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Ren T, Inglis B, Darwiche S, Dailey HL. Torsion constants and virtual mechanical tests are valid image-based surrogate measures of ovine fracture healing. J Orthop Res 2024; 42:1810-1819. [PMID: 38491964 DOI: 10.1002/jor.25836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 08/30/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
In large animal studies, the mechanical reintegration of the bone fragments is measured using postmortem physical testing, but these assessments can only be performed once, after sacrifice. Image-based virtual mechanical testing is an attractive alternative because it could be used to monitor healing longitudinally. However, the procedures and software required to perform finite element analysis (FEA) on subject-specific models for virtual mechanical testing can be time consuming and costly. Accordingly, the goal of this study was to determine whether a simpler image-based geometric measure-the torsion constant, sometimes known as polar moment of inertia-can be reliably used as a surrogate measure of bone healing in large animals. To achieve this, postmortem biomechanical testing and microCT scans were analyzed for a total of 33 operated and 20 intact ovine tibiae. An image-processing procedure to compute the attenuation-weighted torsion constant from the microCT scans was developed in MATLAB and this code has been made freely available. Linear regression analysis was performed between the postmortem biomechanical data, the results of virtual mechanical testing using FEA, and the torsion constants measured from the scans. The results showed that virtual mechanical testing is the most reliable surrogate measure of postmortem torsional rigidity, having strong correlations and high absolute agreement. However, when FEA is not practical, the torsion constant is a viable alternative surrogate measure that is moderately correlated with postmortem torsional rigidity and can be readily calculated.
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Affiliation(s)
- Tianyi Ren
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Salim Darwiche
- Musculoskeltal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
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Ciobanu P, Danciu M, Pascu A, Gardikiotis I, Forna N, Sirbu MT, Calistru AE, Puha B, Veliceasa B, Sirbu PD. Experimental Study on Rats with Critical-Size Bone Defects Comparing Effects of Autologous Bone Graft, Equine Bone Substitute Bio-Gen ® Alone or in Association with Platelet-Rich Fibrin (PRF). Polymers (Basel) 2024; 16:1502. [PMID: 38891449 PMCID: PMC11175103 DOI: 10.3390/polym16111502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A critical-sized bone defect (CsBD) is considered one that will not heal spontaneously and requires reconstruction. This study aims to compare the results of using different bone reconstructive techniques and to study the potential of platelet-rich fibrin (PRF) to enhance the healing properties of a bone substitute (BS). METHODS In this experimental study on rats, the treatment of critical-sized bone defects was carried out by analysing four groups: a control group in which the bone defect was left empty; a group treated with Bio-Gen®; another group in which the defect was treated with PRF in combination with Bio-Gen®; and the last that was treated with autologous bone graft (ABG). The defects were evaluated by microcomputed tomography (µCT) and then histomorphometrically. RESULTS From both the histological and imagistic point of view, the best results were registered in the ABG group, followed by the group treated with Bio-Gen® with PRF, Bio-Gen® group, and control group, with statistically significant differences. CONCLUSIONS A 5 mm defect in the rat radius can be considered critical. ABG showed the best results in treating the bone defect. PRF significantly enhanced the efficacy of Bio-Gen®.
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Affiliation(s)
- Petru Ciobanu
- Department of Surgery II—Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Mihai Danciu
- Department of Morphofunctional Sciences I—Morphopathology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Andrei Pascu
- Department of Morphofunctional Sciences I—Morphopathology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Ioannis Gardikiotis
- Advanced Center for Research and Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Norin Forna
- Department of Surgery II—Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Mihnea Theodor Sirbu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Anca-Elena Calistru
- Research Institute for Agriculture and Environment, Iasi University of Life Science, 700490 Iasi, Romania
| | - Bogdan Puha
- Department of Surgery II—Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Bogdan Veliceasa
- Department of Surgery II—Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
| | - Paul-Dan Sirbu
- Department of Surgery II—Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700454 Iasi, Romania
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Kadkoy Y, Abraham S, Michael P, Tazin T, Wetterstrand C, O'Connor JP. Novel approaches to correlate computerized tomography imaging of bone fracture callus to callus structural mechanics. Bone Rep 2023; 19:101726. [PMID: 38047269 PMCID: PMC10690537 DOI: 10.1016/j.bonr.2023.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/15/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
Estimating the mechanical properties of bone in vivo without destructive testing would be useful for research and clinical orthopedic applications. Micro-computerized tomography (μCT) imaging can provide quantitative, high-resolution 3D representations of bone morphology and is generally the basis from which bone mechanical properties are non-destructively estimated. The goal of this study was to develop metrics using qualitative and quantitative aspects of bone microarchitecture derived from μCT imaging to estimate the mechanical integrity of bone fracture calluses. Mechanical testing data (peak torque) and μCT image data from 12 rat femur fractures were collected at 4 weeks after fracture. MATLAB was used to analyze the callus μCT imaging data which were then correlated to the empirically determined peak torque of the callus. One metric correlated Z-rays, linear contiguities of voxels running parallel to the neutral axis of the femur and through the fracture callus, to peak torque. Other metrics were based on voxel linkage values (LVs), which is a novel measurement defined by the number of voxels surrounding a given voxel (ranging from 1 to 27) that are all above a specified threshold. Linkage values were utilized to segment the callus and compute healing scores (termed eRUST) based on the modified Radiographic Union Score for Tibial fractures (mRUST). Linkage values were also used to calculate linked bone areas (LBAs). All metrics positively correlated with peak torque, yielding correlations of determination (R2) of 0.863 for eRUST, 0.792 for Z-ray scoring, and 0.764 for a normalized Linked Bone Area metric. These novel metrics appear to be promising approaches for extrapolating fracture callus structural properties from bone microarchitecture using objective analytical methods and without resorting to computationally complex finite element analyses.
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Affiliation(s)
- Yazan Kadkoy
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, United States of America
- Rutgers Biomedical Health Sciences, School of Graduate Studies, Newark, United States of America
| | - Sangeeta Abraham
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, United States of America
- Rutgers Biomedical Health Sciences, School of Graduate Studies, Newark, United States of America
| | - Peter Michael
- Department of Biomedical Engineering, New Jersey Institute of Technology, United States of America
| | - Tasmima Tazin
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, United States of America
| | - Charlene Wetterstrand
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, United States of America
| | - J. Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, United States of America
- Rutgers Biomedical Health Sciences, School of Graduate Studies, Newark, United States of America
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Shariyate MJ, Kheir N, Caro D, Abbasian M, Rodriguez EK, Snyder BD, Nazarian A. Assessment of Bone Healing: Opportunities to Improve the Standard of Care. J Bone Joint Surg Am 2023; 105:1193-1202. [PMID: 37339171 DOI: 10.2106/jbjs.22.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.
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Affiliation(s)
- Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University Yerevan, Armenia
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Safdari M, Dastjerdi A, Makhmalbaf N, Makhmalbaf M, Makhmalbaf H. Closing-Wedge and Opening-Wedge High Tibial Osteotomy as Successful Treatments of Symptomatic Medial Osteoarthritis of the Knee: A Randomized Controlled Trial. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:421-428. [PMID: 37404296 PMCID: PMC10314979 DOI: 10.22038/abjs.2023.68944.3253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/13/2023] [Indexed: 07/06/2023]
Abstract
Objectives Closing-wedge high tibial osteotomy (CWHTO) and opening-wedge high tibial osteotomy (OWHTO) are commonly used osteotomy techniques for the symptomatic knee osteoarthritis treatment. However, there is no consensus on which method provides superior outcomes. In this study, we compared the clinical outcomes, radiologic outcomes, and postoperative complications of these techniques. Methods In a randomized controlled trial, 76 patients with medial compartment knee osteoarthritis and associated varus malalignment were randomized into the CWHTO and OWHTO groups (n=38). The primary outcome measures were knee function evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS) and knee pain assessed by a visual analog scale. The secondary outcome measures were posterior tibial slope (PTS), tibial bone varus angle, and postoperative complications. Results Both techniques significantly improved the clinical and radiologic outcome measures. The mean improvement of total KOOS was not significantly different between the CWHTO and OPHTO groups (P=0.55). Moreover, the improvement in various KOOS subscales was not significantly different between the two groups. The mean improvement of Visual Analogue Scale (VAS) was not significantly different between the CWHTO and OWHTO groups (P=0.89). The mean PTS change was not significantly different between the two groups (P=0.34). The mean improvement of the varus angle was not significantly different between the two groups (P=0.28). The rate of postoperative complications was not remarkably different between the CWHTO and OWHTO groups. Conclusion Considering no observed superiority of each osteotomy technique over the other one, two techniques could be used interchangeably and based on the surgeon's preference.
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Affiliation(s)
- Mohammadreza Safdari
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Orthopedic Surgery, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Ali Dastjerdi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Makhmalbaf
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahshid Makhmalbaf
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Makhmalbaf
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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