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Fleischhacker E, Sprecher CM, Milz S, Saller MM, Wirz R, Zboray R, Parrilli A, Gleich J, Siebenbürger G, Böcker W, Ockert B, Helfen T. Inflammatory tissue response in human soft tissue is caused by a higher particle load near carbon fiber-reinforced PEEK compared to titanium plates. Acta Biomater 2024; 180:128-139. [PMID: 38636789 DOI: 10.1016/j.actbio.2024.04.023] [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: 11/28/2023] [Revised: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Titanium as the leading implant material in locked plating is challenged by polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK), which became the focus of interest of researchers and manufacturers in recent years. However, data on human tissue response to these new implant materials are rare. Osteosynthesis plates and peri‑implant soft tissue samples of 16 healed proximal humerus fractures were examined (n = 8 CFR-PEEK, n = 8 titanium). Soft tissue was analyzed by immunohistochemistry and µCT. The entrapped foreign bodies were further examined for their material composition by FTIR. To gain insight into their origin and formation mechanism, explanted and new plates were evaluated by SEM, EDX, profilometry and HR-CT. In the peri‑implant soft tissue of the CFR-PEEK plates, an inflammatory tissue reaction was detected. Tissues contained foreign bodies, which could be identified as tantalum wires, carbon fiber fragments and PEEK particles. Titanium particles were also found in the peri‑implant soft tissue of the titanium plates but showed a less intense surrounding tissue inflammation in immunohistochemistry. The surface of explanted CFR-PEEK plates was rougher and showed exposed and broken carbon fibers as well as protruding and deformed tantalum wires, especially in used screw holes, whereas scratches were identified on the titanium plate surfaces. Particles were present in the peri‑implant soft tissue neighboring both implant materials and could be clearly assigned to the plate material. Particles from both plate materials caused detectable tissue inflammation, with more inflammatory cells found in soft tissue over CFR-PEEK plates than over titanium plates. STATEMENT OF SIGNIFICANCE: Osteosynthesis plates are ubiquitously used in various medical specialties for the reconstruction of bone fractures and defects and are therefore indispensable for trauma surgeons, ENT specialists and many others. The leading implant material are metals such as titanium, but recently implants made of polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK) have become increasingly popular. However, little is known about human tissue reaction and particle generation related to these new implant types. To clarify this question, 16 osteosynthesis plates (n = 8 titanium and n = 8 CFR-PEEK) and the overlying soft tissue were analyzed regarding particle occurrence and tissue inflammation. Tissue inflammation is clinically relevant for the development of scar tissue, which is discussed to cause movement restrictions and thus contributes significantly to patient outcome.
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Affiliation(s)
- E Fleischhacker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany.
| | - C M Sprecher
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - S Milz
- Anatomische Anstalt der Ludwig-Maximilians-Universität, Pettenkoferstrasse 11, 80336 München, Germany
| | - M M Saller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - R Wirz
- RMS Foundation, Bischmattstrasse 12, 2544, Bettlach, Switzerland
| | - R Zboray
- EMPA, Überlandstrasse 129, Dübendorf, Switzerland
| | - A Parrilli
- EMPA, Überlandstrasse 129, Dübendorf, Switzerland
| | - J Gleich
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - G Siebenbürger
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - W Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - B Ockert
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - T Helfen
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
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Senra MR, Marques MFV, Monteiro SN. Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview. Polymers (Basel) 2023; 15. [PMID: 36679253 DOI: 10.3390/polym15020373] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023] Open
Abstract
The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.
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Luoma J, Saarenpää I, Rinne J, Frantzén J, Moritz N, Vallittu PK. Quasi-static loading of glass fiber-reinforced composite cervical fusion cage. J Mech Behav Biomed Mater 2022; 136:105481. [PMID: 36206690 DOI: 10.1016/j.jmbbm.2022.105481] [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: 11/23/2021] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Anterior decompression and fusion in cervical spine has become one of the most common procedures in neurosurgery. In the surgery, cervical cage implants made of different biomaterials are used. Our purpose was to create a cervical cage made of glass fiber-reinforced composite (FRC) filled with bioactive glass particles and to characterize its behavior in quasi-static compression/shear stress loading conditions. MATERIALS AND METHODS FRC cages (n = 6) were manufactured with 2, 4, 6, 8 and 10 layers of glass fiber laminates and thermoset dimethacrylate resin matrix resulting in wall thickness from 0.70 to 2.1 mm. Control cage was a commercial PEEK cage (CeSpaceXP) implant with asymmetrical wall thickness of up 4.0 mm. Interior of the cage was filled with glass particles of the size 500-1250 μm simulating the bioactive glass which are used in FRC cranial implants. The FRC cages were quasi-statically loaded (compressive/shear stress) at a constant speed of 1 mm/min in the air. RESULTS The average yield strength force (YF) of the control PEEK cage was 3483.6 N (±134.3 N). The average YFs for tested FRC cage with 2, 4, 6, 8 and 10 layers of FRC fabric varied from 1336.5 N (±403.8 N) to 7675.0 N (±670.0 N), respectively. The average ultimate forces (UF) for tested FRC cages varied from 1535.8 N (±406.2 N) to 9975.0 N (±1492.4 N). With six layers of FRC fabric, YF of the FRC cage was comparable to the PEEK implants. CONCLUSIONS In this study, it was demonstrated that it is possible to manufacture a cervical interbody fusion device made of FRC and filled with bioactive glass with proper load bearing capacities. Because of physical properties of FRC-bioactive glass, the FRC cage might have some advances compared to the state-of-the-art cages, like faster bony union and smaller rate of subsidence, which will be studied in the future.
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Affiliation(s)
- Jaakko Luoma
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.
| | - Ilkka Saarenpää
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Janek Frantzén
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Niko Moritz
- Department on Biomaterials Science and Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland; Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Finland
| | - Pekka K Vallittu
- Department on Biomaterials Science and Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland; City of Turku, Welfare Division, Turku, Finland
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Oladapo BI, Ismail SO, Ikumapayi OM, Karagiannidis PG. Impact of rGO-coated PEEK and lattice on bone implant. Colloids Surf B Biointerfaces 2022; 216:112583. [PMID: 35662072 DOI: 10.1016/j.colsurfb.2022.112583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/31/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
The composite coating can effectively inhibit bacterial proliferation and promote the expression of bone-building genes in-vitro. Therefore, a novel production was used to produce poly-ether-ether-ketone, and reduced graphene oxide (PEEK-rGO) scaffolds with ratios of 1-3%, combining a different lattice for a bone implant. An inexpensive method was developed to prepare the new coatings on the PEEK scaffold with reduced graphene oxide (rGO). Mechanical testing, data analysis and cell culture tests for in-vitro biocompatibility scaffold characterisation for the PEEK composite were conducted. Novel computation microanalysis of four-dimensional (4D) printing of microstructure of PEEK-rGO concerning the grain size and three dimensional (3D) morphology was influenced by furrow segmentation of grains cell growth on the composite, which was reduced from an average of 216-155 grains and increased to 253 grains on the last day. The proposed spherical nanoparticles cell grew with time after dispersed PEEK nanoparticles in calcium hydroxyapatite (cHAp) grains. Also, the mechanical tests were carried out to validate the strength of the new composites and compare them to that of a natural bone. The established 3D-printed PEEK composite scaffolds significantly exhibited the potential of bone implants for biomimetic heterogeneous bone repair.
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Affiliation(s)
- Bankole I Oladapo
- School of Engineering, Faculty of Technology, University of Sunderland, UK; Sustainable Development, De Montfort University Leicester, UK.
| | - Sikiru O Ismail
- Centre for Engineering Research, Department of Engineering, University of Hertfordshire, UK
| | - Omolayo M Ikumapayi
- Department of Mechanical and Mechatronics Engineering, Afe Babalola University, Ado-Ekiti, Nigeria
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London DA, Stern PJ. A Failed 4-Corner Arthrodesis Using a Polyether-Ether-Ketone Implant: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00072. [PMID: 35102039 DOI: 10.2106/jbjs.cc.21.00102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 59-year-old man underwent scaphoidectomy and 4-corner arthrodesis with a polyether-ether-ketone (PEEK) circular plate for scapholunate advanced collapse of the wrist. Five years later, he presented with a symptomatic nonunion and radiocarpal arthritis. Total wrist arthrodesis with a dorsal plate was performed. During revision surgery, considerable synovitis was encountered. Histological evaluation revealed a foreign body response likely secondary to PEEK particles. CONCLUSION Use of PEEK implants can result in an adverse local tissue reaction if particles are generated. This is a rare biomaterial-related complication, and surgeons should be aware of this adverse tissue response when using this or other PEEK implants.
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Affiliation(s)
- Daniel A London
- Mary S. Stern Hand Surgery Fellowship, Cincinnati, Ohio
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Peter J Stern
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio
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Saracco M, Fulchignoni C, Velluto C, Rocchi L. SAFETY AND RELIABILITY OF CARBON-PEEK PLATE FOR THE TREATMENT OF DISTAL RADIUS FRACTURES: A REVIEW OF THE LITERATURE. Orthop Rev (Pavia) 2021; 13:28362. [PMID: 35478703 PMCID: PMC9037658 DOI: 10.52965/001c.28362] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Distal radius fractures are one of the most common injuries. Open reduction and internal fixation (ORIF) are the most diffused between surgical treatments. Carbon-fiber reinforced (CFR) polyetheretherketone (PEEK) plates have been proposed to prevent effects linked to stainless steel or titanium alloy traditional plates, such as radio-opacity, mismatch of bone-plate elasticity modulus, corrosion, limited fatigue life, osseointegration. OBJECTIVE This review aims to evaluate the actual safety and reliability of CFR- PEEK plates to treat distal radius fractures. METHODS Electronic databases PubMed, Google Scholars, and Cochrane Library were searched in December 2020. Eligible studies were published in peer-reviewed journals. Three authors independently selected relevant articles and discussed those. Searching identified 13 titles and abstracts, 11 manuscripts were considered eligible for the full-text analysis. Of these 11 papers, 7 studies were included in our review. RESULTS 215 patients were analyzed in this systematic review. The mean age of enrolled patients was 52,8 years. 34% were males and 66% were females. Fractures were classified according to AO/ASIF classification system. We reported 12 cases of complications specific to this device, such as intraoperative plate and screws rupture, erosive flexor tendons synovitis, and loosening. CONCLUSION CFR-PEEK distal radius plates are potentially an alternative to traditional ones. But we believe that the use of this device does not entail a significant advantage in the treatment of distal radius fractures, as safe and low-cost traditional devices are available. Further comparative studies are needed to demonstrate the superiority of carbon devices.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics - Hand Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Camillo Fulchignoni
- Department of Orthopaedics - Hand Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Calogero Velluto
- Department of Orthopaedics - Hand Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Lorenzo Rocchi
- Department of Orthopaedics - Hand Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
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Kumar N, Lopez KG, Alathur Ramakrishnan S, Hallinan JTPD, Fuh JYH, Pandita N, Madhu S, Kumar A, Benneker LM, Vellayappan BA. Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material? Radiother Oncol 2021; 163:93-104. [PMID: 34419506 DOI: 10.1016/j.radonc.2021.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022]
Abstract
"Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | | | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore
| | - Naveen Pandita
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Aravind Kumar
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore
| | - Lorin M Benneker
- Department of Orthopaedics, Spine Surgery, Sonnenhofspital, Bern, Switzerland
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do Monte FA, Awad KR, Ahuja N, Kim HK, Aswath P, Brotto M, Varanasi VG. Amorphous Silicon Oxynitrophosphide-Coated Implants Boost Angiogenic Activity of Endothelial Cells. Tissue Eng Part A 2020; 26:15-27. [PMID: 31044666 PMCID: PMC6983748 DOI: 10.1089/ten.tea.2019.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/29/2019] [Indexed: 12/29/2022] Open
Abstract
Lack of osteointegration is a major cause of aseptic loosening and failure of implants used in bone replacement. Implants coated with angiogenic biomaterials can improve osteointegration and potentially reduce these complications. Silicon- and phosphorus-based materials have been shown to upregulate expression of angiogenic factors and improve endothelial cell functions. In the present study, we hypothesize that implants coated with amorphous silica-based coatings in the form of silicon oxynitrophosphide (SiONP) by using plasma-enhanced chemical vapor deposition (PECVD) technique could enhance human umbilical vein endothelial cell angiogenic properties in vitro. The tested groups were: glass coverslip (GCS), tissue culture plate, SiON, SiONP1 (O: 7.3 at %), and SiONP2 (O: 14.2 at %) implants. The SiONP2 composition demonstrated 3.5-fold more fibronectin deposition than the GCS (p < 0.001). The SiONP2 group also presented a significant improvement in the capillary tubule length and thickness compared with the other groups (p < 0.01). At 24 h, we observed at least a twofold upregulation of vascular endothelial growth factor A, hypoxia-inducible factor-1α, angiopoietin-1, and nesprin-2, more evident in the SiONP1 and SiONP2 groups. In conclusion, the studied amorphous silica-coated implants, especially the SiONP2 composition, could enhance the endothelial cell angiogenic properties in vitro and may induce faster osteointegration and healing. Impact Statement In this study, we report for the first time the significant enhancement of human umbilical vein endothelial cell angiogenic properties (in vitro) by the amorphous silica-based coatings in the form of silicon oxynitrophosphide (SiONP). The SiONP2 demonstrated 3.5-fold more fibronectin deposition than the glass coverslip and presented a significant improvement in the capillary tubule length and thickness. At 24 h, SiONP reported twofold upregulation of vascular endothelial growth factor A, hypoxia-inducible factor-1α, angiopoietin-1, and nesprin-2. The studied amorphous silica-coated implants enhance the endothelial cell angiogenic properties in vitro and may induce faster osteointegration and healing.
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Affiliation(s)
- Felipe A. do Monte
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Texas
| | - Kamal R. Awad
- Department of Materials Science and Engineering, University of Texas at Arlington, Arlington, Texas
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Neelam Ahuja
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Harry K.W. Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Texas
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Pranesh Aswath
- Department of Materials Science and Engineering, University of Texas at Arlington, Arlington, Texas
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Venu G. Varanasi
- Department of Materials Science and Engineering, University of Texas at Arlington, Arlington, Texas
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
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Allemann F, Halvachizadeh S, Rauer T, Pape HC. Clinical outcomes after carbon-plate osteosynthesis in patients with distal radius fractures. Patient Saf Surg 2019; 13:30. [PMID: 31516553 PMCID: PMC6727488 DOI: 10.1186/s13037-019-0210-8] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/27/2019] [Indexed: 01/10/2023] Open
Abstract
Background Surgical implant material has changed over time, from metal to stainless steel to titanium. In recent decades a new material, carbon-fibre-reinforced polyether ether ketone, has been introduced. The aim of this study was to assess the clinical and radiological feasibility and functional outcome after treatment of distal radius fractures with this new implant. Methods Inclusion criteria: AO type B distal radius fractures treated with 2.7 mm CF/PEEK plates at one Level 1 trauma centre between 2016 and 2017. Follow-up period 1 year, measurement of range of motion and radiographic assessment, histological analysis of debris only after plate removal. Results Out of 112 eligible patients, 10 (8.9%) patients were included. Mean operation time was 65 ± 10 min. Radiographic healing was confirmed by radiologists at 6 weeks follow-up. During one-year follow-up, no adverse events were reported and functionality and patients subjective satisfaction improved significantly (p < 0.05). Only one plate was removed, with no histological signs of inflammation or allergic reaction. Conclusions The 2.7 mm CF/PEEK plate osteosynthesis appears to be a reliable and safe implant for certain types of distal radius fracture. Assessment of fracture union is substantially more practical and functionality improved significantly over 1 year.
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Affiliation(s)
- Florin Allemann
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Sascha Halvachizadeh
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Thomas Rauer
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Hans-Christoph Pape
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
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Merolli A, Mao Y, Kohn J. A suspended carbon fiber culture to model myelination by human Schwann cells. J Mater Sci Mater Med 2017; 28:57. [PMID: 28210970 DOI: 10.1007/s10856-017-5867-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
Understanding of myelination/remyelination process is essential to guide tissue engineering for nerve regeneration. In vitro models currently used are limited to cell population studies and cannot easily identify individual cell contribution to the process. We established a novel model to study the contribution of human Schwann cells to the myelination process. The model avoids the presence of neurons in culture; Schwann cells respond solely to the biophysical properties of an artificial axon. The model uses a single carbon fiber suspended in culture media far from the floor of the well. The fiber provides an elongated structure of defined diameter with 360-degree of surface available for human Schwann cells to wrap around. This model enabled us to spatially and temporally track the myelination by individual Schwann cells along the fiber. We observed cell attachment, elongation and wrapping over a period of 9 days. Cells remained alive and expressed Myelin Basic Protein and Myelin Associated Glycoprotein as expected. Natural and artificial molecules, and external physical factors (e.g., p atterned electrical impulses), may be tested with this model as possible regulators of myelination.
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Affiliation(s)
- Antonio Merolli
- New Jersey Center for Biomaterials, Rutgers-The State University of New Jersey, 145 Bevier Rd., Piscataway, NJ, 08854, USA.
- Policlinico Gemelli, Universita' Cattolica del Sacro Cuore, largo Gemelli 8, 00168, Rome, Italy.
| | - Yong Mao
- New Jersey Center for Biomaterials, Rutgers-The State University of New Jersey, 145 Bevier Rd., Piscataway, NJ, 08854, USA
| | - Joachim Kohn
- New Jersey Center for Biomaterials, Rutgers-The State University of New Jersey, 145 Bevier Rd., Piscataway, NJ, 08854, USA
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