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Lundin N, Olivecrona H, Bakhshayesh P, Gordon Murkes L, Enocson A. Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3143-3151. [PMID: 37059868 PMCID: PMC10504208 DOI: 10.1007/s00590-023-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE High-energy pelvic fractures are complex injuries often requiring surgical treatment. Different radiological methods exist to evaluate the reduction and healing process postoperatively but with certain limitations. The aim of this study was to evaluate Computed Tomography Micromotion Analysis (CTMA) in a clinical setting for follow-up of surgically treated pelvic fracture patients. METHODS 10 patients surgically treated for a pelvic fracture were included and prospectively followed with Computed Tomography (CT) at 0, 6, 12 and 52 weeks postoperatively. CTMA was used to measure postoperative translation and rotation of the pelvic fracture during the 52 weeks follow-up. Clinical outcomes were collected through the questionnaires EQ-5D index score and Majeed score. RESULTS 10 patients were included with mean age (± SD, min-max) 52 (16, 31-80) years and 70% (n = 7) were males. The median (IQR, min-max) global translation from 0 to 52 weeks was 6.0 (4.6, 1.4-12.6) millimeters and median global rotation was 2.6 (2.4, 0.7-4.7) degrees. The general trend was a larger translation between 0 and 6 weeks postoperatively compared to 6-12 and 12-52 weeks. For the clinical outcomes, the general trend was that all patients started from high scores which decreased in the first postoperative follow-up and recovered to different extent during the study period. CONCLUSION CTMA was successfully used in the follow-up of surgically treated pelvic fracture patients. Movement in the pelvic fractures after surgical fixation was largest between 0 and 6 weeks.
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Affiliation(s)
- Natalie Lundin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Peyman Bakhshayesh
- Leeds General Infirmary Major Trauma Centre, University of Leeds, Leeds, UK
| | - Lena Gordon Murkes
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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2
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Gait Analysis to Monitor Fracture Healing of the Lower Leg. Bioengineering (Basel) 2023; 10:bioengineering10020255. [PMID: 36829749 PMCID: PMC9952799 DOI: 10.3390/bioengineering10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.
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Lopas LA, Shen H, Zhang N, Jang Y, Tawfik VL, Goodman SB, Natoli RM. Clinical Assessments of Fracture Healing and Basic Science Correlates: Is There Room for Convergence? Curr Osteoporos Rep 2022; 21:216-227. [PMID: 36534307 DOI: 10.1007/s11914-022-00770-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the clinical and basic science methods used to assess fracture healing and propose a framework to improve the translational possibilities. RECENT FINDINGS Mainstays of fracture healing assessment include clinical examination, various imaging modalities, and assessment of function. Pre-clinical studies have yielded insight into biomechanical progression as well as the genetic, molecular, and cellular processes of fracture healing. Efforts are emerging to identify early markers to predict impaired healing and possibly early intervention to alter these processes. Despite of the differences in clinical and preclinical research, opportunities exist to unify and improve the translational efforts between these arenas to develop and optimize our ability to assess and predict fracture healing, thereby improving the clinical care of these patients.
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Affiliation(s)
- Luke A Lopas
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA.
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yohan Jang
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd Suite 535, Indianapolis, IN, USA
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Abula A, Cheng E, Abulaiti A, Liu K, Liu Y, Ren P. Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport. BMC Musculoskelet Disord 2022; 23:900. [PMID: 36209097 PMCID: PMC9548124 DOI: 10.1186/s12891-022-05852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to investigate the risk factors of transport gap bending deformity (TGBD) in the treatment of critical-size bone defect (CSBD) after the removal of the external fixator. Methods From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using a unilateral external fixator in our medical institution. TGBD was defined as the bone callus in the distraction area with a deviation to the force line of the femur (> 10°) or tibia (> 12°) after removal of the external fixator. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson’s Chi-square test was analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD. Results A total of 178 patients were enrolled in the study, with a mean follow-up time of 28.6 ± 3.82 months. The positive result of the bacteria isolated test was observed in 144 cases (80.9%). The rate of excellent and good in the bone outcomes (excellent/good/fair/poor/failure, 41/108/15/14/0) was 83.7%, and 92.3% in the functional results (excellent/good/fair/poor/failure, 50/98/16/14/0) according to the ASAMI criteria. TGBD after removal of external fixator occurred in twenty-two patients (12.3%), including 6 tibias, and 16 femurs. Age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, osteoporosis, glucocorticoid intake, duration of infection > 24 months, EFT > 9 months, EFI > 1.8 month/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis (P < 0.05). The incidence more than 50% was found in patients with femoral defect (76.1%), osteoporosis (72.7%), BMI > 25 kg/m2 (69.0%), diabetes (59.5%), glucocorticoid intake (54.7%). In the multivariate logistic regression analyses, the following factors were associated independently with TGBD, including age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, and osteoporosis. Conclusions Bone transport using a unilateral external fixator was a safe and practical method in the treatment of CSBD caused by infection. The top five risk factors of TGBD included femoral defect, BMI > 25 kg/m2, duration of bone infection > 24 months, age > 45 years, and diabetes. Age > 45 years, BMI > 25 kg/m2, femoral defect, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.
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Affiliation(s)
- Abulaiti Abula
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Erlin Cheng
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Alimujiang Abulaiti
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Maeda M, Maeda N, Masuda K, Nagano T, Tanaka Y. Diagnosis of Lumbar Transverse Process Fractures in Orthopedic Clinics Using Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1825-1835. [PMID: 34676569 DOI: 10.1002/jum.15846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/04/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
Sonography is conventionally used to diagnose fractures by identifying cortical discontinuity in the bone. However, its usefulness for diagnosing lumbar transverse process fractures (LTPFs) remains unknown. In this series, we describe static and stress sonography findings during manual application of compression stress on the lateral lumbar vertebrae in 17 patients with LTPFs. Features of LTPFs on static sonography included cortical discontinuity (89.3%), hematoma (71.4%), step-off deformity (67.9%), and focal reverberation echo (78.6%). All LTPFs were confirmed on stress sonography. Thus, stress sonography should be considered for the detection of LTPFs when there is at least one static sonographic fracture sign.
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Affiliation(s)
| | | | - Keisuke Masuda
- Department of Orthopedics, Higashiosaka Medical Center, Higasiosaka, Osaka, Japan
| | | | - Yasuhito Tanaka
- Department of Orthopedics, Nara Medical University, Kashihara, Nara, Japan
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Ganse B, Orth M, Roland M, Diebels S, Motzki P, Seelecke S, Kirsch SM, Welsch F, Andres A, Wickert K, Braun BJ, Pohlemann T. Concepts and clinical aspects of active implants for the treatment of bone fractures. Acta Biomater 2022; 146:1-9. [PMID: 35537678 DOI: 10.1016/j.actbio.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 12/17/2022]
Abstract
Nonunion is a complication of long bone fractures that leads to disability, morbidity and high costs. Early detection is difficult and treatment through external stimulation and revision surgery is often a lengthy process. Therefore, alternative diagnostic and therapeutic options are currently being explored, including the use of external and internal sensors. Apart from monitoring fracture stiffness and displacement directly at the fracture site, it would be desirable if an implant could also vary its stiffness and apply an intervention to promote healing, if needed. This could be achieved either by a predetermined protocol, by remote control, or even by processing data and triggering the intervention itself (self-regulated 'intelligent' or 'smart' implant). So-called active or smart materials like shape memory alloys (SMA) have opened up opportunities to build active implants. For example, implants could stimulate fracture healing by active shortening and lengthening via SMA actuator wires; by emitting pulses, waves, or electromagnetic fields. However, it remains undefined which modes of application, forces, frequencies, force directions, time durations and periods, or other stimuli such implants should ideally deliver for the best result. The present paper reviews the literature on active implants and interventions for nonunion, discusses possible mechanisms of active implants and points out where further research and development are needed to build an active implant that applies the most ideal intervention. STATEMENT OF SIGNIFICANCE: Early detection of delays during fracture healing and timely intervention are difficult due to limitations of the current diagnostic strategies. New diagnostic options are under evaluation, including the use of external and internal sensors. In addition, it would be desirable if an implant could actively facilitate healing ('Intelligent' or 'smart' implant). Implants could stimulate fracture healing via active shortening and lengthening; by emitting pulses, waves, or electromagnetic fields. No such implants exist to date, but new composite materials and alloys have opened up opportunities to build such active implants, and several groups across the globe are currently working on their development. The present paper is the first review on this topic to date.
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Viero A, Biehler-Gomez L, Messina C, Cappella A, Giannoukos K, Viel G, Tagliaro F, Cattaneo C. Utility of micro-CT for dating post-cranial fractures of known post-traumatic ages through 3D measurements of the trabecular inner morphology. Sci Rep 2022; 12:10543. [PMID: 35732857 DOI: 10.1038/s41598-022-14530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/08/2022] [Indexed: 11/09/2022] Open
Abstract
Fracture dating is an issue at the forefront of forensic sciences. While dating fracture is crucial to understanding and verifying the chronology of events in cases of abuse and violent death, its application is the subject of considerable discussion in the scientific community, filled with limitations and difficulties. Current methods for fracture dating are mainly based on a qualitative assessment through macroscopy, microscopy, and imaging and subject to variations depending on the experience of the observer. In this paper, we investigated the potential of quantifiable micro-CT analysis for fracture dating. Five histomorphometric parameters commonly used for the study of the 3D bone trabecular microarchitecture with micro-CT were calculated based on nine fractures of known post-traumatic ages, including the degree of anisotropy, connectivity density, bone volume fraction, trabecular thickness, and trabecular separation. As a result, trends in the evolution of the microarchitecture of the bone relative to age of the callus could be identified, in particular concerning anisotropy, trabecular separation and connectivity density, consistent with the healing bone process. The findings obtained in this pilot study encourage further research in quantifiable parameters of the bone microarchitecture as they could represent useful features for the construction of objective models for fracture dating.
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Affiliation(s)
- Alessia Viero
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.,Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10, 37134, Verona, Italy.,Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Lucie Biehler-Gomez
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy.
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Annalisa Cappella
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Laboratorio Di Morfologia Umana Applicata, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Konstantinos Giannoukos
- Elettra-Sincrotrone Trieste S.C.P.A., SYRMEP Group, AREA Science Park, Strada Statale 14, 34149, Basovizza, Trieste, Italy
| | - Guido Viel
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Franco Tagliaro
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10, 37134, Verona, Italy.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russia
| | - Cristina Cattaneo
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
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Braun BJ, Grimm B, Hanflik AM, Richter PH, Sivananthan S, Yarboro SR, Marmor MT. Wearable technology in orthopedic trauma surgery - An AO trauma survey and review of current and future applications. Injury 2022; 53:1961-1965. [PMID: 35307166 DOI: 10.1016/j.injury.2022.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/02/2023]
Abstract
The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions. A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology. Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results. Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.
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Affiliation(s)
- Benedikt J Braun
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Hospital, Schnarrenbergstr. 95, Tuebingen 72076, Germany.
| | - Bernd Grimm
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods Group, Luxembourg, Institute of Health, Transversal activities, Luxembourg, Luxembourg
| | - Andrew M Hanflik
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Downey Medical Center, Kaiser Permanente Downey, CA, United States
| | - Peter H Richter
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | | | | | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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Hu X, Huang J, Wei Y, Zhao H, Lin S, Hu C, Wang Z, Zhao Z, Zang X. Laser Direct-Write Sensors on Carbon-Fiber-Reinforced Poly-Ether-Ether-Ketone for Smart Orthopedic Implants. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105499. [PMID: 35142105 PMCID: PMC9009116 DOI: 10.1002/advs.202105499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Mechanically close-to-bone carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK)-based orthopedic implants are rising to compete with metal implants, due to their X-ray transparency, superior biocompatibility, and body-environment stability. While real-time strain assessment of implants is crucial for the postsurgery study of fracture union and failure of prostheses, integrating precise and durable sensors on orthopedic implants remains a great challenge. Herein, a laser direct-write technique is presented to pattern conductive features (minimum sheet resistance <1.7 Ω sq-1 ) on CRF-PEEK-based parts, which can act as strain sensors. The as-fabricated sensors exhibit excellent linearity (R2 = 0.997) over the working range (0-2.5% strain). While rigid silicon- or metal-based sensor chips have to be packaged onto flat surfaces, all-carbon-based sensors can be written on the complex curved surfaces of CFR-PEEK joints using a portable laser mounted on a six-axis robotic manipulator. A wireless transmission prototype is also demonstrated using a Bluetooth module. Such results will allow a wider space to design sensors (and arrays) for detailed loading progressing monitoring and personalized diagnostic applications.
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Affiliation(s)
- Xingjian Hu
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Jincai Huang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Yanzhuo Wei
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Haiyan Zhao
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
| | - Shize Lin
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Chuxiong Hu
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Ze Wang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Zhe Zhao
- Orthopedics DepartmentBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing100084China
| | - Xining Zang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
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10
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Wang W, Xiong Z, Li Y, Guo Y, Li M, Mei H, Canavese F, Chen S. Variables influencing radiological fracture healing in children with femoral neck fractures treated surgically: A review of 177 cases. Orthop Traumatol Surg Res 2022; 108:103052. [PMID: 34530130 DOI: 10.1016/j.otsr.2021.103052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed: (1) to determine the probability of and the amount of time needed to achieve fracture healing in children with displaced femoral neck fractures (FNFs) treated surgically; and (2) to determine which factors can affect both the probability of and the amount of time needed to achieve radiological fracture healing in those patients. HYPOTHESIS Pediatric FNFs require longer time to achieve union than previously reported. METHODS We retrospectively reviewed the data of 177 children (mean age 10.5±3.9 years) with FNFs treated surgically. Risk factors, including age, sex, laterality, the mechanism of injury, the initial displacement severity, the type of fracture, the time to reduction, the reduction method, the fixation method and the reduction quality, were recorded. Furthermore, the presence of a comminuted medial or posterior cortex on anteroposterior (AP) or lateral radiographs was also recorded. RESULTS A total of 172 hips (97.2%) achieved radiological fracture healing during the follow-up period. Severe initial displacement, a comminuted cortex on the AP or lateral radiographs and poor reduction quality significantly increased the time needed to achieve radiological fracture healing (p<0.05). Cox regression analysis indicated that the cumulative probability of achieving fracture healing increased linearly during the first 6 months and then plateaued, with a monthly increase of less than 5%. The severity of initial displacement, presence/absence of comminution on the medial or posterior cortex, and reduction quality were factors influencing the probability of achieving fracture healing within the first 6 months after injury (p<0.05). CONCLUSIONS Radiological union of displaced pediatric FNFs treated surgically increases linearly during the first six month after surgery and then it tends to plateau. Risk factors for nonunion are severe initial displacement, poor reduction quality and the presence of comminuted medial or posterior cortex on AP or lateral radiographs; the same factors are associated with a longer time to achieve fracture healing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, ShenZhen Children's Hospital, Shenzhen, China
| | - YiQiang Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - YueMing Guo
- Department of Pediatric Orthopaedics, FoShan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Ming Li
- Department of Pediatric Orthopaedics, Children's Hospital of ChongQing Medical University, Chongqing, China
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, HuNan Children's Hospital, Hunan, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne-de-Flandre Hospital, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopedics,Fuzhou Second Hospital, Xiamen University, Fuzhou, China.
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11
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Wolynski JG, Ilić MM, Notaroš BM, Labus KM, Puttlitz CM, McGilvray KC. Vivaldi Antennas for Contactless Sensing of Implant Deflections and Stiffness for Orthopaedic Applications. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 10:1151-1161. [PMID: 35873899 PMCID: PMC9307137 DOI: 10.1109/access.2021.3137718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The implementation of novel coaxial dipole antennas has been shown to be a satisfactory diagnostic platform for the prediction of orthopaedic bone fracture healing outcomes. These techniques require mechanical deflection of implanted metallic hardware (i.e., rods and plates), which, when loaded, produce measurable changes in the resonant frequency of the adjacent antenna. Despite promising initial results, the coiled coaxial antenna design is limited by large antenna sizes and nonlinearity in the resonant frequency data. The purpose of this study was to develop two Vivaldi antennas (a.k.a., "standard" and "miniaturized") to address these challenges. Antenna behaviors were first computationally modeled prior to prototype fabrication. In subsequent benchtop tests, metallic plate segments were displaced from the prototype antennas via precision linear actuator while measuring resultant change in resonant frequency. Close agreement was observed between computational and benchtop results, where antennas were highly sensitive to small displacements of the metallic hardware, with sensitivity decreasing nonlinearly with increasing distance. Greater sensitivity was observed for the miniaturized design for both stainless steel and titanium implants. Additionally, these data demonstrated that by taking resonant frequency data during implant displacement and then again during antenna displacement from the same sample, via linear actuators, that "antenna calibration procedures" could be used to enable a clinically relevant quantification of fracture stiffness from the raw resonant frequency data. These improvements mitigate diagnostic challenges associated with nonlinear resonant frequency response seen in previous antenna designs.
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Affiliation(s)
- Jakob G Wolynski
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Milan M Ilić
- School of Electrical Engineering, University of Belgrade, 11120 Belgrade, Serbia
| | - Branislav M Notaroš
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Kevin M Labus
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Kirk C McGilvray
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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12
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A Novel Capacitive Measurement Device for Longitudinal Monitoring of Bone Fracture Healing. SENSORS 2021; 21:s21196694. [PMID: 34641013 PMCID: PMC8512850 DOI: 10.3390/s21196694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
The healing process of surgically-stabilised long bone fractures depends on two main factors: (a) the assessment of implant stability, and (b) the knowledge of bone callus stiffness. Currently, X-rays are the main diagnostic tool used for the assessment of bone fractures. However, they are considered unsafe, and the interpretation of the clinical results is highly subjective, depending on the clinician’s experience. Hence, there is the need for objective, non-invasive and repeatable methods to allow a longitudinal assessment of implant stability and bone callus stiffness. In this work, we propose a compact and scalable system, based on capacitive sensor technology, able to measure, quantitatively, the relative pins displacements in bone fractures treated with external fixators. The measurement device proved to be easily integrable with the external fixator pins. Smart arrangements of the sensor units were exploited to discriminate relative movements of the external pins in the 3D space with a resolution of 0.5 mm and 0.5°. The proposed capacitive technology was able to detect all of the expected movements of the external pins in the 3D space, providing information on implant stability and bone callus stiffness.
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13
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Glinkowski W, Chelnokov AN. The orthopaedic surgeon's clinical and experimental experience affect methods used for the fracture healing assessment (FHA) - An International Survey. Injury 2021; 52:2205-2214. [PMID: 33836844 DOI: 10.1016/j.injury.2021.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
Detection of fracture healing (FH), which depends on assessment methods, is a crucial factor affecting treatment. The study aimed to examine orthopedic surgeons in terms of practical methods of fracture healing (FHA) assessment (physical, imaging, measurement, and laboratory) and to check whether surgeons participating in clinical and laboratory experiments or only clinical practitioners prefer different FHA methods. An International Survey on Fracture Healing Assessment Methods was developed and distributed through the Web-based survey portal. Ninety-three orthopedic surgeons, on average age 41.46 years, from 24 countries participated in the study. Thirty-one respondents (33.3%) reported dealing with fractures both in the clinic and in experimental studies, six (6.5%) reported dealing with fractures only in laboratory research work, and fifty-six (60.2%) indicated that they dealt with fractures only clinically. The survey's internal consistency was significantly high (Cronbach's alpha coefficients ranged from 0.84 to 0.96). The majority of respondents (80.83%) use specific clinical criteria to define a fracture union. The FHA was mainly based on the physical examination and plain radiograms. Laboratory findings, patient-oriented outcomes scores, and quantitative methods are rarely used. Orthopaedic surgeons dealing with fractures both in the clinic and in laboratory fracture research studies are more likely to use more quantitative FHA methods. Future research is needed to improve the international standard of the FHA methods for use in research, clinical trials, and clinical practice. Using a quantitative, reliable, and standardized approach, including online support, can be valuable for increasing compliance in the orthopedic surgeon population, effectively improving the adherence of fracture healing assessment in clinical conditions, and improving early detection of fracture healing disorders, improving fracture efficiency treatment.
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Affiliation(s)
- Wojciech Glinkowski
- Centre of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Medical University of Warsaw, 00581 Warsaw, Poland; Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 00581 Warsaw, Poland; Polish Telemedicine and eHealth Society, 03728 Warsaw, Poland; Gabinet Lekarski, 03728 Warsaw, Poland.
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14
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Di Puccio F, Curreli C, Gagliani M, Mattei L. In silico re-foundation of strain-based healing assessment of fractures treated with an external fixator. J Mech Behav Biomed Mater 2021; 121:104619. [PMID: 34198040 DOI: 10.1016/j.jmbbm.2021.104619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023]
Abstract
In the last decades, the literature has demonstrated a renewed interest in finding quantitative and non-invasive techniques for the assessment of bone fractures, by replacing X-ray images. Many different approaches have been proposed from ultrasounds to vibrations. This study aims to numerically assess the foundation of a method firstly proposed in 70' years, based on strain gauges measurements on external fixators for fracture healing monitoring. The theoretical basis consists in the load transfer from the fixator to the bone caused by the callus stiffening during healing. The feasibility is questioned since the level of fixator strain and its variation in invivo conditions should be high enough to be detectable by the sensors. A finite element model of a fractured tibia phantom treated with a monolateral external fixator was developed and validated experimentally. Then, this reference model was used to simulate bone healing and to investigate the sensitivity of virtual strain measurements to callus geometry and loading conditions. The analysis of load distribution among fixator components and their strain maps allowed to identify optimum strain gauges locations which resulted on the pins more distant from the callus, regardless of the simulated conditions. Even in the worst case of a very thin (3 mm) transverse callus in constrained compression conditions, the strain level (≈100 με/100 N) and its variation per week (-50 με/100 N/wk) resulted measurable in the first healing phase, before plateau conditions occurring after about 6 weeks from fixation. A thicker callus causes higher strain levels and can significantly improve measurements, whilst the callus orientation and the loading conditions have a minor effect. However, in case of a free compression loading, also the rods could provide useful indications if sensorized. The results support the method applicability in invivo conditions for the considered test case. Further investigations will be addressed to evaluate the effect of the fixator structure and configuration as well as of patient specific healing timing on the method sensitivity.
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Affiliation(s)
- Francesca Di Puccio
- Department of Civil and Industrial Engineering, Università di Pisa, Largo Lucio Lazzarino 2, 56122, Pisa, Italy.
| | - Cristina Curreli
- Department of Civil and Industrial Engineering, Università di Pisa, Largo Lucio Lazzarino 2, 56122, Pisa, Italy.
| | - Matteo Gagliani
- Department of Civil and Industrial Engineering, Università di Pisa, Largo Lucio Lazzarino 2, 56122, Pisa, Italy.
| | - Lorenza Mattei
- Department of Civil and Industrial Engineering, Università di Pisa, Largo Lucio Lazzarino 2, 56122, Pisa, Italy.
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15
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Augat P, Hast MW, Schemitsch G, Heyland M, Trepczynski A, Borgiani E, Russow G, Märdian S, Duda GN, Hollensteiner M, Bottlang M, Schemitsch EH. Biomechanical models: key considerations in study design. OTA Int 2021; 4:e099(1-6). [PMID: 37608858 PMCID: PMC10441683 DOI: 10.1097/oi9.0000000000000099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 08/24/2023]
Abstract
This manuscript summarizes presentations of a symposium on key considerations in design of biomechanical models at the 2019 Basic Science Focus Forum of the Orthopaedic Trauma Association. The first section outlines the most important characteristics of a high-quality biomechanical study. The second section considers choices associated with designing experiments using finite element modeling versus synthetic bones versus human specimens. The third section discusses appropriate selection of experimental protocols and finite element analyses. The fourth section considers the pros and cons of use of biomechanical research for implant design. Finally, the fifth section examines how results from biomechanical studies can be used when clinical evidence is lacking or contradictory. When taken together, these presentations emphasize the critical importance of biomechanical research and the need to carefully consider and optimize models when designing a biomechanical study.
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Affiliation(s)
- Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University, Salzburg, Austria
| | - Michael W Hast
- Biedermann Lab for Orthopaedic Research, University of Pennsylvania, Philadelphia, PA
| | | | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Adam Trepczynski
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Edoardo Borgiani
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Gabriele Russow
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin, Berlin, Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin, Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health (BIH)
| | - Marianne Hollensteiner
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University, Salzburg, Austria
| | - Michael Bottlang
- Biomechanics Laboratory, Legacy Research Institute, Portland, OR
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
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16
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Viero A, Biehler-Gomez L, Cappella A, Messina C, Montisci M, Cattaneo C. The potential of micro-CT for dating post-cranial bone fractures: a macroscopic, radiographic, and microtomography study of fractures of known post-traumatic ages. Int J Legal Med 2021; 135:1913-1921. [PMID: 33772611 DOI: 10.1007/s00414-021-02582-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
The estimation of the post-traumatic survival time (PTST) in case of bone injuries remains a tricky issue in the forensic field, especially when dealing with dry bones. Newer high-resolution imaging, and in particular microcomputed tomography (micro-CT), has the potential to significantly improve our abilities to interpret antemortem and perimortem lesions and accurately date fractures in a less destructive analysis. In this paper, nine costal fractures of known post-traumatic ages were analyzed through gross examination, conventional radiography, and microcomputed tomography, in order to test the potential of microcomputed tomography for dating fractures. As a result, microcomputed tomography provided images of high quality and definition and allowed the observation of the internal microarchitecture of the fractures and calluses. While microcomputed tomography cannot substitute histological examination for the estimation of the post-traumatic survival time, it constitutes a potent and helpful complementary tool for the analysis of bone trauma.
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Affiliation(s)
- Alessia Viero
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padova, Italy.,Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Lucie Biehler-Gomez
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi di Milano, Via L. Mangiagalli 33, 20133, Milan, Italy
| | - Annalisa Cappella
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy. .,U.O. Laboratorio Di Morfologia Umana Applicata, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Carmelo Messina
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padova, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi di Milano, Via L. Mangiagalli 33, 20133, Milan, Italy
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17
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Sorriento A, Poliziani A, Cafarelli A, Valenza G, Ricotti L. A novel quantitative and reference-free ultrasound analysis to discriminate different concentrations of bone mineral content. Sci Rep 2021; 11:301. [PMID: 33432022 PMCID: PMC7801603 DOI: 10.1038/s41598-020-79365-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Bone fracture is a continuous process, during which bone mineral matrix evolves leading to an increase in hydroxyapatite and calcium carbonate content. Currently, no gold standard methods are available for a quantitative assessment of bone fracture healing. Moreover, the available tools do not provide information on bone composition. Whereby, there is a need for objective and non-invasive methods to monitor the evolution of bone mineral content. In general, ultrasound can guarantee a quantitative characterization of tissues. However, previous studies required measurements on reference samples. In this paper we propose a novel and reference-free parameter, based on the entropy of the phase signal calculated from the backscattered data in combination with amplitude information, to also consider absorption and scattering phenomena. The proposed metric was effective in discriminating different hydroxyapatite (from 10 to 50% w/v) and calcium carbonate (from 2 to 6% w/v) concentrations in bone-mimicking phantoms without the need for reference measurements, paving the way to their translational use for the diagnosis of tissue healing. To the best of our knowledge this is the first time that the phase entropy of the backscattered ultrasound signals is exploited for monitoring changes in the mineral content of bone-like materials.
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Affiliation(s)
- A Sorriento
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy.
| | - A Poliziani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | - A Cafarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | - G Valenza
- Bioengineerring and Robotics Research Centre E Piaggio, University of Pisa, 56122, Pisa, Italy
- Department of Information Engineering, University of Pisa, 56123, Pisa, Italy
| | - L Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
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18
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Barcik J, Ernst M, Dlaska CE, Drenchev L, Zeiter S, Epari DR, Windolf M. Programable Active Fixator System for Systematic In Vivo Investigation of Bone Healing Processes. SENSORS (BASEL, SWITZERLAND) 2020; 21:E17. [PMID: 33375087 PMCID: PMC7792812 DOI: 10.3390/s21010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
This manuscript introduces a programable active bone fixator system that enables systematic investigation of bone healing processes in a sheep animal model. In contrast to previous systems, this solution combines the ability to precisely control the mechanical conditions acting within a fracture with continuous monitoring of the healing progression and autonomous operation of the system throughout the experiment. The active fixator system was implemented on a double osteotomy model that shields the experimental fracture from the influence of the animal's functional loading. A force sensor was integrated into the fixator to continuously measure stiffness of the repair tissue as an indicator for healing progression. A dedicated control unit was developed that allows programing of different loading protocols which are later executed autonomously by the active fixator. To verify the feasibility of the system, it was implanted in two sheep with different loading protocols, mimicking immediate and delayed weight-bearing, respectively. The implanted devices operated according to the programmed protocols and delivered seamless data over the whole course of the experiment. The in vivo trial confirmed the feasibility of the system. Hence, it can be applied in further preclinical studies to better understand the influence of mechanical conditions on fracture healing.
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Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Constantin E. Dlaska
- Orthopaedic Research Institute of Queensland, 7 Turner Street, Townsville, QLD 4812, Australia;
| | - Ludmil Drenchev
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Devakara R. Epari
- Institute of Health and Biomedical Innovation, Queensland University of Technology, George Street 2, Brisbane City, QLD 4000, Australia;
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
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19
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Abstract
This chapter provides an overview of the growth factors active in bone regeneration and healing. Both normal and impaired bone healing are discussed, with a focus on the spatiotemporal activity of the various growth factors known to be involved in the healing response. The review highlights the activities of most important growth factors impacting bone regeneration, with a particular emphasis on those being pursued for clinical translation or which have already been marketed as components of bone regenerative materials. Current approaches the use of bone grafts in clinical settings of bone repair (including bone grafts) are summarized, and carrier systems (scaffolds) for bone tissue engineering via localized growth factor delivery are reviewed. The chapter concludes with a consideration of how bone repair might be improved in the future.
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20
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Chen CH, Hsu EL, Stupp SI. Supramolecular self-assembling peptides to deliver bone morphogenetic proteins for skeletal regeneration. Bone 2020; 141:115565. [PMID: 32745692 PMCID: PMC7680412 DOI: 10.1016/j.bone.2020.115565] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022]
Abstract
Recombinant human bone morphogenetic proteins (BMPs) have shown clinical success in promoting bone healing, but they are also associated with unwanted side effects. The development of improved BMP carriers that can retain BMP at the defect site and maximize its efficacy would decrease the therapeutic BMP dose and thus improve its safety profile. In this review, we discuss the advantages of using self-assembling peptides, a class of synthetic supramolecular biomaterials, to deliver recombinant BMPs. Peptide amphiphiles (PAs) are a broad class of self-assembling peptides, and the use of PAs for BMP delivery and bone regeneration has been explored extensively over the past decade. Like many self-assembling peptide systems, PAs can be designed to form nanofibrous supramolecular biomaterials in which molecules are held together by non-covalent bonds. Chemical and biological functionality can be added to PA nanofibers, through conjugation of chemical moieties or biological epitopes to PA molecules. For example, PA nanofibers have been designed to bind heparan sulfate, a natural polysaccharide that is known to bind BMPs and potentiate their signal. Alternatively, PA nanofibers have been designed to synthetically mimic the structure and function of heparan sulfate, or to directly bind BMP specifically. In small animal models, these bio-inspired PA materials have shown the capacity to promote bone regeneration using BMP at doses 10-100 times lower than established therapeutic doses. These promising results have motivated further evaluation of PAs in large animal models, where their safety and efficacy must be established before clinical translation. We conclude with a discussion on the possiblity of combining PAs with other materials used in orthopaedic surgery to maximize their utility for clinical translation.
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Affiliation(s)
- Charlotte H Chen
- Simpson Querrey Institute, Northwestern University, 303 East Superior Street, Chicago, IL 60611, USA; Department of Materials Science and Engineering, Northwestern University, 2220 Campus Drive, Evanston, IL 60208, USA
| | - Erin L Hsu
- Simpson Querrey Institute, Northwestern University, 303 East Superior Street, Chicago, IL 60611, USA; Department of Orthopaedic Surgery, Northwestern University, 676 North St. Clair Street, Chicago, IL 60611, USA
| | - Samuel I Stupp
- Simpson Querrey Institute, Northwestern University, 303 East Superior Street, Chicago, IL 60611, USA; Department of Materials Science and Engineering, Northwestern University, 2220 Campus Drive, Evanston, IL 60208, USA; Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA; Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA; Department of Medicine, Northwestern University, 676 North St. Clair Street, Chicago, IL 60611, USA.
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21
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Amygdalin Promotes Fracture Healing through TGF- β/Smad Signaling in Mesenchymal Stem Cells. Stem Cells Int 2020; 2020:8811963. [PMID: 32963548 PMCID: PMC7492948 DOI: 10.1155/2020/8811963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Chondrogenesis and subsequent osteogenesis of mesenchymal stem cells (MSCs) and angiogenesis at injured sites are crucial for bone fracture healing. Amygdalin, a cyanogenic glycoside compound derived from bitter apricot kernel, has been reported to inhibit IL-1β-induced chondrocyte degeneration and to stimulate blood circulation, suggesting a promising role of amygdalin in fracture healing. In this study, tibial fractures in C57BL/6 mice were treated with amygdalin. Fracture calluses were then harvested and subjected to radiographic, histological, and biomechanical testing, as well as angiography and gene expression analyses to evaluate fracture healing. The results showed that amygdalin treatment promoted bone fracture healing. Further experiments using MSC-specific transforming growth factor- (TGF-) β receptor 2 conditional knockout (KO) mice (Tgfbr2Gli1-Cre) and C3H10 T1/2 murine mesenchymal progenitor cells showed that this effect was mediated through TGF-β/Smad signaling. We conclude that amygdalin could be used as an alternative treatment for bone fractures.
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22
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Burska AN, Giannoudis PV, Tan BH, Ilas D, Jones E, Ponchel F. Dynamics of Early Signalling Events during Fracture Healing and Potential Serum Biomarkers of Fracture Non-Union in Humans. J Clin Med 2020; 9:jcm9020492. [PMID: 32054088 PMCID: PMC7073571 DOI: 10.3390/jcm9020492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023] Open
Abstract
To characterise the dynamic of events during the early phases of fracture repair in humans, we investigated molecular events using gene expression profiling of bone fragments from the fracture site at different time points after trauma and immune/stromal cells recruitment at the fracture site using flow cytometry. Bone and inflammatory markers were expressed at low levels at homeostasis, while transcripts for bone constituent proteins were consistently detected at higher levels. Early after fracture (range 2-4 days), increased expression of CXCL12, suggested recruitment of immune cells associated with a change in the balance of degradation enzymes and their inhibitors. At intermediate time after fracture (4-8 days), we observed high expression of inflammatory cytokines (IL1-beta, IL6), CCL2, the T-cell activation marker CD69. Late after fracture (8-14 days), high expression of factors co-operating towards the regulation of bone turnover was detected. We identified potential soluble factors and explored circulating levels in patients for whom a union/non-union (U/NU) outcome was known. This showed a clear difference for PlGF (p = 0.003) at day 1. These findings can inform future studies further investigating the cascade of molecular events following fractures and for the prediction of fracture non-union.
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Affiliation(s)
- Agata N. Burska
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
| | - Peter V. Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust (LTHT), Leeds LS9 7TF, UK
- Correspondence:
| | - Boon Hiang Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust (LTHT), Leeds LS9 7TF, UK
| | - Dragos Ilas
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
| | - Frederique Ponchel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.N.B.); (B.H.T.); (D.I.); (E.J.); (F.P.)
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23
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Radiostereometric Analysis of Stability and Inducible Micromotion After Locked Lateral Plating of Distal Femur Fractures. J Orthop Trauma 2020; 34:e60-e66. [PMID: 31794438 DOI: 10.1097/bot.0000000000001684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate interfragmentary motion over 1 year after distal femoral fracture fixation using radiostereometric analysis (RSA). The secondary aim was to assess whether RSA data are consistent with diagnoses of nonunion. DESIGN Prospective cohort study. SETTING Level I urban trauma center. PATIENTS Sixteen patients between 22 and 89 years of age with distal femoral fracture (OTA/AO type 33). INTERVENTION All fractures were treated with a lateral locking plate, and tantalum markers were inserted into the main proximal and distal fracture fragments. RSA was performed at 2, 6, 12, 18, and 52 weeks postoperatively. Both unloaded and loaded RSA measurements were performed. MAIN OUTCOME MEASUREMENTS Unloaded fracture migration over time and inducible micromotion at the fracture site in the coronal plane were determined at each follow-up interval. RESULTS RSA precision in the coronal plane of interfragmentary motion over time and inducible micromotion were 1.2 and 0.9 mm in the coronal plane, respectively. Two cases required revision surgery for nonunion 1 year postoperatively. For cases of union, unloaded fracture migration stopped being detectable between 12 and 18 weeks, and inducible micromotion was no longer detectable by the 12-week visit. For cases of nonunion, both unloaded migration and inducible micromotion were detected throughout the study period. CONCLUSIONS RSA may be used to reliably assess distal femoral fracture healing. RSA revealed differences in cases of union and nonunion by 3 months and more consistently than traditional x-rays. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Effects of fibrin sealant and bone fragments on defect regeneration performed on rat tibiae: An experimental study. J Mech Behav Biomed Mater 2020; 104:103662. [PMID: 32174420 DOI: 10.1016/j.jmbbm.2020.103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/23/2022]
Abstract
Fibrin sealant (FS) is a biomaterial that exhibits hemostatic and repairing properties. It has been successfully used as scaffolds and adhesives to improve repair and regeneration of tissues. The objective of this study was to evaluate the effect of FS in the regeneration process of bone defects in male rat tibias through macroscopic, microscopic and mechanical analysis. A bone defect of 2.9 mm was performed on the medial face of the proximal third of the tibia of 40 rats and implanted FS and autologous bone graft (AG). The animals were divided into four groups: animals with bone defect without any treatment (CON), animals treated with fibrin sealant (TFS), animals treated with autologous graft (TAG) and animals treated with fibrin sealant and autologous graft (FSAG). The animals were euthanized 42 days after surgery. Macroscopic analysis showed no difference between the groups (p > 0.05) in relation to tibial weight, but a statistically significant difference (p = 0.005) was observed for their length. Micro-computed tomography (micro-CT) revealed tendentious values regarding bone microarchitecture and FS. Bone mineral densitometry (BMD) showed significance between the FSAG (p = 0.009) and TFS (p = 0.007) groups. The bone mineral content (BMC) presented a significant difference between all groups (p = 0.020). Maximum strength showed a significant difference between the FSAG group (p = 0.007) and the others. The results obtained in relation to the relative stiffness also present a significant difference (p = 0.023). Newly formed bone showed significant differences between groups (p = 0.035). We conclude that bone defect regeneration was directly influenced by the use of FS and AG.
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Lack of Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) Disturbs Callus Formation. J Mol Neurosci 2019; 71:1543-1555. [PMID: 31808034 PMCID: PMC8349325 DOI: 10.1007/s12031-019-01448-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
Pituitary adenylate cyclase–activating polypeptide (PACAP) is a naturally secreted signaling peptide and has important regulatory roles in the differentiation of the central nervous system and its absence results in disorders in femur development. PACAP has an important function in prevention of oxidative stress or mechanical stress in chondrogenesis but little is known about its function in bone regeneration. A new callus formation model was set to investigate its role in bone remodeling. Fracturing was 5 mm distal from the proximal articular surface of the tibia and the depth was 0.5 mm. Reproducibility of callus formation was investigated with CT 3, 7, and 21 days after the operation. Absence of PACAP did not alter the alkaline phosphatase (ALP) activation in PACAP KO healing process. In developing callus, the expression of collagen type I increased in wild-type (WT) and PACAP KO mice decreased to the end of healing process. Expression of the elements of BMP signaling was disturbed in the callus formation of PACAP KO mice, as bone morphogenic protein 4 (BMP4) and 6 showed an early reduction in bone regeneration. However, elevated Smad1 expression was demonstrated in PACAP KO mice. Our results indicate that PACAP KO mice show various signs of disturbed bone healing and suggest PACAP compensatory and fine tuning effects in proper bone regeneration.
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Joutsen A, Hautalahti J, Jaatinen E, Goebeler S, Paldanius A, Viik J, Laurikka J, Hyttinen J. A device for measuring sternal bone connectivity using vibration analysis techniques. Proc Inst Mech Eng H 2019; 234:81-90. [DOI: 10.1177/0954411919884802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Stability of bone splitting sternotomy is essential for normal healing after open cardiac surgery. Mechanical vibration transmittance may offer a means for early detection of separation of bone (diastasis) in the sternotomy and prevent further complications. This article describes the technical implementation and validation of vibration analysis–based prototype device built for measuring sternal bone connectivity after sternotomy. Methods: An in-house built measurement system, sternal vibration device, consisting of actuator, sensor, and main controller and signal acquisition unit was designed and manufactured. The system was validated, and three different test settings were studied in mockups (polylactide rods in ballistic gel) and in two human sternums: intact, stable wire fixation, and unstable wire fixation with a gap mimicking bone diastasis. The transmittance of vibration stimulus across the median sternotomy was measured. Results: The validation showed that the force produced by the actuator was stable, and the sensor could be calibrated to precisely measure the acceleration values. The vibration transmittance response to material cut and sternotomy was evident and detectable in the 20 Hz to 2 kHz band. The transmittance decreased when the connectivity between the sternal halves became unstable. The trend was visible in all the settings. Conclusion: Technical solutions and description of validation process were given. The device was calibrated, and the vibration transmittance analysis differentiated intact and cut polylactide rod. In the sternum, intact bone, wire fixation with exact apposition, and with a gap were identified separately. Although further studies are needed to assess the accuracy of the method to detect different levels of diastases, the method appears to be feasible.
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Affiliation(s)
- Atte Joutsen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Cardiothoracic Surgery, Tampere Heart Hospital, Tampere, Finland
| | - Juha Hautalahti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Cardiothoracic Surgery, Tampere Heart Hospital, Tampere, Finland
| | | | - Sirkka Goebeler
- Forensic Medicine, National Institute for Health and Welfare, Tampere, Finland
| | - Antti Paldanius
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Cardiothoracic Surgery, Tampere Heart Hospital, Tampere, Finland
| | - Jari Hyttinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Carlos BL, Yamanaka JS, Yanagihara GR, Macedo AP, Watanabe PCA, Issa JPM, Herculano RD, Shimano AC. Effects of latex membrane on guided regeneration of long bones. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:1291-1307. [DOI: 10.1080/09205063.2019.1627653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bruna Leonel Carlos
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jéssica Suzuki Yamanaka
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gabriela Rezende Yanagihara
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prosthesis, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Plauto Christopher Aranha Watanabe
- Department of Stomatoligy, Collective Health and Legal Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - João Paulo Mardegan Issa
- Department of Basic and Oral Biology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Rondinelli Donizetti Herculano
- eDepartment of Bioprocesses and Biotechnology, School of Pharmaceutical Sciences of Araraquara, Paulista State University, Araraquara, Brazil
| | - Antônio Carlos Shimano
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Mattei L, Di Puccio F, Marchetti S. Fracture Healing Monitoring by Impact Tests: Single Case Study of a Fractured Tibia With External Fixator. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 7:2100206. [PMID: 31001457 PMCID: PMC6467180 DOI: 10.1109/jtehm.2019.2901455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/14/2019] [Accepted: 02/11/2019] [Indexed: 11/06/2022]
Abstract
The correct evaluation of the healing process is important to define proper times of fixator dynamization and removal, avoiding refractures. Unfortunately, a quantitative healing assessment is not yet available in clinical practice. The aim of the paper is to prove the feasibility of the mechanical vibration method to assess bone healing in fractures treated with external fixation, in in vivo conditions. The case study was a patient with a tibial fracture treated with a monoaxial fixator. The healing process was monitored for three months through a series of five impact tests. The pins screwed into the bone were used both to excite and measure vibrations. Fracture healing was quantitatively assessed by estimating the resonant frequencies of the leg. The first frequency increased of about 4% per week during the observation period. After the hard callus formation (13 week), also other frequencies increased within the range 1%-6% per week. X-ray observations confirmed the healing progress and proved the method potentiality. In addition, the vibratory response of the leg after fixator removal was evaluated and resulted characterized by five modes in the bandwidth 0-1000 Hz. The results suggest that the vibratory response of a fractured bone treated with external fixation can be a promising indicator for quantitative healing monitoring. The mechanical vibration method could be helpful for reducing X-ray exposure of patients and could be performed more frequently, as desirable for obtaining more attentive monitoring.
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Affiliation(s)
- Lorenza Mattei
- Dipartimento di Ingegneria Cvile e IndustrialeUniversità di Pisa56122PisaItaly
| | - Francesca Di Puccio
- Dipartimento di Ingegneria Cvile e IndustrialeUniversità di Pisa56122PisaItaly
| | - Stefano Marchetti
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e ChirurgiaUniversità di Pisa56122PisaItaly
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Zhao X, Li J, Chen Y, Tao C, Ji R. Investigation of load transfer process between external fixator and bone model by experimental and finite element methods. J Appl Biomater Funct Mater 2019; 17:2280800019826512. [PMID: 30803304 DOI: 10.1177/2280800019826512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION: Unilateral external fixators are widely used in orthopedics to stabilize fractured bones and to treat limb deformities. One of the main problems is that it is difficult to detect healing status. In addition, whether load transfer progress between the fixator and bone model are the same under axial, torsional, and bending loads has not been studied. METHODS: Therefore the main purpose of this study was to detect the load transfer process between the fixator and a bone model by measuring strains on the fixator-bone system during four healing states using experimental and finite element methods. In the experimental method, 20 strain gauges were used to measure strain on the fixator and bone model under three load conditions. Polyacetal slice models with different material properties were used to simulate the callus model during four growth states. RESULTS: The results indicate that strain on the bone model increased and strain on the fixator parts decreased with maturation of the callus under axial, bending, and torsional loads. Although all curves showed a similar changing trend, they were slightly different under the three loads. DISCUSSION AND CONCLUSIONS: This study provides a useful method to monitor the fracture healing process, and identifies the healing endpoint, detects healing status, and provides useful information for the orthopedist.
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Affiliation(s)
- Xia Zhao
- 1 Beijing University of Technology, Beijing, China
| | - Jianfeng Li
- 1 Beijing University of Technology, Beijing, China
| | - Ying Chen
- 1 Beijing University of Technology, Beijing, China
| | - Chunjing Tao
- 2 National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Run Ji
- 2 National Research Center for Rehabilitation Technical Aids, Beijing, China
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Li J, Zhao X, Hu X, Tao C, Ji R. A finite element analysis for monitoring the healing progression of fixator-bone system under three loading conditions. Biomed Mater Eng 2018; 29:473-483. [PMID: 30282344 DOI: 10.3233/bme-181003] [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: 11/15/2022]
Abstract
BACKGROUND Unilateral external fixators are widely used in orthopedics to stabilize fractured bones and in the treatment of limb deformities. The main value for evaluation of mechanical stability of the external fixator is fixator stiffness. The fixator stiffness is an important factor as it will influence the biomechanical environment to which fixator and regenerating tissues are exposed. OBJECTIVE The main objective of this work was to monitor the transmission of stress and the change of displacement generated in fixator-bone system under three loading conditions during healing process. METHODS In this study, a finite element model with changing Young's modulus of the callus is established, finite element analysis was used to investigating stress and deformation of fixator-bone system caused by axial load, torsional load and bending load during three healing stages. RESULTS The results reveal that at different healing stages, stress distribution between the fixator and fractured bone is different, the position of displacement is mainly concentrated in the fracture site and proximal bone and with the increase of healing time, the deformation decreased. CONCLUSIONS This work helps orthopedic doctors to monitor the progression of fracture healing and determine the appropriate time for removal of a fixation device and provide useful information.
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Affiliation(s)
- Jianfeng Li
- Beijing University of Technology, Beijing, China
| | - Xia Zhao
- Beijing University of Technology, Beijing, China
| | - XiaoJie Hu
- Beijing University of Technology, Beijing, China
| | - Chunjing Tao
- National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Run Ji
- National Research Center for Rehabilitation Technical Aids, Beijing, China
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Del Amo C, Olivares V, Cóndor M, Blanco A, Santolaria J, Asín J, Borau C, García-Aznar JM. Matrix architecture plays a pivotal role in 3D osteoblast migration: The effect of interstitial fluid flow. J Mech Behav Biomed Mater 2018; 83:52-62. [PMID: 29677555 DOI: 10.1016/j.jmbbm.2018.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/28/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022]
Abstract
Osteoblast migration is a crucial process in bone regeneration, which is strongly regulated by interstitial fluid flow. However, the exact role that such flow exerts on osteoblast migration is still unclear. To deepen the understanding of this phenomenon, we cultured human osteoblasts on 3D microfluidic devices under different fluid flow regimes. Our results show that a slow fluid flow rate by itself is not able to alter the 3D migratory patterns of osteoblasts in collagen-based gels but that at higher fluid flow rates (increased flow velocity) may indirectly influence cell movement by altering the collagen microstructure. In fact, we observed that high fluid flow rates (1 µl/min) are able to alter the collagen matrix architecture and to indirectly modulate the migration pattern. However, when these collagen scaffolds were crosslinked with a chemical crosslinker, specifically, transglutaminase II, we did not find significant alterations in the scaffold architecture or in osteoblast movement. Therefore, our data suggest that high interstitial fluid flow rates can regulate osteoblast migration by means of modifying the orientation of collagen fibers. Together, these results highlight the crucial role of the matrix architecture in 3D osteoblast migration. In addition, we show that interstitial fluid flow in conjunction with the matrix architecture regulates the osteoblast morphology in 3D.
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Affiliation(s)
- Cristina Del Amo
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Vanesa Olivares
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Mar Cóndor
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Alejandro Blanco
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Jorge Santolaria
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain; Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Jesús Asín
- Department of Statistical Methods, University of Zaragoza, Zaragoza, Spain
| | - Carlos Borau
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - José Manuel García-Aznar
- Multiscale in Mechanical and Biological Engineering, Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain.
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Li J, Zhao X, Hu X, Tao C, Ji R. A theoretical analysis and finite element simulation of fixator-bone system stiffness on healing progression. J Appl Biomater Funct Mater 2018; 16:115-125. [PMID: 29582693 DOI: 10.1177/2280800017750357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The unilateral external fixator has become a quick and easy application for fracture stabilization of the extremities; the main value for evaluation of mechanical stability of the external fixator is stiffness. The stiffness property of the external fixator affects the local biomechanical environment of fractured bone. METHODS In this study, a theoretical model with changing Young's modulus of the callus is established by using the Castigliano's theory, investigating compression stiffness, torsional stiffness and bending stiffness of the fixator-bone system during the healing process. The effects of pin deviation angle on three stiffness methods are also investigated. In addition, finite element simulation is discussed regarding the stress distribution between the fixator and bone. RESULTS The results reveal the three stiffness evaluation methods are similar for the fixator-bone system. Finite element simulation shows that with increased healing time, the transmission of the load between the fixator and bone are different. In addition, the finite element analyses verify the conclusions obtained from the theoretical model. CONCLUSIONS This work helps orthopedic doctors to monitor the progression of fracture healing and determine the appropriate time for removal of a fixation device and provide important theoretical methodology.
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Affiliation(s)
- Jianfeng Li
- 1 College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Xia Zhao
- 1 College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Xiaojie Hu
- 1 College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Chunjing Tao
- 2 National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Run Ji
- 2 National Research Center for Rehabilitation Technical Aids, Beijing, China
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Bojan AJ, Jönsson A, Granhed H, Ekholm C, Kärrholm J. Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study. Injury 2018; 49:673-679. [PMID: 29397996 DOI: 10.1016/j.injury.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/13/2017] [Accepted: 01/06/2018] [Indexed: 02/02/2023]
Abstract
Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out.
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Affiliation(s)
- Alicja J Bojan
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Anders Jönsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Hans Granhed
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
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Pelham H, Benza D, Millhouse PW, Carrington N, Arifuzzaman M, Behrend CJ, Anker JN, DesJardins JD. Implantable strain sensor to monitor fracture healing with standard radiography. Sci Rep 2017; 7:1489. [PMID: 28473698 PMCID: PMC5431424 DOI: 10.1038/s41598-017-01009-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/20/2017] [Indexed: 12/23/2022] Open
Abstract
Current orthopaedic clinical methods do not provide an objective measure of fracture healing or weight bearing for lower extremity fractures. The following report describes a novel approach involving in-situ strain sensors to objectively measure fracture healing. The sensor uses a cantilevered indicator pin that responds to plate bending and an internal scale to demonstrate changes in the pin position on plain film radiographs. The long lever arm amplifies pin movement compared to interfragmentary motion, and the scale enables more accurate measurement of position changes. Testing with a human cadaver comminuted metaphyseal tibia fracture specimen demonstrated over 2.25 mm of reproducible sensor displacement on radiographs with as little as 100 N of axial compressive loading. Finite element simulations determined that pin displacement decreases as the fracture callus stiffens and that pin motion is linearly related to the strain in the callus. These results indicate that an implanted strain sensor is an effective tool to help assess bone healing after internal fixation and could provide an objective clinical measure for return to weight bearing.
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Affiliation(s)
- Hunter Pelham
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA.
| | - Donald Benza
- Department of Electrical Engineering, Clemson University, Clemson, SC, USA
| | | | - Nathan Carrington
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - Md Arifuzzaman
- Department of Chemistry, Clemson University, Clemson, SC, USA
| | - Caleb J Behrend
- Department of Bioengineering, Clemson University, Clemson, SC, USA.,Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA, USA
| | - Jeffrey N Anker
- Department of Bioengineering, Clemson University, Clemson, SC, USA.,Department of Chemistry, Clemson University, Clemson, SC, USA
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Vibration Testing Procedures for Bone Stiffness Assessment in Fractures Treated with External Fixation. Ann Biomed Eng 2016; 45:1111-1121. [DOI: 10.1007/s10439-016-1769-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/26/2016] [Indexed: 01/03/2023]
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Braun BJ, Bushuven E, Hell R, Veith NT, Buschbaum J, Holstein JH, Pohlemann T. A novel tool for continuous fracture aftercare - Clinical feasibility and first results of a new telemetric gait analysis insole. Injury 2016; 47:490-4. [PMID: 26626806 DOI: 10.1016/j.injury.2015.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Weight bearing after lower extremity fractures still remains a highly controversial issue. Even in ankle fractures, the most common lower extremity injury no standard aftercare protocol has been established. Average non weight bearing times range from 0 to 7 weeks, with standardised, radiological healing controls at fixed time intervals. Recent literature calls for patient-adapted aftercare protocols based on individual fracture and load scenarios. We show the clinical feasibility and first results of a new, insole embedded gait analysis tool for continuous monitoring of gait, load and activity. Ten patients were monitored with a new, independent gait analysis insole for up to 3 months postoperatively. Strict 20 kg partial weight bearing was ordered for 6 weeks. Overall activity, load spectrum, ground reaction forces, clinical scoring and general health data were recorded and correlated. Statistical analysis with power analysis, t-test and Spearman correlation was performed. Only one patient completely adhered to the set weight bearing limit. Average time in minutes over the limit was 374 min. Based on the parameters load, activity, gait time over 20 kg weight bearing and maximum ground reaction force high and low performers were defined after 3 weeks. Significant difference in time to painless full weight bearing between high and low performers was shown. Correlation analysis revealed a significant correlation between weight bearing and clinical scoring as well as pain (American Orthopaedic Foot and Ankle Society (AOFAS) Score rs=0.74; Olerud-Molander Score rs=0.93; VAS pain rs=-0.95). Early, continuous gait analysis is able to define aftercare performers with significant differences in time to full painless weight bearing where clinical or radiographic controls could not. Patient compliance to standardised weight bearing limits and protocols is low. Highly individual rehabilitation patterns were seen in all patients. Aftercare protocols should be adjusted to real-time patient conditions, rather than fixed intervals and limits. With a real-time measuring device high performers could be identified and influenced towards optimal healing conditions early, while low performers are recognised and missing healing influences could be corrected according to patient condition.
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Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany.
| | - Eva Bushuven
- Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Germany
| | - Rebecca Hell
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Nils T Veith
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Jan Buschbaum
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Joerg H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
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Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury 2015; 46 Suppl 8:S8-S19. [PMID: 26747924 DOI: 10.1016/s0020-1383(15)30049-8] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Non-union continues to be the most devastating complication after fracture fixation. Its treatment can be prolonged and often unpredictable. The burden to the patient, surgeon and health care system can be immense. Strategies to prevent it and or identify early its development are desirable in order to improve the clinical course of the affected patients and their outcomes. We undertook a systematic review of the literature in order to identify the most common and important risk factors based on the hierarchy of level of evidence. Accordingly, a stratification scale was formed which highlighted 10 risk factors including; an open method of fracture reduction, open fracture, presence of post-surgical fracture gap, smoking, infection, wedge or comminuted types of fracture, high degree of initial fracture displacement, lack of adequate mechanical stability provided by the implant used, fracture location in the poor zone of vascularity of the affected bone, and the presence of the fracture in the tibia. Clinicians should take in to account these findings when managing patients with long bone fractures, particularly the femur and tibia in order to minimise the risk of non-union.
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Affiliation(s)
- Emmanuele Santolini
- Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK; Clinica Orthopedica, University of Genoa, IRCCS A.O.U. San Martino - IST, Largo R. Benzi 10 - 16132, Genova, Italy
| | - Robert West
- Academic Department of Statistics, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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McGilvray KC, Unal E, Troyer KL, Santoni BG, Palmer RH, Easley JT, Demir HV, Puttlitz CM. Implantable microelectromechanical sensors for diagnostic monitoring and post-surgical prediction of bone fracture healing. J Orthop Res 2015; 33:1439-46. [PMID: 26174472 DOI: 10.1002/jor.22918] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/02/2015] [Indexed: 02/04/2023]
Abstract
The relationship between modern clinical diagnostic data, such as from radiographs or computed tomography, and the temporal biomechanical integrity of bone fracture healing has not been well-established. A diagnostic tool that could quantitatively describe the biomechanical stability of the fracture site in order to predict the course of healing would represent a paradigm shift in the way fracture healing is evaluated. This paper describes the development and evaluation of a wireless, biocompatible, implantable, microelectromechanical system (bioMEMS) sensor, and its implementation in a large animal (ovine) model, that utilized both normal and delayed healing variants. The in vivo data indicated that the bioMEMS sensor was capable of detecting statistically significant differences (p-value <0.04) between the two fracture healing groups as early as 21 days post-fracture. In addition, post-sacrifice micro-computed tomography, and histology data demonstrated that the two model variants represented significantly different fracture healing outcomes, providing explicit supporting evidence that the sensor has the ability to predict differential healing cascades. These data verify that the bioMEMS sensor can be used as a diagnostic tool for detecting the in vivo course of fracture healing in the acute post-treatment period.
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Affiliation(s)
- Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
| | - Emre Unal
- Departments of Electrical and Electronics Engineering and Physics, UNAM-Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Turkey
| | - Kevin L Troyer
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
| | - Brandon G Santoni
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
| | - Ross H Palmer
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, 80523
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, 80523
| | - Hilmi Volkan Demir
- Departments of Electrical and Electronics Engineering and Physics, UNAM-Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Turkey.,School of Electrical and Electronic Engineering and School of Physical and Mathematical Science, Nanyang Technological University, Singapore
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
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39
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Sensitivities of biomechanical assessment methods for fracture healing of long bones. Med Eng Phys 2015; 37:650-6. [DOI: 10.1016/j.medengphy.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 04/01/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
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