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Jones PJ, Bibb RJ, Davies MJ, Khunti K, McCarthy M, Fong DTP, Webb D. A fitting problem: Standardising shoe fit standards to reduce related diabetic foot ulcers. Diabetes Res Clin Pract 2019; 154:66-74. [PMID: 31128134 DOI: 10.1016/j.diabres.2019.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
AIMS Incorrectly fitting shoes are implicated in callus formation and a significant proportion of diabetic foot ulcers, yet remain surprisingly prevalent. We review the current shoe fit guidelines for consistency and discuss ways in which technology may assist us in standardising methods of footwear assessment. METHODS Narrative review. RESULTS Incorrectly fitted shoes are implicated in the development of some diabetic foot ulcers yet surprisingly there's no consensus on shoe fit, despite substantial spending on prescription footwear. Suggested toe gaps vary from 6 to 20 mm and measurement methods also vary from Brannock Devices and callipers to manual measurement. CONCLUSIONS To prevent fit-related foot ulceration, we need to standardise our biomechanical definition of fit. Future research should (1) evaluate the potential use of 3D scanning technology to provide a standardised means of capturing foot morphology; (2) develop a working biomechanical definition of fit, including toe gap through the identification of key physiological markers that capture and predict dynamic foot shape changes during different physical activities and body weight loading conditions; and (3) determine whether changes in dynamic foot shape of those with diabetes differs from those without, impacting on their shoe fitting needs, potentially necessitating specialist footwear at an earlier stage to avoid ulceration.
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Affiliation(s)
- Petra J Jones
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - Richard J Bibb
- Loughborough Design School, Loughborough University, Loughborough, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Matthew McCarthy
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Daniel T P Fong
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - David Webb
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
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Wu X, Wang Z, Li H, Li Y, Wang H, Tian W. Biomechanical evaluation of osteoporotic fracture: Metal fixation versus absorbable fixation in Sawbones models. Injury 2019; 50:1272-1276. [PMID: 31147181 DOI: 10.1016/j.injury.2019.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Accepted: 05/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The failure of osteoporotic fracture after internal fixation is mainly caused by the underlying bone loss and strength compromise. The aim of this study is to investigate whether absorbable internal fixation can provide adequate mechanical stability and a reduction in the incidence of failure of fixation caused by bone loss and stress shielding. METHODS A low density cancellous bone model was selected to compare the insertion of screw (screw-in), removal of screw (screw -out) and pull - out strength of absorbable screw and metal screw. The long bone model of thin cortical bone was used to create the transverse fracture model. The model was fixed with absorbable plate-screw system and metal plate-screw system respectively. The fatigue test and static bending test were compared. Moreover, the size of screw hole area was assessed. RESULTS The maximal screw - in and screw - out torque of the absorbable screw was significantly greater than that of the metal screw (P < 0.05), but there was no significant difference in pull-out test (P > 0.05). No visible failure occurred in fatigue test. There was no significant difference between the maximum load of static bending test (P > 0.05). The screw hole area of absorbable samples was significantly smaller than that of metal samples (P < 0.05). CONCLUSIONS In this experimental set-up it was found that the stability of absorbable screws in osteoporotic bone was better than metal screws. The absorbable system tested can achieve good stability, and the destruction of osteoporotic bone is small, which can reduce the occurrence of bone failure. Considering that absorbable material avoids the need of second surgery (implant removal) and reduces the stress shielding effect, we believe that absorbable internal fixation can be considered for fixation treatment of osteoporotic fractures.
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Affiliation(s)
- Xinbao Wu
- School of Clinical Medicine, Tsinghua University, China.
| | | | - Hui Li
- Naton Institute of Medical Technology, China.
| | | | - Hao Wang
- Beijing Jishuitan Hospital, China.
| | - Wei Tian
- School of Clinical Medicine, Tsinghua University, China.
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Wiggenhauser PS, Schwarz S, Freutel M, Koerber L, Wolf N, Dürselen L, Rotter N. Differences between human septal and alar cartilage with respect to biomechanical features and biochemical composition. J Mech Behav Biomed Mater 2019; 96:236-43. [PMID: 31059899 DOI: 10.1016/j.jmbbm.2019.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 11/21/2022]
Abstract
Cartilage grafts have become popular in facial plastic surgery to reconstruct defects or to improve aesthetic outcomes in various applications. But there is a considerable rate of graft failure like resorption or deformation. To improve graft survival and function, accurate understanding of the properties of the recipient site is indispensable. Therefore 10 noses of human cadavers were meticulously dissected and specimens of alar and septal cartilage subjected to confined compression and tensile tests. Furthermore, cell number, glycosaminoglycan and hydroxyproline content were measured. RESULTS: showed a significant difference (p < 0.05) of alar and septal cartilage regarding Equilibrium Modulus, cell number and glycosaminoglycan but not hydroxyproline content. Tensile tests showed a significant difference (p < 0.001) between alar and septal cartilage (vertical vector of force) for E-modulus, maximal force and maximal strain but not for horizontal vector of force. There was a significant difference (p < 0.05) within septal cartilage samples depending on vector of force (vertical vs. horizontal). Finally multifactorial linear regression allowed an estimation of Equilibrium Modulus depending on compression, glycosaminoglycan content and cell number with statistical significance (p < 0.05). In conclusion, nasal cartilage differs in function and composition depending on anatomical location and the prevalent forces. Therefore further research will be necessary to evaluate if graft failure depends on a mismatch of functional properties and if grafts can be adapted to the recipient site.
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104
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Rebgetz PR, Daniele L, Underhill ID, Öchsner A, Taylor FJ. A biomechanical study of headless compression screws versus a locking plate in radial head fracture fixation. J Shoulder Elbow Surg 2019; 28:e111-e116. [PMID: 30685273 DOI: 10.1016/j.jse.2018.10.008] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Fixation of a 3-part radial head fracture with cannulated compression screws will show equivalent stiffness to a locking plate under axial load. Debate exists regarding the management of Mason type III fractures, with many believing that open reduction and internal fixation provides advantages over other options. By virtue of their subarticular placement, screw fixation is less likely to cause impingement compared with plate fixation, which can result in loss of rotation and requirement for hardware removal. Insufficient fixation stability can lead to nonunions, necrosis of the radial head, pain, and instability. We tested the mechanical stability of fixation of simulated radial head fractures using headless compression screws compared with standard plate construct. METHODS Standardized test constructs were created with repeatable osteotomy cuts and hardware placement on each Synbone model (Synbone AG, Malans, Switzerland). We presectioned 22 proximal radius Synbone models to simulate a 3-part radial head fracture. The models were fixed using a radial head locking plate or headless compression screws in a tripod construct. The constructs were potted into a compression test jig using 2-part epoxy resin. Compression testing was performed using a 30-kN Instron Universal machine (Instron, Norwood, MA, USA). The compression tool was spherical, representing the surface of the capitellum. RESULTS There was no significant difference between the stiffness of the Synbone constructs under axial load. CONCLUSION There was no significant difference between fixation stiffness of a 3-part radial head fracture with headless compression screws in a tripod structure vs. a locking plate in Synbone. Further study is required to allow clinical application.
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Affiliation(s)
- Paul R Rebgetz
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - Luca Daniele
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ian D Underhill
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Andreas Öchsner
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Fraser J Taylor
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
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Sauerwald A, Langer L, Ratiu D, Prescher A, Scaal M, Noé GK, Wegmann K, Bulian DR, Eichler C. Laparoscopic pectopexy: a follow-up cyclic biomechanical analysis determining time to functional stability. Arch Gynecol Obstet 2019; 299:1337-43. [PMID: 30905000 DOI: 10.1007/s00404-019-05117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in previous transient testing by this group. It was shown that a single suture, yielding an ultimate load of 35 N, was equivalent to continuous suturing. This was demonstrated in an in vitro cadaver study. This transient data were used to establish an elastic stress-strain envelope. It was now possible to proceed to dynamic in vitro analysis of this surgical method to establish time to functional stability. METHODS Cyclic testing of this fixation method was performed on human female embalmed cadaver (cohort 1) and fresh, non-embalmed cadaver (cohort 2) pelvises. The testing envelope was 5-25 N at a speed of 1 mm/s. 100 load regulated cycles were applied. RESULTS 100 cycles were completed with each model; no overall system failure occurred. Steady state, i.e., functional stability was reached after 14.5 (± 2.9) cycles for the embalmed group and after 19.1 (± 7.2) cycles for the non-embalmed group. This difference was statistically significant p = 0.00025. CONCLUSION This trial showed in an in vitro cyclic testing of the pectopexy method that functional stability may be achieved after no more than 19.1 cycles of load exposure. When remaining within the established load envelope of below 25 N, patients do not need to fear global fixation failure. Testing did demonstrate differences in non-embalmed and embalmed cadaver testing. Embalmed cadaver testing tends to underestimate time to steady state by 26.3%.
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Ren Y, Zhao H, Yang K, Zhang Y. Biomechanical compatibility of high strength nickel free stainless steel bone plate under lightweight design. Mater Sci Eng C Mater Biol Appl 2019; 101:415-22. [PMID: 31029335 DOI: 10.1016/j.msec.2019.03.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/01/2019] [Accepted: 03/22/2019] [Indexed: 11/22/2022]
Abstract
High nitrogen nickel-free stainless steel (HNNFSS) has excellent mechanical properties, corrosion resistance and biocompatibility, but its strength advantage is not fully used even though with one time higher than that of the conventional 316 L stainless steel. In this work, the lightweight design of HNNFSS bone plate was studied using finite element analysis, and the effect of lightweight plate fixation on histological and biomechanical behavior of healing bone were also researched on fractured rabbit femur. The finite element analysis results showed that the lightweight plate within 18.2% thickness reduction had higher bending strength and more homogeneous stress distribution compared with 316 L stainless steel plate. There was no obvious difference in radiography, histology analysis of callus and expression pattern of insulin like growth factor-1(IGF-1) of callus between the lightweight HNNFSS plate group and 316 L stainless steel plate group in animal test, and the IGF-1 concentrations of callus and the biomechanical bending test results also showed no statistical significance (p > 0.05), even though the data of the lightweight HNNFSS plate group were relatively better than that of 316 L stainless steel plate group. Therefore, the high nitrogen nickel-free stainless steel has the lightweight potential to keep good fixing function and improve bone healing compared with 316 L stainless steel plate.
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107
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Li K, Zhang J, Liu X, Zhang M. Estimation of continuous elbow joint movement based on human physiological structure. Biomed Eng Online 2019; 18:31. [PMID: 30894195 PMCID: PMC6427875 DOI: 10.1186/s12938-019-0653-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 03/15/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Human intention recognition technology plays a vital role in the application of robotic exoskeletons and powered exoskeletons. However, the precise estimation of the continuous motion of each joint represents a major challenge. In the current study, we present a method for estimating continuous elbow joint movement. Methods We developed a novel approach for estimating the elbow joint angle based on human physiological structure. We used surface electromyography signals to analyze the biomechanical properties of the muscle and combined it with physiological structure to achieve a model for estimating continuous motion. And a genetic algorithm was used to optimize unknown parameters. Results We performed extensive trials to verify the generalizability and effectiveness of this method. The trial types included elbow joint motion with single cycle trials, typical cycle trials, gradually increasing amplitude trials, and random movement trials for handheld loads of 1.25 and 2.5 kg. The results revealed that the average root-mean-square errors ranged from 0.12 to 0.26 rad, reflecting an appropriate level of estimation accuracy. Conclusion Establishing a reasonable physiological model and applying an efficient optimization algorithm enabled more accurate estimation of the joint angle. The proposed method provides a theoretical foundation for robotic exoskeletons and powered exoskeletons to understand the intentions of human continuous motion.
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Affiliation(s)
- Kexiang Li
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300130, China
| | - Jianhua Zhang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300130, China. .,State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, 110016, China.
| | - Xuan Liu
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300130, China
| | - Minglu Zhang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300130, China
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108
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Brown WE, DuRaine GD, Hu JC, Athanasiou KA. Structure-function relationships of fetal ovine articular cartilage. Acta Biomater 2019; 87:235-244. [PMID: 30716555 DOI: 10.1016/j.actbio.2019.01.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022]
Abstract
It is crucial that the properties of engineered neocartilage match healthy native cartilage to promote the functional restoration of damaged cartilage. To accurately assess the quality of neocartilage and the degree of biomimicry achieved, its properties must be evaluated against native cartilage and tissue from which the cells for neocartilage formation were sourced. Fetal ovine cartilage is a promising and translationally relevant cell source with which to engineer neocartilage, yet, it is largely non-characterized. The influence of biomechanics during cartilage development, as well as their potential impact on structure-function relationships in utero motivates additional study of fetal cartilage. Toward providing tissue engineering design criteria and elucidating structure-function relationships, 11 locations across four regions of the fetal ovine stifle were characterized. Locational and regional differences were found to exist. Although differences in GAG content were observed, compressive stiffness did not vary or correlate with any biochemical component. Patellar cartilage tensile stiffness and strength were significantly greater than those of the medial condyle. Tensile modulus and UTS significantly correlated with pyridinoline content. More advanced zonal organization, more intense collagen II staining, and greater collagen and pyridinoline contents in the trochlear groove and patella suggest these regions exhibit a more advanced maturational state than others. Regional differences in functional properties and their correlations suggest that structure-function relationships emerge in utero. These data address the dearth of information of the fetal ovine stifle, may serve as a repository of information for cartilage engineering strategies, and may help elucidate functional adaptation in fetal articular cartilage. STATEMENT OF SIGNIFICANCE: Engineered neocartilage must be evaluated against healthy native cartilage and cell source tissue to determine its quality and degree of biomimicry. While fetal ovine cartilage has emerged as a promising and translationally relevant cell source with which to engineer neocartilage, it is largely non-characterized. Therefore, 11 locations across four regions (medial condyle, lateral condyle, trochlear groove, and patella) of the fetal ovine stifle were characterized. Importantly, locational and regional differences in functional properties were observed, and significant correlations of tensile properties to collagen and crosslink contents were detected, suggesting that functional adaptation begins in utero. This study provides a repository of quantitative information, clarifies the developmental order of cartilage functional properties, and informs future cartilage engineering efforts.
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MacKoul P, Danilyants N, Sarfoh V, van der Does L, Kazi N. A Retrospective Review of Vaginal Cuff Dehiscence: Comparing Absorbable and Nonabsorbable Sutures. J Minim Invasive Gynecol 2019; 27:122-128. [PMID: 30853572 DOI: 10.1016/j.jmig.2019.03.002] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To compare the rate of spontaneous and complete vaginal cuff dehiscence (VCD) using absorbable versus nonabsorbable sutures for vaginal cuff closure. DESIGN Retrospective comparative cohort design. SETTING Freestanding ambulatory surgery center in suburban Maryland. PATIENTS Women age >18 years old who underwent hysterectomy for benign conditions between October 2013 and April 2018. INTERVENTION Laparoscopic retroperitoneal hysterectomy was performed by 2 gynecologic surgical specialists. Transvaginal cuff closure was performed using either absorbable Vicryl (polyglactin 910) sutures (n = 881) or nonabsorbable Ethibond (polyester) sutures (n = 574). The nonabsorbable sutures were surgically removed after 90 days. MEASUREMENTS AND MAIN RESULTS No statistically significant differences in age, race, weight, body mass index, parity, uterine weight, or number of comorbidities were noted between the nonabsorbable and absorbable suture groups. Spontaneous vaginal cuff dehiscence (VCD) occurred in 3 patients (0.52%) in the nonabsorbable group and in 12 patients (1.4%) in the absorbable group (p = .183). Eleven of the 12 cases of VCD in the absorbable group were precipitated by intercourse and occurred within 90 days of surgery. CONCLUSION Our data suggest that use of a nonabsorbable suture may be an effective approach to prevent spontaneous VCD, but the benefits should be weighed against the inherent risk associated with a second procedure to remove sutures.
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Xiong C, Luo J, Yin D, Zhan X, Liu H. Biomechanical Evaluation of an Anterior Upper Thoracic Plate Fixation System: An In Vitro Human Cadaveric Study. World Neurosurg 2019; 124:e503-e509. [PMID: 30611948 DOI: 10.1016/j.wneu.2018.12.121] [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: 08/24/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the biomechanical characteristics of the anterior upper thoracic plate fixation system (AUTP). METHODS Twelve specimens were divided into 2 groups: the AUTP group and the anterior cervical locking plate (ACLP) group. Bone mineral density was assessed in all specimens. The specimens were loaded with pure bending moments of ±4 Nm to move toward extension/flexion, right/left lateral tilt, and right/left axial rotation. Each specimen was tested in 3 load cycles under 3 conditions (native, destabilized, and torsion). The tightening moments were assessed in every screw using a torsion meter. RESULTS The tightening moment of the AUTP screws was more pronounced than the ACLP (P < 0.05). Significant decreases after stabilization with the AUTP compared with the native situation were observed in the AUTP group (P < 0.05). In terms of the direction of lateral tilt and torsion, the neutral zone increased significantly after stabilization with the AUTP compared with the native situation (P < 0.05). CONCLUSIONS The AUTP was shown to provide more rigidity to the destabilized spine than the ACLP.
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Affiliation(s)
- Chunxiang Xiong
- Co Culture of Post-doctoral Research Center of People's Hospital of Guangxi Zhuang Autonomous Region and Post-doctoral Mobile Station of Clinical Medicine of Shanxi Medical University, Nanning, Guangxi, People's Republic of China; Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Juli Luo
- Department of Orthopedics, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Dong Yin
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Xinli Zhan
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
| | - Huijiang Liu
- Spine Ward, First People's Hospital of Nanning, Nanning, Guangxi, People's Republic of China
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Singh R, Alzyoud J, Trickett R, Thomas P, Theobald P, Khan I. Growth Factor and Intense Pulse Light in Flexor Tendon Repair: A Biomechanical Study at Strength and Gap Resistance. J Hand Surg Asian Pac Vol 2018; 23:463-468. [PMID: 30428791 DOI: 10.1142/s2424835518500431] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND Flexor tendon injuries are extremely common and they are usually the result of incised traumatic glass or knife injury. The process of tendon healing is a complicated and exceptionally-regimented mechanism that is originated and monitored by a vast number of diverse molecules. One of the most pivotal groups of mediators that are crucial to the healing process are growth factors (GF). Intense pulse light (IPL) can lead to evidence of new collagen formation with associated clinical improvement in tissue healing. The biological benefit of Intense pulse light (IPL) relies on judicious photothermolysis, where heat driven radiation is dissipated and focused at the cellular level. The aims of this study is to set out the effect of growth factor and IPL on healing following a tendon repair. METHODS Bovine common digital extensor tendons (CDET) were used as an ex vivo model. 44 tendon repairs were performed by the lead author using 2.5 × magnification loupes and standard instruments. Clamped tendons were assigned into the following groups; control, IPL, GF, IPL and GF. After culturing, biomechanical testing was carried out using monotonic tensile testing with displacement-controlled uniaxial tension to failure. RESULTS The mean values for ultimate tensile stress (UTS) for the control group was 53.51 N, for IPL it was 51.15 N, for growth factor was 70.10 N and for combined growth factor and IPL it was 75.16 N. CONCLUSIONS This study showed significant improvement in UTS when repaired tendons were cultured with growth factor compared to control and IPL. This would suggest a biomechanical advantage for tendon healing.
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Affiliation(s)
- Rohit Singh
- * Robert Jones Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jihad Alzyoud
- † School of Biochemistry, Swansea University, Swansea, UK
| | - Ryan Trickett
- ‡ Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - Peter Thomas
- § University Hospital of North Midlands, Stoke on Trent, UK
| | - Peter Theobald
- ‖ School of Engineering, Cardiff University, Cardiff, UK
| | - Ilyas Khan
- † School of Biochemistry, Swansea University, Swansea, UK
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Mugnai R, Tarallo L, Capra F, Catani F. Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures. Orthop Traumatol Surg Res 2018; 104:877-882. [PMID: 29807189 DOI: 10.1016/j.otsr.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/02/2017] [Revised: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. HYPOTHESIS Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. MATERIALS AND METHODS Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. RESULTS The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (-16%) for the titanium plate. Statistical analysis between groups reported significant values (p<001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p=.197). DISCUSSION The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Raffaele Mugnai
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy.
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
| | | | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
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113
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Tanoğlu O, Alemdaroğlu KB, İltar S, Özmeriç A, Demir T, Erbay FK. Biomechanical comparison of three different fixation techniques for anterior column posterior hemitransverse acetabular fractures using anterior intrapelvic approach. Injury 2018; 49:1513-1519. [PMID: 29934096 DOI: 10.1016/j.injury.2018.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/21/2018] [Revised: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to biomechanically compare three different fixation methods for the fixation of anterior column posterior hemitransverse type acetabular fracture (ACPHT). METHODS ACPHT fracture models were created on twenty-four foam cortical shell artificial hemipelvis models. Three fixation methods were assessed - Group 1: posterior column lag screws over a suprapectineal plate; Group 2: Posterior column lag screws over a suprapectineal plate and an infrapectineal plate; Group 3: A suprapectineal plate and a vertical infrapectineal plate. Stiffness and displacement amounts of fixation methods under dynamic and static axial loading conditions were measured. RESULTS In the dynamic and static tests, Group 3 showed the less stable fixation compared to Group 2. There was no statistically significant difference between the stiffness values of the fixation groups. In the static tests, there was no statistically significant difference between Group 1 and 2, although less displacements were obtained in Group 2. CONCLUSIONS A combination of posterior lag screws over a suprapectineal plate and an infrapectineal plate supporting the pelvic brim along both sides of the linea terminalis resulted in a better fixation construct than a suprapectineal plate accompanying with a vertical infrapectineal plate provide better stability with less fracture displacement.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Erzincan University Mengücek Gazi Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | | | - Serkan İltar
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Ahmet Özmeriç
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Teyfik Demir
- TOBB Economics and Technology University, Mechanical Engineering Department, Turkey
| | - Fatma Kübra Erbay
- TOBB Economics and Technology University, Micro-Nanotechnology Programme, Turkey
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Abstract
Background Numerous reports have shown that rigid spinal fixation contributes to a series of unwanted complications in lumbar fusion procedure. This innovative micro-dynamic pedicle screw study was designed to investigate the biomechanical performance of lumbar implants using numerical simulation technique and biomechanical experiment. Methods Instrumented finite element models of three configurations (dynamic fixation, rigid fixation and hybrid fixation) using a functional L3-L4 lumbar unit were developed, to compare the range of motion of the lumbar spine and stress values on the endplate and implants. An in vitro experiment was simultaneously conducted using 18 intact porcine lumbar spines and segmental motion analyses were performed as well. Results Simulation results indicated that the dynamic fixation and the hybrid fixation models respectively increased the range of motion of the lumbar spine by 95 and 60% in flexion and by 83 and 55% in extension, compared with the rigid fixation model. The use of micro-dynamic pedicle screw led to higher stress on endplates and lower stress on pedicle screws. The outcome of the in vitro experiment demonstrated that the micro-dynamic pedicle screw could provide better range of motion at the instrumented segments than a rigid fixation. Conclusion The micro-dynamic pedicle screw has the advantage of providing better range of motion than conventional pedicle screw in flexion-extension, without compromising stabilization, and has the potential of bringing the load transfer behavior of fusional segment closer to normal and also lowers the stress values of pedicle screws.
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Affiliation(s)
- Chuang Liu
- School of Mechanical Engineering & Automation, Northeastern University, Shenyang, Liaoning, 110819, People's Republic of China.
| | - Allieu Kamara
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning Province, People's Republic of China
| | - Yunhui Yan
- School of Mechanical Engineering & Automation, Northeastern University, Shenyang, Liaoning, 110819, People's Republic of China
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115
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Feng S, Zhou L, Zhang Y, Lü S, Long M. Mechanochemical modeling of neutrophil migration based on four signaling layers, integrin dynamics, and substrate stiffness. Biomech Model Mechanobiol 2018; 17:1611-1630. [PMID: 29968162 DOI: 10.1007/s10237-018-1047-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/21/2018] [Accepted: 06/24/2018] [Indexed: 01/09/2023]
Abstract
Directional neutrophil migration during human immune responses is a highly coordinated process regulated by both biochemical and biomechanical environments. In this paper, we developed an integrative mathematical model of neutrophil migration using a lattice Boltzmann-particle method built in-house to solve the moving boundary problem with spatiotemporal regulation of biochemical components. The mechanical features of the cell cortex are modeled by a series of spring-connected nodes representing discrete cell-substrate adhesive sites. The intracellular signaling cascades responsible for cytoskeletal remodeling [e.g., small GTPases, phosphoinositide-3-kinase (PI3K), and phosphatase and tensin homolog] are built based on our previous four-layered signaling model centered on the bidirectional molecular transport mechanism and implemented as reaction-diffusion equations. Focal adhesion dynamics are determined by force-dependent integrin-ligand binding kinetics and integrin recycling and are thus integrated with cell motion. Using numerical simulations, the model reproduces the major features of cell migration in response to uniform and gradient biochemical stimuli based on the quantitative spatiotemporal regulation of signaling molecules, which agree with experimental observations. The existence of multiple types of integrins with different binding kinetics could act as an adaptation mechanism for substrate stiffness. Moreover, cells can perform reversal, U-turn, or lock-on behaviors depending on the steepness of the reversal biochemical signals received. Finally, this model is also applied to predict the responses of mutants in which PTEN is overexpressed or disrupted.
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Affiliation(s)
- Shiliang Feng
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory), and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, China
| | - Lüwen Zhou
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory), and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory), and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, China
| | - Shouqin Lü
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory), and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, China
| | - Mian Long
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory), and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China.
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, China.
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116
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Hewett TE, Myer GD. Mapping current research trends on anterior cruciate ligament injury risk against the existing evidence: In vivo biomechanical risk factors - A Letter to the Editor. Clin Biomech (Bristol, Avon) 2018; 56:92-93. [PMID: 27717510 PMCID: PMC6590683 DOI: 10.1016/j.clinbiomech.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Timothy E Hewett
- Mayo Clinic, 200 First Street SW; RO_Gu_01_28BIOM; Rochester, MN 55905 United States.
| | - Gregory D Myer
- Cincinnati Children's Hospital, 3333 Burnet Avenue MLC 10001 Cincinnati, OH 45229-3039, United States
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117
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Hulsmans MH, van Heijl M, Houwert RM, Burger BJ, Verleisdonk EJM, Veeger DJ, van der Meijden OA. Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies. Injury 2018. [PMID: 29523350 DOI: 10.1016/j.injury.2018.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/02/2023]
Abstract
PURPOSE Surgical treatment of displaced midshaft clavicle fractures requires a decision between plate fixation and intramedullary (IM) fixation. Numerous studies report on the biomechanical properties of various repair constructs. The goal of this systematic review was to provide an overview of studies describing the biomechanical properties of the most commonly used surgical fixations of midshaft clavicle fractures. Additionally, we aimed to translate these biomechanical results into clinically relevant conclusions. METHODS A computer-aided search of the EMBASE and PudMed/MEDLINE databases was conducted. Studies included for review compared biomechanical properties of plate fixation with IM fixation and superiorly positioned plates with anteroinferiorly positioned plates for midshaft clavicle fractures. RESULTS Fifteen studies were eligible for inclusion. Plate fixation seemed to form a more robust construct than IM fixation in terms of stiffness and failure loading. The remaining clavicle was stronger after removal of the IM device than after removal of the plate. Superior plating of transverse fractures generally seemed to provide greater stiffness and strength during bending loads than anteroinferior plating did. The absence of cortical alignment in wedge and comminuted fractures directly influenced the fixation stability for both IM fixation and plate fixation, regardless of location. CONCLUSION Each type of fracture fixation has biomechanical advantages and disadvantages. However, exact thresholds of stiffness for inducing healing and failure strength to withstand refractures are unknown. The clinical relevance of the biomechanical studies may be arguable. Since none of the studies investigate the effect of tissue adaptation over time they should be interpreted with caution.
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Affiliation(s)
- Martijn H Hulsmans
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Roderick M Houwert
- Utrecht Traumacenter, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart J Burger
- Department of Orthopaedic Surgery/Centre for Orthopaedic Research Alkmaar (CORAL), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Egbert Jan M Verleisdonk
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
| | - Dirk Jan Veeger
- MOVE Research Institute, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Olivier A van der Meijden
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands; Department of Orthopaedic Surgery/Centre for Orthopaedic Research Alkmaar (CORAL), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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118
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Matthai T, George VM, Rao AS, Oommen AT, Korula RJ, Devasahayam S, Poonnoose PM. Biomechanical assessment of an alternative method of staple fixation for anchoring the Bone Patellar Tendon Bone graft to the tibia. J Clin Orthop Trauma 2018; 9:157-162. [PMID: 29896020 PMCID: PMC5995006 DOI: 10.1016/j.jcot.2017.04.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The Anterior cruciate ligament (ACL) is the most commonly injured ligament around the knee and is best reconstructed with a biological graft. For ideal graft fixation, there should be sufficient initial strength to avoid failure of fixation and sufficient stiffness to restore the stability of the knee and to avoid gradual loosening in the post-operative period.When considering fixation of Bone Patellar Tendon Bone (BPTB) grafts to the tibia, the interference screw is considered to be the gold standard. As an alternative, we have used of staples and stainless steel (SS) wire to anchor the BPTB graft to the tibia and femur. The aim of this study was to assess the biomechanical efficacy of this fixation technique for anchoring the BPTB graft to the proximal tibia. We used a bovine model to compare three fixation techniques -interference screw, braided polyester sutures tied to a screw post and SS wire tied to a staple. MATERIALS AND METHODS Fifteen fresh bovine knees specimens were used for the study. The patella was fixed to a load cell and the construct was pre-tensioned to 40N to allow for creep of the tendon. The BPTB graft was fixed to the tibia using the three fixation techniques - the interference screw, polyester suture tied to a post, and SS wire anchored to a staple. After fixation, the graft was subjected to a single load to failure test, and the forces generated were recorded. The ultimate failure load (the pullout strength), stiffness, and mode of failure were noted. RESULTS In the single load-to-failure biomechanical testing, the ultimate failure load and stiffness for Staple with SS wire were 726.40N and 61.9N/mm respectively. For the screw post and polyester suture, it was 733.20N and 53.22N/mm, and for Interference screw - 594.00N and 79.50 N/mm respectively. There was no statistically significant difference in the stiffness or ultimate failure load between the three fixation techniques. The graft fixation using interference screws failed at the bone- tunnel interface by slippage of the bone block from the tunnel in all 5 specimens. In all 5 of the specimens fixed with polyester suture and the screw post, the fixation failed when the polyester suture snapped. When the SS wire and staple construct was stressed, the graft failed as the SS wire cut through the graft in 4 specimens, and in the fifth construct, the knot over the staple unraveled as the load was applied. CONCLUSION The biomechanical properties of BPTB graft fixation with SS wire tied to a staple is similar to that of other fixation devices like the interference screw and suture post. This technique provides a simple, yet effective fixation for the graft - but needs further clinical assessment.
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Affiliation(s)
- Thomas Matthai
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Vinu M. George
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anbu S. Rao
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anil T. Oommen
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Ravi J. Korula
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Suresh Devasahayam
- Department of Biomedical Engineering, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Pradeep M. Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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119
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Louati H, Uhthoff HK, Culliton K, Laneuville O, Lapner P, Trudel G. Supraspinatus tendon repair using anchors: a biomechanical evaluation in the rabbit. J Orthop Surg Res 2018; 13:64. [PMID: 29587870 PMCID: PMC5870745 DOI: 10.1186/s13018-018-0773-6] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/15/2018] [Indexed: 01/06/2023] Open
Abstract
Background Arthroscopic rotator cuff repairs are mostly secured with suture anchors and often supplemented by footprint decortication. The objectives of this study were to characterize the strength of bone–tendon healing following anchor repair and assess the effect of channeling the supraspinatus (SSP) humeral footprint 1 week ahead of reattachment surgery. Methods One hundred twelve rabbits underwent unilateral detachment of one SSP tendon and were randomly assigned to two groups: channeling the footprint at time of detachment and no channeling. One week later, reattachment was performed using an anchor. The repaired and contralateral shoulders were harvested at 0, 1, 2, or 4 weeks after repair and mechanically tested to failure. Outcome measures included load at failure, stiffness, and site of failure. Results Anchor fixation had a mean load at failure of 81 ± 32 N and a stiffness of 27 ± 9 N/mm immediately after repair compared to 166 ± 47 N and 66 ± 13 N/mm in the contralateral (both p < 0.05). Mechanical recovery of the reattached SSP tendon was achieved after 4 weeks (221 ± 73 N, 206 ± 59 N, and 198 ± 49 N in the channeling, no channeling, and contralateral groups, respectively, p > 0.05). The dominant site of failure shifted from the footprint at 0/1 week to bone avulsion/mid-substance tear at 4 weeks (p < 0.05). There were no differences in outcomes between the channeling and no channeling groups. Conclusions This study is the first of its kind to provide quantitative data on the mechanical properties of the enthesis following anchor repair in a rabbit model. Anchor repair led to rapid and complete restoration of SSP mechanical properties. Further evidence is needed before recommending channeling ahead of repair surgery.
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Affiliation(s)
- Hakim Louati
- Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Canada
| | - Hans K Uhthoff
- Bone and Joint Research Laboratory and Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Kathryn Culliton
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | | | - Peter Lapner
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Guy Trudel
- Bone and Joint Research Laboratory, Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, Canada. .,Division of Physical Medicine and Rehabilitation, The Ottawa Hospital Rehabilitation Centre, 505 Smyth Rd., Ottawa, ON, K1H 8M2, Canada.
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120
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Robinson S, Krigbaum H, Kramer J, Purviance C, Parrish R, Donahue J. Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique. J Orthop 2018; 15:426-431. [PMID: 29881170 DOI: 10.1016/j.jor.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques. Methods Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated. Results The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques. Conclusions This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting. Level of Evidence Basic science biomechanical study.
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Affiliation(s)
- Sean Robinson
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | - Jon Kramer
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
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121
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Dou N, Lehrman JN, Newcomb AGUS, Kelly BP. A Novel C2 Screw Trajectory: Preliminary Anatomic Feasibility and Biomechanical Comparison. World Neurosurg 2018; 113:e93-e100. [PMID: 29408275 DOI: 10.1016/j.wneu.2018.01.177] [Citation(s) in RCA: 8] [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: 11/02/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pedicle screw and translaminar screw fixation in C2 may not be applicable in many patients with anatomic abnormalities or narrow laminar thickness and spinous process height. The aim of this study was to assess morphometric and mechanical feasibilities of a novel alternative screw trajectory that pierces the bifid base of C2. METHODS Anatomic measurements that determined the feasibility of spinous process bifid base (SPB) screw fixation were assessed in 14 cadaveric C2 vertebrae. Pullout tests to assess ultimate fixation strength for 3 screw trajectories (transpedicular, translaminar, and SPB) were performed in cadaveric vertebrae for comparison. RESULTS Anatomic measurements included mean spinous process height (10.4 ± 4.2 mm) and mean bilateral bifid base length (10.1 ± 2.2 mm) and thickness (left, 4.4 ± 1.0 mm; right, 4.3 ± 0.9 mm). In 64% (9/14) of specimens, bifid base length was ≥9 mm. Mean pullout strength for transpedicle, translaminar, and SPB screws in 9 viable specimens was 648 ± 305 N, 628 ± 417 N, and 755 ± 279 N. CONCLUSIONS SPB screw fixation may be viable anatomically and mechanically for C2 fixation. Feasibility of SPB screw fixation is determined by length, thickness, and mutual angle of the bilateral bifid bases. Patients with thin (<4 mm) and short (<9 mm) bifid bases are not likely to be suitable candidates. SPB screw fixation shows potential as an alternative approach or a salvage technique for patients with high-riding vertebral arteries or severely thin C2 lamina and warrants further investigation.
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Affiliation(s)
- NingNing Dou
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jennifer N Lehrman
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anna G U S Newcomb
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Brian P Kelly
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Anwar A, Zhang Z, Lv D, Lv G, Zhao Z, Wang Y, Cai Y, Qasim W, Nazir MU, Lu M. Biomechanical efficacy of AP, PA lag screws and posterior plating for fixation of posterior malleolar fractures: a three dimensional finite element study. BMC Musculoskelet Disord 2018; 19:73. [PMID: 29510693 PMCID: PMC5840778 DOI: 10.1186/s12891-018-1989-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 01/19/2017] [Accepted: 02/23/2018] [Indexed: 01/29/2023] Open
Abstract
Background Clinically there are different fixation methods used for fixation of the posterior malleolar fractures (PMF), but the best treatment modality is still not clear. Few studies have concentrated on this issue, least of all using a biomechanical comparison. The purpose of this study was to carry out a computational comparative biomechanics of three different commonly used fixation constructs for the fixation of PMF by finite element analysis (FEA). Methods Computed tomography (CT) images were used to reconstruct three dimensional (3D) model of the tibia. Computer aided design (CAD) software was used to design 3D models of PMF. Finally, 3D models of PMF fixed with two antero-posterior (AP) lag screws, two postero-anterior (PA) lag screws and posterior plate were simulated through computational processing. Simulated loads of 500 N, 1000 N and 1500 N were applied to the PMF and proximal ends of the models were fixed in all degrees of freedom. Output results representing the model von Mises stress, relative fracture micro-motion and vertical displacement of the fracture fragment were analyzed. Results The mean vertical displacement value in the posterior plate group (0.52 mm) was lower than AP (0.68 mm) and PA (0.69 mm) lag groups. Statistically significant low amount of the relative micro-motion (P < 0.05) was observed in the posterior plate group. Conclusions It was concluded that the posterior plate is biomechanically the most stable fixation method for fixation of PMF.
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Affiliation(s)
- Adeel Anwar
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, 116011, Dalian, Liaoning, People's Republic of China
| | - Zhen Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, 116011, Dalian, Liaoning, People's Republic of China.
| | - Decheng Lv
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, 116011, Dalian, Liaoning, People's Republic of China.
| | - Gang Lv
- Department of Orthopaedic Surgery, The First Affiliated Hospital of China Medical University, 155 Nanjing north street, 110001, Shenyang, Liaoning, People's Republic of China
| | - Zhi Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Dalian Medical University, 456 Zhongshan road, 116027, Dalian, Liaoning, People's Republic of China
| | - Yanfeng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of China Medical University, 155 Nanjing north street, 110001, Shenyang, Liaoning, People's Republic of China
| | - Yue Cai
- Department of Automation, School of Electrical Engineering, Dalian Jiaotong University, 794 Huanghe road, 116028, Dalian, Liaoning, People's Republic of China
| | - Wasim Qasim
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, 456 Zhongshan road, 116027, Dalian, Liaoning, People's Republic of China
| | - Muhammad Umar Nazir
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, 456 Zhongshan road, 116027, Dalian, Liaoning, People's Republic of China
| | - Ming Lu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, 116011, Dalian, Liaoning, People's Republic of China
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Mandell D, Karbassi J, Zhou H, Burroughs B, Aurigemma P, Patel AR. A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion: A biomechanical comparison. Foot (Edinb) 2018; 34:69-73. [PMID: 29353123 DOI: 10.1016/j.foot.2017.11.001] [Citation(s) in RCA: 3] [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: 06/27/2016] [Revised: 02/09/2017] [Accepted: 11/01/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The treatment of end-stage first metatarso-phalangeal joint (MTP) arthritis has been arthrodesis. A dorsal non-locking plate with a lag screw has been the standard traditional fixation method. This study compares the biomechanical strength of a locking compression plate (LCP) with and without internal compression versus this known gold standard. METHODS In group 1, six matched pairs of cadaver great toes were used to compare the standard non-locking dorsal plate and 3.5mm lag screw to an anatomic locking compression plate in which a lag screw was utilized rather than the internal compression features of the plate. In group 2, another six matched pairs of cadaver great toes were used to compare the gold standard to the locking compression plate, utilizing the plate's internal compression feature instead of a lag screw. A material testing system (MTS) machine applied loads to the MTP joints and measured displacement and stiffness of the constructs. The stiffness of the constructs (Young's modulus) was calculated from the force-displacement curves, and the displacement was measured. RESULTS The locking compression plate group that used the compression features of the plate, without the lag screw, had less joint displacement and higher stiffness than control (p<0.05). The same plating construct in which a lag screw was used rather than internal compression of the plate was found to be stiffer than the control (p<0.05), but displacement was not statistically significant. DISCUSSION The results suggest that a locking compression plate alone provides the stiffest construct for a first MTP joint fusion.
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Affiliation(s)
- Daniel Mandell
- University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - John Karbassi
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Hanbing Zhou
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Brian Burroughs
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Philip Aurigemma
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Abhay R Patel
- University of Massachusetts Medical School, Worcester, MA 01655, USA
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Abstract
Different types of intraosseous suture anchors can be used for thumb ulnar collateral ligament (UCL) repair surgery. Some of them have already been tested biomechanically in intact bone; however, there exists little knowledge of their stability when implanted in avulsion fracture. In this biomechanical in vitro study, three anchor types (hard, soft and novel BoneWelding) were tested on 24 fresh frozen human thumbs from 12 body donors. After the repair of an iatrogenic ligamentous UCL rupture, the thumbs were cyclically loaded. A new set of anchors was implanted at the contralateral radial side of the same specimen into an iatrogenic avulsion fracture and pulled out of the bone. The most common mode of failure in ligamentous UCL repairs was the suture-ligament interface, especially when using soft anchors. In avulsion fractures, the novel anchor withstood significantly higher pullout forces than the hard or soft anchor (65 N vs. 42 N vs. 27 N; p = .006). The BW anchor provides sufficient anchorage in trabecular bone for UCL repair in case of avulsion fractures.
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Affiliation(s)
- M Wagner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - W Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - R Arora
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Duff J, Hussain MM, Klocke N, Harris JA, Yandamuri SS, Bobinski L, Daniel RT, Bucklen BS. Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? An in vitro biomechanical study. Clin Biomech (Bristol, Avon) 2018; 53:72-78. [PMID: 29455101 DOI: 10.1016/j.clinbiomech.2018.02.009] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical vertebral body fractures generally are treated through an anterior-posterior approach. Cervical pedicle screws offer an alternative to circumferential fixation. This biomechanical study quantifies whether cervical pedicle screws alone can restore the stability of a three-column vertebral body fracture, making standard 360° reconstruction unnecessary. METHODS Range of motion (2.0 Nm) in flexion-extension, lateral bending, and axial rotation was tested on 10 cadaveric specimens (five/group) at C2-T1 with a spine kinematics simulator. Specimens were tested for flexibility of intact when a fatigue protocol with instrumentation was used to evaluate construct longevity. For a C4-6 fracture, spines were instrumented with 360° reconstruction (corpectomy spacer + plate + lateral mass screws) (Group 1) or cervical pedicle screw reconstruction (C3 and C7 only) (Group 2). FINDINGS Results are expressed as percentage of intact (100%). In Group 1, 360° reconstruction resulted in decreased motion during flexion-extension, lateral bending, and axial rotation, to 21.5%, 14.1%, and 48.6%, respectively, following 18,000 cycles of flexion-extension testing. In Group 2, cervical pedicle screw reconstruction led to reduced motion after cyclic flexion-extension testing, to 38.4%, 12.3%, and 51.1% during flexion-extension, lateral bending, and axial rotation, respectively. INTERPRETATION The 360° stabilization procedure provided the greatest initial stability. Cervical pedicle screw reconstruction resulted in less change in motion following cyclic loading with less variation from specimen to specimen, possibly caused by loosening of the shorter lateral mass screws. Cervical pedicle screw stabilization may be a viable alternative to 360° reconstruction for restoring multilevel vertebral body fracture.
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Affiliation(s)
- John Duff
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Mir M Hussain
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Noelle Klocke
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Soumya S Yandamuri
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
| | - Lukas Bobinski
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Roy T Daniel
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., Audubon, PA, USA.
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Beutel BG, Ayalon O, Kennedy OD, Lendhey M, Capo JT, Melamed E. Crossed K-Wires Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Neck Fractures: A Biomechanical Study. Iowa Orthop J 2018; 38:153-157. [PMID: 30104939 PMCID: PMC6047383] [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] [Indexed: 06/08/2023]
Abstract
BACKGROUND Intramedullary headless screw (IMHS) has shown promise as an alternative to other fixation devices for metacarpal neck fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus the commonly-used crossed K-wire technique. We hypothesized that IMHS fixation provides superior stability to K-wires. METHODS A metacarpal neck fracture model in 23 human cadaveric metacarpals was created. The specimens were divided into two groups based upon fixation method: Group 1, 3 mm intramedullary headless screw; and Group 2, 0.045 inch crossed K-wires. A cantilever bending model was used to assess load-to-failure (LTF), maximum displacement, energy absorption, and stiffness. RESULTS The mean LTF was 70.6 ± 30.1 N for IMHS and 97.5 ± 34.7 N for crossed K-wires. Mean stiffness was 11.3 ± 3.4 N/mm and 17.7 ± 7.8 N/mm for IMHS and crossed K-wires, respectively. The mean maximum displacement was 20.2 ± 4.6 mm for IMHS and 24.1 ± 3.7 mm for crossed K-wires. Moreover, mean energy absorption was 778.3 ± 528.9 Nmm and 1095.9 ± 454.4 Nmm, respectively, for IMHS and crossed K-wires. Crossed K-wires demonstrated significantly higher stiffness and maximum displacement than IMHS (p < 0.05). CONCLUSIONS IMHS fixation of unstable metacarpal neck fractures offers less stability compared to crossed K-wires when loaded in bending. CLINICAL RELEVANCE Crossed K-wires offer superior stability for the treatment of metacarpal neck fractures. These results reveal that IMHS fixation is less favorable biomechanically and should be cautiously selected with regards to fracture stability.
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Affiliation(s)
- Bryan G Beutel
- The Hand Surgery Center, Mount Sinai Beth Israel, New York, NY
| | - Omri Ayalon
- Division of Hand Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Oran D Kennedy
- Royal College of Surgeons in Ireland, Trinity College, Dublin, Ireland
| | - Matin Lendhey
- Musculoskeletal Research Center, NYU Langone Orthopedic Hospital, New York, NY
| | - John T Capo
- Department of Orthopaedics, Jersey City Medical Center, Jersey City, NJ
| | - Eitan Melamed
- Division of Hand Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Valentim DP, Sato TO, Comper MLC, Silva AMD, Boas CV, Padula RS. Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). Braz J Phys Ther 2018; 22:198-204. [PMID: 29246454 DOI: 10.1016/j.bjpt.2017.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 02/18/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are very few observational methods for analysis of biomechanical exposure available in Brazilian-Portuguese. OBJECTIVE This study aimed to cross-culturally adapt and test the measurement properties of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). METHODS The cross-cultural adaptation and measurement properties test were established according to Beaton et al. and COSMIN guidelines, respectively. Several tasks that required static posture and/or repetitive motion of upper limbs were evaluated (n>100). RESULTS The intra-raters' reliability for the RULA ranged from poor to almost perfect (k: 0.00-0.93), and SI from poor to excellent (ICC2.1: 0.05-0.99). The inter-raters' reliability was very poor for RULA (k: -0.12 to 0.13) and ranged from very poor to moderate for SI (ICC2.1: 0.00-0.53). The agreement was good for RULA (75-100% intra-raters, and 42.24-100% inter-raters) and to SI (EPM: -1.03% to 1.97%; intra-raters, and -0.17% to 1.51% inter-raters). The internal consistency was appropriate for RULA (α=0.88), and low for SI (α=0.65). Moderate construct validity were observed between RULA and SI, in wrist/hand-wrist posture (rho: 0.61) and strength/intensity of exertion (rho: 0.39). CONCLUSION The adapted versions of the RULA and SI presented semantic and cultural equivalence for the Brazilian Portuguese. The RULA and SI had reliability estimates ranged from very poor to almost perfect. The internal consistency for RULA was better than the SI. The correlation between methods was moderate only of muscle request/movement repetition. Previous training is mandatory to use of observations methods for biomechanical exposure assessment, although it does not guarantee good reproducibility of these measures.
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McGrath DJ, Thiebes AL, Cornelissen CG, O'Brien B, Jockenhoevel S, Bruzzi M, McHugh PE. Evaluating the interaction of a tracheobronchial stent in an ovine in-vivo model. Biomech Model Mechanobiol 2017; 17:499-516. [PMID: 29177931 DOI: 10.1007/s10237-017-0974-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/28/2017] [Indexed: 12/19/2022]
Abstract
Tracheobronchial stents are used to restore patency to stenosed airways. However, these devices are associated with many complications such as stent migration, granulation tissue formation, mucous plugging and stent strut fracture. Of these, granulation tissue formation is the complication that most frequently requires costly secondary interventions. In this study a biomechanical lung modelling framework recently developed by the authors to capture the lung in-vivo stress state under physiological loading is employed in conjunction with ovine pre-clinical stenting results and device experimental data to evaluate the effect of stent interaction on granulation tissue formation. Stenting is simulated using a validated model of a prototype covered laser-cut tracheobronchial stent in a semi-specific biomechanical lung model, and physiological loading is performed. Two computational methods are then used to predict possible granulation tissue formation: the standard method which utilises the increase in maximum principal stress change, and a newly proposed method which compares the change in contact pressure over a respiratory cycle. These computational predictions of granulation tissue formation are then compared to pre-clinical stenting observations after a 6-week implantation period. Experimental results of the pre-clinical stent implantation showed signs of granulation tissue formation both proximally and distally, with a greater proximal reaction. The standard method failed to show a correlation with the experimental results. However, the contact change method showed an apparent correlation with granulation tissue formation. These results suggest that this new method could be used as a tool to improve future device designs.
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Affiliation(s)
- Donnacha J McGrath
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Anja Lena Thiebes
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Christian G Cornelissen
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany.,Department for Internal Medicine - Section for Pneumology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Barry O'Brien
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Mark Bruzzi
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Peter E McHugh
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland.
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Aldebeyan W, Liddell A, Steffen T, Beckman L, Martineau PA. Proximal tibial fracture following anterior cruciate ligament reconstruction surgery: a biomechanical analysis of the tibial tunnel as a stress riser. Knee Surg Sports Traumatol Arthrosc 2017; 25:2397-404. [PMID: 26467809 DOI: 10.1007/s00167-015-3826-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/24/2014] [Accepted: 09/29/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE This is the first biomechanical study to examine the potential stress riser effect of the tibial tunnel or tunnels after ACL reconstruction surgery. In keeping with literature, the primary hypothesis tested in this study was that the tibial tunnel acts as a stress riser for fracture propagation. Secondary hypotheses were that the stress riser effect increases with the size of the tunnel (8 vs. 10 mm), the orientation of the tunnel [standard (STT) vs. modified transtibial (MTT)], and with the number of tunnels (1 vs. 2). METHODS Tibial tunnels simulating both single bundle hamstring graft (8 mm) and bone-patellar tendon-bone graft (10 mm) either STT or MTT position, as well as tunnels simulating double bundle (DB) ACL reconstruction (7, 6 mm), were drilled in fourth-generation saw bones. These five experimental groups and a control group consisting of native saw bones without tunnels were loaded to failure on a Materials Testing System to simulate tibial plateau fracture. RESULTS There were no statistically significant differences in peak load to failure between any of the groups, including the control group. The fracture occurred through the tibial tunnel in 100 % of the MTT tunnels (8 and 10 mm) and 80 % of the DB tunnels specimens; however, the fractures never (0 %) occurred through the tibial tunnel of the standard tunnels (8 or 10 mm) (P = 0.032). CONCLUSIONS In the biomechanical model, the tibial tunnel does not appear to be a stress riser for fracture propagation, despite suggestions to the contrary in the literature. Use of a standard, more vertical tunnel decreases the risk of ACL graft compromise in the event of a fracture. This may help to inform surgical decision making on ACL reconstruction technique.
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Lorbach O, Haupert A, Efe T, Pizanis A, Weyers I, Kohn D, Kieb M. Biomechanical evaluation of MPFL reconstructions: differences in dynamic contact pressure between gracilis and fascia lata graft. Knee Surg Sports Traumatol Arthrosc 2017; 25:2502-2510. [PMID: 26820966 DOI: 10.1007/s00167-016-4005-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/09/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the knee kinematics of the intact, MPFL-ruptured and MPFL-reconstructed knee and, moreover, to compare dynamic patellofemoral contact pressure of the gracilis tendon and the fascia lata as an alternative graft option for reconstruction of the MPFL. METHODS Eight paired human cadaveric knees were fixed in a custom-made fixation device. Patellofemoral contact pressure was assessed during a dynamic flexion movement at 15°-30°-45°-60°-75° and 90° using a pressure-sensitive film (Tekscan). The medial patellofemoral ligament was cut, and measurements were repeated. Finally, reconstruction of the MPFL was performed using the gracilis tendon (group I) or a fascia lata graft (group II). Tunnel localization was performed under fluoroscopic control. Grafts were fixed at 30° of flexion, and pressure measurements were repeated. RESULTS Incision of the medial patellofemoral ligament significantly reduced patellofemoral contact pressure at 15°, 30° and 45° of knee flexion compared to the intact knee (p < 0.05), whereas reconstruction of the MPFL using either gracilis tendon of the fascia lata was able to restore pressure distributions at 15° and 30° of knee flexion. However, in the hamstring group, reconstruction of the MPFL revealed a significantly reduced contact pressure at 45° of flexion (p = 0.038) compared to the intact knee. In the fascia lata group, a significant reduction in patellofemoral contact pressure was observed after MPFL reconstruction at 45°, 60°, 75° and 90° of knee flexion (p < 0.05). CONCLUSIONS Anatomic reconstruction of the MPFL with either a gracilis or a fascia lata graft showed comparable patellofemoral pressure distributions which were closely restored compared to the native knee. Therefore, the fascia lata has shown to be a viable alternative to the gracilis tendon for reconstruction of the MPFL. However, anatomic reconstruction of the MPFL may lead to persistently altered patellofemoral contact pressure during knee flexion compared to the native knee independent of the tested graft.
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Affiliation(s)
- Olaf Lorbach
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany.
| | - Alexander Haupert
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Turgay Efe
- Department of Orthopaedic Surgery, Marburg University, Marburg, Germany
| | - Antonius Pizanis
- Department of Trauma-Hand and Reconstructive Surgery, Saarland University, Homburg (Saar), Germany
| | - Imke Weyers
- Institute of Anatomy, Lübeck University, Lübeck, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Matthias Kieb
- Department of Orthopaedic and Trauma Surgery, Klinikum Ernst von Bergmann, Potsdam/Bad Belzig, Germany
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Carmont MR, Kuiper JH, Grävare Silbernagel K, Karlsson J, Nilsson-Helander K. Tendon end separation with loading in an Achilles tendon repair model: comparison of non-absorbable vs. absorbable sutures. J Exp Orthop 2017; 4:26. [PMID: 28733950 PMCID: PMC5520830 DOI: 10.1186/s40634-017-0101-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/28/2017] [Accepted: 07/14/2017] [Indexed: 12/28/2022] Open
Abstract
Background Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was performed to determine differences in initial separation, strength and failure characteristics of differing sutures and numbers of core strands in a percutaneous Achilles tendon repair model in response to initial loading. Methods Nineteen bovine Achilles tendons were repaired using a percutaneous/minimally invasive technique with a combination of a modified Bunnell suture proximally and a Kessler suture distally, using non-absorbable 4-strand 6-strand repairs and absorbable 8-strand sutures. Specimens were then cyclically loaded using phases of 10 cycles of 100 N, 100 cycles of 100 N, 100 cycles of 190 N consistent with early range of motion training and weight-bearing, before being loaded to failure. Results Pre-conditioning of 10 cycles of 100 N resulted in separations of 4 mm for 6-strand, 5.9 mm for 4-strand, but 11.5 mm in 8-strand repairs, this comprised 48.5, 68.6 and 72.7% of the separation that occurred after 100 cycles of 100 N. The tendon separation after the third phase of 100 cycles of 190 N was 17.4 mm for 4-strand repairs, 16.6 mm for 6-strand repairs and 26.6 mm for 8-strand repairs. There were significant differences between the groups (p < 0.0001). Four and six strand non-absorbable repairs had significantly less separation than 8-strand absorbable repairs (p = 0.017 and p = 0.04 respectively). The mean (SEM) ultimate tensile strengths were 4-strand 464.8 N (27.4), 6-strand 543.5 N (49.6) and 8-strand 422.1 N (80.5). Regression analysis reveals no significant difference between the overall strength of the 3 repair models (p = 0.32) (4 vs. 6: p = 0.30, 4 vs. 8: p = 0.87; 6 vs. 8: p = 0.39). The most common mode of failure was pull out of the Kessler suture from the distal stump in 41.7% of specimens. Conclusion The use of a non-absorbable suture resulted in less end-to-end separation when compared to absorbable sutures when an Achilles tendon repair model was subject to cyclical loading. Ultimate failure occurred more commonly at the distal Kessler suture end although this occurred with separations in excess of clinical failure. The effect of early movement and loading on the Achilles tendon is not fully understood and requires more research.
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Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital, Telford, UK. .,Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Jan Herman Kuiper
- Department of Biomechanical Engineering, The Robert Jones & Agnes Hunt District General Hospital, University of Keele, Keele, UK
| | | | - Jón Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedic Surgery, Kungsbacka Hospital, Kungsbacka, Sweden
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Abstract
In this article, I shall outline some of the most important aspects of the evidentiary basis of the so-called Kriz model for the development of glomerular sclerosis, a model that we continue to modify to this day. In my mind, the most important findings include the fact that podocytes are generally post-mitotic cells, so that loss of a significant number for any cause leads to podocyte insufficiency. Another pivotal finding is that in many experimental models and in human disease, podocytes detach from the GBM as living cells. These facts, together with biomechanical deduction, have led to the ongoing evolution of the original Heidelberg model.
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133
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Shuttlewood K, Beazley J, Smith CD. Distal triceps injuries (including snapping triceps): A systematic review of the literature. World J Orthop 2017; 8:507-513. [PMID: 28660143 PMCID: PMC5478494 DOI: 10.5312/wjo.v8.i6.507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.
METHODS We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.
RESULTS Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4th-5th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.
CONCLUSION Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.
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Riedl M, Glisson RR, Matsumoto T, Hofstaetter SG, Easley ME. Torsional stiffness after subtalar arthrodesis using second generation headless compression screws: Biomechanical comparison of 2-screw and 3-screw fixation. Clin Biomech (Bristol, Avon) 2017; 45:32-7. [PMID: 28458187 DOI: 10.1016/j.clinbiomech.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/18/2016] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subtalar joint arthrodesis is a common operative treatment for symptomatic subtalar arthrosis. Because excessive relative motion between the talus and calcaneus can delay or prohibit fusion, fixation should be optimized, particularly in patients at risk for subtalar arthrodesis nonunion. Tapered, fully-threaded, variable pitch screws are gaining popularity for this application, but the mechanical properties of joints fixed with these screws have not been characterized completely. We quantified the torsion resistance of 2-screw and 3-screw subtalar joint fixation using this type of screw. METHODS Ten pairs of cadaveric subtalar joints were prepared for arthrodesis and fixed using Acutrak 2-7.5 screws. One specimen from each pair was fixed with two diverging posterior screws, and the contralateral joint was fixed using two posterior screws and a third screw directed through the anterior calcaneus into the talar neck. Internal and external torsional loads were applied and joint rotation and torsional stiffness were measured at two torque levels. FINDINGS Internal rotation was significantly less in specimens fixed with three screws. No difference was detectable between 2-screw and 3-screw fixation in external rotation or torsional stiffness in either rotation direction. Both 2-screw and 3-screw fixation exhibited torsion resistance surpassing that reported previously for subtalar joints fixed with two diverging conventional lag screws. INTERPRETATION Performance of the tapered, fully threaded, variable pitch screws exceeded that of conventional lag screws regardless of whether two or three screws were used. Additional resistance to internal rotation afforded by a third screw placed anteriorly may offer some advantage in patients at risk for nonunion.
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Hey HWD, Tan KA, Neo CSE, Lau ETC, Choong DAW, Lau LL, Liu GKP, Wong HK. T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations. Spine J 2017; 17:615-621. [PMID: 27856380 DOI: 10.1016/j.spinee.2016.11.008] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/18/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity correction sometimes involves long posterior pedicle screw constructs extending from the lumbosacral spine to the thoracic vertebra. As fusion obliterates motion and places supraphysiological stress on adjacent spinal segments, it is crucial to ascertain the ideal upper instrumented vertebra (UIV) to minimize risk of proximal junctional failure (PJF). The T10 vertebra is often chosen to allow bridging of the thoracolumbar junction into the immobile thoracic vertebrae on the basis that it is the lowest immobile thoracic vertebra strut by the rib cage. PURPOSE This study aimed to characterize the range of motion (ROM) of each vertebral segment from T7 to S1 to determine if T10 is truly the lowest immobile thoracic vertebra. STUDY DESIGN/SETTING This is a prospective, comparative study. PATIENT SAMPLE Seventy-nine adults (mean age of 45.4 years) presenting with low back pain or lower limb radiculopathy or both, without previous spinal intervention, metastases, fractures, infection, or congenital deformities of the spine, were included in the study. OUTCOME MEASURES A ROM >5° across two vertebral segments as determined by the Cobb method from radiographs. METHODS Lumbar flexion-extension and neutral erect radiographs were obtained in randomized order using a slot scanner. Segmental ROM was measured from T7-T8 to L5-S1 and analyzed for significant differences using t tests. Age, gender, radiographical indices such as standard spinopelvic parameters, sagittal vertical axis (SVA), C7-T12 SVA, T1 slope, thoracic kyphosis (TK), and lumbar lordosis (LL) were studied via multivariate analysis to identify predictive factors for >5° change in ROM at the various segmental levels. There were no sources of funding and no conflicts of interest associated with this study. RESULTS In the thoracolumbar spine, significant decreases in ROM when compared with the adjacent caudad segment occurs up to T9-T10, with mean total ROM of 1.98±1.47° (p<.001) seen in T9-T10, 2.19±1.67° (p<.001) in T10-T11, and 3.92±3.21°(p<.001) in T11-T12. The total ROM of T8-T9 (2.53±1.79°) was not significantly different from that of T9-T10 (p=.261). At the thoracolumbar junction, absence of scoliosis (OR 11.37, p=.020), high pelvic incidence (OR 1.14, p=.046), and low T1 slope (OR 1.45, p=.030) were predictive of ROM >5°. CONCLUSIONS Lumbar spine flexion-extension ROM decreases as it approaches the thoracolumbar junction. T10 is indeed the lowest immobile thoracic vertebra strut by the rib cage, and the last significant decrease in ROM is observed at T9-T10, in relation to T10-T11. However, because this also implies that a UIV of T10 would mean there is only one level of fixation above the relatively mobile segment, while respecting other factors that influence UIV selection, we propose the T9 vertebra as a more ideal UIV to fulfill the biomechanical concept of bridge fixation. However, this decision should still be taken on a case-by-case basis.
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Affiliation(s)
| | - Kimberly-Anne Tan
- Department of Orthopedic Surgery, National University Health System, Singapore
| | | | - Eugene Tze-Chun Lau
- Department of Orthopedic Surgery, National University Health System, Singapore
| | | | - Leok-Lim Lau
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Gabriel Ka-Po Liu
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Hee-Kit Wong
- Department of Orthopedic Surgery, National University Health System, Singapore
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Perruisseau-Carrier A, Bahlouli N, Bierry G, Vernet P, Facca S, Liverneaux P. Comparison between isotropic linear-elastic law and isotropic hyperelastic law in the finite element modeling of the brachial plexus. ANN CHIR PLAST ESTH 2017; 62:664-668. [PMID: 28385568 DOI: 10.1016/j.anplas.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/02/2017] [Indexed: 12/17/2022]
Abstract
Augmented reality could help the identification of nerve structures in brachial plexus surgery. The goal of this study was to determine which law of mechanical behavior was more adapted by comparing the results of Hooke's isotropic linear elastic law to those of Ogden's isotropic hyperelastic law, applied to a biomechanical model of the brachial plexus. A model of finite elements was created using the ABAQUS® from a 3D model of the brachial plexus acquired by segmentation and meshing of MRI images at 0°, 45° and 135° of shoulder abduction of a healthy subject. The offset between the reconstructed model and the deformed model was evaluated quantitatively by the Hausdorff distance and qualitatively by the identification of 3 anatomical landmarks. In every case the Hausdorff distance was shorter with Ogden's law compared to Hooke's law. On a qualitative aspect, the model deformed by Ogden's law followed the concavity of the reconstructed model whereas the model deformed by Hooke's law remained convex. In conclusion, the results of this study demonstrate that the behavior of Ogden's isotropic hyperelastic mechanical model was more adapted to the modeling of the deformations of the brachial plexus.
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Affiliation(s)
- A Perruisseau-Carrier
- Department of hand surgery, SOS main, CCOM, university of Strasbourg, Icube CNRS 7357, university hospital of Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - N Bahlouli
- Department of mechanics, university of Strasbourg/CNRS, ICUBE, 2, rue Boussingault, 67000 Strasbourg, France
| | - G Bierry
- Guillaume Bierry, radiology department, university of Strasbourg, FMTS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - P Vernet
- Department of hand surgery, SOS main, CCOM, university of Strasbourg, Icube CNRS 7357, university hospital of Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - S Facca
- Department of hand surgery, SOS main, CCOM, university of Strasbourg, Icube CNRS 7357, university hospital of Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - P Liverneaux
- Department of hand surgery, SOS main, CCOM, university of Strasbourg, Icube CNRS 7357, university hospital of Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France.
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137
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Wong AL, Meals CG, Ruff CB. Computed tomographic analysis of the internal structure of the metacarpals and its implications for hand use, pathology, and surgical intervention. Anat Sci Int 2017; 93:231-237. [PMID: 28341969 DOI: 10.1007/s12565-017-0400-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
The variation of bone structure and biomechanics between the metacarpals is not well characterized. It was hypothesized that their structure would reflect their common patterns of use (i.e., patterns of hand grip), specifically that trabecular bone density would be greater on the volar aspect of all metacarpal bases, that this would be most pronounced in the thumb, and that the thumb diaphysis would have the greatest bending strength. Cross-sections at basal and mid-diaphyseal locations of 50 metacarpals from 10 human hands were obtained by peripheral quantitative computed tomography. The volar and dorsal trabecular densities of each base were measured and characterized using the volar/dorsal density ratio. The polar stress-strain index (SSIp), a surrogate measure of torsional/bending strength, was measured for each diaphysis and standardized for bone length and mass. Comparisons were made using mixed-model analyses of variance (ANOVAs) and post hoc tests. Volar/dorsal trabecular density ratios showed even distribution in all metacarpal bases except for the thumb, which showed greater values on the volar aspect. The thumb, second, and third metacarpals all had high bending strength (SSIp), but the thumb's SSIp relative to its length and trabecular mass was much higher than those of the other metacarpals. Trabecular density of the metacarpal bases was evenly distributed except in the thumb, which also showed higher bending strength relative to its length and mass. Understanding of how these indicators of strength differ across metacarpals may improve both fracture diagnosis and treatment and lays the groundwork for investigating changes with age, hand dominance, and occupation.
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Affiliation(s)
- Alison L Wong
- Center for Bioengineering Innovation and Design, Johns Hopkins University, 3400 N. Charles Street, Clark Hall, Suite 200, Baltimore, MD, 21218, USA. .,Division of Plastic and Reconstructive Surgery, Dalhousie University, Room 4714 Halifax Infirmary Site, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
| | - Clifton G Meals
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD, 21218, USA
| | - Christopher B Ruff
- Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 302, Baltimore, MD, 21205, USA
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Zhang F, Xu HC, Yin B, Xia XL, Ma XS, Wang HL, Yin J, Shao MH, Lyu FZ, Jiang JY. Can an Endplate-conformed Cervical Cage Provide a Better Biomechanical Environment than a Typical Non-conformed Cage?: A Finite Element Model and Cadaver Study. Orthop Surg 2017; 8:367-76. [PMID: 27627721 DOI: 10.1111/os.12261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/11/2015] [Accepted: 03/21/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate the biomechanical characteristics of endplate-conformed cervical cages by finite element method (FEM) analysis and cadaver study. METHODS Twelve specimens (C2 -C7 ) and a finite element model (C3 -C7 ) were subjected to biomechanical evaluations. In the cadaver study, specimens were randomly assigned to intact (I), endplate-conformed (C) and non-conformed (N) groups with C4-5 discs as the treated segments. The morphologies of the endplate-conformed cages were individualized according to CT images of group C and the cages fabricated with a 3-D printer. The non-conformed cages were wedge-shaped and similar to commercially available grafts. Axial pre-compression loads of 73.6 N and moment of 1.8 Nm were used to simulate flexion (FLE), extension (EXT), lateral bending (LB) and axial rotation (AR). Range of motion (ROM) at C4-5 of each specimen was recorded and film sensors fixed between the cages and C5 superior endplates were used to detect interface stress. A finite element model was built based on the CT data of a healthy male volunteer. The morphologies of the endplate-conformed and wedge-shaped, non-conformed cervical cages were both simulated by a reverse engineering technique and implanted at the segment of C4-5 in the finite element model for biomechanical evaluation. Force loading and grouping were similar to those applied in the cadaver study. ROM of C4-5 in group I were recorded to validate the finite element model. Additionally, maximum cage-endplate interface stresses, stress distribution contours on adjoining endplates, intra-disc stresses and facet loadings at adjacent segments were measured and compared between groups. RESULTS In the cadaver study, Group C showed a much lower interface stress in all directions of motion (all P < 0.05) and the ROM of C4-5 was smaller in FLE-EXT (P = 0.001) but larger in AR (P = 0.017). FEM analysis produced similar results: the model implanted with an endplate-conformed cage presented a lower interface stress with a more uniform stress distribution than that implanted with a non-conformed cage. Additionally, intra-disc stress and facet loading at the adjacent segments were obviously increased in both groups C and N, especially those at the supra-jacent segments. However, stress increase was milder in group C than in group N for all directions of motion. CONCLUSIONS Endplate-conformed cages can decrease cage-endplate interface stress in all directions of motion and increase cervical stability in FLE-EXT. Additionally, adjacent segments are possibly protected because intra-disc stress and facet loading are smaller after endplate-conformed cage implantation. However, axial stability was reduced in group C, indicating that endplate-conformed cage should not be used alone and an anterior plate system is still important in anterior cervical discectomy and fusion.
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Affiliation(s)
- Fan Zhang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hao-Cheng Xu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Yin
- Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin-Lei Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Sheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-Li Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Yin
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Hao Shao
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei-Zhou Lyu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China. .,Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Jian-Yuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
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Scordino LE, Obopilwe E, Charette R, Edgar CM, DeBerardino TM, Mazzocca AD. Calcium phosphate cement enhances the torsional strength and stiffness of high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2017; 25:817-22. [PMID: 26231147 DOI: 10.1007/s00167-015-3692-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/17/2014] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There has been a resurgence in the use of opening wedge high tibial osteotomy (owHTO). Calcium phosphate cement has been shown to improve strength in compression for augmentation of tibial plateau and owHTO fixation. However, knee kinematics includes a torsional load during ambulation, which is as yet unstudied in this model. The purpose of this paper is to investigate the effect of injectable calcium phosphate cement on the biomechanical stability of standard high tibial osteotomy defect with applied torsional load and ultimate stiffness of the supporting construct. METHODS Testing was performed on 22 bone mineral density-matched and age-matched cadaver specimens. Intact specimens were treated with 10° opening wedge osteotomies, identical surgical techniques as clinically used and fixation provided by iBalance© PEEK implant (Arthrex, Naples FL). Nine specimens were augmented with calcium phosphate injectable cement, Quickset (Arthrex Inc., Naples Fl). Constructs were for construct stiffness, torsional loads to failure, and mechanisms of failure. As a gold-standard comparison group, four samples were tested with a titanium, fixed angle device alone: Contourlock plate (Arthrex Inc., Naples Fl). RESULTS Peak torque to failure was significantly greater in samples augmented with calcium phosphate bone cement (23.0 ± 9.6 Nm) compared with specimens fixed with PEEK implant alone (18.1 ± 7.3). Construct stiffness in torsion was also significantly improved with bone cement application (349.0 ± 126.8 Nm/°) compared with PEEK implant alone (202.2 ± 153.4 Nm/°) and fixed angle implant system (142.9 ± 74.7 Nm/°). CONCLUSION Injectable calcium phosphate cement improves the initial maximal torsional strength and stiffness of high tibial osteotomy construct.
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Yammine K, Assi C. Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies. Foot (Edinb) 2017; 30:13-20. [PMID: 28171797 DOI: 10.1016/j.foot.2016.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 05/24/2016] [Accepted: 09/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Achilles injuries are very common, mainly among young athletes. When indicated, the surgical treatment aims for strong repairs that can resist distraction and consequently ruptures. The majority of the published clinical meta-analyses reported comparisons between broad treatment modalities such as conservative treatment, open, and minimally invasive surgery. METHODS A meta-analysis has been conducted to assess further clinical and biomechanical variables on human cadavers related to the efficacy of Achilles repair. A total of 26 studies with 596 legs met the inclusion criteria. The maximal load to failure was set as the primary outcome. Eleven studies were amenable to meta-analysis. RESULTS In the reinsertion group, the analysis of the single row vs. double row subgroup showed a significantly higher strength for the latter (1.27, 95% CI=0.748-1.806, I2=81%, P<0.0001). In the mid-tendon repair group, the Achillon vs. Krackow sutures and the Bunnell vs. Krackow sutures subgroups showed no difference while the Bunnell and Krakow sutures were significantly stronger than the Kessler sutures (0.96, 95% CI=0.510-1.405, I2=63.3%, P<0.0001 and 1.37, 95% CI=2.286-0.468, I2=83.4%, P=0.003; respectively). CONCLUSIONS The assessment of heterogeneity located variables such as age, suture/material type, number of strands, type of testing machine and software, preloading, ankle position and loading type as potential confounders. The results of this meta-analysis are likely to have a significant impact in clinical practice.
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Affiliation(s)
- Kaissar Yammine
- The Foot and Hand Clinic and The Center for Evidence-Based Anatomy, Sport & Orthopedic Research, Jdeideh Highway, Fouad Yammine Bld., 1st Floor, Beirut, Lebanon.
| | - Chahine Assi
- The Orthopedic Department, Lebanese American University, Lebanon.
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Rajfer RA, Kilic A, Neviaser AS, Schulte LM, Hlaing SM, Landeros J, Ferrini MG, Ebramzadeh E, Park SH. Enhancement of fracture healing in the rat, modulated by compounds that stimulate inducible nitric oxide synthase: Acceleration of fracture healing via inducible nitric oxide synthase. Bone Joint Res 2017; 6:90-97. [PMID: 28188129 PMCID: PMC5331177 DOI: 10.1302/2046-3758.62.bjr-2016-0164.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 07/18/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days. Materials and Methods Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density of the callus were measured by quantitative CT on days 14 and 42. Expression of iNOS was measured by immunohistochemistry. Results When compared with the control group, the COMB-4 group exhibited 46% higher maximum strength (t-test, p = 0.029) and 92% higher stiffness (t-test, p = 0.023), but no significant changes were observed in the tadalafil group. At days 14 and 42, there was no significant difference between the three groups with respect to callus volume, mineral content and bone density. Expression of iNOS at day 14 was significantly higher in the COMB-4 group which, as expected, had returned to baseline levels at day 42. Conclusion This study demonstrates an enhancement in fracture healing by an oral natural product known to augment iNOS expression. Cite this article: R. A. Rajfer, A. Kilic, A. S. Neviaser, L. M. Schulte, S. M. Hlaing, J. Landeros, M. G. Ferrini, E. Ebramzadeh, S-H. Park. Enhancement of fracture healing in the rat, modulated by compounds that stimulate inducible nitric oxide synthase: Acceleration of fracture healing via inducible nitric oxide synthase. Bone Joint Res 2017:6:–97. DOI: 10.1302/2046-3758.62.BJR-2016-0164.R2.
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Affiliation(s)
- R A Rajfer
- Department of Orthopaedic Surgery, George Washington University, Washington DC, USA
| | - A Kilic
- Department of Orthopaedics, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - A S Neviaser
- Department of Orthopaedic Surgery, George Washington University, Washington DC, USA
| | - L M Schulte
- Department of Orthopaedic Surgery, George Washington University, Washington DC, USA
| | - S M Hlaing
- Department of Health and Life Sciences, College of Science and Health, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - J Landeros
- Department of Health and Life Sciences, College of Science and Health, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - M G Ferrini
- Department of Health and Life Sciences, College of Science and Health, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - E Ebramzadeh
- Department of Orthopaedic Surgery, The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, University of California, Los Angeles, California, USA
| | - S-H Park
- Department of Orthopaedic Surgery, The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, University of California, Los Angeles, California, USA
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Saltzman BM, Erickson BJ, Frank JM, Harris JD, Nicholson GP, Bach BR, Verma NN, Romeo AA. Biomechanical testing of the reconstructed ulnar collateral ligament: a systematic review of the literature. Musculoskelet Surg 2016; 100:157-163. [PMID: 27628911 DOI: 10.1007/s12306-016-0426-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose was to perform a systematic review of the literature investigating biomechanical studies of ulnar collateral ligament reconstruction (UCLR) techniques to summarize the most commonly analyzed methods of fixation (at both the ulna and humerus), the degree of elbow flexion at the time of fixation, graft characteristics, and modes of failure with these techniques. MATERIALS AND METHODS A systematic review was performed. All cadaveric biomechanical studies that tested a reconstruction method for UCLR were included. Descriptive statistics were calculated for each study and parameter/variable analyzed. RESULTS Twenty-three studies were included with a total of 397 elbows in 242 cadavers (mean age 54.8 ± 20 years, range 16-96). The majority of studies (65 %) used a palmaris longus graft. The docking technique (37.2 %) was the most commonly tested reconstruction method. Significant heterogeneity between studies precluded assimilation of specific techniques (each of the 23 studies utilized a unique technique). Fixation was performed at 30°-90° of elbow flexion. The most common mode of failure was suture failure (51 %), followed by midsubstance rupture (27.00 %), and bone tunnel fracture (14.00 %). No significant differences were observed amongst techniques for all measures analyzed. CONCLUSION This study found the docking technique to be the most commonly tested technique, while the mode of reconstruction failure was most commonly at the suture interface. If the graft failed at the bone interface, it was most likely to occur at the ulna. Surgeon preference and comfort level with a specific technique should dictate choice.
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Affiliation(s)
- B M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
| | - B J Erickson
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA
| | - J M Frank
- Division of Sports Medicine, The Steadman Clinic, 181 W Meadow Dr., Vail, CO, 81657, USA
| | - J D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6550 Fannin, Smith Tower, Suite 2500, Houston, TX, 77030, USA
| | - G P Nicholson
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA
| | - B R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA
| | - N N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA
| | - A A Romeo
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA
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Zhang P, Zhang L, Slepian MJ, Deng Y, Bluestein D. A multiscale biomechanical model of platelets: Correlating with in-vitro results. J Biomech 2016; 50:26-33. [PMID: 27894676 DOI: 10.1016/j.jbiomech.2016.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Using dissipative particle dynamics (DPD) combined with coarse grained molecular dynamics (CGMD) approaches, we developed a multiscale deformable platelet model to accurately describe the molecular-scale intra-platelet constituents and biomechanical properties of platelets in blood flow. Our model includes the platelet bilayer membrane, cytoplasm and an elaborate elastic cytoskeleton. Correlating numerical simulations with published in-vitro experiments, we validated the biorheology of the cytoplasm, the elastic response of membrane to external stresses, and the stiffness of the cytoskeleton actin filaments, resulting in an accurate representation of the molecular-level biomechanical microstructures of platelets. This enabled us to study the mechanotransduction process of the hemodynamic stresses acting onto the platelet membrane and transmitted to these intracellular constituents. The platelets constituents continuously deform in response to the flow induced stresses. To the best of our knowledge, this is the first molecular-scale platelet model that can be used to accurately predict platelets activation mechanism leading to thrombus formation in prosthetic cardiovascular devices and in vascular disease processes. This model can be further employed to study the effects of novel therapeutic approaches of modulating platelet properties to enhance their shear resistance via mechanotransduction pathways.
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Affiliation(s)
- Peng Zhang
- Biomedical Engineering Department, Stony Brook University, NY 11794, USA
| | - Li Zhang
- Applied Mathematics Department, Stony Brook University, NY 11794, USA
| | - Marvin J Slepian
- Biomedical Engineering Department, Stony Brook University, NY 11794, USA; Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Yuefan Deng
- Applied Mathematics Department, Stony Brook University, NY 11794, USA
| | - Danny Bluestein
- Biomedical Engineering Department, Stony Brook University, NY 11794, USA.
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Mugnai R, Zambianchi F, Digennaro V, Marcovigi A, Tarallo L, Del Giovane C, Catani F. Clinical outcome is not affected by total knee arthroplasty alignment. Knee Surg Sports Traumatol Arthrosc 2016; 24:3339-3345. [PMID: 27034086 DOI: 10.1007/s00167-016-4094-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to analyse the influence on total knee arthroplasty (TKA) clinical outcomes of biomechanical intra-operative computer-assisted surgery-measured parameters, together with radiographic and demographical data. METHODS Between 2007 and 2009, 227 computer-assisted surgery (CAS) primary TKAs were performed in 219 consecutive patients. Information about gender, age and body mass index (BMI) was collected for each patient. Before knee replacement, all patients underwent a complete radiographic examination and passive flexion-extension range of motion was recorded. All TKAs were implanted using an image-free knee navigation system. Patients included in the study were evaluated at 3, 6 and 12 months of follow-up and then yearly. At each follow-up, subjects were asked to answer the validated Italian version of the Knee Injury and Osteoarthritis Outcome Score. RESULTS One hundred and eighty patients (187 knees) had data available for analysis. Complications were reported in 13 patients (7.0 %). Intra-operative CAS-measured parameters, together with age, BMI, gender, pre- and post-operative radiographic alignment, did not influence TKA clinical results at a mean 2 years of follow-up. On the other hand, higher post-operative flexion arc of movement was suggestive of better clinical outcomes. CONCLUSION TKA clinical outcome is influenced by post-operative knee flexion, other than neutral mechanical limb alignment. Therefore, it is recommended to prefer TKA designs that allow high flexion and to encourage early physical rehabilitation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Raffaele Mugnai
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Francesco Zambianchi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Vitantonio Digennaro
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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145
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Switaj PJ, Fuchs D, Alshouli M, Patwardhan AG, Voronov LI, Muriuki M, Havey RM, Kadakia AR. A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures. J Orthop Surg Res 2016; 11:100. [PMID: 27628500 PMCID: PMC5024498 DOI: 10.1186/s13018-016-0435-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 05/29/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022] Open
Abstract
Background A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern. This study sought to biomechanically compare an emerging technology with an established method of fixation for distal fibular fractures that traditionally require an extensive exposure. Methods Ten matched cadaveric pairs from the proximal tibia to the foot were prepared to simulate an Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 44C2 ankle fracture and randomized to fixation with a distal fibular locking plate or intramedullary fibular rod. A constant 700-N axial load was applied, and all specimens underwent testing for external rotation stiffness, external rotation cyclic loading, and torque to failure. The syndesmotic diastasis, stiffness, torque to failure, angle at failure, and mode of failure were obtained from each specimen. Results There was no significant difference in syndesmotic diastasis during cyclic loading or at maximal external rotation between the rod and plate groups. Post-cycle external rotation stiffness across the syndesmosis was significantly higher for the locking plate than the fibular rod. There was no significant difference between the rod and plate in torque at failure or external rotation angle. The majority of specimens had failure at the syndesmotic screw. Conclusions In the present cadaveric study of an AO/OTA 44C2 ankle fracture, a modern fibular rod demonstrated less external rotation stiffness while maintaining the syndesmotic diastasis to within acceptable tolerances and having similar failure characteristics.
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Affiliation(s)
- Paul J Switaj
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA.
| | - Daniel Fuchs
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Mohammed Alshouli
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Chicago, IL, USA
| | - Leonard I Voronov
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Chicago, IL, USA
| | - Muturi Muriuki
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Chicago, IL, USA
| | - Robert M Havey
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Chicago, IL, USA
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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146
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Hoon QJ, Pelletier MH, Christou C, Johnson KA, Walsh WR. Biomechanical evaluation of shape-memory alloy staples for internal fixation-an in vitro study. J Exp Orthop 2016; 3:19. [PMID: 27578288 PMCID: PMC5005248 DOI: 10.1186/s40634-016-0055-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 05/23/2016] [Accepted: 08/18/2016] [Indexed: 12/05/2022] Open
Abstract
Background The field of orthopaedics is a constantly evolving discipline. Despite the historical success of plates, pins and screws in fracture reduction and stabilisation, there is a continuing search for more efficient and improved methods of fracture fixation. The aim of this study was to evaluate shape-memory staples and to compare them to a currently used implant for internal fracture fixation. Multi-plane bending stability and interfragmentary compression were assessed across a simulated osteotomy using single and double-staple fixation and compared to a bridging plate. Methods Transverse osteotomies were made in polyurethane blocks (20 × 20 × 120 mm) and repairs were performed with one (n = 6), or two (n = 6) 20 mm nitinol staples, or an eight-hole 2.7 mm quarter-tubular plate (n = 6). A pressure film was placed between fragments to determine contact area and compressive forces before and after loading. Loading consisted of multi-planar four-point bending with an actuator displacement of 3 mm. Gapping between segments was recorded to determine loads corresponding to a 2 mm gap and residual post-load gap. Results Staple fixations showed statistically significant higher mean compressive loads and contact areas across the osteotomy compared to plate fixations. Double-staple constructs were superior to single-staple constructs for both parameters (p < 0.001). Double-staple constructs were significantly stiffer and endured significantly larger loads before 2 mm gap formation compared to other constructs in the dorsoventral plane (p < 0.001). However, both staple constructs were significantly less stiff and tolerated considerably lower loads before 2 mm gap formation when compared to plate constructs in the ventrodorsal and right-to-left lateral loading planes. Loading of staple constructs showed significantly reduced permanent gap formation in all planes except ventrodorsally when compared to plate constructs. Conclusions Although staple fixations were not as stable as plate fixations in particular loading planes, double-staple constructs demonstrated the most consistent bending stiffness in all planes. Placing two perpendicular staples is suggested instead of single-staples whenever possible, with at least one staple applied on the compression side of the anticipated loading to improve construct stability.
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Affiliation(s)
- QiCai Jason Hoon
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Sydney, 2031, NSW, Australia.,Faculty of Veterinary Science, University of Sydney, Sydney, 2006, NSW, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Sydney, 2031, NSW, Australia
| | - Chris Christou
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Sydney, 2031, NSW, Australia.
| | - Kenneth A Johnson
- Faculty of Veterinary Science, University of Sydney, Sydney, 2006, NSW, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Sydney, 2031, NSW, Australia
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147
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Sarin JK, Amissah M, Brommer H, Argüelles D, Töyräs J, Afara IO. Near Infrared Spectroscopic Mapping of Functional Properties of Equine Articular Cartilage. Ann Biomed Eng 2016; 44:3335-45. [PMID: 27234817 DOI: 10.1007/s10439-016-1659-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/20/2016] [Indexed: 12/13/2022]
Abstract
Mechanical properties of articular cartilage are vital for normal joint function, which can be severely compromised by injuries. Quantitative characterization of cartilage injuries, and evaluation of cartilage stiffness and thickness by means of conventional arthroscopy is poorly reproducible or impossible. In this study, we demonstrate the potential of near infrared (NIR) spectroscopy for predicting and mapping the functional properties of equine articular cartilage at and around lesion sites. Lesion and non-lesion areas of interests (AI, N = 44) of equine joints (N = 5) were divided into grids and NIR spectra were acquired from all grid points (N = 869). Partial least squares (PLS) regression was used to investigate the correlation between the absorbance spectra and thickness, equilibrium modulus, dynamic modulus, and instantaneous modulus at the grid points of 41 AIs. Subsequently, the developed PLS models were validated with spectral data from the grid points of 3 independent AIs. Significant correlations were obtained between spectral data and cartilage thickness (R 2 = 70.3%, p < 0.0001), equilibrium modulus (R 2 = 67.8%, p < 0.0001), dynamic modulus (R 2 = 68.9%, p < 0.0001) and instantaneous modulus (R 2 = 41.8%, p < 0.0001). Relatively low errors were observed in the predicted thickness (5.9%) and instantaneous modulus (9.0%) maps. Thus, if well implemented, NIR spectroscopy could enable arthroscopic evaluation and mapping of cartilage functional properties at and around lesion sites.
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148
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Curtis BD, Fajolu O, Ruff ME, Litsky AS. Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed K-Wires and Plate-Screw Constructs. Orthop Surg 2016; 7:256-60. [PMID: 26311101 DOI: 10.1111/os.12195] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 04/13/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Metacarpal (MC) fractures are very common, accounting for 18% of all fractures distal to the elbow. Many MC fractures can be treated non-operatively; however, some are treated most effectively with surgical stabilization, for which there are multiple methods. It was postulated that plates would have a significantly higher (P < 0.05) load to failure than crossed K(XK)-wires and that intramedullary metacarpal nails (IMNs) and XK-wires would have equivalent load to failure. METHODS Mid-diaphyseal transverse fractures were created in 36 synthetic metacarpals and stabilized using nails, XK-wires or non-locking plates. Three-point bending was performed with continuous recording of load and displacement. Statistical analysis was performed using single factor ANOVA and Scheffe's test. Statistical significance was defined as P < 0.05. RESULTS Biomechanical testing revealed significant differences between groups in load-to-failure. Average load to failure was significantly greater in the plate (1669 ± 322 N) than the XK-wire (146 ± 56 N) or IMN (110 ± 43 N) groups. The loads to failure of the K-wires and nails were equivalent. Plates were 11 and 15 times stronger in three-point bending than the K-wires and nails, respectively. There was no statistically significant difference between strengths of the K-wires and nails. CONCLUSIONS Although plates are the most stable means of fixation of midshaft metacarpal fractures, if minimally-invasive techniques are indicated, intramedullary nails may provide equivalent stability as commonly-used XK-wires. Although some studies have shown favorable clinical outcomes with IMNs, additional clinical correlation of these biomechanical results to fracture healing and outcomes is needed.
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Affiliation(s)
- Benjamin D Curtis
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Olukemi Fajolu
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Michael E Ruff
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Alan S Litsky
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
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149
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Lee KT, Kim ES, Kim YH, Ryu JS, Rhyu IJ, Lee YK. All-inside arthroscopic modified Broström operation for chronic ankle instability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2016; 24:1096-100. [PMID: 24996867 DOI: 10.1007/s00167-014-3159-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 12/26/2013] [Accepted: 06/20/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The all-inside arthroscopic modified Broström operation has been developed for lateral ankle instability. We compared the biomechanical parameters of the all-inside arthroscopic procedure to the open modified Broström operation. METHODS Eleven matched pairs of human cadaver specimens [average age 71.5 (range 58-98) years] were subject to the arthroscopic modified Broström operation using a suture anchor and the open modified Broström operation. The ligaments were loaded cyclically 20 times and then tested to failure. Torque to failure, degrees to failure, and stiffness were measured. A matched-pair analysis was performed. RESULTS There was no significant difference in torque to failure between the open and arthroscopic modified Broström operation (19.9 ± 8.9 vs. 23.3 ± 12.1 Nm, n.s). The degrees to failure did not differ significantly between the open and arthroscopic modified Broström operations (46.8 ± 9.9° vs. 46.7 ± 7.6°, n.s). The working construct stiffness (or stiffness to failure) was no significant difference in the two groups (0.438 ± 0.21 vs. 0.487 ± 0.268 Nm/deg for the open and arthroscopic modified Broström operations, respectively, n.s). CONCLUSION The all-inside arthroscopic modified Broström operation and the open modified Broström operation resulted in no significantly different torque to failure, degrees to failure, and working construct stiffness with no significant differences (n.s, n.s, and n.s, respectively). Our results indicate that the arthroscopic modified Broström operation is a reasonable alternative procedure for chronic ankle instability.
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Affiliation(s)
- Kyung Tai Lee
- Foot and Ankle Clinic, KT Lee's Orthopedic Hospital, Seoul, Republic of Korea
| | - Eung Soo Kim
- Department of Orthopedic Surgery, Saeum Hospital, Seoul, Republic of Korea
| | - Young Ho Kim
- Department of Biomedical Engineering, Yonsei University, R204, Medical Industry Techno Tower, Heungeop-myeon, Wonju-si, Gangwon-do, 220-710, Republic of Korea
| | - Je Seong Ryu
- Department of Biomedical Engineering, Yonsei University, R204, Medical Industry Techno Tower, Heungeop-myeon, Wonju-si, Gangwon-do, 220-710, Republic of Korea
| | - Im Joo Rhyu
- Department of Anatomy, College of Medicine Korea University, 126-1 Anam dong 5 Ka SungBuk ku, Seoul, 136-705, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, Soonchunhyang University, 4 Jung-Dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea.
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150
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Nguyen DC, Patel KB, Parikh RP, Skolnick GB, Woo AS. Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study. J Plast Reconstr Aesthet Surg 2016; 69:789-795. [PMID: 27105546 DOI: 10.1016/j.bjps.2016.03.012] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/17/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This biomechanical study aims to characterize the nasal mucosa during palatoplasty, thereby describing the soft tissue attachments at different zones and quantifying movement following their release. METHODS Palatal nasal mucosa was exposed and divided in the midline in 10 adult cadaver heads. Five consecutive maneuvers were performed: (1) elevation of nasal mucosa off the maxilla, (2) dissection of nasal mucosa from soft palate musculature, (3) separation of nasal mucosa from palatine aponeurosis, (4) release of mucosa at the pterygopalatine junction, and (5) mobilization of vomer flaps. The mucosal movements across the midline at the midpalate (MP) and posterior nasal spine (PNS) following each maneuver were measured. RESULTS At the MP, maneuvers 1-4 cumulatively provided 3.8 mm (36.9%), 4.9 mm (47.6%), 6.1 mm (59.2%), and 10.3 mm, respectively. Vomer flap (10.5 mm) elevation led to mobility equivalent to that of maneuvers 1-4 (p = 0.72). At the PNS, cumulative measurements after maneuvers 1-4 were 1.3 mm (10%), 2.4 mm (18.6%), 5.7 mm (44.2%), and 12.9 mm. Here, vomer flaps (6.5 mm) provided less movement (p < 0.001). Maneuver 4 yielded the greatest amount of movement of the lateral nasal mucosa at both MP (4.2 mm, 40.8%) and PNS (7.2 mm, 55.8%). CONCLUSION At the MP, complete release of the lateral nasal mucosa achieves as much movement as the vomer flap. At the hard-soft palate junction, the maneuvers progressively add to the movement of the lateral nasal mucosa. The most powerful step is release of attachments along the posterior aspect of the medial pterygoid.
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Affiliation(s)
- Dennis C Nguyen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA.
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Rajiv P Parikh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
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