1
|
Colding-Rasmussen T, Schwarzenberg P, Horstmann PF, Ottesen CBS, Garcia JSJ, Hutchinson DJ, Malkoch M, Petersen MM, Varga P, Tierp-Wong CNE. Biomechanical Variability and Usability of a Novel Customizable Fracture Fixation Technique. Bioengineering (Basel) 2023; 10:1146. [PMID: 37892877 PMCID: PMC10604275 DOI: 10.3390/bioengineering10101146] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
A novel in situ customizable osteosynthesis technique, Bonevolent™ AdhFix, demonstrates promising biomechanical properties under the expertise of a single trained operator. This study assesses inter- and intra-surgeon biomechanical variability and usability of the AdhFix osteosynthesis platform. Six surgeons conducted ten osteosyntheses on a synthetic bone fracture model after reviewing an instruction manual and completing one supervised osteosynthesis. Samples underwent 4-point bending tests at a quasi-static loading rate, and the maximum bending moment (BM), bending stiffness (BS), and AdhFix cross-sectional area (CSA: mm²) were evaluated. All constructs exhibited a consistent appearance and were suitable for biomechanical testing. The mean BM was 2.64 ± 0.57 Nm, and the mean BS was 4.35 ± 0.44 Nm/mm. Statistically significant differences were observed among the six surgeons in BM (p < 0.001) and BS (p = 0.004). Throughout ten trials, only one surgeon demonstrated a significant improvement in BM (p < 0.025), and another showed a significant improvement in BS (p < 0.01). A larger CSA corresponded to a statistically significantly higher value for BM (p < 0.001) but not for BS (p = 0.594). In conclusion, this study found consistent biomechanical stability both across and within the surgeons included, suggesting that the AdhFix osteosynthesis platform can be learned and applied with minimal training and, therefore, might be a clinically viable fracture fixation technique. The variability in BM and BS observed is not expected to have a clinical impact, but future clinical studies are warranted.
Collapse
Affiliation(s)
- Thomas Colding-Rasmussen
- Department of Orthopedic Surgery, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark;
| | - Peter Schwarzenberg
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (P.S.); (P.V.)
| | - Peter Frederik Horstmann
- Department of Orthopedic Surgery, Gentofte Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark;
| | - Casper Bent Smedegaard Ottesen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; (C.B.S.O.); (M.M.P.)
| | - Jorge San Jacinto Garcia
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Daniel John Hutchinson
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Michael Malkoch
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; (C.B.S.O.); (M.M.P.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (P.S.); (P.V.)
| | - Christian Nai En Tierp-Wong
- Department of Orthopedic Surgery, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark;
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| |
Collapse
|
2
|
Colding-Rasmussen T, Horstmann PF, Jørgensen PH, Hettwer W, Hansen BH, Tierp-Wong CNE, Petersen MM. Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231202155. [PMID: 37688488 DOI: 10.1177/10225536231202155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Polymethyl-methacrylate cement (PMMA) is often used as bone defect reconstruction material after surgical removal of giant cell tumors. The purpose of this study was to investigate if the application of PMMA improves the local recurrence rates for giant cell tumors (GCT) of appendicular bone treated with intralesional curettage. METHODS A retrospective analysis of all appendicular GTCs treated at two major Danish sarcoma centres between the 1st of January 1998 and December 31st 2013; minimum follow-up of 3.0 years (median: 8.9; 1.3-18.7 years). Kaplan-Meier survival model, log-rank and multivariate Cox regression were used to calculate and compare local recurrence rates. p-values <0.05 were considered statistically significant. RESULTS 102 patients (M59/F43), median age 31Y (11-84) were included in this study. The overall 3-years local recurrence-rate was 19.9% (95%CI: 11.9-27.9%); 91% had occurred within 3 years. In patients treated with intralesional curettage (n = 64), the 3-years recurrence-rate was 30.6% (95%CI: 18.8-42.4%), compared to 2.6% (95%CI: 0.0-7.8%) in patients treated with wide resection or amputation (n = 38), p < .001. The 3-years recurrence-rate for patients treated with intralesional curettage and reconstruction using PMMA was 29.0% (95%CI: 12.6-45.4%) and without PMMA: 31.8% (95%CI: 15.2-48.4%), p = .83. CONCLUSION We found that the use of PMMA for bone defect reconstruction after intralesional curettage of GTCs in the appendicular skeleton did not ensure a reduced risk of local recurrence.
Collapse
Affiliation(s)
| | - Peter F Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter H Jørgensen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Werner Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne H Hansen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael M Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|