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Frost MW, Tirta M, Rahbek O, Rytoft LA, Ding M, Shen M, Duch K, Kold S. Electrical impedance detects early stages of bone healing: An in vivo explanatory study of tibial fractures in rabbits. J Exp Orthop 2024; 11:e12048. [PMID: 38863940 PMCID: PMC11165676 DOI: 10.1002/jeo2.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose Healing after bone fracture is assessed by clinical examination and frequent radiographs, which expose patients to radiation and lack standardisation. This study aimed to explore electrical impedance patterns during bone healing using electrical impedance spectroscopy in 18 rabbits subjected to tibial fracture stabilised with an external fixator. Methods Impedance was measured daily across the fracture site at a frequency range of 5 Hz to 1 MHz. Biweekly radiographs were analysed using modified anterior-posterior (AP) radiographic union score of the tibia (RUST). The animals were divided into three groups with different follow-up times: 1, 3 and 6 weeks for micro-computer tomography and mechanical testing. Results A decreasing trend in impedance was observed over time for all rabbits at lower frequencies. Impedance closest to 5 Hz showed a statistically significant decrease over time, with greatest decrease occurring during the first 7 postoperative days. At 5 Hz, a statistically significant correlation was found between impedance and the modified AP RUST score and between impedance and bone volume fraction. Conclusions This study showed that the electrical impedance can be measured in vivo at a distance from the fracture site with a consistent change in impedance over time and revealed significant correlation between increasing radiographic union score and decreasing impedance. Level of Evidence Not applicable.
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Affiliation(s)
| | - Maria Tirta
- Department of OrthopaedicsAalborg University HospitalAalborgDenmark
| | - Ole Rahbek
- Department of OrthopaedicsAalborg University HospitalAalborgDenmark
| | | | - Ming Ding
- Department of Orthopaedic Surgery & TraumatologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Ming Shen
- Department of Electronic SystemsAalborg UniversityAalborgDenmark
| | - Kirsten Duch
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Søren Kold
- Department of OrthopaedicsAalborg University HospitalAalborgDenmark
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Conceição C, Completo A, Soares dos Santos MP. Ultrasensitive capacitive sensing system for smart medical devices with ability to monitor fracture healing stages. J R Soc Interface 2023; 20:20220818. [PMCID: PMC9943881 DOI: 10.1098/rsif.2022.0818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Bone fractures are a global public health problem. A sustained increase in the number of incident cases has been observed in the last few decades, as well as the number of prevalent cases and the number of years lived with disability. Current monitoring techniques are based on imaging techniques, which are highly subjective, radioactive, expensive and unable to provide daily monitoring of fracture healing stages. The development of reliable, non-invasive and non-subjective technologies is mandatory to minimize non-union risks. Delayed healing and non-union conditions require timely medical intervention, such that preventive procedures and shortened treatment periods can be carried out. This work proposes the development of an ultrasensitive capacitive sensing system for smart implantable fixation implants with ability to effectively monitor the evolution of bone fractures. Both in vitro experimental tests and numerical simulations highlight that networks of co-surface capacitive systems are able: (i) to detect four different bone healing phases, capacitance decrease patterns occurring as the healing process progresses and (ii) to monitor the callus evolution in multiple target regions. These are very promising results that highlight the potential of capacitive technologies to minimize the individual and social burdens related to fracture management, mainly when delayed healing or non-union conditions occur.
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Affiliation(s)
- Cassandra Conceição
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Completo
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal,TEMA—Centre for Mechanical Technology and Automation, 3810-193 Aveiro, Portugal,LASI—Intelligent Systems Associate Laboratory, Portugal
| | - Marco P. Soares dos Santos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal,TEMA—Centre for Mechanical Technology and Automation, 3810-193 Aveiro, Portugal,LASI—Intelligent Systems Associate Laboratory, Portugal
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3
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Altering the course of fracture healing monitoring. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Fukase N, Duke VR, Lin MC, Stake IK, Huard M, Huard J, Marmor MT, Maharbiz MM, Ehrhart NP, Bahney CS, Herfat ST. Wireless Measurements Using Electrical Impedance Spectroscopy to Monitor Fracture Healing. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166233. [PMID: 36016004 PMCID: PMC9412277 DOI: 10.3390/s22166233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 05/05/2023]
Abstract
There is an unmet need for improved, clinically relevant methods to longitudinally quantify bone healing during fracture care. Here we develop a smart bone plate to wirelessly monitor healing utilizing electrical impedance spectroscopy (EIS) to provide real-time data on tissue composition within the fracture callus. To validate our technology, we created a 1-mm rabbit tibial defect and fixed the bone with a standard veterinary plate modified with a custom-designed housing that included two impedance sensors capable of wireless transmission. Impedance magnitude and phase measurements were transmitted every 48 h for up to 10 weeks. Bone healing was assessed by X-ray, µCT, and histology. Our results indicated the sensors successfully incorporated into the fracture callus and did not impede repair. Electrical impedance, resistance, and reactance increased steadily from weeks 3 to 7-corresponding to the transition from hematoma to cartilage to bone within the fracture gap-then plateaued as the bone began to consolidate. These three electrical readings significantly correlated with traditional measurements of bone healing and successfully distinguished between union and not-healed fractures, with the strongest relationship found with impedance magnitude. These results suggest that our EIS smart bone plate can provide continuous and highly sensitive quantitative tissue measurements throughout the course of fracture healing to better guide personalized clinical care.
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Affiliation(s)
- Naomasa Fukase
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Victoria R. Duke
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Monica C. Lin
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA
| | - Ingrid K. Stake
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, 1714 Graalum, Norway
| | - Matthieu Huard
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Johnny Huard
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Meir T. Marmor
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Michel M. Maharbiz
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Nicole P. Ehrhart
- Department of Clinical Sciences, Flint Animal Cancer Center, College of Veterinary Medicine, Colorado State University, Fort Collins, CO 80523, USA
| | - Chelsea S. Bahney
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Correspondence: (C.S.B.); (S.T.H.)
| | - Safa T. Herfat
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Correspondence: (C.S.B.); (S.T.H.)
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Peña-Mercado E, Garcia-Lorenzana M, Huerta-Yepez S, Cruz-Ledesma A, Beltran-Vargas NE. Effect of melatonin on electrical impedance and biomarkers of damage in a gastric ischemia/reperfusion model. PLoS One 2022; 17:e0273099. [PMID: 35972989 PMCID: PMC9380938 DOI: 10.1371/journal.pone.0273099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
The damage to the gastrointestinal mucosa induced by ischemia/reperfusion (I/R) is closely related to high mortality in critically ill patients, which is attributable, in part, to the lack of an early method of diagnosis to show the degree of ischemia-induced injury in this type of patients. Electrical Impedance Spectroscopy (EIS) has been shown to be a tool to early diagnose gastric mucosal damage induced by ischemia. A therapeutic alternative to reduce this type of injury is melatonin (MT), which has gastroprotective effects in I/R models. In this work, the effect of treatment with MT on the electrical properties of gastric tissue, biomarkers of inflammatory (iNOS and COX-2), proliferation, and apoptotic process under I/R conditions in male Wistar rats was evaluated through EIS, histological and immunohistochemical analysis. Treatment with MT prevents gastric mucosa damage, causing a decrease in gastric impedance parameters related to the inflammatory process and cellular damage. This suggests that EIS could be used as a tool to diagnose and monitor the evolution of gastric mucosal injury, as well as in the recovery process in critically ill patients.
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Affiliation(s)
- Eduardo Peña-Mercado
- Departamento de Procesos y Tecnologia, Universidad Autonoma Metropolitana, Unidad Cuajimalpa, CDMX, Mexico
| | - Mario Garcia-Lorenzana
- Departamento de Biologia de la Reproduccion, Universidad Autonoma Metropolitana, Unidad Iztapalapa, CDMX, Mexico
| | - Sara Huerta-Yepez
- Unidad de Investigacion en Enfermedades Hematooncologicas, Hospital Infantil de Mexico, Federico Gomez, CDMX, Mexico
| | | | - Nohra E. Beltran-Vargas
- Departamento de Procesos y Tecnologia, Universidad Autonoma Metropolitana, Unidad Cuajimalpa, CDMX, Mexico
- * E-mail:
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Bone Healing Monitoring in Bone Lengthening Using Bioimpedance. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3226440. [PMID: 35432825 PMCID: PMC9010194 DOI: 10.1155/2022/3226440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
The most common technique of orthopedic surgical procedure for the correction of deformities is bone lengthening by “distraction osteogenesis,” which requires periodic and ongoing bone assessment following surgery. Bone impedance is a noninvasive, quantitative method of assessing bone fracture healing. The purpose of this study was to monitor bone healing and determine when fixation devices should be removed. The left tibia of eight male New Zealand white rabbits (2.4 ± 0.4 kg) undergoing osteotomy was attached with a mini-external fixator. The bone length was increased by 1 cm one week after surgery by distracting it 1 mm per day. Before and after osteotomy, as well as every week after, bone impedance was measured in seven frequency ranges using an EVAL-AD5933EBZ board. Three orthopedic surgeons analyzed the radiographs using the Radiographic Union Scale for Tibial (RUST) score. The Kappa Fleiss coefficient was used to determine surgeon agreement, and the Spearman rank correlation coefficient was used to find out the relationship between impedance measurements and RUST scores. Finally, the device removal time was calculated by comparing the bone impedance to the preosteotomy impedance. The agreement of three orthopedic surgeons on radiographs had a Fleiss' Kappa coefficient of 49%, indicating a moderate level of agreement. The Spearman rank correlation coefficient was 0.43, indicating that impedance and radiographic techniques have a direct relationship. Impedance is expected to be used to monitor fractured or lengthened bones in a noninvasive, low-cost, portable, and straightforward manner. Furthermore, when used in conjunction with other qualitative methods such as radiography, impedance can be useful in determining the precise time of device removal.
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Paudel S, Lee WH, Lee M, Zahoor T, Mitchell R, Yang SY, Zhao H, Schon L, Zhang Z. Intravenous administration of multipotent stromal cells and bone allograft modification to enhance allograft healing. Regen Med 2019; 14:199-211. [PMID: 30761943 DOI: 10.2217/rme-2018-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study investigated a coordinated strategy of revitalizing bone allograft with circulating multipotent stromal cells (MSCs). Materials & methods: After chemotactic and releasing assessments, stromal cell-derived factor 1 and platelet-derived growth factor BB in copolymers were coated on the bone allograft (AlloS-P). Allograft coated with copolymers alone (Allo), as controls, or AlloS-P was implanted into the femur of athymic mice, which received intravenous injections of human MSCs or saline at weeks 1, 2 and 3. Results: At week 8, the total callus volume (both cartilaginous and bony callus) around the allograft was the largest in the AlloS-P + MSC group (p < 0.05). Conclusion: Coating bone allograft with stromal cell-derived factor 1 and platelet-derived growth factor BB and intravenous injections of MSCs improved allograft incorporation.
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Affiliation(s)
- Sharada Paudel
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Wen-Han Lee
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Moses Lee
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Talal Zahoor
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Reed Mitchell
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Shang-You Yang
- Department of Orthopaedic Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Haiqing Zhao
- Department of Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Lew Schon
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Zijun Zhang
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Lin MC, Hu D, Marmor M, Herfat ST, Bahney CS, Maharbiz MM. Smart bone plates can monitor fracture healing. Sci Rep 2019; 9:2122. [PMID: 30765721 PMCID: PMC6375940 DOI: 10.1038/s41598-018-37784-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/07/2018] [Indexed: 11/08/2022] Open
Abstract
There are currently no standardized methods for assessing fracture healing, with physicians relying on X-rays which are only useful at later stages of repair. Using in vivo mouse fracture models, we present the first evidence that microscale instrumented implants provide a route for post-operative fracture monitoring, utilizing electrical impedance spectroscopy (EIS) to track the healing tissue with high sensitivity. In this study, we fixed mouse long bone fractures with external fixators and bone plates. EIS measurements taken across two microelectrodes within the fracture gap were able to track longitudinal differences between individual mice with good versus poor healing. We additionally present an equivalent circuit model that combines the EIS data to classify fracture repair states. Lastly, we show that EIS measurements strongly correlated with standard quantitative µCT values and that these correlations validate clinically-relevant operating frequencies for implementation of this technique. These results demonstrate that EIS can be integrated into current fracture management strategies such as bone plating, providing physicians with quantitative information about the state of fracture repair to guide clinical decision-making for patients.
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Affiliation(s)
- Monica C Lin
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA.
| | - Diane Hu
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Meir Marmor
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Safa T Herfat
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Chelsea S Bahney
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, CO, 81657, USA
| | - Michel M Maharbiz
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
- Department of Electrical Engineering and Computer Science, University of California, Berkeley, CA, 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
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Lin MC, Hu D, Yang F, Herfat ST, Bahney CS, Marmor M, Maharbiz MM. Using impedance to track fracture healing rates in mice in vivo: A pilot study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1724-1727. [PMID: 29060219 DOI: 10.1109/embc.2017.8037175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fracture injuries are highly prevalent worldwide, with treatment of problematic fractures causing a significant burden on the U.S. healthcare system. Physicians typically monitor fracture healing by conducting physical examinations and taking radiographic images. However, nonunions currently take over 6 months to be diagnosed because these techniques are not sensitive enough to adequately assess fracture union. In this study, we display the utility of impedance spectroscopy to track different healing rates in a pilot study of an in vivo mouse tibia fracture model. We have developed small (56 μm) sensors and implanted them in an externally-stabilized fracture for twice-weekly measurement. We found that impedance magnitude increases steadily over time in healing mice but stalls in non-healing mice, and phase angle displays frequency-dependent behavior that also reflects the extent of healing at the fracture site. Our results demonstrate that impedance can track differences in healing rates early on, highlighting the potential of this technique as a method for early detection of fracture nonunion.
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