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Xue H, Zhang Z, Liu M, Lin Z, Endo Y, Liu G, Mi B, Zhou W, Liu G. Finite element analysis of different fixation methods of screws on absorbable plate for rib fractures. Front Bioeng Biotechnol 2022; 10:960310. [PMID: 35935502 PMCID: PMC9354002 DOI: 10.3389/fbioe.2022.960310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple rib fractures caused by trauma are common injuries and the internal fixation methods of these injuries have been paid more and more attention by surgeons. Absorbable plates and screws are the effective way to treat rib fractures, but there are no reports on which type of screw fixation method is most effective. In this study, finite element analysis was used to study the effects of five different types of screw fixation methods on anterior rib, lateral rib and posterior rib. The finite element model of the ribs was reconstructed from CT images, and the internal pressure (40 kPa) and intercostal force (30 N) on the surfaces of the ribs were simulated accordingly. An intercostal force of 30 N was applied to the upper and lower surfaces of the ribs to simulate the effect of intercostal muscle force. The pressure of 40 kPa was applied to the inner surface of the ribs, and the normal direction was applied to the inner surface of the ribs. The positive direction was considered inspiratory pressure, and the negative direction was considered expiratory pressure. The results indicate the optimal type of screw fixation on the absorbable plate for rib fractures, and provide a basis and reference for clinical application.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yori Endo
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Guodong Liu
- Medical Center of Trauma and War Injuries, Daping Hospital, Army Medical University, Chongqing, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
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Nurmi JT, Itälä A, Sihvonen R, Sillanpää P, Kannus P, Sievänen H, Järvinen TLN. Bioabsorbable Versus Metal Screw in the Fixation of Tibial Tubercle Transfer: A Cadaveric Biomechanical Study. Orthop J Sports Med 2017; 5:2325967117714433. [PMID: 28812035 PMCID: PMC5528201 DOI: 10.1177/2325967117714433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In tibial tubercle transfer (TTT) procedures, the osteotomized and transferred tibial tubercle is usually fixed into the host bone using metal screws. Purpose: To compare the strength of fixation provided by a single bioabsorbable screw versus a metal screw for TTT. Study Design: Controlled laboratory study. Methods: Twenty-two pairs of human cadaveric tibiae were used to compare the fixation strength of a single 4.5-mm bicortical bioabsorbable or metal screw for TTT. In our 2-phase biomechanical testing protocol, the specimens were first subjected to a cyclic-loading test (1500 loading cycles between 50 and 300 N at 0.5 Hz frequency), after which they were loaded to failure (single-cycle load-to-failure test). To control for possible differences in bone quality, volumetric bone mineral density was determined using peripheral quantitative computed tomography. Results: No significant displacement differences were observed between the 2 groups for the cyclic-loading test. In the subsequent single-cycle load-to-failure test, the mean yield load was 566 ± 234 N in the bioabsorbable screw group and 984 ± 630 N in the metal screw group (P = .002). The failure mode of bioabsorbable screws was breakage and/or bending, and that of metal screws was bending and/or pull-out. Bone density was similar in the 2 groups. Conclusion: A metal screw seems to provide greater fixation strength than a biodegradable screw in the TTT of a human cadaveric knee. However, considering the maximum quadriceps pull in vivo, the strength of fixation provided by a biodegradable screw seems clinically sufficient. Clinical Relevance: Bioabsorbable screws, particularly if used in duplicate, could provide a viable option for metal screws in TTT fixation.
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Affiliation(s)
- Janne T Nurmi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ari Itälä
- Terveystalo\-Pulssi Hospital, Turku, Finland
| | - Raine Sihvonen
- Department of Orthopaedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | | | - Pekka Kannus
- Tampere Research Center of Sports Medicine, Tampere, Finland.,UKK Institute, Tampere, Finland
| | | | - Teppo L N Järvinen
- Clinical Medicine/Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
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Interfacial sliding properties of bone screw materials and their effect on screw fixation strength. J Appl Biomater Funct Mater 2014; 12:90-6. [PMID: 24425376 DOI: 10.5301/jabfm.5000177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study examined the effect of interfacial sliding and test material properties on the fixation strength and insertional properties of self-tapping bone screws. Various substitute materials (polyacetal [POM], poly(methyl methacrylate) [PMMA] and E-glass-filled Epoxy [Sawbones®]) for human bone were evaluated, and the results were compared with the findings for cadaver bone.
METHODS Initial coefficient of friction (CoF) of the screw material stainless steel AISI316 was tested using a pin-on-disk apparatus, and the screws were exposed to pullout tests after insertion torque tests. The effect of a smooth diamond-like carbon (DLC) coating was studied by applying the coating on both CoF test balls and bone screws.
RESULTS Mechanical properties of test blocks strongly correlated to both pullout strength and insertion torque of the screws: for noncoated 2.7-mm screws, tensile strength correlated to pullout strength and insertion torque, with Pearson correlation coefficients r=0.977 and r=0.738, respectively. In contrast, CoF correlated strongly to screw insertion torque but not to pullout strength in bone substitute materials (for noncoated 2.7-mm screws, r=0.652 and r=0.248, respectively). There were no significant differences in CoF using noncoated and DLC-coated screw materials against bone substitutes.
CONCLUSIONS Proper materials for in vitro testing help in evaluating the biomechanics of the implants in advance. However, choosing the material needs attention, as their ability to model human bone depends on test type.
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Landes C, Ballon A, Ghanaati S, Ebel D, Ulrich D, Spohn U, Heunemann U, Sader R, Jaeger R. Evaluation of the Fatigue Performance and Degradability of Resorbable PLDLLA-TMC Osteofixations. Open Biomed Eng J 2013; 7:133-46. [PMID: 24363786 PMCID: PMC3869107 DOI: 10.2174/1874120701307010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/24/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022] Open
Abstract
The fatigue performance of explanted in-situ degraded osteofixations/osteosyntheses, fabricated from poly (70L-lactide-co-24DL-lactide-6-trimethylane-carbonate or PLDLLA-TMC) copolymer was compared to that of virgin products. The fatigue test was performed on 21 explants retrieved from 12 women and 6 men; 16-46 years by a custom-designed three-point bend apparatus using a staircase method and a specified failure criterion (an increase of the deflection of the specimen > 1 mm) with run-out designated as “no failure” after 150,000 loading cycles. While all the virgin products showed run-out at 38N, all of the specimens fabricated from explants failed at this load level. For the explant specimens, although there was a trend of decreased failure load with increased in-situ time, this decrease was pronounced after 4 months in-situ, however, not yet statistically significant, while a 6-month in-situ explant had significantly less failure load. Three and four month in-situ explants had highly significant differences in failure load between measurements close and distant to the osteotomy line: p=0.0017 (the region of maximum load in-situ). In the virgin products, there were only traces of melt joining and cooling, left from a stage in the manufacturing process. For the implants retrieved after 4.5 months in-situ, the fracture surfaces showed signs of degradation of the implants, possibly caused by hydrolysis, and for those retrieved after 9 months in-situ, there were cracks and pores. Thus, the morphological results are consistent with those obtained in the fatigue test. The present results suggest that resorbable osteofixations fabricated from PLDLLA-TMC are stable enough to allow loading of the healing bone and degrade reliably
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Affiliation(s)
- Constantin Landes
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Alexander Ballon
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Daniel Ebel
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
| | - Dieter Ulrich
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
| | - Uwe Spohn
- Fraunhofer Institute for Mechanics of Materials IWM, Biological and Biocompatible Materials - group, Fraunhofer-IWM, Walter-Hülse-Str. 1, 06120 Halle
| | - Ute Heunemann
- Fraunhofer Institute for Mechanics of Materials IWM, Biological and Biocompatible Materials - group, Fraunhofer-IWM, Walter-Hülse-Str. 1, 06120 Halle
| | - Robert Sader
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Raimund Jaeger
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
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Mode of Failure of Rib Fixation With Absorbable Plates: A Clinical and Numerical Modeling Study. ACTA ACUST UNITED AC 2010; 68:1225-33. [DOI: 10.1097/ta.0b013e3181d27cab] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kukk A, Nurmi JT. A retrospective follow-up of ankle fracture patients treated with a biodegradable plate and screws. Foot Ankle Surg 2010; 15:192-7. [PMID: 19840751 DOI: 10.1016/j.fas.2009.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 01/26/2009] [Accepted: 02/13/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Biodegradable fixation implants have been developed to avoid secondary hardware removal. The aim of this study was to retrospectively follow-up ankle fracture patients treated with a biodegradable plate and screws, and to evaluate the clinical outcome and occurrence of complications. METHODS Fifty-seven ankle fracture patients treated with biodegradable implants were invited, and a total of 50 were available to participate in this study. The follow-up included a review of each patient's medical records, evaluation of radiographs, fracture reduction classification, and functional scoring. RESULTS There were 36 lateral malleolar and 14 bimalleolar fractures. No perioperative complications occurred. Average follow-up time was 17 months. All fractures healed. Fracture alignment was classified as anatomical in 49 patients and good in 1 case. The mean Olerud and Molander functional ankle score at final follow-up was 86. Eight patients had postoperative complications. These included delayed wound healing in 1 case, 3 cases of deep-vein thrombosis, and 4 soft tissue reactions. CONCLUSIONS According to the results of this retrospective study, the biodegradable implants used yielded fracture healing and functional results comparable to those previously reported after conventional metal fixation.
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Affiliation(s)
- Arvo Kukk
- Seinäjoki Central Hospital, Seinäjoki, Finland.
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