid bone loss. Results Overall, 13 of the 363 studies screened met the inclusion criteria. The included studies measured the biomechanical strength of screws or suture buttons on a cadaveric or synthetic Latarjet construct. Screws and suture buttons were biomechanically similar, as both constructs exhibited comparable loads at failure and final displacement. Screw type (diameter, threading, or composition) did not significantly affect construct strength, and double-screw fixation was superior to single-screw fixation. Additionally, 2 screws augmented with a small plate had a higher load at failure than screws that were not augmented. Unicortical double-screw fixation was inferior to bicortical double-screw fixation, although construct strength did not significantly decrease if 1 of these screws was unicortical. Further, 2 screws inserted at 15° off axis experienced significantly higher graft displacement and lower ultimate failure loads than those inserted at 0° parallel to the glenoid. Conclusion Suture buttons provided comparable strength to screws and offer an effective alternative to reduce screw-related complications. Augmentation with a small plate may clinically enhance construct strength and decrease complications through the dispersion of force loads over a greater surface area. Differences in screw type did not appear to alter construct strength, provided that screws were placed parallel to the articular surface and were bicortical.
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Affiliation(s)
- John N. Manfredi
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samuel Schick
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle D. Paul
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Joseph W. Elphingstone
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Josiah Sowell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Megan Lameka
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eugene W. Brabston
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amit M. Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Vis MAM, Zhao F, Bodelier ESR, Bood CM, Bulsink J, van Doeselaar M, Amirabadi HE, Ito K, Hofmann S. Osteogenesis and osteoclastogenesis on a chip: Engineering a self-assembling 3D coculture. Bone 2023; 173:116812. [PMID: 37236415 DOI: 10.1016/j.bone.2023.116812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023]
Abstract
Healthy bone is maintained by the process of bone remodeling. An unbalance in this process can lead to pathologies such as osteoporosis which are often studied with animal models. However, data from animals have limited power in predicting the results that will be obtained in human clinical trials. In search for alternatives to animal models, human in vitro models are emerging as they address the principle of reduction, refinement, and replacement of animal experiments (3Rs). At the moment, no complete in vitro model for bone-remodeling exists. Microfluidic chips offer great possibilities, particularly because of the dynamic culture options, which are crucial for in vitro bone formation. In this study, a scaffold free, fully human, 3D microfluidic coculture model of bone remodeling is presented. A bone-on-a-chip coculture system was developed in which human mesenchymal stromal cells differentiated into the osteoblastic lineage and self-assembled into scaffold free bone-like tissues with the shape and dimensions of human trabeculae. Human monocytes were able to attach to these tissues and to fuse into multinucleated osteoclast-like cells, establishing the coculture. Computational modeling was used to determine the fluid flow induced shear stress and strain in the formed tissue. Furthermore, a set-up was developed allowing for long-term (35 days) on-chip cell culture with benefits including continuous fluid-flow, low bubble formation risk, easy culture medium exchange inside the incubator and live cell imaging options. This on-chip coculture is a crucial advance towards developing in vitro bone remodeling models to facilitate drug testing.
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Affiliation(s)
- M A M Vis
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands.
| | - F Zhao
- Department of Biomedical Engineering and Zienkiewicz Centre for Computational Engineering, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
| | - E S R Bodelier
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - C M Bood
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - J Bulsink
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - M van Doeselaar
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - S Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
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Steffen C, Sellenschloh K, Willsch M, Soares AP, Morlock MM, Heiland M, Kreutzer K, Huber G, Rendenbach C. Patient-specific miniplates versus patient-specific reconstruction plate: A biomechanical comparison with 3D-printed plates in mandibular reconstruction. J Mech Behav Biomed Mater 2023; 140:105742. [PMID: 36857975 DOI: 10.1016/j.jmbbm.2023.105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Patient-specific 3D-printed miniplates for free flap fixation in mandibular reconstruction were recently associated with enhanced osseous union. Higher mechanical strains resulting from these plates are discussed as reasons, but biomechanical studies are missing. This study aims to examine, whether patient-specific 3D-printed miniplates provide an increased interosteotomy movement (IOM) and lower stiffness compared with reconstruction plates. METHODS Polyurethane (PU) mandible and fibula models (Synbone AG, Malans, Schweiz) were used to simulate mandibular reconstruction with a one segment fibula flap equivalent. Osteosynthesis was performed using either four patient-specific 3D-printed miniplates (3D-Mini) or one patient-specific 3D-printed reconstruction plate (3D-Recon). Mastication was simulated using cyclic dynamic loading with increasing loads until material failure or a maximum load of 1000 N. Continuous IOM recording was carried out using a 3D optical tracking system (ARAMIS, Carl Zeiss GOM Metrology, Braunschweig, Germany). FINDINGS The averaged stiffness at a load of 100-300 N load did not differ between the groups (p = 0.296). There was a faster 1.0 mm vertical displacement in the 3D-Mini group (26 376 ± 14 190 cycles versus 44 817 ± 30 430 cycles, p = 0.018). The IOM were higher with miniplate fixation in the distal gap (p = 0.040). In the mesial gap, there was no significant difference between the groups (p = 0.160). INTERPRETATION Fixation with patient-specific 3D-printed miniplates results in higher mechanical strains. Lower rates of pseudarthrosis, as seen in clinical studies, might be caused by this phenomenon. Surgeons should evaluate the primary use of 3D-printed miniplates in mandibular reconstruction due to advantages of intraoral plate removal alongside safe osteosynthesis.
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Miramini S, Ganadhiepan G, Lin YC, Patel M, Richardson M, Pandy M, Zhang L. Influence of muscle loading on early-stage bone fracture healing. J Mech Behav Biomed Mater 2023; 138:105621. [PMID: 36549248 DOI: 10.1016/j.jmbbm.2022.105621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Designing weight-bearing exercises for patients with lower-limb bone fractures is challenging and requires a systematic approach that accounts for patient-specific loading conditions. However, 'trial-and-error' approaches are commonplace in clinical settings due to the lack of a fundamental understanding of the effect of weight-bearing exercises on the bone healing process. Whilst computational modelling has the potential to assist clinicians in designing effective patient-specific weight-bearing exercises, current models do not explicitly account for the effects of muscle loading, which could play an important role in mediating the mechanical microenvironment of a fracture site. We combined a fracture healing model involving a tibial fracture stabilised with a locking compression plate (LCP) with a detailed musculoskeletal model of the lower limb to determine interfragmentary strains in the vicinity of the fracture site during both full weight-bearing (100% body weight) and partial weight-bearing (50% body weight) standing. We found that muscle loading significantly altered model predictions of interfragmentary strains. For a fractured bone with a standard LCP configuration (bone-plate distance = 2 mm, working length = 30 mm) subject to full weight-bearing, the predicted strains at the near and far cortices were 23% and 11% higher when muscle loading was included compared to the case when muscle loading was omitted. The knee and ankle muscles accounted for 38% of the contact force exerted at the knee joint during quiet standing and contributed significantly to the strains calculated at the fracture site. Thus, models of bone fracture healing ought to account explicitly for the effects of muscle loading. Furthermore, the study indicated that LCP configuration parameters play a crucial role in influencing the fracture site microenvironment. The results highlighted the dominance of working length over bone-plate distance in controlling the flexibility of fracture sites stabilised with LCP devices.
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Ma Q, Miri Z, Haugen HJ, Moghanian A, Loca D. Significance of mechanical loading in bone fracture healing, bone regeneration, and vascularization. J Tissue Eng 2023; 14:20417314231172573. [PMID: 37251734 PMCID: PMC10214107 DOI: 10.1177/20417314231172573] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/13/2023] [Indexed: 05/31/2023] Open
Abstract
In 1892, J.L. Wolff proposed that bone could respond to mechanical and biophysical stimuli as a dynamic organ. This theory presents a unique opportunity for investigations on bone and its potential to aid in tissue repair. Routine activities such as exercise or machinery application can exert mechanical loads on bone. Previous research has demonstrated that mechanical loading can affect the differentiation and development of mesenchymal tissue. However, the extent to which mechanical stimulation can help repair or generate bone tissue and the related mechanisms remain unclear. Four key cell types in bone tissue, including osteoblasts, osteoclasts, bone lining cells, and osteocytes, play critical roles in responding to mechanical stimuli, while other cell lineages such as myocytes, platelets, fibroblasts, endothelial cells, and chondrocytes also exhibit mechanosensitivity. Mechanical loading can regulate the biological functions of bone tissue through the mechanosensor of bone cells intraosseously, making it a potential target for fracture healing and bone regeneration. This review aims to clarify these issues and explain bone remodeling, structure dynamics, and mechano-transduction processes in response to mechanical loading. Loading of different magnitudes, frequencies, and types, such as dynamic versus static loads, are analyzed to determine the effects of mechanical stimulation on bone tissue structure and cellular function. Finally, the importance of vascularization in nutrient supply for bone healing and regeneration was further discussed.
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Affiliation(s)
- Qianli Ma
- Department of Biomaterials, Institute
of Clinical Dentistry, University of Oslo, Norway
- Department of Immunology, School of
Basic Medicine, Fourth Military Medical University, Xi’an, PR China
| | - Zahra Miri
- Department of Materials Engineering,
Isfahan University of Technology, Isfahan, Iran
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute
of Clinical Dentistry, University of Oslo, Norway
| | - Amirhossein Moghanian
- Department of Materials Engineering,
Imam Khomeini International University, Qazvin, Iran
| | - Dagnjia Loca
- Rudolfs Cimdins Riga Biomaterials
Innovations and Development Centre, Institute of General Chemical Engineering,
Faculty of Materials Science and Applied Chemistry, Riga Technical University, Riga,
Latvia
- Baltic Biomaterials Centre of
Excellence, Headquarters at Riga Technical University, Riga, Latvia
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12
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Ramos Xavier Coutinho Nascimento L, Monteiro Torelly G, Carlos Nelson Elias :. Analysis of Bone Stress and Primary Stability of a Dental Implant Using Strain and Torque Measurements. Saudi Dent J 2023; 35:263-269. [PMID: 37091277 PMCID: PMC10114542 DOI: 10.1016/j.sdentj.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Introduction The consensus among researchers is that early failure of dental implants is due to the lack of primary stability and compressive stress on the peri-implant bone that exceeds the physiological tolerance. Objective The objective of this work is to propose a new methodology to quantify bone stress during dental implant insertion and to correlate it with primary stability. Materials and Methods Titanium dental implants with a diameter of 3.75 mm were inserted in a 3.35 mm hole of a synthetic bone of polyurethane (PU) foam with a density of 20 PCF (0.32 g/cm3). During insertion, the insertion torque was measured with a digital torque meter and the bone strain was measured with strain gages located at 2, 4, 6, 8, and 10 mm from the coronal region. Results The tests showed that the compressive strain is maximum in the third coronal region and decreases in the apical direction. The data also showed that there is a relationship between strain, insertion torque, and the primary stability of dental implants. Conclusion The stress and strain on the bone progressively decreased from the coronal to the apical third. The maximum compressive stress (0.42 MPa) during insertion of the implant did not exceed bone strength. Insertion of 3.75 mm implants in type D2 bone with a 3.35 mm hole provides adequate primary stability without excessive compression of the bone. Clinical Significance For the implant-bone combination used in the present study, the compressive stress generated during implant insertion did not exceed the physiological limit of cortical and medullary bone to the point of impairing osseointegration.
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13
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Mathew SE, Malyavko A, Tabaie S. Simultaneous Bilateral Proximal Femur Implant Failure: A Case Report. Cureus 2022; 14:e32543. [PMID: 36531788 PMCID: PMC9752960 DOI: 10.7759/cureus.32543] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
A seven-year-old boy with Moebius syndrome and bilateral hip dysplasia underwent left-sided adductor lengthening, bilateral proximal femur varus derotational osteotomies, and internal fixation with proximal femur blade plates, and left-sided Dega pelvic osteotomy. Postoperatively, he was immobilized in a Petrie cast. A month later, the child presented with bilateral proximal femur blade plate implant failure. Simultaneous bilateral proximal femur implant failure in a child, to our knowledge, has not yet been reported. Implant failure in the absence of significant trauma is rare. We describe various contributory factors that may lead to implant failure which must be carefully considered while managing a non-ambulatory child.
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Affiliation(s)
- Smitha E Mathew
- Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
| | - Alisa Malyavko
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
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14
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Kaymaz I, Murat F, Korkmaz İH, Yavuz O. A new design for the humerus fixation plate using a novel reliability-based topology optimization approach to mitigate the stress shielding effect. Clin Biomech (Bristol, Avon) 2022; 99:105768. [PMID: 36150287 DOI: 10.1016/j.clinbiomech.2022.105768] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to high stiffness, metal fixation plates are prone to stress shielding of the peri-prosthetic bones, leading to bone loss. Therefore, it has become important to design implants with reduced rigidity but increased load-carrying capacity. Considering the uncertainties in the parameters affecting the implant-bone structure is critical in making more reliable implant designs. In this study, a Response Surface Method based Reliability-based Topology Optimization approach was proposed to design a fixation plate for humerus fracture having less stiffness than the conventional plate. METHODS The design of the fixation plate was described as an Reliability-based Topology Optimization problem in which the probabilistic constraint was replaced with a meta-model generated using the Kriging method. The artificial humerus bone model was scanned, and the 3D simulation model was used in the finite element analysis required in the solution. The optimum plate was manufactured using Selective Laser Melting. Both designs were experimentally compared in terms of rigidity. FINDINGS The volume of the conventional plate was reduced from 2512.5 mm3 to 1667.3 mm3; nevertheless, the optimum plate had almost one-third less rigidity than the conventional plate. The probability of failure of the conventional plate was computed as 0.994. However, this value was almost half for the optimum fixation plate. Interpretation The studies showed that the new fixation plate design was less rigid but more reliable than the conventional one. The computation time required to have the optimum plate was reduced by one-tenth by applying the Response Surface Method for the Reliability-based Topology Optimization problem.
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Affiliation(s)
- Irfan Kaymaz
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey; Biomechanics Research Group, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey.
| | - Fahri Murat
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey; Biomechanics Research Group, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey.
| | - İsmail H Korkmaz
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey; Biomechanics Research Group, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey.
| | - Osman Yavuz
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey; Biomechanics Research Group, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum 25050, Turkey.
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15
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Shetty S, Nelson B, Knopp B, Schneppendahl J, Kaufmann RA. Strength of Humeral and Ulnar Intramedullary Screw Fixation. J Hand Surg Am 2022; 47:1014.e1-1014.e8. [PMID: 34579980 DOI: 10.1016/j.jhsa.2021.07.037] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to test the pullout strength of intramedullary (IM) screws from within the humerus to establish their ability to seat an uncemented elbow arthroplasty. METHODS Six humerus and 6 ulna Sawbones specimens were drilled with a drill bit diameter of 5/16 inches, and the inner cortex was hand tapped for a ⅜-16 thread. A ⅜-16 custom-made titanium screw with an outer bolt diameter of 3/8 inches and 16 threads per inch was inserted by hand into the tapped holes. The specimens were then axially tensile loaded at a rate of 5 mm per minute until either the screw began to pull out from the bone or a fracture was noted. RESULTS Intramedullary screw fixation in the humerus achieved an average pullout strength of 1,439 pound-force (6,401 N), and IM screw fixation in the ulna achieved an average pullout strength of 882 pound-force (3,923 N). A fracture was noted in 3 humeral specimens, with 3 screws pulling out. In the ulna, the IM axial load caused a fracture in 5 specimens, and in 1 specimen, the screw pulled out. CONCLUSIONS Our findings demonstrate that IM screw fixation can create a tensile force within the screw that is greater than that required to generate the calculated level of compression between the implant and bone. CLINICAL RELEVANCE This may be beneficial in ensuring fixation between arthroplasty components and bone.
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Affiliation(s)
- Sameer Shetty
- Department of Orthopedics, University of Pittsburgh Medical Center, Bethel Park, PA
| | | | | | - Johannes Schneppendahl
- Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, Düsseldorf, Germany
| | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
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16
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Chantarapanich N, Jitprapaikulsarn S, Mahaisavariya B, Mahaisavariya C. Comparative biomechanical performance of two configurations of screw constructs and types used to stabilize different sites of unstable Pauwels type II femoral neck fractures: A finite element analysis. Med Eng Phys 2022; 107:103856. [DOI: 10.1016/j.medengphy.2022.103856] [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] [Received: 04/04/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
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17
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Wu CC. Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft. J Orthop Surg Res 2022; 17:339. [PMID: 35794570 PMCID: PMC9258056 DOI: 10.1186/s13018-022-03229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Closed reamed locked intramedullary nailing has been the treatment of choice for most of femoral shaft fractures. A high union rate with a low complication rate is generally predictable. For an aseptic femoral shaft nonunion with a prior inserted intramedullary nail, exchange nailing is one of favored surgical techniques for treatment. However, a greatly varied success rate of 72–100% has been reported. To improve the success rate of exchange femur nailing, a modified bone grafting technique was developed. The purpose of this retrospective study intended to evaluate outcomes of such a revised technique. Methods From July 2011 to March 2019, 48 consecutive adult patients (average, 38 years; range, 19–67 years) with aseptic femoral shaft nonunions after intramedullary nailing treatment were studied. All femoral shaft fractures were initially caused by traffic accidents, which were treated by a closed or open intramedullary nailing technique at various hospitals. The current revision treatment was performed after an average of 2.2 years (range 1.1–6.2 years) from initial injuries. In the surgery, the prior nail was removed and the marrow cavity was reamed widely (at least 2 mm as possible). Sufficient cancellous bone grafts harvested on the trochanteric marrow wall from the inside were placed in the marrow cavity of the junction of nonunion fragments. A new 1-mm smaller size locked intramedullary nail was inserted. Whether the dynamic or static mode of nails were used mainly depended on the nonunion level. Postoperatively, protected weight bearing with crutches was allowed for all patients. Results Forty-one patients were followed for an average of 2.8 years (85.4%; range, 1.9–4.5 years) and all fractures healed. The union rate was 100% (41/41, p < 0.001) with a union time of an average of 3.4 months (range, 2.5–5.0 months). There were no complications of deep infection, nonunions, malunions, implant failures or an avulsed trochanter tip fracture. The satisfactory knee function improved from 73.2% (30/41) preoperatively to 92.7% (38/41) at the latest follow-up (p = 0.019). Conclusions The described modified bone grafting technique may effectively improve a union rate of exchange femur nailing while the surgical procedure is not complicated. It may therefore be used concomitantly in all aseptic femoral shaft nonunions when exchange nailing is performed.
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18
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Dumrongwanich O, Chantarapanich N, Patchanee S, Inglam S, Chaiprakit N. Finite element analysis between Hunsuck/Epker and novel modification of Low Z plasty technique of mandibular sagittal split osteotomy. Proc Inst Mech Eng H 2022; 236:646-655. [DOI: 10.1177/09544119221082436] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck–Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.
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Affiliation(s)
- Orawee Dumrongwanich
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
| | - Siripatra Patchanee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Samroeng Inglam
- Division of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Narissaporn Chaiprakit
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Hu J, Gundry M, Zheng K, Zhong J, Hourigan P, Meakin JR, Winlove CP, Toms AD, Knapp KM, Chen J. The biomechanics of metaphyseal cone augmentation in revision knee replacement. J Mech Behav Biomed Mater 2022; 131:105233. [DOI: 10.1016/j.jmbbm.2022.105233] [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] [Received: 06/14/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
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20
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Chantarapanich N, Riansuwan K. Biomechanical performance of short and long cephalomedullary nail constructs for stabilizing different levels of subtrochanteric fracture. Injury 2022; 53:323-333. [PMID: 34969504 DOI: 10.1016/j.injury.2021.11.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/13/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess biomechanical performance of short and long Cephalomedullary nail constructs consisting of different number of distal screw for stabilizing different levels of subtrochanteric fracture. MATERIALS AND METHODS The femur obtained from computed tomography scanner was used to create a transverse fracture at 15 mm (level A), 35 mm (level B), and 55 mm (level C) below the lesser trochanter. Short and long Cephalomedullary nails were virtually inserted to the fractured femur. Four-node tetrahedral element was used to build up finite element (FE) models for biomechanical analysis. The analysis focused on post-operative stage of partial weight-bearing. RESULTS Stress on the implant localized at the surface between lag screw/nail and distal screw/nail. Short Cephalomedullary nail exhibited higher stress than long Cephalomedullary nail. The stress in short Cephalomedullary nail could be reduced by using two distal screws fixation and the fracture at level A produced less stress than that of level B and C. Either short or long nail with two distal screws is sufficient to withstand the stress magnitude produced from the physiologic load. When single dynamic distal screw was used, stress on implant, elastic strain at fracture gap, and bone stress reached the high values. Elastic strain of the fracture gap at level C were less than that of level A and B, but no statistically significant difference. There was no proximal cancellous bone damage observed from the FE analysis. CONCLUSIONS Long Cephalomedullary nail with at least two distal locking screws remains a proper implant for subtrochanteric fracture fixation in overall locations. However, short Cephalomedullary nail with two distal screws may be a candidate for a high subtrochanteric fracture. Single dynamic screw insertion is strongly not recommended with either short or long nail regarding implant failure.
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Affiliation(s)
- Nattapon Chantarapanich
- Digital Industrial Design and Manufacturing Research Unit, Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi 20230, Thailand
| | - Kongkhet Riansuwan
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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21
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Duan D, Cao Y, Li R, Wang G, Zhang Y, Xiang K, Hu Y, Li Y, Peng P, Zhang P, Liu X. Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis. Pain Res Manag 2021; 2021:8609921. [PMID: 34900072 DOI: 10.1155/2021/8609921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Background High tibial osteotomy (HTO) is used to treat medial degeneration of the osteoarthritis (OA) knee. However, shortcomings still exist in the current procedure, like unprecise creation, inability to correct knee rotation, and internal fixed failure. Here, we reported a novel procedure: patient-specific 3D-printed plates for opening wedge high tibial osteotomy (OWHTO) combined with Taylor spatial frame (TSF). The detailed technique was described, and the clinical outcomes were evaluated. Methods We prospectively evaluate outcomes of patient-specific 3D-printed plates for OWHTO with use of TSF in 25 patients with knee OA and varus alignment. Postoperative efficacy was evaluated using the HSS knee score, pain visual simulation score (VAS), and knee joint motion (ROM), and lower limb alignment was evaluated by measuring femorotibial angle (FTA) and hip-knee-ankle (HKA). Results and Conclusion. All patients did not experience complications such as wound infection, nerve damage, or bone amputation. 25 patients were followed up for 6–18 months. The bony union at bone amputation was achieved in 3 months after surgery, and the pain symptoms were significantly alleviated or disappeared. The VAS score was significantly reduced in 6 months after surgery compared with preoperative; the HSSS score was significantly added in 6 months after surgery compared with preoperative. The ROM of knee joint increased significantly 6 months after operation compared with that before operation, and the difference was statically significant (P < 0.05). The FTA and HKA after operation were significantly superior to that before operation, and the difference was statically significant (P < 0.01). Conclusions Our study showed that patient-specific 3D-printed plates for HTO with the use of TSF have the advantages of small trauma, few complications, simple operation, and fast recovery in treating knee OA and varus alignment.
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22
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Mahendra J, Chand YB, Mahendra L, Fageeh HN, Fageeh HI, Ibraheem W, Alzahrani KM, Alqahtani NM, Alahmari NM, Almagbol M, Robaian A, Jigeesh N, Varadarajan S, Balaji TM, Patil S. Evaluation of Stress Distribution during Insertion of Tapered Dental Implants in Various Osteotomy Techniques: Three-Dimensional Finite Element Study. Materials 2021; 14:7547. [PMID: 34947142 PMCID: PMC8704667 DOI: 10.3390/ma14247547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022]
Abstract
Conventional osteotomy techniques can, in some cases, induce higher stress on bone during implant insertion as a result of higher torque. The aim of the present study was to evaluate and compare the stress exerted on the underlying osseous tissues during the insertion of a tapered implant using different osteotomy techniques through a dynamic finite element analysis which has been widely applied to study biomedical problems through computer-aided software. In three different types of osteotomy techniques, namely conventional (B1), bone tap (B2), and countersink (B3), five models and implants designed per technique were prepared, implant insertion was simulated, and stress exerted by the implant during each was evaluated. Comparison of stress scores on the cortical and cancellous bone at different time points and time intervals from initiation of insertion to the final placement of the implant was made. There was a highly statistically significant difference between B1 and B2 (p = 0.0001) and B2 and B3 (p = 0.0001) groups. In contrast, there was no statistically significant difference in the stress scores between B1 and B3 (p = 0.3080) groups at all time points of implant placement. Overall, a highly significant difference was observed between the stresses exerted in each technique. Within the limitations of our study, bone tap significantly exerted lesser stresses on the entire bone than conventional and countersink type of osteotomy procedures. Considering the stress distribution at the crestal region, the countersink showed lower values in comparison to others.
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Carter A, Popowski K, Cheng K, Greenbaum A, Ligler FS, Moatti A. Enhancement of Bone Regeneration Through the Converse Piezoelectric Effect, A Novel Approach for Applying Mechanical Stimulation. Bioelectricity 2021; 3:255-271. [PMID: 35018335 PMCID: PMC8742263 DOI: 10.1089/bioe.2021.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Serious bone injuries have devastating effects on the lives of patients including limiting working ability and high cost. Orthopedic implants can aid in healing injuries to an extent that exceeds the natural regenerative capabilities of bone to repair fractures or large bone defects. Autografts and allografts are the standard implants used, but disadvantages such as donor site complications, a limited quantity of transplantable bone, and high costs have led to an increased demand for synthetic bone graft substitutes. However, replicating the complex physiological properties of biological bone, much less recapitulating its complex tissue functions, is challenging. Extensive efforts to design biocompatible implants that mimic the natural healing processes in bone have led to the investigation of piezoelectric smart materials because the bone has natural piezoelectric properties. Piezoelectric materials facilitate bone regeneration either by accumulating electric charge in response to mechanical stress, which mimics bioelectric signals through the direct piezoelectric effect or by providing mechanical stimulation in response to electrical stimulation through the converse piezoelectric effect. Although both effects are beneficial, the converse piezoelectric effect can address bone atrophy from stress shielding and immobility by improving the mechanical response of a healing defect. Mechanical stimulation has a positive impact on bone regeneration by activating cellular pathways that increase bone formation and decrease bone resorption. This review will highlight the potential of the converse piezoelectric effect to enhance bone regeneration by discussing the activation of beneficial cellular pathways, the properties of piezoelectric biomaterials, and the potential for the more effective administration of the converse piezoelectric effect using wireless control.
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Affiliation(s)
- Amber Carter
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Kristen Popowski
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Ke Cheng
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Alon Greenbaum
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Frances S. Ligler
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Adele Moatti
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
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Bartsch KM, Baumgart C, Freiwald J, Wilke J, Slomka G, Turnhöfer S, Egner C, Hoppe MW, Klingler W, Schleip R. Expert Consensus on the Contraindications and Cautions of Foam Rolling-An International Delphi Study. J Clin Med 2021; 10:5360. [PMID: 34830642 DOI: 10.3390/jcm10225360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.
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Kopyl S, Surmenev R, Surmeneva M, Fetisov Y, Kholkin A. Magnetoelectric effect: principles and applications in biology and medicine- a review. Mater Today Bio 2021; 12:100149. [PMID: 34746734 PMCID: PMC8554634 DOI: 10.1016/j.mtbio.2021.100149] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 08/18/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 12/26/2022] Open
Abstract
Magnetoelectric (ME) effect experimentally discovered about 60 years ago remains one of the promising research fields with the main applications in microelectronics and sensors. However, its applications to biology and medicine are still in their infancy. For the diagnosis and treatment of diseases at the intracellular level, it is necessary to develop a maximally non-invasive way of local stimulation of individual neurons, navigation, and distribution of biomolecules in damaged cells with relatively high efficiency and adequate spatial and temporal resolution. Recently developed ME materials (composites), which combine elastically coupled piezoelectric (PE) and magnetostrictive (MS) phases, have been shown to yield very strong ME effects even at room temperature. This makes them a promising toolbox for solving many problems of modern medicine. The main ME materials, processing technologies, as well as most prospective biomedical applications will be overviewed, and modern trends in using ME materials for future therapies, wireless power transfer, and optogenetics will be considered.
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Affiliation(s)
- S. Kopyl
- Department of Physics & CICECO - Aveiro Institute of Materials, University of Aveiro, Aveiro, Portugal
| | - R. Surmenev
- Physical Materials Science and Composite Materials Centre, Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk, Russia
- Piezo- and Magnetoelectric Materials Research & Development Centre, Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk, Russia
| | - M. Surmeneva
- Physical Materials Science and Composite Materials Centre, Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk, Russia
- Piezo- and Magnetoelectric Materials Research & Development Centre, Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk, Russia
| | - Y. Fetisov
- Research & Education Centre ‘Magnetoelectric Materials and Devices’, MIREA – Russian Technological University, Moscow, Russia
| | - A. Kholkin
- Department of Physics & CICECO - Aveiro Institute of Materials, University of Aveiro, Aveiro, Portugal
- Piezo- and Magnetoelectric Materials Research & Development Centre, Research School of Chemistry & Applied Biomedical Sciences, National Research Tomsk Polytechnic University, Tomsk, Russia
- School of Natural Sciences and Mathematics, Ural Federal University, Ekaterinburg, Russia
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Ganadhiepan G, Miramini S, Mendis P, Patel M, Zhang L. A probabilistic approach for modelling bone fracture healing under Ilizarov circular fixator. Int J Numer Method Biomed Eng 2021; 37:e3466. [PMID: 33864429 DOI: 10.1002/cnm.3466] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/27/2020] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Bone fracture treatments using Ilizarov circular fixator (ICF) involve dealing with uncertainties about a range of critical factors that control the mechanical microenvironment of the fracture site such as ICF configuration, fracture gap size, physiological loading etc. To date, the effects of the uncertainties about these critical factors on the mechanical microenvironment of the fracture site have not been fully understood. The purpose of this study is to tackle this challenge by using computational modelling in conjunction with engineering reliability analysis. Particularly, the effects of uncertainties in fracture gap size (GS), level of weight-bearing (P), ICF wire pretension (T) and wire diameter (WD) on the fracture site mechanical microenvironment at the beginning of the reparative phase of healing was investigated in this study. The results show that the mechanical microenvironment of fracture site stabilised with ICF is very sensitive to the uncertainties in P and GS. For example, an increase in the coefficient of variation of P (COVP ) from 0.1 to 0.9 (i.e., an increase in the uncertainty in P) could reduce the probability of achieving a favourable mechanical microenvironment within the fracture site (i.e., Probability of Success, PoS) by more than 50%, while an increase in the coefficient of variation of GS (COVGS ) from 0.1 to 0.9 could decrease PoS by around 30%. In contrast, an increase in the uncertainties in T and WD (COV increase from 0.1 to 0.9) has little influence on the fracture site mechanical microenvironment (PoS changes <5%).
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
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Aloraibi S, Booth V, Robinson K, Lunt EK, Godfrey D, Caswell A, Kerr M, Ollivere B, Gordon AL, Gladman JRF. Optimal management of older people with frailty non-weight bearing after lower limb fracture: a scoping review. Age Ageing 2021; 50:1129-1136. [PMID: 33993209 PMCID: PMC8266651 DOI: 10.1093/ageing/afab071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group. Methods MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term ‘non-weight bearing’. All study types were included. Analysis was by narrative synthesis. Results No papers were identified from a search using the key phrase ‘non-weight bearing’. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing. Discussion These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process.
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Affiliation(s)
| | - Vicky Booth
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Katie Robinson
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Eleanor Katharine Lunt
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Margaret Kerr
- Member of PPI, University of Nottingham, Nottingham, UK
| | - Benjamin Ollivere
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam Lee Gordon
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - J R F Gladman
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
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Ganadhiepan G, Miramini S, Patel M, Mendis P, Zhang L. Optimal time-dependent levels of weight-bearing for bone fracture healing under Ilizarov circular fixators. J Mech Behav Biomed Mater 2021; 121:104611. [PMID: 34082182 DOI: 10.1016/j.jmbbm.2021.104611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/12/2019] [Revised: 04/25/2021] [Accepted: 05/23/2021] [Indexed: 02/09/2023]
Abstract
It is known that weight-bearing exercises under Ilizarov circular fixators (ICF) could enhance bone fracture healing by mechano-regulation. However, interfragmentary movements at the fracture site induced by weight-bearing may inhibit angiogenesis and ultimately delay the healing process. To tackle this challenge, a computational model is presented in this study which considers the spatial and temporal changes in mechanical properties of fracture callus to predict optimal levels of weight-bearing during fracture healing under ICF. The study takes sheep fractures as example and shows that the developed model has the capability of predicting patient specific, time-dependent optimal levels of weight-bearing which enhances mechano-regulation mediated healing without hindering the angiogenesis process. The results demonstrate that allowable level of weight-bearing and timings depend on fracture gap size. For normal body weights (BW) and moderate fracture gap sizes (e.g. 3 mm), weight-bearing with 30% BW could start by week 4 post-operation and gradually increase to 100% BW by week 11. In contrast, for relatively large fracture gap sizes (i.e. 6 mm), weight-bearing is recommended to commence in later stages of healing (e.g. week 11 post-operation). Furthermore, increasing ICF stiffness (e.g. using half pins instead of pretension wires) can increase the level of weight-bearing significantly in the early stages up to a certain time point (e.g. week 8 post-operation) beyond which no noticeable benefits could be achieved. The findings of this study have potential applications in designing post-operative weight bearing exercises.
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Affiliation(s)
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Victoria, 3121, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia.
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Gardas BB, Ghongade NP, Jagtap AH. Application of multi‐criteria decision‐making approach in healthcare surgical management. Multi Criteria Decision Anal 2021. [DOI: 10.1002/mcda.1753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bhaskar B. Gardas
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Nilesh P. Ghongade
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Annasaheb H. Jagtap
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
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30
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Aloraibi S, Gladman J, Godfrey D, Booth V, Robinson K, Lunt E, Caswell A, Kerr M, Ollivere B, Gordon AL. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study. BMC Geriatr 2021; 21:332. [PMID: 34030635 PMCID: PMC8146625 DOI: 10.1186/s12877-021-02265-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. Methods A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. Results Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). Conclusions These findings can be used in the generation of a clinical guideline for this group of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02265-z.
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Affiliation(s)
- S Aloraibi
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK. .,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.
| | - J Gladman
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Room WC1388 Level C, West Block, Nottingham, NG7 2UH, UK.,NHR Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
| | - D Godfrey
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Beckside, Gamston, Nottingham, NG2 6PR, UK
| | - V Booth
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Room WC1388 Level C, West Block, Nottingham, NG7 2UH, UK
| | - K Robinson
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Room WC1388 Level C, West Block, Nottingham, NG7 2UH, UK
| | - E Lunt
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Room WC1388 Level C, West Block, Nottingham, NG7 2UH, UK
| | - A Caswell
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK
| | - M Kerr
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK
| | - B Ollivere
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Room WC1388 Level C, West Block, Nottingham, NG7 2UH, UK
| | - A L Gordon
- Division of Rehabilitation, Ageing and Wellbeing, The Medical School, Queens Medical Centre, University of Nottingham, B109, Floor B, Derby Road, Nottingham, NG7 2UH, UK.,Division of Rehabilitation, Ageing and Wellbeing, NIHR Nottingham Biomedical Research Centre, Medical School, QMC, B111, Nottingham, NG7 2UH, UK.,Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby Medical School, Room DSN407, Derby, DE22 3NE, UK
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Schuster AJ, Possebon APDR, Bielemann AM, Chagas-Júnior OL, Faot F. Effect of mandibular residual ridge regularization on peri-implant wound healing when narrow diameter implants are used as overdenture retainers. J Prosthet Dent 2021:S0022-3913(21)00001-9. [PMID: 33752905 DOI: 10.1016/j.prosdent.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM Alveolar ridge regularization involves the smoothing and minimal reduction of rough alveolar bone ridge to achieve adequate bone thickness around the implant. The effect of this procedure on peri-implant health is unclear. PURPOSE The purpose of this clinical study was to evaluate whether bone regularization affects the clinical and biological parameters of peri-implant health when narrow diameter implants are placed as mandibular implant overdenture retainers during initial healing and after occlusal loading. MATERIAL AND METHODS The need for mandibular ridge regularization in the anterior mandibular region was analyzed before the placement of 2 implants (2.9×10 mm, Facility; Neodent) in 21 participants provided with mandibular overdentures. Primary stability was measured by the insertion torque and implant stability quotient (ISQ). Clinical and biological evaluations measuring the plaque index, presence of calculus, probing depth, bleeding on probing index, gingival index, secondary stability (ISQ), and interleukine-1β (IL-1β) and tumor necrosis factor-α (TNF-α) concentrations in peri-implant crevicular fluid were measured during osseointegration on days 7, 15, 30, 60, and 90 and after loading on day 180 after implant placement. Multilevel mixed-effects linear regression analysis and the Kaplan-Meier test were used to analyze the data (α=.05). RESULTS The ISQ values showed significant differences on days 7 (P<.001) and 15 (P=.002) with higher values and on day 180 (P=.008) with a lower value compared with the baseline value in the ridge regularization group. Additionally, a significant decrease in probing depth was observed on days 60 (P=.008) and 180 (P=.027) compared with that on day 15 after implant placement. In the nonridge regularization group, significant decreases in probing depth were observed on days 30 and 180. Moreover, TNF-α levels in this group were significantly lower on days 30 (P=.001), 60, 90, and 180 (P<.001) when compared with the value on day 7 (P<.001). The ridge regularization group presented with significant differences in TNF-α and IL-1β levels on days 60 (P=.004) and 30 (P=.007), respectively, when compared with the values on day 7. The ISQ and probing depth in the ridge regularization group were associated with changes in TNF-α and IL-1β levels; furthermore, bone type, duration of edentulism, and mandibular bone atrophy were correlated with the clinical outcomes and TNF-α release. The implant survival rate was 67% in the nonridge regularization group and 100% in the ridge regularization group. CONCLUSIONS Mandibular ridge regularization appeared to be beneficial for peri-implant healing during the early stages and after 3 months of occlusal loading in patients with an atrophic ridge, prolonged time since edentulism, and poor bone quality.
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Abstract
Bone, as a physiological and anatomical construct, displays remarkable intrinsic healing capacity. The overwhelming majority of fractures will heal satisfactorily, if aligned anatomically, compressed and immobilised appropriately. Of the 10% of fractures that do not heal, even under ideal mechanical and biological conditions, further consideration must be given to augment bone healing. Management strategies for non-union pose a significant clinical challenge to the practicing orthopaedic surgeon. Stem cell therapy is beginning to demonstrate significant potential for augmented bone repair in the context of non-union. This review attempts to contextualise the function of stem cells within this clinical setting, reviewing the relevant cellular mechanisms and clinical applications. From evaluating the literature base, there is a lack of high-quality evidence examining the role of mesenchymal stem cells (MSCs) within this research focus. Appropriately designed randomised controlled trials are required to evaluate this research area further, with a view to guiding future treatment options for the practicing orthopaedic surgeon.
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Affiliation(s)
- Harman Khatkar
- Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, GBR.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, GBR
| | - Abbas See
- Trauma and Orthopaedics, Kettering General Hospital, Kettering, GBR
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Rugg AL, Requist MR, Johnson BW, Son MM, Alvarez A, Latt LD. Mechanical Effects of Lag Screw Retightening in a Simulated Hindfoot Arthrodesis Model. Foot & Ankle Orthopaedics 2021; 6:24730114211015203. [PMID: 35097452 PMCID: PMC8702740 DOI: 10.1177/24730114211015203] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Nonunion following hindfoot arthrodesis may be caused by failure to maintain compression at the arthrodesis site. The ability of lag screws, commonly used in arthrodesis, to maintain compression in hindfoot bones has not been well characterized. The aim of this work was to quantify the stress relaxation response of hindfoot bone with initial and repeated compression with a lag screw. Methods: Ten sets of 25-mm-diameter bone cylinders were cut from the talus and calcaneus in fresh-thawed cadaveric feet. A load cell was compressed between cylinders with an 8.0-mm partially threaded cannulated lag screw simulating arthrodesis. For 7 sets, screws were tightened by 3 quarter-turns, rested for 3 minutes, retightened 1 quarter-turn, and rested for 30 minutes. Three sets served as controls in which screws were not retightened. Results: Maximum compression after initial screw tightening and retightening averaged 275 and 337 N (P = .07), respectively. Compression 3 minutes after initial screw tightening and retightening averaged 199 and 278 N (P = .027), respectively. The compression recorded 3 minutes after screw retightening was an average of 40% higher than that recorded 3 minutes after initial tightening. The average compression 30 minutes after screw retightening was 255 N, a compression loss of 25% from the average maximum compression after retightening. Eighty percent of this compression loss happened in an average of 5.5 minutes. Conclusion: Hindfoot bones exhibit compression loss over time during simulated arthrodesis. Compression maintenance in bone is improved with screw retightening. Further work is needed to understand the mechanism of action and determine optimum time for recompression. Clinical Relevance: Retightening lag screws before wound closure may improve compression at the arthrodesis site and thereby decrease the chance of nonunion. Level of Evidence: N/A, laboratory experiment.
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Affiliation(s)
- Amanda L. Rugg
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Melissa R. Requist
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Brooks W. Johnson
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Michelle M. Son
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Alicia Alvarez
- Department of Physiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
- College of Engineering, University of Arizona, Tucson, AZ, USA
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Steffen C, Sellenschloh K, Vollmer M, Morlock MM, Heiland M, Huber G, Rendenbach C. Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction. J Mech Behav Biomed Mater 2020; 111:104007. [DOI: 10.1016/j.jmbbm.2020.104007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
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Schultz BJ, Koval K, Salehi PP, Gardner MJ, Cerynik DL. Controversies in Fracture Healing: Early Versus Late Dynamization. Orthopedics 2020; 43:e125-e133. [PMID: 32077970 DOI: 10.3928/01477447-20200213-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
Dynamization of fracture fixation constructs provides early rigidity for primary bone healing and late motion for secondary healing. A review of laboratory, animal, and clinical studies investigating the impact, and optimal timing, of dynamization is limited by lack of standardization across studies. However, in animal models, dynamization improves histologic and biomechanical properties compared with statically rigid or flexible controls. In animals, dynamization at 3 to 4 weeks showed improved histologic results. In clinical studies, it showed faster, stronger, and stiffer bone healing. Clinical success dynamizing external fixators and intramedullary nails suggests a role for late dynamization in other fixation types, such as bridge plating. [Orthopedics. 2020;43(3):e125-e133.].
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Hamandi F, Simon G, Laughlin R, Goswami T. Biomechanical Behavior of a Variable Angle Locked Tibiotalocalcaneal Construct. Bioengineering (Basel) 2020; 7:E27. [PMID: 32183268 DOI: 10.3390/bioengineering7010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/05/2022] Open
Abstract
This paper examines the mechanics of the tibiotalocalcaneal construct made with a PHILOS plating system. A failed device consisting of the LCP plate and cortical, locking, and cannulated screws was used to perform the analysis. Visual, microstructure, and fractographic examinations were carried out to characterize the fracture surface topology. These examinations revealed the presence of surface scratching, inclusions, discoloration, corrosion pits, beach marks, and cleavage and striations on the fracture surface. Further examination of the material crystallography and texture revealed an interaction of S, Ni, and Mo-based inclusions that may have raised pitting susceptibility of the device made with Stainless Steel 316L. These features suggest that the device underwent damage by pitting the corrosion-fatigue mechanism and overloading towards the end to fail the plate and screws in two or more components. The screws failed via conjoint bending and torsion fatigue mechanisms. Computer simulations of variable angle locking screws were performed in this paper. The material of construction of the device was governed by ASTM F138-8 or its ISO equivalent 5832 and exhibited inconsistencies in chemistry and hardness requirements. The failure conditions were matched in finite element modeling and those boundary conditions discussed in this paper.
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Schultz BJ, Amin NH, Mattison BJ, Mir HR, Shah AR, Cerynik DL. Locking Screws With a Threaded Degradable Polymer Collar Reduce Construct Stiffness Over Time. J Orthop Trauma 2020; 34:151-7. [PMID: 32084090 DOI: 10.1097/BOT.0000000000001664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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 The stiffness of locking plates provide increased stability for early fracture healing but may limit late interfragmentary motion (IFM) necessary for secondary bone healing. An ideal plating construct would provide early rigidity and late flexibility to optimize bone healing. A novel screw plate construct utilizing locking screws with a degradable polymer locking mechanism is a dynamic option. METHODS Conventional locked plating constructs (group A) were compared with locking screws with a threaded degradable polymer collar before (group B) and after polymer dissolution (group C). Monotonic axial compression, monotonic torsion, cyclic axial load to failure, and IFM at the near and far cortices were tested on synthetic bone models. RESULTS One-way analysis of variance and post hoc Tukey-Kramer testing demonstrated similar axial stiffness in group A (873 ± 146 N/mm) and B (694 ± 314 N/mm) but significantly less stiffness in group C (379 ± 59 N/mm; F(2,15) = 9.12, P = 0.003). Groups A and B also had similar IFM, but group C had significantly increased IFM at both the near (F(2, 15) = 48.66, P = 2.76E-07) and far (F(2, 15) = 11.78, P = 0.0008) cortices. In cyclic axial load to failure, group A (1593 ± 233 N) and B (1277 ± 141 N) were again similar, but group C was significantly less (912 ± 256 N; F(2, 15) = 15.00, P = 0.0003). All failures were above the 500-N threshold seen in typical weight-bearing restrictions for fracture care. Torsional stiffness demonstrated significant differences between all groups (F(2, 15) = 106.64, P = 1.4E-09). CONCLUSIONS Use of locking plates with a degradable polymer collar show potential for in vitro construct dynamization. Future in vivo studies are warranted to assess performance under combined loading and the effects of decreasing construct stiffness during the course of bony healing.
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Rabinowitz J, Lin JJ, Greenhouse A, Rao MV, Provencher M, Parada S, Friedman RJ, Eichinger JK. The Effect of Screw Design and Cortical Augmentation on Insertional Torque and Compression in Coracoid-Glenoid Fixation in a Sawbones Model. Arthroscopy 2020; 36:689-95. [PMID: 31901392 DOI: 10.1016/j.arthro.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare screw insertional torque and coracoid-glenoid compression from 4 fixation techniques with different screw design parameters and cortical augmentation for the Latarjet procedure. METHODS Simulated Latarjet procedures were performed with 4 fixation techniques using laminated polyurethane blocks with dimensions similar to the coracoid-glenoid construct. The groups included DePuy Synthes Mitek 3.5-mm partially threaded screws with top hats, Arthrex 3.75-mm fully threaded screws with a 2-hole plate, Arthrex 3.75-mm fully threaded screws, and Smith & Nephew 4.0-mm partially threaded screws. Screws were inserted using a digital torque-measuring screwdriver to determine maximum insertional torque. Pressure-sensitive film was used to measure the maximum contact pressure and the effective pressure distribution (EPD) between the coracoid and glenoid; the EPD represents the percentage of the film's surface area that experienced pressure greater than 10 MPa. One-way analysis of variance and post hoc tests were used for statistical analysis. RESULTS Significant differences were found between the 4 fixation groups for each variable measured. The 2 cortically augmented systems produced significantly higher maximum insertional torque than the non-cortically augmented systems (P < .001 for both). The 3.75-mm screws with a 2-hole plate yielded significantly higher contact pressures than the 4.0-mm screws (P = .028). This group also had a high EPD, with a mean value more than double the values of the non-cortically augmented systems (P = .037 and P < .001). CONCLUSIONS Cortically augmented fixation methods showed higher maximum insertional torque, maximum contact pressure, and EPD between the surfaces of the coracoid and glenoid in this Sawbones model. CLINICAL RELEVANCE Various implants are available for the Latarjet procedure, but their biomechanical characteristics have not yet been fully elucidated. Graft fracture and nonunion represent 2 modes of failure that may be related to insertional torque and coracoid-glenoid compression. This study compared screw insertional torque and compression achieved using 4 fixation techniques with different screw design parameters and cortical augmentation in a Sawbones model.
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Yan L, Lim JL, Lee JW, Tia CSH, O'Neill GK, Chong DYR. Finite element analysis of bone and implant stresses for customized 3D-printed orthopaedic implants in fracture fixation. Med Biol Eng Comput 2020; 58:921-931. [PMID: 32077012 DOI: 10.1007/s11517-019-02104-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/23/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
3D printing allows product customisation to be cost efficient. This presents opportunity for innovation. This study investigated the effects of two modifications to the locking compression plate (LCP), an established orthopaedic implant used for fracture fixation. The first was to fill unused screw holes over the fracture site. The second was to reduce the Young's modulus by changing the microarchitecture of the LCP. Both are easily customisable with 3D printing. Finite element (FE) models of a fractured human tibia fixed with 4.5/5.0 mm LCPs were created. FE simulations were conducted to examine stress distribution within the LCPs. Next, a material sweep was performed to examine the effects of lowering the Young's modulus of the LCPs. Results showed at a knee joint loading of 3× body weight, peak stress was lowered in the modified broad LCP at 390.0 MPa compared to 565.1 MPa in the original LCP. It also showed that the Young's modulus of material could be lowered to 50 GPa before the minimum principal stresses increased exponentially. These findings suggested the modifications could lead to improved performances of fracture fixation, and therefore likely that other orthopaedic implants survivorship could also be enhanced by customisation via 3D printing. Graphical abstract.
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Affiliation(s)
- Lina Yan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore
| | - Joel Louis Lim
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jun Wei Lee
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
| | - Clement Shi Hao Tia
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
| | - Gavin Kane O'Neill
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore. .,Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Desmond Y R Chong
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
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Denadai R, Chou P, Pai BCJ, Chen C, Cheng-hui Lin C, Huang C, Chen Y, Lo L. Skeletofacial Reconstruction for Cleft-Related Deformities: Four Decades of Evolving Cleft Care. Ann Plast Surg 2020; 85:3-11. [PMID: 31913899 DOI: 10.1097/sap.0000000000002187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lovecchio J, Gargiulo P, Vargas Luna JL, Giordano E, Sigurjónsson ÓE. A standalone bioreactor system to deliver compressive load under perfusion flow to hBMSC-seeded 3D chitosan-graphene templates. Sci Rep 2019; 9:16854. [PMID: 31728040 PMCID: PMC6856067 DOI: 10.1038/s41598-019-53319-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022] Open
Abstract
The availability of engineered biological tissues holds great potential for both clinical applications and basic research in a life science laboratory. A prototype standalone perfusion/compression bioreactor system was proposed to address the osteogenic commitment of stem cells seeded onboard of 3D chitosan-graphene (CHT/G) templates. Testing involved the coordinated administration of a 1 mL/min medium flow rate together with dynamic compression (1% strain at 1 Hz; applied twice daily for 30 min) for one week. When compared to traditional static culture conditions, the application of perfusion and compression stimuli to human bone marrow stem cells using the 3D CHT/G template scaffold induced a sizable effect. After using the dynamic culture protocol, there was evidence of a larger number of viable cells within the inner core of the scaffold and of enhanced extracellular matrix mineralization. These observations show that our novel device would be suitable for addressing and investigating the osteogenic phenotype commitment of stem cells, for both potential clinical applications and basic research.
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Affiliation(s)
- Joseph Lovecchio
- Institute of Biomedical and Neural Engineering, Reykjavík University, Menntavegur 1, 101, Reykiavík, Iceland.
- Laboratory of Cellular and Molecular Engineering "Silvio Cavalcanti" - Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Via Cesare Pavese 50, 47522, Cesena, FC, Italy.
- Advanced Research Center on Electronic Systems (ARCES), University of Bologna, Via Vincenzo Toffano 2/2, 40125, Bologna, Italy.
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavík University, Menntavegur 1, 101, Reykiavík, Iceland
| | - Jose Luis Vargas Luna
- Institute of Biomedical and Neural Engineering, Reykjavík University, Menntavegur 1, 101, Reykiavík, Iceland
- Department of Science, Reykjavík University, Menntavegur 1, 101, Reykiavík, Iceland
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20/4L, 1090, Wien, Austria
| | - Emanuele Giordano
- Laboratory of Cellular and Molecular Engineering "Silvio Cavalcanti" - Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Via Cesare Pavese 50, 47522, Cesena, FC, Italy
- Advanced Research Center on Electronic Systems (ARCES), University of Bologna, Via Vincenzo Toffano 2/2, 40125, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Via Tolara di Sopra 41/E, 40064, Ozzano dell'Emilia, BO, Italy
| | - Ólafur Eysteinn Sigurjónsson
- Institute of Biomedical and Neural Engineering, Reykjavík University, Menntavegur 1, 101, Reykiavík, Iceland
- The Blood Bank, The Landspitali University Hospital, Snorrabraut 60, 105, Reykjavík, Iceland
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Ganadhiepan G, Zhang L, Miramini S, Mendis P, Patel M, Ebeling P, Wang Y. The Effects of Dynamic Loading on Bone Fracture Healing Under Ilizarov Circular Fixators. J Biomech Eng 2019; 141:2727816. [DOI: 10.1115/1.4043037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 11/08/2022]
Abstract
Early weight bearing appears to enhance bone fracture healing under Ilizarov circular fixators (ICFs). However, the role of early weight bearing in the healing process remains unclear. This study aims to provide insights into the effects of early weight bearing on healing of bone fractures stabilized with ICFs, with the aid of mathematical modeling. A computational model of fracture site was developed using poro-elastic formulation to simulate the transport of mesenchymal stem cells (MSCs), fibroblasts, chondrocytes, osteoblasts, osteogenic growth factor (OGF), and chondrogenic growth factor (CGF) and MSC differentiation during the early stage of healing, under various combinations of fracture gap sizes (GS), ICF wire pretension forces, and axial loads. 1 h of physiologically relevant cyclic axial loading followed by 23 h of rest in the post-inflammation phase (i.e., callus with granulation tissue) was simulated. The results show that physiologically relevant dynamic loading could significantly enhance cell and growth factor concentrations in the fracture site in a time and spatially dependent manner. 1 h cyclic loading (axial load with amplitude, PA, of 200 N at 1 Hz) increased the content of chondrocytes up to 37% (in all zones of callus), CGF up to 28% (in endosteal and periosteal callus) and OGF up to 50% (in endosteal and cortical callus) by the end of the 24 h period simulated. This suggests that the synergistic effect of dynamic loading-induced advective transport and mechanical stimuli due to early weight bearing is likely to enhance secondary healing. Furthermore, the study suggests that relatively higher PA values or lower ICF wire pretension forces or smaller GS could result in increased chondrocyte and GF content within the callus.
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia e-mail:
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Victoria 3121, Australia
| | - Peter Ebeling
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Yulong Wang
- Rehabilitation Centre, The First Affiliated Hospital, Shenzhen University, Guangdong 518060, China
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Udomsawat C, Rungsiyakull P, Rungsiyakull C, Khongkhunthian P. Comparative study of stress characteristics in surrounding bone during insertion of dental implants of three different thread designs: A three-dimensional dynamic finite element study. Clin Exp Dent Res 2019; 5:26-37. [PMID: 30847230 PMCID: PMC6392841 DOI: 10.1002/cre2.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The objective of this study is to evaluate the stress distribution characteristics around three different dental implant designs during insertion into bone, using dynamic finite element stress analysis. Dental implant placement was simulated using finite element models. Three implants with different thread and body designs (Model 1: root form implant with three different thread shapes; Model 2: tapered implant with a double-lead thread; and Model 3: conical tapered implant with a constant buttress thread) were assigned to insert into prepared bone cavity models until completely placed. Stress and strain distributions were descriptively analyzed. The von Mises stresses within the surrounding bone were measured. At the first 4-mm depth of implant insertion, maximum stress within cortical bone for Model 3 (175 MPa) was less than the other models (180 MPa each). Stress values and concentration area were increasing whereas insertion depth increased. At full implant insertion depth, maximum stress level in Model 1 (35 MPa) within the cancellous bone was slightly greater than in Models 2 (30 MPa) and 3 (25 MPa), respectively. Generally, for all simulations, the highest stress value and the location of the stress concentration area were mostly in cortical bone. However, the stress distribution patterns during the insertion process were different between the models depending on the different designs geometry that contacted the surrounding bone. Different implant designs affect different stress generation patterns during implant insertion. A range of stress magnitude, generated in the surrounding bone, may influence bone healing around dental implants and final implant stability.
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Affiliation(s)
- Chaiwat Udomsawat
- Center of Excellence for Dental Implantology, Faculty of DentistryChiang Mai UniversityThailand
| | | | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of EngineerChiang Mai UniversityThailand
| | - Pathawee Khongkhunthian
- Center of Excellence for Dental Implantology, Faculty of DentistryChiang Mai UniversityThailand
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Abstract
Post-operative rehabilitation and weight-bearing protocols are important to fracture fixation outcomes, yet there is a dearth in the literature concerning universal treatment guidelines following plate fixation of extremity fractures. There are controversies regarding time to allow weight-bearing and range of motion for most fractures of the upper and lower extremity. This lack of a consensus has led to varying practice guidelines and differing anecdotal protocols between treating surgeons. This review attempts to establish consensus guidelines for the post-operative rehabilitation required for patients following plate fixation of common upper and lower extremity fractures.
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Affiliation(s)
- Niloofar Dehghan
- Department of Orthopaedic Surgery, University of Arizona Phoenix; Banner University Medical Center Phoenix, Phoenix, Arizona USA; The CORE Institute, Phoenix, Arizona USA.
| | - Sean M Mitchell
- University of Arizona Phoenix; Banner University Medical Centre Phoenix, Phoenix, Arizona, USA
| | - Emil H Schemitsch
- Division of Orthopaedics, Department of Surgery, Western University, London, Canada
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Yang JH, Kim TW, Kim SH, Lee BJ, Yoon JA, Moon NH, Shin MJ, Shin YB. Amount of Weight-Bearing During Tilt Table Inclination, With Neutral and Unilateral Knee Flexion Postures. Ann Rehabil Med 2018; 42:346-351. [PMID: 29765889 PMCID: PMC5940612 DOI: 10.5535/arm.2018.42.2.346] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/07/2017] [Indexed: 11/06/2022] Open
Abstract
Objective To analyze the amount of weight-bearing during tilt table increments, with a review of neutral and unilateral knee flexion postures. Methods There were 17 healthy participants enrolled in this study. The subjects were tilted from 10° to 90°, and their body weight was measured at each 10° increment. In the first test, both plantar pressures, with the subjects in neutral posture, were recorded. During the second and third tests, the angle of inclination was thus recorded and increased, with the subjects in unilateral knee flexion posture; flexion was maintained at 25° by attaching a cylindrical support to the tilt table at the level of the popliteal fossa. Results The study was divided into two types of postures: neutral and unilateral knee flexion. The percentage of body weight (%BW) between each leg during neutral posture was noted as not being statistically significant. The %BW of one side during tilt table inclination was significantly different between the two postures at 10° to 80° (p<0.05). The weight during unilateral knee flexion posture was lower as analyzed, regardless of tilt table inclination compared with that in neutral posture. We note that fifty percent of the ratio of %BW was noted at 33.12° and 38.76° in neutral and flexion postures, respectively. Conclusion The unilateral knee flexion could induce the effect of decreased body weight compared with non-flexion side. The results of this study will help in setting a safe and quantitative percentage of weight-bearing on the lower extremity during tilt training.
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Affiliation(s)
- Jung Hyun Yang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Tae Wan Kim
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Myung Jun Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Paineiras-Domingos LL, Sá-Caputo DDCD, Moreira-Marconi E, Morel DS, da Fontoura Dionello C, Sousa-Gonçalves CR, Frederico ÉHFF, Marín PJ, Tamini S, Sartorio A, Bernardo-Filho M. Can whole body vibration exercises affect growth hormone concentration? A systematic review. Growth Factors 2017; 35:189-200. [PMID: 29228887 DOI: 10.1080/08977194.2017.1401619] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Whole body vibration (WBV) has been recognized as an effective alternative exercise modality to resistance exercise for its ability in enhancing force and power, generating capacity in skeletal muscle, increasing bone mass and improving cardiovascular function. Since the effect of WBV exercises on growth hormone (GH) levels has been never compared and discussed, the aim of this study was to review systematically the literature to verify the WBV effects on GH concentration. By using PubMed, Scopus and PEDRo databases with the keywords 'growth hormone' or GH and 'whole body vibration' or WBV, we found and analysed 12 papers (182 subjects recruited), verifying their level of evidence (National Health and Medical Research Council hierarchy of evidence) and the methodological quality (PEDRo scale). Although WBV induced GH responses in nine out of 12 publications, caution should be however taken when considering the results due to the markedly different methodologies among these publications.
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Affiliation(s)
- Laisa Liane Paineiras-Domingos
- a Programa de Pós-graduação em Ciências Médicas , Faculdade de Ciências Médicas Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Danúbia da Cunha de Sá-Caputo
- a Programa de Pós-graduação em Ciências Médicas , Faculdade de Ciências Médicas Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Eloá Moreira-Marconi
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- c Programa de Pós-graduação em Fisiopatologia Clínica e Experimental , Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Danielle Soares Morel
- a Programa de Pós-graduação em Ciências Médicas , Faculdade de Ciências Médicas Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Carla da Fontoura Dionello
- a Programa de Pós-graduação em Ciências Médicas , Faculdade de Ciências Médicas Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Cintia Renata Sousa-Gonçalves
- a Programa de Pós-graduação em Ciências Médicas , Faculdade de Ciências Médicas Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Éric Heleno Freire Ferreira Frederico
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
- d Programa de Pós Graduação em Biociências , Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Sofia Tamini
- f Experimental Laboratory for Auxo-endocrinological Research, Division of Auxology and Metabolic Diseases , IRCCS, Istituto Auxologico Italiano , Verbania and Milan , Italy
| | - Alessandro Sartorio
- f Experimental Laboratory for Auxo-endocrinological Research, Division of Auxology and Metabolic Diseases , IRCCS, Istituto Auxologico Italiano , Verbania and Milan , Italy
| | - Mario Bernardo-Filho
- b Departamento de Biofísica e Biometria , Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
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Henderson DJ, Rushbrook JL, Harwood PJ, Stewart TD. What Are the Biomechanical Properties of the Taylor Spatial Frame™? Clin Orthop Relat Res 2017; 475:1472-1482. [PMID: 27896679 PMCID: PMC5384917 DOI: 10.1007/s11999-016-5182-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/16/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Taylor Spatial Frame™ (TSF) is a versatile variant of the traditional Ilizarov circular fixator. Although in widespread use, little comparative data exist to quantify the biomechanical effect of substituting the tried-and-tested Ilizarov construct for the TSF hexapod system. QUESTIONS/PURPOSES This study was designed to investigate the mechanical properties of the TSF system under physiologic loads, with and without the addition of a simulated bone model, with comparison to the standard Ilizarov frame. METHODS The mechanical behaviors of three identical four-ring TSF and Ilizarov constructs were tested under levels of axial compression, bending, and rotational torque to simulate loading during normal gait. An acrylic-pipe fracture model subsequently was mounted, using fine wires and 5 mm half pins, and the testing was repeated. Load-deformation curves, and so rigidity, for each construct were calculated, with statistical comparisons performed using paired t-tests. RESULTS Under axial loading, the TSF was found to be less rigid than the Ilizarov frame (645 ± 57 N/mm versus 1269 ± 256 N/mm; mean difference, 623 N/mm; 95% CI, 438.3-808.5 N/mm; p < 0.001), but more rigid under bending and torsional loads (bending: 42 ± 9 Nm/degree versus 78 ± 13 Nm/degree; mean difference, 37 Nm/degree; 95% CI, 25.0-47.9 Nm/degree; p < 0.001; torsion: 16 ± 2 Nm/degree versus 5 ± 0.35 Nm/degree; mean difference, 11 Nm/degree; 95% CI, 9.5-12.2 Nm/degree; p < 0.001). On mounting the bone models, these relationships broadly remained in the half-pin and fine-wire groups, however the half-pin constructs were universally more rigid than those using fine wires. This effect resulted in the TSF, using half pins, showing no difference in axial rigidity to the fine-wire Ilizarov (107 ± 3 N/mm versus 107 ± 4 N/mm; mean difference, 0.05 N/mm; 95% CI, -6.99 to 7.1 N/mm; p > 0.999), while retaining greater bending and torsional rigidity. Throughout testing, a small amount of laxity was observed in the TSF construct on either side of neutral loading, amounting to 0.72 mm (±0.37 mm) for a change in loading between -10 N and 10 N axial load, and which persisted with the addition of the synthetic fracture model. CONCLUSIONS This study broadly shows the TSF construct to generate lower axial rigidity, but greater bending and torsional rigidity, when compared with the Ilizarov frame, under physiologic loads. The anecdotally described laxity in the TSF hexapod strut system was shown in vitro, but only at low levels of loading around neutral. It also was shown that the increased stiffness generated by use of half pins produced a TSF construct replicating the axial rigidity of a fine-wire Ilizarov frame, for which much evidence of good clinical and radiologic outcomes exist, while providing greater rigidity and so improved resistance to potentially detrimental bending and rotational shear loads. CLINICAL RELEVANCE If replicated in the clinical setting, these findings suggest that when using the TSF, care should be taken to minimize the observed laxity around neutral with appropriate preloading of the construct, but that its use may produce constructs better able to resist bending and torsional loading, although with lower axial rigidity. Use of half pins in a TSF construct however may replicate the axial mechanical behavior of an Ilizarov construct, which is thought to be conducive to bone healing.
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Affiliation(s)
- Daniel J Henderson
- Department of Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
| | - Jeremy L Rushbrook
- Department of Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Paul J Harwood
- Department of Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Todd D Stewart
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Abstract
Bone, despite its relatively inert appearance, is a tissue that is capable of adapting to its environment. Wolff’s law, first described in the 19th century, describes the ability of bone to change structure depending on the mechanical forces applied to it. The mechanostat model extended this principle and suggested that the amount of strain a bone detects depends on bone strength and the amount of muscle force applied to the bone. Experimental studies have found that low-magnitude, high-frequency mechanical loading is considered to be the most effective at increasing bone formation. The osteocyte is considered to be the master regulator of the bone response to mechanical loading. Deformation of bone matrix by mechanical loading is thought to result in interstitial fluid flow within the lacunar–canalicular system, which may activate osteocyte mechanosensors, leading to changes in osteocyte gene expression and ultimately increased bone formation and decreased bone resorption. However, repetitive strain applied to bone can result in microcracks, which may propagate and coalesce, and if not repaired predispose to catastrophic fracture. Osteocytes are a key component in this process, whereby apoptotic osteocytes in an area of microdamage promote targeted remodeling of the damaged bone. If fractures do occur, fracture repair can be divided into 2 types: primary and secondary healing. Secondary fracture repair is the most common and is a multistage process consisting of hematoma formation and acute inflammation, callus formation, and finally remodeling, whereby bone may return to its original form.
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van Lieshout R, Stukstette MJ, de Bie RA, Vanwanseele B, Pisters MF. Biofeedback in Partial Weight Bearing: Validity of 3 Different Devices. J Orthop Sports Phys Ther 2016; 46:993-1001. [PMID: 27733088 DOI: 10.2519/jospt.2016.6625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study to assess criterion-related validity, with a cross-sectional within-subject design. Background Patients with orthopaedic conditions have difficulties complying with partial weight-bearing instructions. Technological advances have resulted in biofeedback devices that offer real-time feedback. However, the accuracy of these devices is mostly unknown. Inaccurate feedback can result in incorrect lower-limb loading and may lead to delayed healing. Objectives To investigate validity of peak force measurements obtained using 3 different biofeedback devices under varying levels of partial weight-bearing categories. Methods Validity of 3 biofeedback devices (OpenGo science, SmartStep, and SensiStep) was assessed. Healthy participants were instructed to walk at a self-selected speed with crutches under 3 different weight-bearing conditions, categorized as a percentage range of body weight: 1% to 20%, greater than 20% to 50%, and greater than 50% to 75%. Peak force data from the biofeedback devices were compared with the peak vertical ground reaction force measured with a force plate. Criterion validity was estimated using simple and regression-based Bland-Altman 95% limits of agreement and weighted kappas. Results Fifty-five healthy adults (58% male) participated. Agreement with the gold standard was substantial for the SmartStep, moderate for OpenGo science, and slight for SensiStep (weighted ± = 0.76, 0.58, and 0.19, respectively). For the 1% to 20% and greater than 20% to 50% weight-bearing categories, both the OpenGo science and SmartStep had acceptable limits of agreement. For the weight-bearing category greater than 50% to 75%, none of the devices had acceptable agreement. Conclusion The OpenGo science and SmartStep provided valid feedback in the lower weight-bearing categories, and the SensiStep showed poor validity of feedback in all weight-bearing categories. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 12 Oct 2016. doi:10.2519/jospt.2016.6625.
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van Lieshout R, Pisters MF, Vanwanseele B, de Bie RA, Wouters EJ, Stukstette MJ. Biofeedback in Partial Weight Bearing: Usability of Two Different Devices from a Patient's and Physical Therapist's Perspective. PLoS One 2016; 11:e0165199. [PMID: 27798674 PMCID: PMC5087887 DOI: 10.1371/journal.pone.0165199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Partial weight bearing is frequently instructed by physical therapists in patients after lower-limb trauma or surgery. The use of biofeedback devices seems promising to improve the patient’s compliance with weight-bearing instructions. SmartStep and OpenGo-Science are biofeedback devices that provide real-time feedback. For a successful implementation, usability of the devices is a critical aspect and should be tested from a user’s perspective. Aim To describe the usability from the physical therapists’ and a patients’ perspective of Smartstep and OpenGo-Science to provide feedback on partial weight bearing during supervised rehabilitation of patients after lower-limb trauma or surgery. Methods In a convergent mixed-methods design, qualitative and quantitative data were collected. Usability was subdivided into user performance, satisfaction and acceptability. Patients prescribed with partial weight bearing and their physical therapists were asked to use SmartStep and OpenGo-Science during supervised rehabilitation. Usability was qualitatively tested by a think-aloud method and a semi-structured interview and quantitatively tested by the System-Usability-Scale (SUS) and closed questions. For the qualitative data thematic content analyses were used. Results Nine pairs of physical therapists and their patients participated. The mean SUS scores for patients and physical therapists were for SmartStep 70 and 53, and for OpenGo-Science 79 and 81, respectively. Scores were interpreted with the Curved Grading Scale. The qualitative data showed that there were mixed views and perceptions from patients and physical therapists on satisfaction and acceptability. Conclusion This study gives insight in the usability of two biofeedback devices from the patient’s and physical therapist’s perspective. The overall usability from both perspectives seemed to be acceptable for OpenGo-Science. For SmartStep, overall usability seemed only acceptable from the patient’s perspective. Implication The study findings could help clinicians to decide which biofeedback device is appropriate for their given situation and provide information for future development of biofeedback devices.
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Affiliation(s)
- Remko van Lieshout
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
- Physical Therapy Research, Clinical Health Sciences & Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn F. Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
- Physical Therapy Research, Clinical Health Sciences & Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Benedicte Vanwanseele
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
- Human Movement Biomechanics Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Rob A. de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Eveline J. Wouters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Mirelle J. Stukstette
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
- Physical Therapy Research, Clinical Health Sciences & Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- * E-mail:
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