1
|
Aslan L, Subasi O, Gedik CC, Birsel O, Lazoglu I, Demirhan M, Eren I. In silico analysis of rib force distribution in postscapulothoracic arthrodesis model. J Orthop Res 2024; 42:942-949. [PMID: 38111178 DOI: 10.1002/jor.25771] [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] [Received: 08/14/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
Scapulothoracic arthrodesis (STA) is carried out by fixing the scapula to thoracic ribs which in turn allows the patient suffering from Facioscapulohumeral Muscular Dystrophy to carry out shoulder-joint dependent activities of daily living. A biomechanical analysis of this procedure has not been conducted in the literature and, for the first time, this study investigates the finite element calculated glenohumeral-applied load distributions on ribs by creating a post-STA model. Three loading directions on the glenohumeral joint are designated: anterior-posterior, superior-inferior, and lateral-medial. Reaction forces on the ribs are calculated based on the glenoid force percent. Simulations are repeated by removing a singular rib contact to observe the change in force distributions in the case of missing levels or failed bonding as well as the impact of clavicle osteotomy. Total load distribution is observed highest at T2 followed by T3 and T6. In the T2 missing scenario, total loads on T3 and T4 increase. In the T4 missing case, the most affected level is T3. In the T6 missing scenario, total loads on T5 and T7 increase. In the clavicular osteotomy scenario, all levels' loads increase; the highest is recorded in T7 by 460%, followed by T5, T4, T2, T6, and T3. While all levels contribute to fixation strength, T2 is subjected to the highest loads, and, in the missing level scenarios, the loads are tolerated sufficiently by the remaining levels. Missing T4 scenario has the least effect on the system, which is interpreted as potentially the only skippable level of fixation. Clavicular osteotomy has the highest effect on the arthrodesis site.
Collapse
Affiliation(s)
- Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Lazoglu
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ilker Eren
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Itthipanichpong T, Limskul D, Tanpowpong T, Virulsri C, Tangpornprasert P, Kuptniratsaikul S, Thamrongskulsiri N. Higher contact pressure of the lateral tibiofemoral joint in lateral extra-articular tenodesis with tensioned graft in external rotation than in neutral rotation: a biomechanical study. J ISAKOS 2024:S2059-7754(24)00079-8. [PMID: 38636904 DOI: 10.1016/j.jisako.2024.04.009] [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: 02/28/2024] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To determine the mean contact pressure, peak contact pressure, and mean contact area of the lateral tibiofemoral joint in lateral extra-articular tenodesis (LET) with tension on the graft in tibial neutral and external rotation. METHODS A total of eight Thiel's embalmed cadaveric knees were prepared and divided into two groups (4 knees in each group): the LET-NR group (lateral extra-articular tenodesis tension in neutral rotation) and (2) the LET-ER group (lateral extra-articular tenodesis tension in external rotation). Each knee was prepared according to the corresponding technique. A hydraulic testing system (E10000, Instron) simulates an axial load of 735 N for 10 seconds in each group. RESULTS The LET-ER group exhibited a statistically significant higher peak contact pressure compared to the LET-NR group. The peak contact pressure values in the LET-NR and LET-ER groups were 702.3 ± 233.9 kPa and 1,235.5 ± 171.4 kPa, respectively (p = 0.010, 95% CI, -888.0--178.5). The mean contact pressure values in the LET-NR and LET-ER groups were 344.9 ± 69.0 kPa and 355.3 ± 34.9 kPa, respectively (p = 0.796, 95% CI, -105.1-84.2). The mean contact area values in the LET-NR and LET-ER groups were 36.8 ± 3.1 mm2 and 33.3 ± 6.4 mm2, respectively (p = 0.360, 95% CI, -5.2-12.2). CONCLUSIONS The peak contact pressure of the lateral tibiofemoral joint is greater in LET when the graft is tensioned in external rotation than in neutral rotation. However, no statistically significant difference in the mean contact pressure or the mean contact area was observed between the two groups. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Chanyaphan Virulsri
- Center of Excellence for Prosthetic and Orthopedic Implant, Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
| | - Pairat Tangpornprasert
- Center of Excellence for Prosthetic and Orthopedic Implant, Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | | |
Collapse
|
3
|
亓 一, 王 晓, 张 世. [Research progress on distal interlocking screws of cephalomedullary nails in intertrochanteric fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:356-362. [PMID: 38500431 PMCID: PMC10982033 DOI: 10.7507/1002-1892.202312052] [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] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Indexed: 03/20/2024]
Abstract
Objective To summarize the new research progress in distal interlocking screws of cephalomedullary nails for the treatment of intertrochanteric fractures. Methods Relevant domestic and foreign literature was extensively reviewed to summarize the static/dynamic types of distal interlocking screw holes, biomechanical studies, clinical studies and application principles, effects on toggling in the cavity, and related complications of distal interlocking screws. Results The mode of the distal interlocking screw holes can be divided into static and dynamic. Distal interlocking screws play the role of anti-rotation, maintaining femur length, resisting compression stress, increasing torque stiffness, resisting varus stress, etc. The number of the screws directly affects the toggling of the main nail in the cavity. At present, regardless of whether long or short nails are used, distal interlocking screws are routinely inserted in clinical practice. However, using distal interlocking screws can significantly increase the duration of anesthesia and operation, increase fluoroscopy exposure time, surgical blood loss, and incision length. There is a trend of trying not to use distal interlocking screws in recent years. No significant difference is found in some studies between the effectiveness of dynamic and static interlocking for AO/Orthopaedic Trauma Association (AO/OTA) 31-A1/2 fractures. At present, the selection of the number and mode of distal interlocking screws is still controversial. When inserting distal interlocking screws, orthopedists should endeavor to minimize the occurrence of complications concerning miss shot, vascular injuries, local stress stimulation, and peri-implant fractures. Conclusion Distal interlocking screws are mainly used to prevent rotation. For stable fractures with intact lateral walls, long cephalomedullary nails can be used without distal interlocking screws. For any type of intertrochanteric fractures, distal interlocking screws are required when using short cephalomedullary nails for fixation. Different interlocking modes, the number of interlocking screws, and the application prospects of absorbable interlocking screws may be future research directions.
Collapse
Affiliation(s)
- 一鸣 亓
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, P. R. China
| | - 晓旭 王
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, P. R. China
| | - 世民 张
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, P. R. China
| |
Collapse
|
4
|
Öztürk A, Karakaşlı A, Erbil G, Gökgöz MB, Yapici F. The Impact of Complex Loadings on the Structure of the L2-L3 Intervertebral Disc in a Sheep Spine Cadaver Model: A Biomechanical and Histological Evaluation. Cureus 2024; 16:e51941. [PMID: 38196992 PMCID: PMC10775825 DOI: 10.7759/cureus.51941] [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: 01/09/2024] [Indexed: 01/11/2024] Open
Abstract
Background The human vertebral column generates movements under versatile, dynamic loads. Understanding how the spine reacts to these movements and loads is crucial for developing new spine implants and surgical treatments for intervertebral disc injuries. Mechanically uni-axial compression models have been extensively studied. However, the spine's daily loading is not limited to compression, so it is crucial to measure its behavior in all movements (flexion-extension, rotation, and axial compression). Methods This study utilized L1-L5 segments from 19 healthy adult sheep spines. The L2-L3 disc of the first spine underwent only histological evaluation without biomechanical testing to define basic histological parameters. The remaining 18 were divided into three groups of six and subjected to biomechanical tests. Different mechanisms for three groups of spinal segments were prepared, and tests were performed on Shimadzu AG-IS 10 KN (Universal Drawing Press, Kyoto, Japan). An axial load (800 N) was applied to the first group, an axial load with 15 degrees of flexion to the second group, and an axial load with 10 degrees of rotation plus 15 degrees of flexion to the third group. A biomechanical evaluation of the maximum elongation amounts (MEAs) was performed and compared between the groups. Then, the L2-L3 discs were removed from the sheep spines, and a histological examination of the discs was conducted using Hematoxylin-Eosin (HE), Alcian Blue (AB), and Masson's Trichrome (MT) staining. Results The mean MEA ± Standard Deviation (Range) was 1.39 ± 0.38 (0.91-1.94) for Group 1, 2.02 ± 0.75 (0.91-3.01) for Group 2, and 2.47 ± 1.09 (0.64-3.9) for Group 3. Biomechanically, although MEAs increased from Group 1 to Group 3 (meaning that the mean MEAs increased as the number of types of applied force increased), there was no statistically significant difference between the groups regarding the MEAs (P = 0.092). Histologically, no significant differences were observed between all groups after HE staining. In all groups, hypercellularity, edema in the connective tissue, separation between tissue layers, delamination, and signs of swelling and necrosis in the cells were observed similarly. For the AB staining, there was a decrease in the glycosaminoglycan (GAG) structure in the tissue samples compared to the control tissue, but no significant differences were observed between the groups. However, it was observed that the stratification in Group 3 was slightly more deteriorated than in the other groups. For the MT staining, collagen structure deterioration was observed in all groups. It was observed that the amount of collagen was significantly reduced compared to the control tissue. Conclusion As a result, when the axial load is applied biomechanically, there is more displacement of the vertebral discs in Group 3 with multidimensional movements. Furthermore, histological studies revealed deterioration between tissue layers when exposed to complex movements, and the degradation of stratification in group 3 compared to other loading combinations in groups 2 and 3 may indicate the role of complex loads in the formation of disc herniation.
Collapse
Affiliation(s)
- Akın Öztürk
- Orthopaedics and Traumatology, Mengücek Gazi Hospital, Erzincan, TUR
| | - Ahmet Karakaşlı
- Orthopaedics and Traumatology, Dokuz Eylül University Faculty of Medicine, İzmir, TUR
| | - Güven Erbil
- Histology and Embryology, Kyrenia University Faculty of Medicine, Girne, CYP
| | - Mehmet Burak Gökgöz
- Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, TUR
| | - Furkan Yapici
- Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, TUR
| |
Collapse
|
5
|
Kang A, Lee H, Lee A, Roh Y, Sim B, Jeong J. Biomechanical Comparison of Double 2.3-mm Headless Cannulated Self-Compression Screws and Single 3.5-mm Cortical Screw in Lag Fashion in a Canine Sacroiliac Luxation Model: A Small Dog Cadaveric Study. Vet Comp Orthop Traumatol 2024; 37:13-22. [PMID: 37562428 PMCID: PMC10789505 DOI: 10.1055/s-0043-1771508] [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: 09/15/2022] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of safe positioning of double 2.3-mm headless cannulated self-compression screws (HCS) in a small dog cadaveric sacroiliac luxation model and to compare the static rotational biomechanical properties of fixation repaired using two different screw systems with a minimally invasive osteosynthesis technique: double 2.3-mm HCS and a single 3.5-mm standard cortical screw placed in a lag fashion. STUDY DESIGN A unilateral small dog sacroiliac luxation model was stabilized using double 2.3-mm HCS (n = 11) or a single 3.5-mm cortical screw (n = 11). Radiographic and computed tomography (CT) imaging analyses and biomechanical testing of rotational force on the sacroiliac joint of both fixations were performed. The maximum load at failure and failure modes of each fixation were recorded and compared. RESULTS Fluoroscopically guided percutaneous application of double HCS was safe in a unilateral sacroiliac luxation model in small dogs without violation of the vertebral and ventral sacral foramen. Furthermore, resistance to rotational force applied on fixation of the sacroiliac joint repaired with double 2.3-mm HCS estimated by maximum failure load was significantly higher than that of a single 3.5-mm cortical screw (p < 0.001). CONCLUSION Although this was an experimental cadaveric study, based on our results, the use of smaller double HCS may be beneficial as an alternative to the conventional single lag screw for stabilization of sacroiliac luxation in small dogs.
Collapse
Affiliation(s)
- AhRan Kang
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Haebeom Lee
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Arim Lee
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Yoonho Roh
- Division of Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Bokyun Sim
- Graduate Program of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jaemin Jeong
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| |
Collapse
|
6
|
Hidaka R, Matsuda K, Mochizuki H, Kawano H. Initial stability of cementless acetabular cups using robotic-assisted total hip arthroplasty compared with the conventional manual technique: An in vitro biomechanical study. Int J Med Robot 2023:e2613. [PMID: 38108101 DOI: 10.1002/rcs.2613] [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: 09/06/2023] [Revised: 10/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The aim of this study is to determine whether the initial stability of a cementless cup with the Mako system is superior to that of a conventional manual technique using bone models. METHODS The bone models were prepared using a polyurethane foam block. Two hemispherical cementless cups (highly porous titanium cup [Trident II Tritanium, Stryker] and hydroxyapatite-coated titanium cup [Trident HA, Stryker]) were implanted using the Mako system. The torque of the cups was measured by rotational and lever-out torque testing and compared with that of a conventional manual technique. RESULTS The two types of cups that were implanted using the Mako system demonstrated significantly higher mean rotational torque than that of the manual technique (p < 0.01, p = 0.01, respectively). CONCLUSIONS This study provides the advantage of the initial stability of a cementless hemispherical cup implanted by the Mako system compared with that of the conventional manual technique.
Collapse
Affiliation(s)
- Ryo Hidaka
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenta Matsuda
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hidetaka Mochizuki
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Teo BJX, Yew A, Tan MWP, Chou SM, Lie DTT. The double-lasso loop technique of Biceps tenodesis has lower displacement after cyclic loading, compared to interference screw fixation: Biomechanical analysis in an ovine model. Shoulder Elbow 2023; 15:602-609. [PMID: 37981968 PMCID: PMC10656979 DOI: 10.1177/17585732221095766] [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: 01/02/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2023]
Abstract
Background Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). Methods A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure. Displacement (mm) was recorded every 100 cycles, while stiffness and UFL were observed. Results Cyclic displacement was significantly lower with DLSA at 100 cycles, but not above. During the UFL test, IS was stiffer (27.68 ± 6.56 N/mm versus 14.10 ± 5.80 N/mm, p = .005) and had higher UFL (453.67 ± 148.55 N versus 234.22 ± 44.57 N, p = .001) than DLSA. All DLSA failures occurred with suture/anchor pull-out, while all IS constructs failed at the muscle/tendon. Discussion Comparison of the novel DLSA technique with a traditional IS method found lower initial displacement. While our IS constructs could withstand higher UFL, peak load characteristics of DLSA were similar to previous ovine studies. Hence, the DLSA technique is a viable alternative to IS for biceps tenodesis with its purported non-biomechanical advantages.
Collapse
Affiliation(s)
- Bryon JX Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore, Singapore
| | | |
Collapse
|
8
|
Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Koh KH, Jeon IH. Superior Capsular Reconstruction Combined With Lower Trapezius Tendon Transfer Improves the Biomechanics in Posterosuperior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:3817-3824. [PMID: 37975524 DOI: 10.1177/03635465231207834] [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: 11/19/2023]
Abstract
BACKGROUND Surgical treatments for chronic posterosuperior massive rotator cuff tear (MRCT) are still controversial. Superior capsular reconstruction (SCR), which provides a static stabilizer to decrease superior humeral head translation, and lower trapezius tendon transfer (LTTT) with centralization of the humeral head, which prevents superior humeral head migration, are potential surgical options. To date, SCR combined with LTTT has not been fully investigated. HYPOTHESIS Restoration of static stabilizer and dynamic stabilizer together would effectively improve shoulder kinematics in posterosuperior MRCT. STUDY DESIGN Controlled laboratory study. METHODS A custom-made shoulder mechanics testing system was used to test 8 fresh-frozen cadaveric shoulders. The testing conditions were as follows: (1) intact; (2) posterosuperior MRCT (supraspinatus and infraspinatus removed); (3) SCR using the fascia lata; (4) LTTT; and (5) SCR combined with LTTT. The total rotational range of motion (ROM), superior translation, anteroposterior translation, and peak subacromial contact pressure were evaluated at 0°, 30°, and 60° of shoulder abduction. Repeated-measures analysis of variance and Tukey post hoc tests were performed. RESULTS The total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure increased in posterosuperior MRCTs (all, P < .05). The rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0° and 30° of shoulder abduction decreased in SCR (all, P < .05). However, there was no significant improvement in rotational ROM, superior translation, and peak subacromial contact pressure at 60° of shoulder abduction (P > .05). LTTT resulted in a significant decrease in the superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (P < .05). SCR combined with LTTT restored the total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (all, P < .05). CONCLUSION In the cadaveric model, SCR combined with LTTT showed improved shoulder kinematics and contact pressures in the posterosuperior MRCT model compared with SCR or LTTT alone. CLINICAL RELEVANCE SCR combined with LTTT may be regarded as an alternative surgical procedure for posterosuperior MRCTs.
Collapse
Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Saint Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
Chen YL, Lu WJ, Ma YL, Ma WH, Jiang WY. Biomechanical evaluation of a novel atlas polyaxial transverse connecting screw system, an in vitro human cadaveric study. Medicine (Baltimore) 2023; 102:e36312. [PMID: 38013341 PMCID: PMC10681594 DOI: 10.1097/md.0000000000036312] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To introduce a novel transverse connecting screw system, and to evaluate the biomechanical stability of the novel screw system using human cadaveric specimens. METHODS Six fresh-frozen cadaveric upper cervical spines were used in our study. Every specimen was tested under 5 conditions: intact group; unstable group; C1 to C2 screw rod system group; C1 to C2 + crosslink system group; atlas polyaxial transverse connecting screw (APTCS) system. RESULTS Compared with the intact state, C1 to C2 screw rod system, C1 to C2 + CL system and APTCS showed statistically decrease range of motion in all directions except for the unstable group under posterior extension direction (P < .05). APTCS group has the least range of motion in all directions (P < .001). CONCLUSION The APTCS system was able to restore stability to the atlantoaxial joint. APTCS system has the advantages of easy installation, convenient bone grafting, and strong biomechanical strength.
Collapse
Affiliation(s)
- Yun-Lin Chen
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Wen-Jie Lu
- Zhejiang Chinese Medical University, School of Medicine, Hangzhou, China
| | - Yu-Li Ma
- Tytus Labs, Shanghai Sanyou Medical Co., Ltd, Shanghai, China
| | - Wei-Hu Ma
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Wei-Yu Jiang
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, China
| |
Collapse
|
10
|
Nishimura T, Takahashi T, Takeshita K. Comparison of Electrothermal Ablation and Electrolyte Plasmalization Devices Based on the Mechanical Properties of Anterior Cruciate Ligament Femoral Attachment Following Partial Debridement: A Biomechanical Study Using a Porcine Model. Cureus 2023; 15:e47911. [PMID: 38034242 PMCID: PMC10683839 DOI: 10.7759/cureus.47911] [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: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study aimed to clarify whether differences in ablation devices used in the knee joint during partial debridement of the proximal end of the femoral attachment of the anterior cruciate ligament (ACL) affect the mechanical properties of the femur-ACL-tibia complex. Methods Electrothermal ablation was generated from Vulcan for the left knees, and radiofrequency ablation was generated from Werewolf Flow 50 Wand for the right knees. The probes were set to the default setting of 120 W and 150 W for Vulcan and Werewolf Flow 50 Wand, respectively. To mimic partial debridement in remnant tissue-preserving (RTP) ACL reconstruction, the bipolar ablation mode and serpentine movements were employed while in contact with the femoral fan-like extension fibers of the ACL. To simulate the arthroscopic environment, the model was immersed in a saline solution. The probes were applied for 60 s, and their biomechanical properties were evaluated. Results A significant difference was observed in the upper yield load between the two groups (Vulcan group, 107.1 ± 93.4 N; Werewolf group, 177.9 ± 108.8 N; P = 0.045). However, no significant differences were noted in linear stiffness (Vulcan group, 47.6 ± 30.9 N/mm; Werewolf group, 50.1 ± 30.5 N/mm; P = 0.85), maximum load (Vulcan group, 276.2 ± 171.8 N; Werewolf group, 397.7 ± 150.8 N; P = 0.26), or elongation at failure (Vulcan group, 6.1 ± 0.9 mm; Werewolf group, 11.6 ± 10.4 mm; P = 0.20) between the two groups. Conclusion The mechanical properties of the ACL after partial ACL femoral attachment debridement for RTP-ACL reconstruction were better when an electrolyte plasmalization device was used. When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue. Clinical relevance When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue.
Collapse
Affiliation(s)
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
| | | |
Collapse
|
11
|
Dekker RG, Qin C, Lawton C, Muriuki MG, Havey RM, Alshouli M, Patwardhan AG, Kadakia A. Republication of "A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture". Foot Ankle Orthop 2023; 8:24730114231188112. [PMID: 37506092 PMCID: PMC10369101 DOI: 10.1177/24730114231188112] [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] [Indexed: 07/30/2023] Open
Abstract
Background Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow and limited open repair for Achilles tendon rupture. We hypothesized that there would be no statistical difference in load to failure, work to failure, and initial linear stiffness. Methods A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results The average load to failure (353.8 ± 88.8 N vs 313.3 ± 99.9 N; P = .38) and work to failure (6.4 ± 2.3 J vs 6.3 ± 3.5 J; P = .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than PARS repair (11.8 ± 2.5 N/mm) (P = .011). Conclusion No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications.
Collapse
Affiliation(s)
- Robert G Dekker
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Charles Qin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cort Lawton
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Muturi G Muriuki
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Robert M Havey
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA
| | - Mohammed Alshouli
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA
| | - Anish Kadakia
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| |
Collapse
|
12
|
Zhong Y, Wang Y, Zhou H, Wang Y, Gan Z, Qu Y, Hua R, Chen Z, Chu G, Liu Y, Jiang W. Biomechanical study of two-level oblique lumbar interbody fusion with different types of lateral instrumentation: a finite element analysis. Front Med (Lausanne) 2023; 10:1183683. [PMID: 37457575 PMCID: PMC10345158 DOI: 10.3389/fmed.2023.1183683] [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: 03/10/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The aim of this study was to verify the biomechanical properties of a newly designed angulated lateral plate (mini-LP) suited for two-level oblique lumbar interbody fusion (OLIF). The mini-LP is placed through the lateral ante-psoas surgical corridor, which reduces the operative time and complications associated with prolonged anesthesia and placement in the prone position. Methods A three-dimensional nonlinear finite element (FE) model of an intact L1-L5 lumbar spine was constructed and validated. The intact model was modified to generate a two-level OLIF surgery model augmented with three types of lateral fixation (stand-alone, SA; lateral rod screw, LRS; miniature lateral plate, mini-LP); the operative segments were L2-L3 and L3-L4. By applying a 500 N follower load and 7.5 Nm directional moment (flexion-extension, lateral bending, and axial rotation), all models were used to simulate human spine movement. Then, we extracted the range of motion (ROM), peak contact force of the bony endplate (PCFBE), peak equivalent stress of the cage (PESC), peak equivalent stress of fixation (PESF), and stress contour plots. Results When compared with the intact model, the SA model achieved the least reduction in ROM to surgical segments in all motions. The ROM of the mini-LP model was slightly smaller than that of the LRS model. There were no significant differences in surgical segments (L1-L2, L4-L5) between all surgical models and the intact model. The PCFBE and PESC of the LRS and the mini-LP fixation models were lower than those of the SA model. However, the differences in PCFBE or PESC between the LRS- and mini-LP-based models were not significant. The fixation stress of the LRS- and mini-LP-based models was significantly lower than the yield strength under all loading conditions. In addition, the variances in the PESF in the LRS- and mini-LP-based models were not obvious. Conclusion Our biomechanical FE analysis indicated that LRS or mini-LP fixation can both provide adequate biomechanical stability for two-level OLIF through a single incision. The newly designed mini-LP model seemed to be superior in installation convenience, and equally good outcomes were achieved with both LRS and mini-LP for two-level OLIF.
Collapse
Affiliation(s)
- Yuan Zhong
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yujie Wang
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Hong Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yudong Wang
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Ziying Gan
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Yimeng Qu
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Runjia Hua
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Zhaowei Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
13
|
Wei G, Niu X, Li Y, Chang T, Zhang J, Wang H, Li X, He Y, Wang R, Tian F, Xu Y. Biomechanical analysis of internal fixation system stability for tibial plateau fractures. Front Bioeng Biotechnol 2023; 11:1199944. [PMID: 37388773 PMCID: PMC10303893 DOI: 10.3389/fbioe.2023.1199944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023] Open
Abstract
Background: Complex bone plateau fractures have been treated with bilateral plate fixation, but previous research has overemphasized evaluating the effects of internal fixation design, plate position, and screw orientation on fracture fixation stability, neglecting the internal fixation system's biomechanical properties in postoperative rehabilitation exercises. This study aimed to investigate the mechanical properties of tibial plateau fractures after internal fixation, explore the biomechanical mechanism of the interaction between internal fixation and bone, and make suggestions for early postoperative rehabilitation and postoperative weight-bearing rehabilitation. Methods: By establishing the postoperative tibia model, the standing, walking and running conditions were simulated under three axial loads of 500 N, 1000 N, and 1500 N. Accordingly, finite element analysis (FEA) was performed to analyze the model stiffness, displacement of fractured bone fragments, titanium alloy plate, screw stress distribution, and fatigue properties of the tibia and the internal fixation system under various conditions. Results: The stiffness of the model increased significantly after internal fixation. The anteromedial plate was the most stressed, followed by the posteromedial plate. The screws at the distal end of the lateral plate, the screws at the anteromedial plate platform and the screws at the distal end of the posteromedial plate are under greater stress, but at a safe stress level. The relative displacement of the two medial condylar fracture fragments varied from 0.002-0.072 mm. Fatigue damage does not occur in the internal fixation system. Fatigue injuries develop in the tibia when subjected to cyclic loading, especially when running. Conclusion: The results of this study indicate that the internal fixation system tolerates some of the body's typical actions and may sustain all or part of the weight early in the postoperative period. In other words, early rehabilitative exercise is recommended, but avoid strenuous exercise such as running.
Collapse
Affiliation(s)
- Guoqiang Wei
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Xiaofen Niu
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Yuan Li
- Department of Orthopedics, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Tingjie Chang
- Department of Orthopedics, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Jianfang Zhang
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Haiyan Wang
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Xiaohe Li
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Yujie He
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Ruijiang Wang
- Department of Orthopedics, Changzhi Second People’s Hospital, Changzhi, China
| | - Fei Tian
- Department of Health Management, Changzhi Medical College, Changzhi, China
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Yangyang Xu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
14
|
Wu LC, Hsieh YY, Tsuang FY, Kuo YJ, Chen CH, Chiang CJ. Pullout Strength of Pedicle Screws Inserted Using Three Different Techniques: A Biomechanical Study on Polyurethane Foam Block. Bioengineering (Basel) 2023; 10:660. [PMID: 37370591 DOI: 10.3390/bioengineering10060660] [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: 03/04/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Pullout strength is an important indicator of the performance and longevity of pedicle screws and can be heavily influenced by the screw design, the insertion technique and the quality of surrounding bone. The purpose of this study was to investigate the pullout strength of three different pedicle screws inserted using three different strategies and with two different loading conditions. Three pedicle screws with different thread designs (single-lead-thread (SLT) screw, dual-lead-thread (DLT) screw and mixed-single-lead-thread (MSLT) screw) were inserted into a pre-drilled rigid polyurethane foam block using three strategies: (A) screw inserted to a depth of 33.5 mm; (B) screw inserted to a depth of 33.5 mm and then reversed by 3.5 mm to simulate an adjustment of the tulip height of the pedicle screw and (C) screw inserted to a depth of 30 mm. After insertion, each screw type was set up with and without a cyclic load being applied to the screw head prior to the pullout test. To ensure that the normality assumption is met, we applied the Shapiro-Wilk test to all datasets before conducting the non-parametric statistical test (Kruskal-Wallis test combined with pairwise Mann-Whitney-U tests). All screw types inserted using strategy A had a significantly greater pullout strength than those inserted using strategies B and C, regardless of if the screw was pre-loaded with a cyclic load prior to testing. Without the use of the cyclic pre-load, the MSLT screw had a greater pullout strength than the SLT and DLT screws for all three insertion strategies. However, the fixation strength of all screws was reduced when pre-loaded before testing, with the MSLT screw inserted using strategy B producing a significantly lower pullout strength than all other groups (p < 0.05). In contrast, the MSLT screw using insertion strategies A and C had a greater pullout strength than the SLT and DLT screws both with and without pre-loading. In conclusion, the MSLT pedicle screw exhibited the greatest pullout strength of the screws tested under all insertion strategies and loading conditions, except for insertion strategy B with a cyclic pre-load. While all screw types showed a reduced pullout strength when using insertion strategy B (screw-out depth adjustment), the MSLT screw had the largest reduction in pullout strength when using a pre-load before testing. Based on these findings, during the initial screw insertion, it is recommended to not fully insert the screw thread into the bone and to leave a retention length for depth adjustment to avoid the need for screw-out adjustment, as with insertion strategy B.
Collapse
Affiliation(s)
- Lien-Chen Wu
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City 11031, Taiwan
| | - Yueh-Ying Hsieh
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| | - Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei City 11696, Taiwan
| | - Chia-Hsien Chen
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City 11031, Taiwan
| | - Chang-Jung Chiang
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| |
Collapse
|
15
|
Jiang Y, Cui X, Ji W, Li J, Shi Y, Zhao J, Wang J, Tang P, Zhang W. Novel uniplanar pedicle screw systems applied to thoracolumbar fractures: a biomechanical study. Front Bioeng Biotechnol 2023; 11:1172934. [PMID: 37324437 PMCID: PMC10267819 DOI: 10.3389/fbioe.2023.1172934] [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: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: In this study, the advantages of the internal fixation configuration composed of uniplanar pedicle screws in the treatment of thoracolumbar fractures were verified by biomechanical experimental methods, which provided the basis for subsequent clinical experiments and clinical applications. Methods: A total of 24 fresh cadaveric spine specimens (T12-L2) were utilized to conduct biomechanical experiments. Two different internal fixation configurations, namely, the 6-screw configuration and the 4-screw/2-NIS (new intermediate screws) configuration, were tested using fixed-axis pedicle screws (FAPS), uniplanar pedicle screws (UPPS), and polyaxial pedicle screws (PAPS) respectively. The spine specimens were uniformly loaded with 8NM pure force couples in the directions of anteflexion, extension, left bending, right bending, left rotation, and right rotation, and the range of motion (ROM) of the T12-L1 and L1-L2 segments of the spine was measured and recorded to access biomechanical stability. Results: No structural damage such as ligament rupture or fracture occurred during all experimental tests. In the 6-screw configuration, the ROM of the specimens in the UPPS group was significantly better than that of the PAPS group but weaker than those of the FAPS group (p < 0.01). In the 4-screw/2-NIS configuration, the results were identical to the biomechanical test results for the 6-screw configuration (p < 0.01). Conclusion: Biomechanical test results show that the internal fixation configuration with UPPS can maintain the stability of the spine well, and the results are better than that of PAPS. UPPS has both the biomechanical advantages of FAPS and the superiority of easy operation of PAPS. We believe it is an optional internal fixation device for minimally invasive treatment of thoracolumbar fractures.
Collapse
Affiliation(s)
- Yuheng Jiang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Xiang Cui
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Ji
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Yanli Shi
- Anesthesia and Operation Center, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingxin Zhao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Junsong Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| |
Collapse
|
16
|
Putnam MD, Rau A, Frohbergh M, Ong K, Bushelow M, Blauth M. Comparing the volume of vascular intersection of two femoral neck fracture fixation implants using an In silico technique. OTA Int 2023; 6:e256. [PMID: 37168033 PMCID: PMC10166339 DOI: 10.1097/oi9.0000000000000256] [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: 10/19/2022] [Accepted: 12/28/2022] [Indexed: 05/13/2023]
Abstract
Femoral neck fracture displacement with subsequent vascular disruption is one of the factors that contribute to trauma-induced avascular necrosis of the femoral head. Iatrogenic damage of the intraosseous arterial system during fixation of femoral neck fracture is another possible cause of avascular necrosis that is less well understood. Recently, Zhao et al (2017) reconstructed 3D structures of intraosseous blood supply and identified the epiphyseal and inferior retinacular arterial system to be important structures for maintaining the femoral head blood supply after femoral neck fracture. The authors therefore recommended placing implants centrally to reduce iatrogenic vascular injuries. Our in vitro study compared the spatial footprint of a traditional dynamic hip screw with an antirotation screw versus a newly developed hip screw with an integrated antirotation screw on intraosseous vasculature. Methods Three dimensional (3D) µCT angiograms of 9 cadaveric proximal femora were produced. Three segmented volumes-porous or cancellous bone, filled or cortical bone, and intraosseous vasculature-were converted to surface files. 3D in silico models of the fixation systems were sized and implanted in silico without visibility of the vascular maps. The volume of vasculature that overlapped with the devices was determined. The ratio of the vascular intersection to the comparator device was calculated, and the mean ratio was determined. A paired design, noninferiority test was used to compare the devices. Results Results indicate both significant (P < 0.001) superiority and noninferiority of the hip screw with an integrated antirotation screw when compared with a dynamic hip screw and antirotation screw for the volume of vasculature that overlapped with each device in the femoral neck. Conclusions Combining established methods of vascular visualization with newer methods enables an implant's impact on vascular intersection to be assessed in silico. This methodology suggests that when used for femoral neck fracture management, the new device intersects fewer blood vessels than the comparator. Comparative clinical studies are needed to investigate whether these findings correlate with the incidence of avascular necrosis and clinical outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Michael Bushelow
- DePuy Synthes, West Chester, PA; and
- Corresponding author. Address: Michael Bushelow, MS, 1301 Goshen Parkway, West Chester, PA 19380. E-mail:
| | | |
Collapse
|
17
|
Lee MY, Ahn TH, Son SI, Kim HY. Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model. J Feline Med Surg 2023; 25:1098612X231172630. [PMID: 37212657 DOI: 10.1177/1098612x231172630] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to compare the biomechanical properties of three stabilisation techniques in feline patella transverse fractures and select the strongest method with potentially minimal complications. METHODS Patella fracture was simulated in 27 feline cadaveric pelvic limbs (mean weight of the cadavers 3.78 kg), and the limbs were randomly grouped to be stabilised with one of the three stabilisation methods. The modified tension band wiring technique with a single Kirschner wire (0.9 mm) and figure-of-eight wiring (20 G) was applied to group 1 (n = 9). Group 2 (n = 9) was stabilised with a combination of circumferential and figure-of-eight wiring techniques with orthopaedic wire (20 G). Group 3 (n = 9) was stabilised with the same technique as group 2, but with #2 FiberWire. The knee joints were positioned and fixed in the neutral standing angle (135°) and tested by applying tensile force. The loads at gap formations of 1, 2 and 3 mm were recorded, and the maximum failure load was measured in each group. RESULTS In all the loads at displacement (1, 2 and 3 mm), group 3 was significantly stronger than groups 1 and 2, respectively (P <0.017). Group 3 (261.0 ± 52.8 N) showed significantly stronger fixation in the maximum load compared with group 1 (172.9 ± 45.6 N) (P <0.017). No significant difference was observed between groups 1 and 2 (204.9 ± 68.4 N) or between groups 2 and 3. CONCLUSIONS AND RELEVANCE This study shows that the combination of circumferential and figure-of-eight techniques with FiberWire is more resistant to displacement than metal wire in this ex vivo feline patella fracture model.
Collapse
Affiliation(s)
- Min-Yeong Lee
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Science, College of Veterinary Medicine, Konkuk University, Gwangjin-gu, Seoul, Republic of Korea
| | - Tae-Hwan Ahn
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Science, College of Veterinary Medicine, Konkuk University, Gwangjin-gu, Seoul, Republic of Korea
| | - Sung-Il Son
- Song-Jeong Animal Medical Center, Gwangju-si, Gyeonggi-do, Republic of Korea
| | - Hwi-Yool Kim
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Science, College of Veterinary Medicine, Konkuk University, Gwangjin-gu, Seoul, Republic of Korea
| |
Collapse
|
18
|
Staggers JR, Chong ACM, Piatt BE. Use of electrocautery devices for suture passage through the greater tuberosity: a biomechanical study. J Shoulder Elbow Surg 2023; 32:512-8. [PMID: 36283564 DOI: 10.1016/j.jse.2022.09.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The use of electrocautery to facilitate passage of a suture needle through bone without the aid of a drill or burr is a novel technique that has potential utility in orthopedic procedures, but there is a scarcity of research to support its utility. The specific aims of this cadaveric biomechanical study were to evaluate (1) the axial force reduction during suture passage using electrocautery when applied to rotator cuff repair, (2) the temperature change caused while using electrocautery, and (3) the failure loads and failure modes of this technique. METHODS Five matched pairs of fresh frozen humeri were used, classified into 2 groups: with electrocautery on needle (study group) and without electrocautery on needle (control group). Four individual osseous tunnels were made on the greater tuberosity around the insertion of the supraspinatus tendon. Each specimen was sequentially tested in 2 parts: a needle penetration test (part I) to measure the peak axial force and temperature change and a single load-to-failure test (part II) to measure the maximum load to failure as well as the mechanism of failure. A No. 2 FiberWire suture with a straight needle was used. RESULTS In part I, the mean peak axial force was lower in the study group compared with the control group for all osseous tunnels but was not statistically significant for individual tunnels. However, there was a significant decrease in peak axial force in the study group of 36% compared with the control group overall (P = .033). There was no significant change in temperature of the tunnel site with the use of electrocautery (mean: 0.2 ± 0.3°C, P = .435). In part II, 100% of the samples from each study group experienced bone tunnel failure. Forty percent of the trials in the study group found lower ultimate failure loads compared with the control group (reduction range: 7%-38%). There was no statistically significant difference in the ultimate failure load between either the loop tested or between the 2 study groups (loop 1: P = .352; loop 2: P = .270). CONCLUSION Suture passage using electrocautery does significantly decrease the peak force needed to pass a needle directly through the greater tuberosity. This technique does not appear to burn the bone or weaken the bone tunnels. This technique may be useful during open rotator cuff repair or shoulder arthroplasty, although clinicians should be cautious when using this technique as its utility depends on bone quality and cortical thickness, and in vivo results may differ.
Collapse
|
19
|
Wang H, Teng Y, Peng B, Jia G, Han H, Xia Y. Surgically adjust tibial tunnel in anatomical anterior cruciate ligament single-bundle reconstruction: A time-zero biomechanical study in vitro. J Orthop Surg (Hong Kong) 2023; 31:10225536221151131. [PMID: 36688346 DOI: 10.1177/10225536221151131] [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: 01/24/2023] Open
Abstract
BACKGROUND The anatomical positioning of the graft during anterior cruciate ligament reconstruction (ACLR) is of great significance for restoring normal knee kinematics and preventing early joint degeneration. Therefore, the adjustment of the mispositioned guide pin becomes extremely important. Our research aims to test the time-zero biomechanical properties in adjusting inaccurate guide pins to the center of the tibial footprint in anatomical anterior cruciate ligament single-bundle reconstruction. METHODS Porcine tibias and bovine extensor tendons were used to simulate a transtibial ACL reconstruction in vitro. Load-to failure testing was carried out in 4 groups: control group (n = 45): the guide pin was drilled at the center of the ACL footprint; group I, group II and group III (n = 45, respectively): the guide pin was respectively drilled 1 mm, 2 mm and 3 mm away from the center of the ACL footprint. In the experimental groups, a small tunnel with a 4.5 mm reamer is made and the guide pin is shifted to the center of the footprint. All the reamed tibias were scanned by CT to measure the area of the tunnel in the footprint, and time-zero biomechanical properties were recorded. RESULTS All graft-tibia complexes failed because the grafts slipped past the interference screws. Compare to control group, the ultimate load, yield load, and tunnel exit area in group III decreased significantly (p < 0.05). Regarding to the ultimate load, yield load, tensile stiffness, twisting force and tunnel exit area, t-test showed no significant differences between control group and group I, group II respectively (p > 0.05). Pearson test showed that tunnel exit area was negatively correlated with other characteristics (p < 0.05). CONCLUSIONS Surgical adjustment of the guide pin to the center of the tibial footprint may have significant influence in time-zero biomechanical properties in anatomical anterior cruciate ligament single-bundle reconstruction when the adjusted tibial tunnel was significantly enlarged compare to the standard tibial tunnel.
Collapse
Affiliation(s)
- Hong Wang
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Yuanjun Teng
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Bo Peng
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Gengxin Jia
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Hua Han
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Yayi Xia
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| |
Collapse
|
20
|
Abstract
BACKGROUND Intramedullary nail (IMN) fixation of metacarpal fractures is an alternative to Kirschner wire (K-wire) fixation. The goal of this study was to compare the biomechanical properties of K-wire fixation with a threaded IMN (InNate; ExsoMed, Aliso Viejo, California). METHODS The study design was based on previously described biomechanical models for evaluating metacarpal fractures. Sixteen fresh frozen small finger-matched and ring finger-matched pairs were randomized to either IMN or 0.045 in K-wire fixation after receiving a standardized neck osteotomy. Proper implant placement was confirmed with plain radiographs. Specimens then underwent loading in a 3-point bend configuration. Load to failure (LTF), stiffness, and fracture displacement were recorded. Mechanical failure was defined by a sharp change in the load-displacement curve. RESULTS Age, sex, sidedness (left or right), and digit (ring or small finger) were evenly distributed between groups. The IMN had a significantly higher LTF than K-wires (546 N vs 154 N, P < .001). The K-wire fixation demonstrated plastic deformation between 75 and 150 N. Intramedullary nail stiffness was higher than that of K-wires (155.89 N/mm vs 59.28 N/mm, P < .001). CONCLUSIONS When surgical fixation is indicated for metacarpal neck and shaft fractures, the threaded IMN is biomechanically superior to crossed K-wires with the application of 3-point bend.
Collapse
Affiliation(s)
- Midhat Patel
- The University of Arizona College of
Medicine – Phoenix, USA
| | - Paulo Castañeda
- The University of Arizona College of
Medicine – Phoenix, USA
| | | | - Jill G. Putnam
- The University of Arizona College of
Medicine – Phoenix, USA
| | | |
Collapse
|
21
|
Gao W, Zhao K, Guo Y, Xie M, Feng X, Liu P, Xie X, Fu D. Biomechanical comparison of intramedullary nail and plate osteosynthesis for extra-articular proximal tibial fractures with segmental bone defect. Front Bioeng Biotechnol 2023; 11:1099241. [PMID: 36937755 PMCID: PMC10020223 DOI: 10.3389/fbioe.2023.1099241] [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: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose: Proximal tibial fractures are common, but the current available internal fixation strategies remain debatable, especially for comminuted fractures. This study aimed to compare the biomechanical stability of three internal fixation strategies for extra-articular comminuted proximal tibial fractures. Methods: A total of 90 synthetic tibiae models of simulated proximal tibial fractures with segmental bone defects were randomly divided into three groups: Single lateral plating (LP), double plating (DP) and intramedullary nailing (IN). Based on the different number of fixed screws, the above three groups were further divided into nine subgroups and subjected to axial compression, cyclic loading and static torsional testing. Results: The subgroup of intramedullary nailing with five proximal interlocking screws showed the highest axial stiffness of 384.36 ± 35.00 N/mm. The LP group obtained the lowest axial stiffness performance with a value of 96.59 ± 16.14 N/mm. As expected, the DP group offered significantly greater biomechanical stability than the LP group, with mean static axial stiffness and mean torque increasing by approximately 200% and 50%, respectively. According to static torsional experiments, the maximum torque of the DP subgroup was 3,308.32 ± 286.21 N mm, which outperformed all other groups in terms of torsional characteristics. Conclusion: Utilizing more than four distal screws did not provide improved biomechanical stability in the LP or DP groups, while a substantial increase in the biomechanical stability of DP was obtained when an additional medial plate was used. For the intramedullary nailing group, increasing the number of proximal interlocking screws could significantly improve biomechanical stability, and the intramedullary nailing with three proximal interlocking screws had similar static and cyclic stiffness as the DP group. The intramedullary nailing with five proximal screws had better axial stability, whereas DP had better torsional stability.
Collapse
Affiliation(s)
- Weihang Gao
- Department of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Zhao
- Department of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Guo
- Department of Pharmacy, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mao Xie
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liu
- Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Xie
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xin Xie, ; Dehao Fu,
| | - Dehao Fu
- Department of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xin Xie, ; Dehao Fu,
| |
Collapse
|
22
|
Ko PY, Hsu CH, Hong CK, Hung MT, Su WR, Jou IM, Wu PT, Su FC. Jigless Knotless Internal Brace Versus Other Minimal Invasive Achilles Tendon Repair Techniques in Biomechanical Testing Simulating the Progressive Rehabilitation Protocol. J Foot Ankle Surg 2022; 62:61-67. [PMID: 35477848 DOI: 10.1053/j.jfas.2022.03.014] [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: 12/09/2021] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 02/03/2023]
Abstract
The jigless knotless internal brace surgery (JKIB), an alternative method for minimal invasive surgery (MIS) repair of acute Achilles tendon rupture, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as previous clinical research demonstrates. However, no comparative study on the biomechanical performance between JKIB and other MIS techniques has been reported until now. In this study, 50 fresh porcine Achilles tendons were used to compare the JKIB with open surgery (two-stranded Krachow suture) with other MIS techniques, including Percutaneus Achilles Repair System (PARS), Speedbridge (SB), and Achillon Achilles Tendon Suture System (ACH), using a biomechanical testing with cyclic loading at 1 Hz. This test was used to simulate a progressive rehabilitation protocol where 20 to 100 N was applied in the first 250 cycles, followed by 20 to 190 N in the second 250 cycles, and then 20 to 369 N in the third 250 cycles. The cyclic displacement after 10, 100 and 250 cycles were recorded. The survived cycles were defined as a sudden drop in measured load. In survived cycles, the JKIB group (552.3 ± 72.8) had significantly higher cycles than the open, PARS, and ACH groups (204.3 ± 33.3, 395.9 ± 96.0, and 397.1 ± 80.9, respectively, p < .01) as analyzed by post hoc analysis, but no significant difference as compared with the SB group (641.6 ± 48.7). In cyclic displacement after 250 cyclic loadings, the JKIB group (11.29 ± 1.29) showed no significant difference as compared with PARS, SB, and ACH groups (12.21 ± 1.18, 9.80 ± 0.80, and 11.57 ± 1.10 mm, respectively) and significant less displacement than the open group (14.50 ± 1.85, p < .01). These findings suggest that JKIB could be an option for acute Achilles tendon repair in the MIS fashion due to no larger cyclic elongation compared with other MIS techniques.
Collapse
Affiliation(s)
- Po-Yen Ko
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chieh-Hsiang Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Wei-Ren Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Departments of Orthopedic Surgery and Pathology, E-Da Hospital, I-Shou University, Yen-Chao District, Kaohsiung, Taiwan; GEG Orthopedic Clinic, Tainan, Taiwan
| | - Po-Ting Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
23
|
Beals CJ, Wong GAS, Dupont KM, Safranski DL. Effect of Simulated Bone Resorption on the Biomechanical Performance of Intramedullary Devices for Foot and Ankle Arthrodesis. J Foot Ankle Surg 2022; 62:7-13. [PMID: 35370055 DOI: 10.1053/j.jfas.2022.03.001] [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: 10/12/2021] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
Midfoot and subtalar arthrodesis surgeries are performed to correct foot deformities and relieve arthritic pain. These procedures often employ intramedullary (IM) devices. The aim of the present study was to evaluate the biomechanical performance of a sustained dynamic compression (SDC) IM device compared to mechanically static devices in withstanding the effects of simulated bone resorption. Mechanically static and SDC IM devices were implanted in simulated bone blocks (n = 5/device). Compressive loads were measured with a custom-made mechanism to simulate bone resorption. The construct bending stiffness was determined from a 4-point bend test. Resorption was simulated by cutting a 1 mm or 2 mm gap in the midpoint of each construct and repeating the loading (n = 6/device). Initial compressive loads after device insertion were greater in the SDC IM devices when compared to the static devices (p < .01). The SDC device was able to sustain compression from 2 mm to 5.5 mm of simulated resorption depending upon device length, while the static devices lost compression within 1 mm of simulated resorption regardless of implant length (p < .001). In the 4-point bend test, the SDC device maintained its bending stiffness during simulated resorption whereas the static device displayed a significant loss in bending stiffness after 1 mm of simulated resorption (p < .001). The SDC device exhibited a significantly higher bending stiffness than the static device (p < .001). The SDC IM device demonstrated superior biomechanical performance during simulated resorption compared to static devices (p < .001). In conclusion, the ability of SDC IM devices to maintain construct stability and sustain compression across the fusion site while adapting to bone resorption may lead to greater fusion rates and overall quicker times to fusion than static IM devices. Surgeons who perform midfoot and subtalar arthrodesis procedures should be aware of a device's ability to sustain compression, especially in cases where bone resorption and joint settling are prevalent postoperatively.
Collapse
Affiliation(s)
- Caitlyn J Beals
- Engineering Student, Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Gabriella A S Wong
- Engineering Student, Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - David L Safranski
- Research Leader, Clinical Affairs, Foot & Ankle, Atlanta, GA; School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA.
| |
Collapse
|
24
|
Mereb T, Favreau H, Ollivier M, Jmal H, Bonnomet F, Bahlouli N, Martz P, Ehlinger M. Experimental study of risk of medial hinge fracture during distal femoral varus osteotomy. Orthop Traumatol Surg Res 2022; 109:103527. [PMID: 36563962 DOI: 10.1016/j.otsr.2022.103527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/26/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lateral opening wedge distal femoral osteotomy (LOWDFO) is indicated for isolated lateral osteoarthritis in the valgus morphotype. Medial hinge fracture is a factor for poor prognosis. The present study had two aims: 1) to assess the impact of a temporary K-wire on hinge fracture risk; and 2) to assess the impact of LOWDFO opening speed. HYPOTHESIS The main study hypothesis was that a temporary hinge K-wire reduces hinge fracture risk. The second hypothesis was that faster opening speed increases fracture risk. MATERIAL AND METHOD Twenty femurs were produced by 3D printing from a CT database, reproducing LOWDFO anatomy. The ABS® polymer showed the same breaking-point behavior as human bone. Ten specimens were included in the "K-wire" group (KW+) and 10 in the "No K-wire" group (KW-). To determine high and low speed, a motion-capture glove was used by 2 operators, providing 3D modeling of the surgeon's hand. High speed was defined as 152mm/min and low speed as 38mm/min. The KW+ and KW- groups were subdivided into high- and low-speed subgroups (HS, LS) of 5 each. Compression tests were conducted using an Instron® mechanical test machine up to hinge fracture. The main endpoint was maximum breaking-point force (N); the secondary endpoints were maximum displacement (mm) and maximum speed (min) at breaking point. RESULTS The K-wire significantly increased maximum breaking-point force (LS, 143.08N vs. 93.71N, p<0.01; and HS, 186.98N vs. 95.22N, p<0.01), but not maximum displacement (LS, 26.17mm vs 24.11mm, p= 0.31; and HS 26.18mm vs. 23.66mm, p=0.14) or maximum time (LS, 27.07sec vs. 24.94sec, p=0.31; and HS, 5.24sec vs. 4.73sec, p=0.14). Speed did not affect maximum force (KW+, 143.08N vs. 186.98N, p= 0.06; and KW-, 93.71N vs. 95.22N, p=0.42) or maximum displacement (KW+, 26.17mm vs. 26.18mm, p=1; and KW-, 24.11mm vs. 23.66mm, p=0.69). Only maximum time was greater at low speed (KW+, 27.07sec vs. 5.24sec, p>0.01; and KW-, 24.94sec vs. 4.73sec, p<0.01), which is obvious for constant distance. DISCUSSION The first study hypothesis was confirmed, with significantly lower hinge fracture risk with the K-wire, independently of opening speed. The second hypothesis was not confirmed. The study was performed under strict experimental conditions, unprecedented to our knowledge in the literature. However, complementary clinical studies are needed to confirm the present findings. LEVEL OF EVIDENCE IV, experimental study.
Collapse
Affiliation(s)
- Thomas Mereb
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 2-4 Rue Boussingault, 67000 France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ollivier
- Département de Chirurgie Orthopédique et Traumatologie, Aix Marseille Université, APHM, CNRS, ISM, Hôpital Sainte-Marguerite, Institut de la Locomotion, Marseille, France
| | - Hamdi Jmal
- Laboratoire ICube, CNRS UMR 7357, 2-4 Rue Boussingault, 67000 France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France
| | - Nadia Bahlouli
- Laboratoire ICube, CNRS UMR 7357, 2-4 Rue Boussingault, 67000 France
| | - Pierre Martz
- CHU Dijon, Service d'Orthopédie Traumatologie, 14 Rue Paul Gaffarel, 21000 Dijon, France; Unité INSERM UMR CAPS U1093. UFR STAPS, - BP 27877, Campus Universitaire, 21078 Dijon Cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 2-4 Rue Boussingault, 67000 France.
| |
Collapse
|
25
|
Matsumura T, Takahashi T, Ae R, Takeshita K. Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails. Geriatr Orthop Surg Rehabil 2022; 13:21514593221111350. [PMID: 36081841 PMCID: PMC9445453 DOI: 10.1177/21514593221111350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/26/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction For trochanteric hip fractures, proximal femoral nails (PFNs) have been frequently used for surgical treatment. No study has clarified whether length of the nail affected the wiper motion; the repetitive motion of the distal nail inside canal after surgery. Methods Thirty synthetic femora were used to biomechanically evaluate construct lateral angular movement of 3 different lengths of PFN [TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 170 (short-length), 235 (mid-length), and 300 (long-length) mm] constructs for the fixation of stable pertrochanteric fractures. Cyclic testing and radiological evaluation were performed to investigate the loosening patterns in 3 different fixation constructs. Migration along the mechanical axis during the cyclic testing from 1-100th, 100-500th, 500-1000th, 1000-1500th, and 1500-2000th cycles was compared between TFNA lengths. Also, before and after cycling changes in tip to apex distance, angulation of fracture line, and lateral angular movement of the distal stem inside the canal were compared between TFNA lengths. Results Migration along the mechanical axis during cyclic loading, plus changes after cycling in tip to apex distance, and fracture line angulation did not differ between TFNA lengths for the fixation of stable intertrochanteric fracture model using synthetic femora. Conversely, one-way analysis of variance revealed a significant difference in lateral angular movement of the distal stem inside the canal after cyclic testing between groups (1.4 ± 1.6°, .21 ± .35°, and .26 ± .57° in 170-mm short nail, 235-mm middle nail, and 300-mm long nail, respectively; P = .026), and post-hoc analysis also revealed that middle nail yielded significantly less lateral angular movement compared with short nail (P = .047) but did not significantly differ from the long nail. Conclusions Mid-length TFNA for the fixation of stable trochanteric hip fracture model using synthetic femora resulted in significantly smaller lateral angular movement of the distal stem after cyclic loading.
Collapse
Affiliation(s)
- Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| |
Collapse
|
26
|
Zólyomi D, Ipolyi T, Molnár P, Németh T, Faragó D, Kiss R, Szalay F. Biomechanical testing of canine tibiae: Changes resulting from different tibial tuberosity advancement techniques - Pilot study. Acta Vet Hung 2022; 70:230-235. [PMID: 36037048 DOI: 10.1556/004.2022.00023] [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: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 11/19/2022]
Abstract
The objective of the present pilot study was to determine the force required to break (a) intact canine tibiae, (b) tibiae following the osteotomy of the tibial tuberosity and (c) tibiae following Tibial Tuberosity Advancement- (TTA-) rapid surgery. Six pairs of tibiae of dogs between 15 and 35 kg body weight were used in a cadaver study. Three groups were created with four tibiae in each group; intact (Group 1), osteotomy of the tibial tuberosity and tibial crest (Group 2) and TTA-rapid (Group 3). The tibiae were put under static axial compressive load, applied until failure. The force required to break the tibiae was termed maximal force (F max). The mean of F max was 8193.25 ± 2082.84 N in Group 1, 6868.58 ± 1950.44 N in Group 2 and 7169.71 ± 4450.39 N in Group 3. The sample size was small for a statistical analysis but as a preliminary result, we have determined the force (F max) required to break canine tibiae. Furthermore, we hypothesise that osteotomies result in weakening of the tibial structure.
Collapse
Affiliation(s)
- Dorottya Zólyomi
- 1 Department of Small Animal Surgery and Ophthalmology, University of Veterinary Medicine Budapest, István u. 2, H-1078, Budapest, Hungary
| | - Tamás Ipolyi
- 1 Department of Small Animal Surgery and Ophthalmology, University of Veterinary Medicine Budapest, István u. 2, H-1078, Budapest, Hungary
| | - Péter Molnár
- 1 Department of Small Animal Surgery and Ophthalmology, University of Veterinary Medicine Budapest, István u. 2, H-1078, Budapest, Hungary
| | - Tibor Németh
- 1 Department of Small Animal Surgery and Ophthalmology, University of Veterinary Medicine Budapest, István u. 2, H-1078, Budapest, Hungary
| | - Dénes Faragó
- 2 Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| | - Rita Kiss
- 2 Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ferenc Szalay
- 3 Department of Anatomy and Histology, University of Veterinary Medicine Budapest, Hungary
| |
Collapse
|
27
|
Böhle S, Bischoff L, Ehrenmann K, Layher F, Sander K, Matziolis G, Pietsch S. Forgivingness of an Anteromedially Positioned Small Locked Plate for High Tibial Osteotomy in Case of Overcorrection and Lateral Hinge Fracture. Life (Basel) 2022; 12:1265. [PMID: 36013443 DOI: 10.3390/life12081265] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
High tibial osteotomy (HTO) represents a sensible treatment option for patients with moderate unicondylar osteoarthritis of the knee and extraarticular malalignment. The possibility of a continuously variable correction setting and a surgical approach low in complications has meant that the medial opening osteotomy has prevailed over the past decades. The objective of the present study was to determine whether anteromedially positioned small plates are nevertheless forgiving under biomechanically unfavourable conditions (overcorrection and lateral hinge fracture). In this study, a simulated HTO was performed on composite tibiae with a 10-mm wedge and fixed-angle anteromedial osteosynthesis with a small implant. Force was applied axially in a neutral mechanical axis, a slight and a marked overcorrection into valgus, with and without a lateral hinge fracture in each case. At the same time, a physiological gait with a dual-peak force profile and a peak load of 2.4 kN was simulated. Interfragmentary motion and rigidity were determined. The rigidity of the osteosynthesis increased over the cycles investigated. A slight overcorrection into valgus led to the lowest interfragmentary motion, compared with pronounced valgisation and neutral alignment. A lateral hinge fracture led to a significant decrease in rigidity and increase in interfragmentary motion. However, in no case was the limit of 1 mm interfragmentary motion critical for osteotomy healing exceeded. The degree of correction of the leg axis, and the presence of a lateral hinge fracture, have an influence on rigidity and interfragmentary motion. From a mechanically neutral axis ranging up to pronounced overcorrection, the implant investigated offers sufficient stability to allow healing of the osteotomy, even if a lateral hinge fracture is present.
Collapse
|
28
|
Murata Y, Fukase N, Brady AW, Douglass BW, Bryniarski AR, Dornan GJ, Utsunomiya H, Uchida S, Philippon MJ. Biomechanical Evaluation of 4 Suture Techniques for Hip Capsular Closure. Orthop J Sports Med 2022; 10:23259671221089946. [PMID: 35757238 PMCID: PMC9218465 DOI: 10.1177/23259671221089946] [Citation(s) in RCA: 4] [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: 01/06/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The most reliable suture technique for capsular closure after a capsulotomy remains unknown. Purpose: To determine which suture technique best restores native stability after a 5-cm interportal capsulotomy. Study Design: Controlled laboratory study. Methods: Ten human cadaveric hip specimens were tested using a 6-degrees-of-freedom robotic arm in 7 states: intact, capsular laxity, 5-cm capsulotomy, standard suture, shoelace, double shoelace, and Quebec City slider (QCS). Rotational range of motion (ROM) was measured across 9 tests: flexion, extension, abduction, abduction at 45° of flexion, adduction, external rotation, internal rotation, anterior impingement, and log roll. Distraction (ie, femoral head translation [FHT]) was measured across a range of flexion and abduction angles. Results: When compared with the native state, the 5-cm capsulotomy state showed the largest laxity increases on all tests, specifically in external rotation ROM (+13.4°), extension ROM (+11.5°), and distraction FHT (+4.5 mm) (P < .001 for all). The standard suture technique was not significantly different from the 5-cm capsulotomy on any test and demonstrated significantly more flexion ROM than the double shoelace suture (+1.41°; P = .049) and more extension ROM (+5.51°; P = .014) and external rotation ROM (+6.03°; P = .021) than the QCS. The standard suture also resulted in significantly higher distraction FHT as compared with the shoelace suture (+1.0 mm; P = .005), double shoelace suture (+1.4 mm; P < .001), and QCS (+1.1 mm; P = .003). The shoelace, double shoelace, and QCS techniques significantly reduced hip laxity when compared with the 5-cm capsulotomy state, specifically in external rotation ROM (respectively, –8.1°, –7.8°, and –10.2°), extension ROM (–6.3°, –7.3°, and –8.1°), and distraction FHT (–1.8, –2.2, and –1.9 mm) (P ≤ .003 for all). These 3 techniques restored native stability (no significant difference from intact) on some but not all tests, and no significant differences were observed among them on any test. Conclusion: Hip capsule closure with the standard suture technique did not prevent postoperative hip instability after a 5-cm capsulotomy, and 3 suture techniques were found to be preferable; however, none perfectly restored native stability at time zero. Clinical Relevance: The shoelace, double shoelace, and QCS suture techniques are recommended when closing the hip capsule.
Collapse
Affiliation(s)
- Yoichi Murata
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Alex W Brady
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Brenton W Douglass
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Anna R Bryniarski
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
29
|
Barbaric Starcevic K, Bicanic G, Alar Z, Sakoman M, Starcevic D, Delimar D. Measurement of safe acetabular medial wall defect size in revision hip arthroplasty with a porous cup. Hip Int 2022; 33:478-484. [PMID: 35438036 DOI: 10.1177/11207000221080706] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The majority of acetabular revisions can be performed with an uncemented, porous acetabular component with or without bone grafting. These are contained acetabular defects, with an intact acetabular rim (Paprosky type I and II). As defects of the medial wall of the acetabulum are a challenge situation revision surgery, we performed this biomechanical study on a pig pelvis model with contained acetabular defects to determine the size of medial wall defect at which the acetabular cup will have sufficient primary stability. MATERIALS AND METHODS In 24 pig pelvis models, different diameter of medial wall defects were created, followed by acetabular component placement. The acetabulum externally loaded, and the force at a level in which the acetabular component remains stable for each diameter of defect, or at which point the acetabular cup moves into the pelvis for >2 mm. RESULTS In the models with acetabular medial wall defects of 10 and 20 mm, 2 mm acetabular displacement occurred under a force between 1000 and 1500 N. In those with a medial wall defect of 25 mm, the force that caused acetabular instability was between 700 and 1000 N. In the models with 30 mm of medial wall defect all acetabular components were unstable under a force of 700 N. CONCLUSIONS According to our results, acetabular component should be stable if the defect of the medial wall of the acetabulum is less than 68% of the diameter of the acetabular component or if the uncovered surface area of the acetabular component is not greater than 27%, and the force <700 N. For a load of 1000 N, the medial wall defect should not exceed 45% of acetabular component diameter or 18% of uncovered acetabular component surface.
Collapse
Affiliation(s)
| | - Goran Bicanic
- Orthopedic Department, Al Habib Hospital Dubai, Dubai, UAE
| | - Zeljko Alar
- Department of Materials, Laboratory for Testing Mechanical Properties, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Matija Sakoman
- Department of Materials, Laboratory for Testing Mechanical Properties, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Damir Starcevic
- Special Hospital for Orthopaedic Surgery "Akromion", Krapinske Toplice, Croatia
| | - Domagoj Delimar
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Croatia
| |
Collapse
|
30
|
Rau D, Rußow G, Heyland M, Wulsten D, Kösters C, Schmölz W, Märdian S. A New System for Periprosthetic Fracture Stabilization-A Biomechanical Comparison. J Clin Med 2022; 11:892. [PMID: 35160342 DOI: 10.3390/jcm11030892] [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: 12/31/2021] [Revised: 01/26/2022] [Accepted: 02/05/2022] [Indexed: 11/23/2022] Open
Abstract
In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ®, aap Implantate AG) with a standard L.I.S.S. LCP® (DePuy Synthes) regarding their biomechanical properties in fixation of periprosthetic femur fractures after hip arthroplasty. We hypothesized that the new LOQTEQ system has superior stability and durability in comparison. Eighteen artificial left femurs were randomized in two groups (Group A: LOQTEQ®; Group B: L.I.S.S. LCP®) and tested until failure. Failure was defined as 10° varus deformity and catastrophic implant failure (loosening, breakage, progressive bending). Axial stiffness, loads of failure, cycles of failure, modes of failure were recorded. The axial stiffness in Group A with 73.4 N/mm (SD +/− 3.0) was significantly higher (p = 0.001) than in Group B (40.7 N/mm (SD +/− 2.8)). Group A resists more cycles than Group B until 10° varus deformity. Catastrophic failure mode was plate breakage in Group A and bending in Group B. In conclusion, LOQTEQ® provides higher primary stability and tends to have higher durability.
Collapse
|
31
|
Nassar M, Sallam A, Sokkar S, Abdelsadek H, Zada M. Comparison of 4 Different 4-Strand Core Suturing Techniques for Flexor Tendon Laceration: An Ex Vivo Biomechanical Study. Hand (N Y) 2022:15589447211073831. [PMID: 35132896 DOI: 10.1177/15589447211073831] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Forces applied to the repaired flexor tendon should not exceed its yield force during early postoperative rehabilitation to prevent gapping and rupture. We aimed to biomechanically compare the tensile strengths and the 2-mm gapping of 4 different 4-strand core suturing techniques for flexor tendon repair. METHODS Fifty-six goat deep digital flexor tendons were repaired with the 4-strand double-modified Kessler, the 4-strand augmented Becker, the 4-strand Savage, and the 4-strand modified Tang techniques. All tendons were repaired with 4-0 polyester for core suture and 5-0 polyester for continuous epitendinous running suture. The specimens were subjected to static linear tensile testing by applying a single linear load-to-failure pull. After the linear load testing, the yield load, the ultimate strength of the repaired tendons, and the force exerted to yield a 2-mm gap were measured. RESULTS All peripheral sutures ruptured near the yield point. All core suture techniques were similar regarding the yield force. The augmented Becker 4-strand technique had the greatest ultimate strength (98.7 [82-125.3] N). The modified double Kessler technique was the weakest in resisting a 2-mm gap formation. The 4-strand modified Tang repair had the shortest (11.3 [7-15] minutes), while the 4-strand augmented Becker had the longest operative time (29 [23-33] minutes). CONCLUSIONS All 4 techniques demonstrated similar yield force, with differences in operative time, ultimate strength, and resistance to gapping. Future clinical studies can further elucidate their appropriateness for early active motion protocols.
Collapse
Affiliation(s)
| | - Asser Sallam
- Suez Canal University Hospitals, Ismailia, Egypt
| | | | | | - Mohamed Zada
- Suez Canal University Hospitals, Ismailia, Egypt
| |
Collapse
|
32
|
Layher F, Matziolis G, Kayhan LN, Bungartz M, Brinkmann O. Minimally Invasive Internal Fixation of Femoral Shaft Fractures-A Biomechanical Study with a Disruptive Technique. Life (Basel) 2021; 11:life11111254. [PMID: 34833130 PMCID: PMC8620013 DOI: 10.3390/life11111254] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.
Collapse
Affiliation(s)
- Frank Layher
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Leos N. Kayhan
- Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland;
| | - Matthias Bungartz
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Olaf Brinkmann
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
- Correspondence:
| |
Collapse
|
33
|
Takahashi T, Takeshita K. In Vivo biomechanical evaluations of suture anchors for repairing grade 3 superficial medial collateral ligament injury in a porcine model. J Orthop Surg (Hong Kong) 2021; 29:23094990211021536. [PMID: 34121508 DOI: 10.1177/23094990211021536] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To clarify the biomechanical and radiological outcomes of superficial medial collateral ligament (sMCL) repair using suture anchors in a large animal model. METHODS The right sMCLs of nine male castrated pigs was completely detached at the femoral attachment. sMCL repair surgery was performed using two suture anchors. The same skin incision, sMCL exposure, and immediate wound closure were made at the left knee as a sham surgery. Magnetic resonance imaging was performed preoperatively and 4 weeks after surgery. The structural properties (upper yield load, maximum load, linear stiffness, and elongation at failure) of the femur-sMCL-tibia complex were determined. RESULTS During tensile testing, all the repaired sMCLs avulsed from the femoral attachment. There were no significant differences in the upper yield load, maximum load, linear stiffness, or elongation at failure between the groups 4 weeks after surgery or in the MRI-derived signal-to-noise quotients (SNQs) at the mid and tibial sMCL. The SNQs differed significantly at the femoral (2.7 ± 1.2 vs 0.3 ± 0.7; P = 0.00064) portions between groups. CONCLUSION The injured sMCLs biomechanically recovered after surgery using suture anchors even though the SNQs were higher than those with native contralateral sMCLs. For clinical relevance, sMCL repair of grade 3 sMCL injuries using suture anchors was both safe and successful with less tissue dissection.
Collapse
Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| |
Collapse
|
34
|
Ishak B, von Glinski A, Dupont G, Lachkar S, Yilmaz E, Iwanaga J, Unterberg A, Oskouian R, Tubbs RS, Chapman JR. Update on the Biomechanics of the Craniocervical Junction, Part II: Alar Ligament. Global Spine J 2021; 11:1064-1069. [PMID: 32691628 PMCID: PMC8351059 DOI: 10.1177/2192568220941452] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVE The strength of the alar ligament has been described inconsistently, possibly because of the nonphysiological biomechanical testing models, and the inability to test the ligament with both attachments simultaneously. The purpose of this biomechanical model was to reevaluate the alar ligament's tensile strength with both bony attachments, while also keeping the transverse ligament intact, all in a more physiological biomechanical model that mimics the mechanism of traumatic injury closely. METHODS Eleven fresh-frozen occipito-atlanto-axial (C0-C1-C2) specimens were harvested from individuals whose mean age at death was 77.4 years (range 46-97 years). Only the alar and transverse ligaments were preserved, and the bony C0-C1-C2 complex was left intact. Axial tension was exerted on the dens to displace it posteriorly, while the occipito-axial complex was fixed anteriorly. A device that applies controlled increasing force was used to test the tensile strength (M2-200, Mark-10 Corporation). RESULTS The mean force required for the alar ligament to fail was 394 ± 52 N (range 317-503 N). However, both the right and left alar ligaments ruptured simultaneously in 10 specimens. The ligament failed most often at the dens (n = 10), followed by occipital condyle rupture (n = 1). The transverse ligament remained intact in all specimens. CONCLUSIONS When both the right and left alar ligament were included, the total alar ligament failure occurred at an average force of 394 N. The alar ligament failed before the transverse ligament.
Collapse
Affiliation(s)
- Basem Ishak
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany,Basem Ishak, Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Alexander von Glinski
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,BG University Hospital Bochum, Bochum, Germany
| | | | | | - Emre Yilmaz
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,BG University Hospital Bochum, Bochum, Germany
| | - Joe Iwanaga
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rod Oskouian
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | - R. Shane Tubbs
- Tulane University School of Medicine, New Orleans, LA, USA,St. George’s University, Grenada, West Indies
| | | |
Collapse
|
35
|
Sun T, Zhang H. Biomechanical Comparison of a Novel Tibial Fixation Technique Versus Interference Screw Fixation for ACL Reconstruction Using Soft Tissue Grafts. Orthop J Sports Med 2021; 9:23259671211028559. [PMID: 34458385 PMCID: PMC8392818 DOI: 10.1177/23259671211028559] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Controversy remains regarding the optimal technique for tibial fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis: To compare the biomechanical outcomes of a novel transtibial tubercle fixation technique with those of a commonly utilized interference screw fixation at the tibial site. Our hypothesis was that transtibial tubercle fixation achieves higher ultimate failure loads than interference screw fixation. Study Design: Controlled laboratory study. Methods: We used 24 matched porcine tibias and digital extensor tendons, from which 12 grafts and tibial tunnels were prepared using the novel transtibial tubercle fixation technique and 12 were prepared using the interference screw fixation technique. The specimens underwent a cyclic loading test (50-250 N applied for 1000 cycles at a frequency of 1 Hz), followed by a load-to-failure test. The slippage, stiffness, and ultimate failure loads were compared between the techniques. Results: No differences in slippage were found during the cyclic loading test, and no graft fixation or tibial complex failures occurred during cyclic testing in either group. The transtibial tubercle fixation technique had higher ultimate failure loads (mean ± SD, 756.28 ± 123.43 N) as compared with interference screw fixation (602.15 ± 81.62 N; P < .05). The grafts in the transtibial tubercle fixation group were less stiff than those in the interference screw fixation group (84.43 vs 101.23 N/mm; P < .05). Conclusion: Transtibial tubercle fixation achieved higher ultimate failure loads than interference screw fixation in the load-to-failure test. Clinical Relevance: The novel transtibial tubercle fixation technique compared favorably with interference screw fixation during ACL reconstruction. This technique does not require hardware, has a low cost, theoretically eliminates the risk of complications associated with hardware implantation (eg, graft damage and pain attributed to retained hardware requiring removal), and is relatively easy to perform.
Collapse
Affiliation(s)
| | - Hangzhou Zhang
- Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
36
|
Augat P, Hast MW, Schemitsch G, Heyland M, Trepczynski A, Borgiani E, Russow G, Märdian S, Duda GN, Hollensteiner M, Bottlang M, Schemitsch EH. Biomechanical models: key considerations in study design. OTA Int 2021; 4:e099(1-6). [PMID: 37608858 PMCID: PMC10441683 DOI: 10.1097/oi9.0000000000000099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/05/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 08/24/2023]
Abstract
This manuscript summarizes presentations of a symposium on key considerations in design of biomechanical models at the 2019 Basic Science Focus Forum of the Orthopaedic Trauma Association. The first section outlines the most important characteristics of a high-quality biomechanical study. The second section considers choices associated with designing experiments using finite element modeling versus synthetic bones versus human specimens. The third section discusses appropriate selection of experimental protocols and finite element analyses. The fourth section considers the pros and cons of use of biomechanical research for implant design. Finally, the fifth section examines how results from biomechanical studies can be used when clinical evidence is lacking or contradictory. When taken together, these presentations emphasize the critical importance of biomechanical research and the need to carefully consider and optimize models when designing a biomechanical study.
Collapse
Affiliation(s)
- Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University, Salzburg, Austria
| | - Michael W Hast
- Biedermann Lab for Orthopaedic Research, University of Pennsylvania, Philadelphia, PA
| | | | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Adam Trepczynski
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Edoardo Borgiani
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Gabriele Russow
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin, Berlin, Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin, Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Marianne Hollensteiner
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University, Salzburg, Austria
| | - Michael Bottlang
- Biomechanics Laboratory, Legacy Research Institute, Portland, OR
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
37
|
Abstract
The biomechanical study helps us to understand the mechanics of the human cervical spine. A three dimensional Finite Element (FE) model for C3 to C6 level was developed using computed tomography (CT) scan data to study the mechanical behaviour of the cervical spine. A moment of 1 Nm was applied at the top of C3 vertebral end plate and all degrees of freedom of bottom end plate of C6 were constrained. The physiological motion of the cervical spine was validated using published experimental and FE analysis results. The von Mises stress distribution across the intervertebral disc was calculated along with range of motion. It was observed that the predicted results of functional spine units using FE analysis replicate the real behaviour of the cervical spine.
Collapse
Affiliation(s)
- Pechimuthu Susai Manickam
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Sandipan Roy
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| |
Collapse
|
38
|
Ishak B, Dupont G, Lachkar S, Yilmaz E, Glinski AV, Altafulla J, Kikuta S, Iwanaga J, Chapman JR, Oskouian R, Tubbs RS. Update on the Biomechanics of the Craniocervical Junction-Part I: Transverse Atlantal Ligament in the Elderly. Global Spine J 2021; 11:180-186. [PMID: 32875854 PMCID: PMC7882814 DOI: 10.1177/2192568219896544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVE The transverse ligament is the strongest ligament of the craniocervical junction and plays a critical role in atlanto-axial stability. The goal of this cadaveric study, and the subsequent study (part II), was to reevaluate the force required for the transverse ligament and alar ligament to fail in a more physiological biomechanical model in elderly specimens. METHODS Twelve C1-2 specimens were harvested from fresh-frozen Caucasian cadavers with a mean age at death of 81 years (range 68-89 years). Only the transverse ligament was preserved, and the bony C1-2 complex was left intact. The dens was pulled away from the anterior arch of C1 using a strength test machine that applies controlled increasing force. After testing, the axis was split in half to check for hidden pathologies and osteoporosis. The differences in the failure force between sex and age groups (group 1: <80 years, group 2: >80 years) were compared. RESULTS The mean force required for the transverse ligament to fail was 236.2 ± 66 N (range 132-326 N). All but 2 specimens had significant osteoporotic loss of trabecular bone. No significant differences between sex and age groups were found. CONCLUSIONS The transverse ligament's failure in elderly specimens occurred at an average force of 236 N, which was lower than that reported in the previous literature. The ligament's failure force in younger patients differs and may be similar to the findings published to date.
Collapse
Affiliation(s)
- Basem Ishak
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,Heidelberg University Hospital, Heidelberg, Germany,Basem Ishak, Swedish Neuroscience Institute, Seattle, WA 98122, USA.
| | | | | | - Emre Yilmaz
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | | | | | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | | | - Rod Oskouian
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | - R. Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA,St. George’s University, Grenada, West Indies
| |
Collapse
|
39
|
Kurata S, Inoue K, Hasegawa H, Shimizu T, Iida A, Kawamura K, Omokawa S, Mahakkanukrauh P, Tanaka Y. The Role of the Acromioclavicular Ligament in Acromioclavicular Joint Stability: A Cadaveric Biomechanical Study. Orthop J Sports Med 2021; 9:2325967120982947. [PMID: 33623800 PMCID: PMC7878954 DOI: 10.1177/2325967120982947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Acromioclavicular (AC) joint dislocation is evaluated using the radiologically based Rockwood classification. The relationship between ligamentous injury and radiological assessment is still controversial. Purpose/Hypothesis: To investigate how the AC ligament and trapezoid ligament biomechanically contribute to the stability of the AC joint using cadaveric specimens. The hypothesis was that isolated sectioning of the AC ligament would result in increased instability in the superior direction and that displacement >50% of the AC joint would occur. Study Design: Controlled laboratory study. Methods: Six shoulders from 6 fresh-frozen cadavers were used in this study. Both the scapula and sternum were solidly fixed on a customized wooden jig with an external fixator. We simulated distal clavicular dislocation with sequential sectioning of the AC and coracoclavicular (CC) ligaments. Sectioning stages were defined as follows: stage 0, the AC ligament, CC ligament, and AC joint capsule were left intact; stage 1, the anteroinferior bundle of the AC ligament, joint capsule, and disk were sectioned; stage 2, the superoposterior bundle of the AC ligament was sectioned; and stage 3, the trapezoid ligament was sectioned. The distal clavicle was loaded with 70 N in the superior and posterior directions, and the magnitudes of displacement were measured. Results: The amounts of superior displacement averaged 3.7 mm (stage 0), 3.8 mm (stage 1), 8.3 mm (stage 2), and 9.5 mm (stage 3). Superior displacement >50% of the AC joint was observed in stage 2 (4/6; 67%) and stage 3 (6/6; 100%). The magnitudes of posterior displacement were 3.7 mm (stage 0), 3.7 mm (stage 1), 5.6 mm (stage 2), and 9.8 mm (stage 3). Posterior displacement >50% of the AC joint was observed in stage 3 (1/6; 17%). Conclusion: We found that the AC ligaments contribute significantly to AC joint stability, and superior displacement >50% of the AC joint can occur with AC ligament tears alone. Clinical Relevance: The AC ligament plays an important role not only in horizontal stability but also in vertical stability of the AC joint.
Collapse
Affiliation(s)
- Shimpei Kurata
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuya Inoue
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hideo Hasegawa
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takamasa Shimizu
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Akio Iida
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center (ORCT), Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
40
|
Bean BA, Smyth NA, Abbasi P, Parks BG, Hembree WC. Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures. Foot Ankle Int 2021; 42:89-95. [PMID: 32981339 DOI: 10.1177/1071100720953083] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. METHODS Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. RESULTS The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. CONCLUSION A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. CLINICAL RELEVANCE Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.
Collapse
Affiliation(s)
- Bryan A Bean
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Niall A Smyth
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
41
|
Noia G, Maccagnano G, Sarni L, Stigliani C, Colacicco G, Quitadamo R, Vicenti G, Ziranu A, Pesce V. Biomechanical study of shaft fracture with the butterfly fragment: software simulation. J BIOL REG HOMEOS AG 2020; 34:107-112. IORS Special Issue on Orthopedics. [PMID: 33739014 DOI: pmid/33739014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The specific traumatic mechanism that leads to the formation of the butterfly fragment is debated in literature. The aim of the present study is to analyze the biomechanics of fractures with a "butterfly" fragment, using a software that simulates the movement of the lines of force (and related iso-displacement points) that occur on the bone, when traumatic forces are applied on it. We have shown that the formation of the butterfly fragment derives from the application of three forces (compression, torsion and bending) with the bending force that acts by increasing the curvature of the long bone.
Collapse
Affiliation(s)
- G Noia
- Azienda Ospedaliero Universitaria di Foggia. Policlinico Riuniti di Foggia. UOC Ortopedia e Traumatologia Universitaria, Foggia, Italy
| | - G Maccagnano
- Azienda Ospedaliero Universitaria di Foggia. Policlinico Riuniti di Foggia. UOC Ortopedia e Traumatologia Universitaria, Foggia, Italy.,Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| | - L Sarni
- Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| | - C Stigliani
- Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| | - G Colacicco
- Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| | - R Quitadamo
- Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - A Ziranu
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - V Pesce
- Azienda Ospedaliero Universitaria di Foggia. Policlinico Riuniti di Foggia. UOC Ortopedia e Traumatologia Universitaria, Foggia, Italy.,Università degli Studi di Foggia. Dipartimento di Medicina Clinica e Sperimentale
| |
Collapse
|
42
|
Houskamp DJ, Tompane T, Barlow BT. What Is the Critical Tibial Resection Depth During Unicompartmental Knee Arthroplasty? A Biomechanical Study of Fracture Risk. J Arthroplasty 2020; 35:2244-2248. [PMID: 32362480 DOI: 10.1016/j.arth.2020.04.005] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Fracture after medial unicompartmental knee arthroplasty (UKA) is a rare complication. Biomechanical studies evaluating association between depth of resection and maximum load to failure are lacking. The purpose of this study is to establish the relationship between depth of resection of the medial tibial plateau and mean maximum load to failure. METHODS Medial tibial resections were performed from 2 to 10 mm in 25 standardized fourth-generation Sawbones composite tibias (Sawbones, Vashon Island, Washington). A metal-backed tibial component with a 9-mm polyethylene bearing was used (Stryker PKR). Tibias were mounted on a biomechanical testing apparatus (MTESTQuattro) and axially loaded cyclically 10 times per cycle and incrementally increased until failure occurred. RESULTS Load to failure was recorded in 25 proximal tibia model samples after medial UKA using sequential resections from 2 to 10 mm. Analysis of variance testing identified significant differences in mean maximum load to failure between groups (P = .0003). Analysis of regression models revealed a statistically significant fit of a quadratic model (R2 = 0.59, P = .0001). The inflection point of this quadratic curve was identified at 5.82 mm, indicating that the maximum load to failure across experimental models in this study began to decline beyond a resection depth of 5.82 mm. CONCLUSION In this biomechanical model, medial tibial resections beyond 5.82 mm produced a significantly lower mean load to failure using a quadratic curve model. Resections from 2 to 6 mm showed no significant differences in mean load to failure. Identification of the tibial resection depth at which the mean load to failure significantly decreases is clinically relevant as this depth may increase the risk of periprosthetic fracture after a medial UKA.
Collapse
|
43
|
Blum LE, Yee MA, Mauffrey C, Goulet JA, Perdue AM, Hake ME. Comparison of reamed long and short intramedullary nail constructs in unstable intertrochanteric femur fractures: A biomechanical study. OTA Int 2020; 3:e075. [PMID: 33937699 PMCID: PMC8022903 DOI: 10.1097/oi9.0000000000000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/24/2019] [Accepted: 01/12/2020] [Indexed: 04/19/2023]
Abstract
OBJECTIVES There is no definitive evidence to guide clinicians in their decision-making for implant choice regarding long or short intramedullary nails for unstable fracture patterns. Historically short nails were associated with higher rates of perisprothetic fractures which seem to have improved with newer designs. Long intramedullary nails have higher blood loss and time under anesthesia. The purpose of this study was to assess stability of long and short intramedullary nail constructs in unstable intertrochanteric fracture patterns to better elucidate if unstable intertrochanteric fractures are amenable to treatment with short intramedullary nails. METHODS This study utilized composite model femurs which were assigned to either a comminuted or reverse obliquity fracture pattern, then subsequently assigned to implantation with either a long or short intramedullary nail. All the samples were reamed to the level of the distal femur and instrumented with the appropriate nail. Axial and torsional stiffness as well as axial load to failure values were determined using a servohydraulic loading system. RESULTS Short nail constructs exhibited significantly greater axial stiffness in A1 fractures and torsional stiffness in A3 fractures when compared with long nails. There was no significant difference between axial load to failure between long nails and short nails. DISCUSSION We found no significant difference in axial load to failure values between long and short intramedullary nail fixation in 2 unstable intertrochanteric fracture patterns in a composite femur model. Short nails exhibited greater stiffness in axial loads in the A1 pattern and torsional stiffness in the A3 pattern. This suggests short or long intramedullary nails could be appropriately employed for fixation of unstable intertrochanteric hip fracture patterns.
Collapse
Affiliation(s)
- Laura E Blum
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michael A Yee
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | - James A Goulet
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Aaron M Perdue
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Mark E Hake
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
44
|
Nishida N, Jiang F, Ohgi J, Tanaka A, Imajo Y, Suzuki H, Funaba M, Sakai T, Sakuramoto I, Chen X. Compression analysis of the gray and white matter of the spinal cord. Neural Regen Res 2020; 15:1344-1349. [PMID: 31960823 PMCID: PMC7047803 DOI: 10.4103/1673-5374.272604] [Citation(s) in RCA: 4] [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] [Indexed: 11/04/2022] Open
Abstract
The spinal cord is composed of gray matter and white matter. It is well known that the properties of these two tissues differ considerably. Spinal diseases often present with symptoms that are caused by spinal cord compression. Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders. Previous studies have reported on the physical properties of gray and white matter, however, these were focused on longitudinal tension tests. Little is known about the differences between gray and white matter in terms of their response to compression. We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression. We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate. We found that increased compression (especially more than 50% compression) resulted in more severe injuries to both the gray and white matter. The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.
Collapse
Affiliation(s)
- Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Fei Jiang
- Faculty of Engineering, Yamaguchi University, Yamaguchi, Japan
| | - Junji Ohgi
- Faculty of Engineering, Yamaguchi University, Yamaguchi, Japan
| | - Akihiro Tanaka
- Faculty of Engineering, Yamaguchi University, Yamaguchi, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Itsuo Sakuramoto
- Department of Mechanical and Electrical Engineering, National Institute of Technology Tokuyama College, Yamaguchi, Japan
| | - Xian Chen
- Faculty of Engineering, Yamaguchi University, Yamaguchi, Japan
| |
Collapse
|
45
|
Almansour H, Sonntag R, Pepke W, Bruckner T, Kretzer JP, Akbar M. Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs-An In Vitro Biomechanical Study. Materials (Basel) 2019; 12:ma12152471. [PMID: 31382555 PMCID: PMC6696314 DOI: 10.3390/ma12152471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
Instrumentation failure in the context of spine surgery is attributed to cyclic loading leading to formation of fatigue cracks, which later propagate and result in rod fracture. A biomechanical analysis of the potential impact of electrocautery on the fatigue life of spinal implants has not been previously performed. The aim of this study was to assess the fatigue life of titanium (Ti) and cobalt-chrome (CoCr) rod-screw constructs after being treated with electrocautery. Twelve spinal constructs with CoCr and Ti rods were examined. Specimens were divided into four groups by rod material (Ti and CoCr) and application of monopolar electrocautery on the rods’ surface (control-group and electrocautery-group). Electrocautery was applied on each rod at three locations, then constructs were cyclically tested. Outcome measures were load-to-failure, total number of cycles-to-failure, and location of rod failure. Ti-rods treated with electrocautery demonstrated a significantly decreased fatigue life compared to non-treated Ti-rods. Intergroup comparison of cycles-to-failure revealed a significant mean decrease of almost 9 × 105 cycles (p = 0.03). No CoCr-rods failed in this experiment. Electrocautery application on the surface of Ti-rods significantly reduces their fatigue life. Surgeons should exercise caution when using electrocautery in the vicinity of Ti-rods to mitigate the risk of rod failure.
Collapse
Affiliation(s)
- Haidara Almansour
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Wojciech Pepke
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69118 Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| |
Collapse
|
46
|
Valcarenghi J, Moungondo F, Andrzejewski A, Feipel V, Schuind F. Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study. J Hand Surg Eur Vol 2019; 44:632-639. [PMID: 30909782 DOI: 10.1177/1753193419837485] [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] [Indexed: 02/03/2023]
Abstract
This study reports the gains in length of nerves after three different humeral shortenings. Ten brachial plexuses were dissected. The lengths of the different parts of the brachial plexus were measured using a three-dimensional digitizing system after humeral shaft shortenings of 2, 4 and 6 cm and after a standardized force of 0.588 N was used to apply tension to the plexus. The feasibility of nerve suturing was studied. Humeral shortening allowed for significant gains in lengths of the musculocutaneous (42 mm), median (41 mm), ulnar (29 mm) and radial nerves (15 mm). A 2 cm humeral shortening allowed a 2 cm nerve gap to be directly sutured in 70% to 90% of cases. This study suggests that humeral shortening could allow direct suture of nerve defects, or shorten the length of nerve grafts required to bridge a gap.
Collapse
Affiliation(s)
- Jérôme Valcarenghi
- 1 Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Brussels, Belgium.,2 Department of Orthopaedics and Traumatology, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Fabian Moungondo
- 1 Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Brussels, Belgium
| | - Aurélie Andrzejewski
- 1 Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- 3 Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric Schuind
- 1 Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
47
|
Yagnik GP, Brady PC, Zimmerman JP, Jordan CJ, Porter DA. A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating. J Shoulder Elbow Surg 2019; 28:982-988. [PMID: 30713066 DOI: 10.1016/j.jse.2018.11.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/12/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unstable distal clavicular fractures treated surgically are associated with high failure rates and hardware-related complications. Newer techniques have shown promising early clinical results with fewer hardware complications; however, their biomechanical performance has not been assessed. This study biomechanically compared a distal-third locking plate with 3 newer techniques that incorporate coracoid fixation into the construct. METHODS The study randomized 36 adult fresh frozen cadaveric shoulders to 4 groups: (1) distal-third locking plate (P); (2) distal-third locking plate with a coracoid button augmentation (P + CB); (3) coracoclavicular button (CB); and (4) coracoclavicular button with coracoclavicular ligament reconstruction using semitendinosus allograft (CB + CC). After fixation, each specimen was stressed in the coronal plane. Cyclic displacement, load at 10-mm displacement, and ultimate load to failure were measured. RESULTS All 3 experimental groups biomechanically outperformed the locking plate. Mean load to failure was significantly higher in the CB (343 ± 76 N) and CB + CC (349 ± 94 N) groups compared with the P group (193 ± 52 N). There was also significantly less cyclic displacement in the CB (4.3 ± 1.9 mm) and CB + CC (4.4 ± 1.9 mm) groups compared with the P group (8.2 ± 2.9 mm). With respect to load at 10 mm of displacement, which essentially measures a clinical failure, the P + CB (235 ± 112 N), CB (253 ± 111 N), and CB+CC (238 ± 76 N) experimental groups significantly outperformed the P group (96 ± 29 N). CONCLUSIONS CB and CB + CC techniques demonstrated more than 75% greater strength than the traditional locking plate alone. Coupled with greater overall construct strength and lower-profile hardware, these newer techniques may result in improved clinical outcome and fewer hardware-related complications.
Collapse
Affiliation(s)
- Gautam P Yagnik
- Miami Orthopaedics and Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - Paul C Brady
- Tennessee Orthopaedic Clinics, Knoxville, TN, USA
| | - Joseph P Zimmerman
- Miami Orthopaedics and Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - Charles J Jordan
- Miami Orthopaedics and Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - David A Porter
- Miami Orthopaedics and Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, USA.
| |
Collapse
|
48
|
Gkouvas G, Agathangelidis F, Nakas C, David C, Sagris D, Petsatodis G. Biomechanical comparison of six intramedullary nails, for the treatment of ex-tra-articular, proximal tibial fractures. Hippokratia 2019; 23:58-63. [PMID: 32265585 PMCID: PMC7127914] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intramedullary nailing is the "gold standard" treatment modality of diaphyseal fractures of the tibia. However, when the same method is used for extra-articular fractures of the proximal tibia, various problems may occur, like malalignment, loss of reduction, and non-union. The objective of the present biomechanical study was to compare the stability of six tibial nails when these are used for the treatment of unstable, extra-articular, proximal tibial fractures. METHODS Thirty composite tibia models were divided into six groups, and a corresponding number of nails from six manufacturers (Citieffe, Braun Aesculap, Orthoselect, Orthofix, Stryker, and Depuy Synthes) was implanted in each group. The maximum number of proximal screws was used for each specimen, and a proximal gap osteotomy was performed. Each bone model was then submitted in dynamic, followed by static loading, and the passive construct stiffness was calculated, representing the specimen's rigidity. Furthermore, for each specimen, the force needed to cause a displacement of more than one millimeter at the fracture site was calculated. RESULTS Stiffness values of a solid nail with two proximal screws and a cannulated nail with five screws were significantly higher compared to all other groups. On the other hand, a titanium cannulated nail with three screws showed the lowest rigidity. CONCLUSION Solid nails provide more rigidity compared to cannulated ones, and the maximum number of proximal screws in all possible directions should be used in order to achieve maximum stability. HIPPOKRATIA 2019, 23(2): 58-63.
Collapse
Affiliation(s)
- G Gkouvas
- 424 Military General Hospital, Thessaloniki,Greece
| | - F Agathangelidis
- 1 Department of Orthopaedics, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Thessaloniki,Greece
| | - C Nakas
- Laboratory of Biometry, School of Agriculture, University of Thessaly, Volos, Greece
| | - C David
- Laboratory of Biometry, School of Agriculture, University of Thessaly, Volos, Greece
| | - D Sagris
- Mechanical Engineering Department, School of Engineering, International Hellenic University, Serres, Greece
| | - G Petsatodis
- 1 Department of Orthopaedics, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Thessaloniki,Greece
| |
Collapse
|
49
|
Willinger L, Foehr P, Achtnich A, Forkel P, Voss A, Liska F, Lacheta L, Imhoff AB, Burgkart R. Effect of Lower Limb Alignment in Medial Meniscus-Deficient Knees on Tibiofemoral Contact Pressure. Orthop J Sports Med 2019; 7:2325967118824611. [PMID: 30800688 PMCID: PMC6378645 DOI: 10.1177/2325967118824611] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Degenerative medial meniscal tears and subsequent partial meniscal resection compromise meniscal function and lead to an overload of the medial compartment. In addition, lower limb alignment plays a key role in load distribution between the medial and lateral knee compartments, and varus alignment is a potential risk factor for medial osteoarthritis. Purpose/Hypothesis: The purpose of this biomechanical study was to investigate the effect of valgus and varus alignment on peak pressure and contact area in knees with concomitant horizontal medial meniscal tears and subsequent leaflet resection. It was hypothesized that varus alignment in combination with meniscal loss leads to the highest peak pressure within the medial compartment. Study Design: Controlled laboratory study. Methods: Six fresh-frozen human cadaveric knees were axially loaded using a 1000-N compressive load in full extension with the mechanical axis rotated to intersect the tibial plateau at 40%, 45%, 50%, 55%, and 60% of its width (TPW) to simulate varus and valgus alignment. Tibiofemoral peak contact pressure and contact area of the medial and lateral compartments were determined using pressure-sensitive foils in each of 4 different meniscal conditions: intact, 15-mm horizontal tear of the posterior horn, inferior leaflet resection, and resection of both leaflets. Results: The effect of alignment on peak pressure (normalized to the neutral axis) within the medial compartment in cases of an intact meniscus was measured as follows: varus shift resulted in a mean increase in peak pressure of 18.5% at 45% of the TPW and 37.4% at 40% of the TPW, whereas valgus shift led to a mean decrease in peak pressure of 8.7% at 55% of the TPW and 23.1% at 60% of the TPW. Peak pressure changes between the intact meniscus and resection within the medial compartment was less in valgus-aligned knees (0.21 MPa at 60% TPW, 0.59 MPa at 50% TPW, and 0.76 MPa at 40% TPW). Contact area was significantly reduced after partial meniscal resection in the neutral axis (intact, 553.5 ± 87.6 mm2; resection of both leaflets, 323.3 ± 84.2 mm2; P < .001). This finding was consistent in any alignment. Conclusion: Both partial medial meniscal resection and varus alignment led to an increase in medial compartment peak pressure. Valgus alignment prevented medial overloading by decreasing contact pressure even after partial meniscal resection. A horizontal meniscal tear did not influence peak pressure and contact area even in varus alignment. Clinical Relevance: As a clinical consequence, partial meniscal resection should be avoided to maintain the original biomechanical behavior, and the mechanical axis should be taken into account if partial meniscectomy is necessary.
Collapse
Affiliation(s)
- Lukas Willinger
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Peter Foehr
- Department of Orthopedics and Sports Orthopedics, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Philipp Forkel
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.,Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Franz Liska
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| |
Collapse
|
50
|
Abstract
BACKGROUND The use of barbed sutures in wound closure and tendon repair has been previously been studied with improved results over traditional suture material. We examine the use of barbed suture in muscle belly repair in a custom configuration, comparing it with traditional configurations and a control. METHODS Twenty-five matched porcine psoas muscles were assigned to 5 different test groups: Mason-Allen with #1 Ethibond, Figure of Eight Allen with #1 Ethibond, Modified Kessler with #1 Ethibond, Custom Configuration with #2 Barbed PDS, Custom Configuration with #1 Ethibond. Repair was performed on the cut edge of muscle, with the free end of the suture anchored to a fixed base, forming a single-sided repair. An Instron 8874 tensiometer was used to linearly distract the repair to failure at 1 mm/s after 1 N preload. Five samples of each group were run, comparing load to failure and distraction at 10 N. RESULTS Repair with barbed suture in custom configuration had statistically significantly greater load to failure than all other methods. It also showed statistically significant less displacement at 10 N of force than all other methods of repair except the Mason-Allen repair with #1 Ethibond. Mode of failure for traditional techniques was suture pull-through with tissue loss. Failure with barbed suture was through suture pullout without tissue loss. CONCLUSIONS Custom configuration with a barbed suture increases the load to failure and decreases displacement of the repair site at 10 N of force. In addition, when the suture does pull out, it does so with minimal tissue loss.
Collapse
Affiliation(s)
- Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA,Kanu S. Goyal, Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite #3200, Columbus, OH 43212, USA.
| | | | | | | |
Collapse
|