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Adamović P, Matoc L, Knežević P, Sabalić S, Kodvanj J. Biomechanical analysis of a novel screw system with a variable locking angle in mandible angle fractures. Med Biol Eng Comput 2023; 61:2951-2961. [PMID: 37535297 DOI: 10.1007/s11517-023-02895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
Locking plates nowadays represent an important treatment in bone trauma and bone healing due to its strong biomechanical properties. The purpose of this study was to both computationally and experimentally validate a novel screw locking system by comparing it to another locking system from state-of-the-art and to apply it in an environment of a fractured mandible. FEA was used to test both systems prior to experimental tests. The systems were locked in the plate holes at 0°, 10°, 15°, and 20°. Cyclic bending tests and push-out tests were performed in order to determine the stiffness and push-out forces of both locking systems. Finally, newly designed locking system was implemented in mandibular angle fracture. Control locking system was biomechanically superior in push-out test, but with no greater significance. In contrast, the new locking system showed greater stiffness by 17.3% at the deflection angle of 20° in cyclic tests, with lower values for other deflection angles. Similar values were displayed in fractured mandible angle environment. Greater stiffness of the new locking system in cyclic loading tests, together with polyaxiallity of the new locking screw, could lead to easier application and improved biomechanical stability of the mandible angle fractures.
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Affiliation(s)
- Petra Adamović
- Experimental Mechanics Laboratory, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb, Croatia
| | - Lovro Matoc
- Department of Maxillofacial Surgery, University Hospital Centre Zagreb, Kišpatićeva Ulica 12, 10000, Zagreb, Croatia.
| | - Predrag Knežević
- Department of Maxillofacial and Oral Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia
| | - Srećko Sabalić
- Department of Traumatology, Sestre Milosrdnice University Hospital Center, Draškovićeva 19, 10000, Zagreb, Croatia
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Janoš Kodvanj
- Experimental Mechanics Laboratory, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb, Croatia
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Newby SD, Forsynth C, Bow AJ, Bourdo SE, Hung M, Cheever J, Moffat R, Gross AJ, Licari FW, Dhar MS. Xenogenic Implantation of Human Mesenchymal Stromal Cells Using a Novel 3D-Printed Scaffold of PLGA and Graphene Leads to a Significant Increase in Bone Mineralization in a Rat Segmental Femoral Bone Defect. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1149. [PMID: 37049243 PMCID: PMC10097331 DOI: 10.3390/nano13071149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Tissue-engineering technologies have the potential to provide an effective approach to bone regeneration. Based on the published literature and data from our laboratory, two biomaterial inks containing PLGA and blended with graphene nanoparticles were fabricated. The biomaterial inks consisted of two forms of commercially available PLGA with varying ratios of LA:GA (65:35 and 75:25) and molecular weights of 30,000-107,000. Each of these forms of PLGA was blended with a form containing a 50:50 ratio of LA:GA, resulting in ratios of 50:65 and 50:75, which were subsequently mixed with a 0.05 wt% low-oxygen-functionalized derivative of graphene. Scanning electron microscopy showed interconnected pores in the lattice structures of each scaffold. The cytocompatibility of human ADMSCs transduced with a red fluorescent protein (RFP) was evaluated in vitro. The in vivo biocompatibility and the potential to repair bones were evaluated in a critically sized 5 mm mechanical load-bearing segmental femur defect model in rats. Bone repair was monitored by radiological, histological, and microcomputed tomography methods. The results showed that all of the constructs were biocompatible and did not exhibit any adverse effects. The constructs containing PLGA (50:75)/graphene alone and with hADMSCs demonstrated a significant increase in mineralized tissues within 60 days post-treatment. The percentage of bone volume to total volume from microCT analyses in the rats treated with the PLGA + cells construct showed a 50% new tissue formation, which matched that of a phantom. The microCT results were supported by Von Kossa staining.
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Affiliation(s)
- Steven D. Newby
- Large Animal Regenerative Medicine Program, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Chris Forsynth
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN 37996, USA
| | - Austin J. Bow
- Large Animal Regenerative Medicine Program, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Shawn E. Bourdo
- Center for Integrative Nanotechnologies, University of Arkansas at Little Rock, Little Rock, AR 72204, USA
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT 84095, USA
- Department of Orthopedic Surgery Operations, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Joseph Cheever
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT 84095, USA
| | - Ryan Moffat
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT 84095, USA
| | - Andrew J. Gross
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT 84095, USA
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN 37996, USA
| | - Frank W. Licari
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Parkway, South Jordan, UT 84095, USA
| | - Madhu S. Dhar
- Large Animal Regenerative Medicine Program, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
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Grzeskowiak RM, Rifkin RE, Croy EG, Steiner RC, Seddighi R, Mulon PY, Adair HS, Anderson DE. Temporal Changes in Reverse Torque of Locking-Head Screws Used in the Locking Plate in Segmental Tibial Defect in Goat Model. Front Surg 2021; 8:637268. [PMID: 33987199 PMCID: PMC8111000 DOI: 10.3389/fsurg.2021.637268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate changes in peak reverse torque (PRT) of the locking head screws that occur over time. A locking plate construct, consisting of an 8-hole locking plate and 8 locking screws, was used to stabilize a tibia segmental bone defect in a goat model. PRT was measured after periods of 3, 6, 9, and 12 months of ambulation. PRT for each screw was determined during plate removal. Statistical analysis revealed that after 6 months of loading, locking screws placed in position no. 4 had significantly less PRT as compared with screws placed in position no. 5 (p < 0.05). There were no statistically significant differences in PRT between groups as a factor of time (p > 0.05). Intracortical fractures occurred during the placement of 151 out of 664 screws (22.7%) and were significantly more common in the screw positions closest to the osteotomy (positions 4 and 5, p < 0.05). Periosteal and endosteal bone reactions and locking screw backout occurred significantly more often in the proximal bone segments (p < 0.05). Screw backout significantly, negatively influenced the PRT of the screws placed in positions no. 3, 4, and 5 (p < 0.05). The locking plate-screw constructs provided stable fixation of 2.5-cm segmental tibia defects in a goat animal model for up to 12 months.
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Affiliation(s)
- Remigiusz M Grzeskowiak
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Rebecca E Rifkin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Elizabeth G Croy
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Richard C Steiner
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Henry S Adair
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - David E Anderson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
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Grzeskowiak RM, Freeman LR, Harper DP, Anderson DE, Mulon P. Effect of cyclic loading on the stability of screws placed in the locking plates used to bridge segmental bone defects. J Orthop Res 2021; 39:516-524. [PMID: 32844515 PMCID: PMC7984344 DOI: 10.1002/jor.24838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to evaluate the ex vivo effect of cyclic loading on the stability of screws placed in locking plates used to bridge segmental bone defects. The primary interface stability was assessed using peak reverse torque. Eighteen, 8-hole stainless-steel 4.5 mm locking plates and 4.0-mm self-tapping locking-head screws were used to stabilize 40-mm segmental defects in goat tibiae. Treatment groups included control constructs without cyclic loading (n = 6) and constructs tested to 5000 (n = 6) and 10,000 cycles (n = 6) of 600 N compressive axial loading. The insertion of all screws was standardized to 400 N-cm insertion torque. Peak reverse torque was measured immediately after screw placement (control), or after the completion of the respective loading cycles. The difference between treatment groups was compared using univariate analysis of variance. The analysis revealed a significant difference in peak reverse torque of the screws among the treatment groups (p = .000). The mean reverse torque values equaled 343.5 ± 18.3 N-cm for non-cycled controls, 303.3 ± 25.9 and 296.0 ± 42.9 N-cm after 5000 and 10,000 cycles, respectively. Among all treatment groups, screws placed in the distal bone segment tended to have lesser peak reverse torque reduction than those placed in the proximal segment and the difference was proportional to the number of cycles (p = .562; p = .255; p = .013 in control, and after 5000 and 10,000 cycles, respectively). Cyclic loading may have a negative effect on the primary stability of screws placed in locking plate constructs used to bridge segmental bone defects and could contribute to the risk of screw loosening.
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Affiliation(s)
- Remigiusz M. Grzeskowiak
- Large Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Laura R. Freeman
- Large Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - David P. Harper
- The Center for Renewable Carbon, Institute of AgricultureUniversity of TennesseeKnoxvilleTennesseeUSA
| | - David E. Anderson
- Large Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Pierre‐Yves Mulon
- Large Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
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Grzeskowiak RM, Schumacher J, Dhar MS, Harper DP, Mulon PY, Anderson DE. Bone and Cartilage Interfaces With Orthopedic Implants: A Literature Review. Front Surg 2020; 7:601244. [PMID: 33409291 PMCID: PMC7779634 DOI: 10.3389/fsurg.2020.601244] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
The interface between a surgical implant and tissue consists of a complex and dynamic environment characterized by mechanical and biological interactions between the implant and surrounding tissue. The implantation process leads to injury which needs to heal over time and the rapidity of this process as well as the property of restored tissue impact directly the strength of the interface. Bleeding is the first and most relevant step of the healing process because blood provides growth factors and cellular material necessary for tissue repair. Integration of the implants placed in poorly vascularized tissue such as articular cartilage is, therefore, more challenging than compared with the implants placed in well-vascularized tissues such as bone. Bleeding is followed by the establishment of a provisional matrix that is gradually transformed into the native tissue. The ultimate goal of implantation is to obtain a complete integration between the implant and tissue resulting in long-term stability. The stability of the implant has been defined as primary (mechanical) and secondary (biological integration) stability. Successful integration of an implant within the tissue depends on both stabilities and is vital for short- and long-term surgical outcomes. Advances in research aim to improve implant integration resulting in enhanced implant and tissue interface. Numerous methods have been employed to improve the process of modifying both stability types. This review provides a comprehensive discussion of current knowledge regarding implant-tissue interfaces within bone and cartilage as well as novel approaches to strengthen the implant-tissue interface. Furthermore, it gives an insight into the current state-of-art biomechanical testing of the stability of the implants. Current knowledge reveals that the design of the implants closely mimicking the native structure is more likely to become well integrated. The literature provides however several other techniques such as coating with a bioactive compound that will stimulate the integration and successful outcome for the patient.
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Affiliation(s)
- Remigiusz M. Grzeskowiak
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Jim Schumacher
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Madhu S. Dhar
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David P. Harper
- The Center for Renewable Carbon, Institute of Agriculture, University of Tennessee, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
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