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Zheng XQ, Huang J, Lin JL, Song CL. Pathophysiological mechanism of acute bone loss after fracture. J Adv Res 2023; 49:63-80. [PMID: 36115662 PMCID: PMC10334135 DOI: 10.1016/j.jare.2022.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Acute bone loss after fracture is associated with various effects on the complete recovery process and a risk of secondary fractures among patients. Studies have reported similarities in pathophysiological mechanisms involved in acute bone loss after fractures and osteoporosis. However, given the silence nature of bone loss and bone metabolism complexities, the actual underlying pathophysiological mechanisms have yet to be fully elucidated. AIM OF REVIEW To elaborate the latest findings in basic research with a focus on acute bone loss after fracture. To briefly highlight potential therapeutic targets and current representative drugs. To arouse researchers' attention and discussion on acute bone loss after fracture. KEY SCIENTIFIC CONCEPTS OF REVIEW Bone loss after fracture is associated with immobilization, mechanical unloading, blood supply damage, sympathetic nerve regulation, and crosstalk between musculoskeletals among other factors. Current treatment strategies rely on regulation of osteoblasts and osteoclasts, therefore, there is a need to elucidate on the underlying mechanisms of acute bone loss after fractures to inform the development of efficacious and safe drugs. In addition, attention should be paid towards ensuring long-term skeletal health.
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Affiliation(s)
- Xuan-Qi Zheng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jie Huang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jia-Liang Lin
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chun-Li Song
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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Zhang S, Patel D, Brady M, Gambill S, Theivendran K, Deshmukh S, Swadener J, Junaid S, Leslie LJ. Experimental testing of fracture fixation plates: A review. Proc Inst Mech Eng H 2022; 236:1253-1272. [PMID: 35920401 PMCID: PMC9449446 DOI: 10.1177/09544119221108540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Metal and its alloys have been predominantly used in fracture fixation for
centuries, but new materials such as composites and polymers have begun to see
clinical use for fracture fixation during the past couple of decades. Along with
the emerging of new materials, tribological issues, especially debris, have
become a growing concern for fracture fixation plates. This article for the
first time systematically reviews the most recent biomechanical research, with a
focus on experimental testing, of those plates within ScienceDirect and PubMed
databases. Based on the search criteria, a total of 5449 papers were retrieved,
which were then further filtered to exclude nonrelevant, duplicate or
non-accessible full article papers. In the end, a total of 83 papers were
reviewed. In experimental testing plates, screws and simulated bones or cadaver
bones are employed to build a fixation construct in order to test the strength
and stability of different plate and screw configurations. The test set-up
conditions and conclusions are well documented and summarised here, including
fracture gap size, types of bones deployed, as well as the applied load, test
speed and test ending criteria. However, research on long term plate usage was
very limited. It is also discovered that there is very limited experimental
research around the tribological behaviour particularly on the debris’
generation, collection and characterisation. In addition, there is no identified
standard studying debris of fracture fixation plate. Therefore, the authors
suggested the generation of a suite of tribological testing standards on
fracture fixation plate and screws in the aim to answer key questions around the
debris from fracture fixation plate of new materials or new design and
ultimately to provide an insight on how to reduce the risks of debris-related
osteolysis, inflammation and aseptic loosening.
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Affiliation(s)
- Shiling Zhang
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Dharmesh Patel
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Mark Brady
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Sherri Gambill
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | | | - Subodh Deshmukh
- Sandwell and West Birmingham Hospital NHS Trust, Birmingham, UK
| | - John Swadener
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Sarah Junaid
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Laura Jane Leslie
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
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Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.
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Boström A, Amin AK, Macpherson GJ, Pankaj P, Scott CEH. Hinge location and apical drill holes in opening wedge high tibial osteotomy: A finite element analysis. J Orthop Res 2021; 39:628-636. [PMID: 32352597 DOI: 10.1002/jor.24704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/13/2020] [Accepted: 04/24/2020] [Indexed: 02/04/2023]
Abstract
At the time of medial opening wedge high tibial osteotomy (HTO) to realign the lower limb and offload medial compartment knee osteoarthritis, unwanted fractures can propagate from the osteotomy apex. The aim of this study was to use finite element (FE) analysis to determine the effect of hinge location and apical drill holes on cortical stresses and strains in HTO. A monoplanar medial opening wedge HTO was created above the tibial tuberosity in a composite tibia. Using the FE method, intact lateral hinges of different widths were considered (5, 7.5, and 10 mm). Additional apical drill holes (2, 4, and 6 mm diameters) were then incorporated into the 10 mm hinge model. The primary outcome measure was the maximum principal strain in the cortical bone surrounding the hinge axis. Secondary outcomes included the force required for osteotomy opening, minimum principal strain, and mean cortical bone stresses (maximum principal/minimum principal/von Mises). Larger intact hinges (10 mm) were associated with higher cortical bone maximum principal strain and stress, lower minimum principal strain/stress, and required greater force to open. Lateral cortex strain concentrations were present in all scenarios, but extended to the joint surface with the 10 mm hinge. Apical drill holes reduced the mean cortical bone maximum principal strain adjacent to the hinge axis: 2 mm hole 6% reduction; 4 mm 35% reduction; and 6 mm 55% reduction. Incorporating a 4-mm apical drill hole centered 10 mm from the intact lateral cortex maintains a cortical bone hinge, minimizes cortical bone strains and reduces the force required to open the HTO; thus improving control.
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Affiliation(s)
- Anna Boström
- Mechanical Engineering, School of Engineering, The University of Edinburgh, UK
| | - Anish K Amin
- Department of Orthopaedics, Royal Infirmary of Edinburgh, UK
| | | | - Pankaj Pankaj
- School of Engineering, Institute for Bioengineering, The University of Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, UK.,School of Engineering, Institute for Bioengineering, The University of Edinburgh, UK
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Medial Opening Wedge High Tibial Osteotomy in Knee Osteoarthritis—A Biomechanical Approach. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10248972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper provides an analysis from a biomechanical perspective of the medial opening wedge high tibial osteotomy surgery, a medical procedure commonly used in treating knee osteoarthritis. The aim of this research is to improve the analysed surgical strategy by establishing optimal values for several very important parameters for the geometric planning of this type of surgical intervention. The research methods used are numerical and experimental. We used finite element, a numerical method used to study the intraoperative behavior of the CORA area for different positions of the initiation point of the cut of the osteotomy plane and for different correction angles. We also used an experimental method in order to determine the maximum force which causes the occurrence of cracks or microcracks in the CORA area. This helped us to determine the stresses, the maximum forces, and the force-displacement variations in the hinge area, elements that allowed us to identify the optimal geometric parameters for planning the surgery.
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Koh YG, Lee JA, Lee HY, Chun HJ, Kim HJ, Kang KT. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res 2019; 14:219. [PMID: 31311570 PMCID: PMC6636153 DOI: 10.1186/s13018-019-1269-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022] Open
Abstract
Background High tibial osteotomy (HTO) is a common treatment for moderate osteoarthritis of the medial compartment in the knee joint by the translation of the force center toward the lateral compartment. However, the stability of a short plate such as Puddu used in this procedure was not as effective as other long plates such as Tomofix. No previous studies have used a rigorous and systematic design optimization method to determine the optimal shape of short HTO plate. Therefore, the purpose of this study is to evaluate the improved biomechanical stability of a short HTO plate by using design optimization and finite element (FE) analysis. Methods A FE model of HTO was subjected to physiological and surgical loads in the tibia. Taguchi-style L27 orthogonal arrays were used to identify the most significant factors for optimizing the design parameters. The optimal design variables were calculated using the nondominated sorting genetic algorithm II. Plate and bone stresses and wedge micromotions in the initial and optimized designs were chosen as the comparison indices. Results Optimal designed HTO plate showed the decreased micromotions over the initial HTO plate with enhanced plate stability. In addition, increased bone stress and decreased plate stress supported the positive effect on stress shielding compared to initial HTO plate design. The results yielded a new short HTO design while demonstrating the feasibility of design optimization and potential improvements to biomechanical stability in HTO design. The newly developed short HTO plate throughout the optimization and computational simulation showed the improved biomechanical effect as good as the golden standard, TomoFix, does. Conclusions This study showed that plate design has a strong influence on the stability after HTO. This study demonstrated that the optimized short plates had low stress shielding effect and less micromotion because of its improvement in biomechanical performances. Our result showed that design optimization is an effective tool for HTO plate design. This information can aid future developments in HTO plate design and can be expanded to other implant designs.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjae-dearo, Songpa-gu, Seoul, 05541, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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