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Abd Aziz AU, Ammarullah MI, Ng BW, Gan HS, Abdul Kadir MR, Ramlee MH. Unilateral external fixator and its biomechanical effects in treating different types of femoral fracture: A finite element study with experimental validated model. Heliyon 2024; 10:e26660. [PMID: 38404809 PMCID: PMC10884926 DOI: 10.1016/j.heliyon.2024.e26660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
Previous works had successfully demonstrated the clinical effectiveness of unilateral external fixator in treating various types of fracture, ranging from the simple type, such as oblique and transverse fractures, to complex fractures. However, literature that investigated its biomechanical analyses to further justify its efficacy is limited. Therefore, this paper aimed to analyse the stability of unilateral external fixator for treating different types of fracture, including the simple oblique, AO32C3 comminuted, and 20 mm gap transverse fracture. These fractures were reconstructed at the distal diaphysis of the femoral bone and computationally analysed through the finite element method under the stance phase condition. Findings showed a decrease in the fixation stiffness in large gap fracture (645.2 Nmm-1 for oblique and comminuted, while 23.4 Nmm-1 for the gap fracture), which resulted in higher displacement, IFM and stress distribution at the pin bone interface. These unfavourable conditions could consequently increase the risk of delayed union, pin loosening and infection, as well as implant failure. Nevertheless, the stress observed on the fracture surfaces was relatively low and in controlled amount, indicating that bone unity is still allowable in all models. Briefly, the unilateral fixation may provide desirable results in smaller fracture gap, but its usage in larger gap fracture might be alarming. These findings could serve as a guide and insight for surgeons and researchers, especially on the biomechanical stability of fixation in different fracture types and how will it affect bone unity.
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Affiliation(s)
- Aishah Umairah Abd Aziz
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru, 81310, Johor, Malaysia
| | - Muhammad Imam Ammarullah
- Department of Mechanics and Aerospace Engineering, College of Engineering, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
- Department of Mechanical Engineering, Faculty of Engineering, Universitas Diponegoro, Semarang, 50275, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Universitas Diponegoro, Semarang, 50275, Central Java, Indonesia
| | - Bing Wui Ng
- Department of Orthopaedics and Traumatology, Hospital Universiti Kebangsaan Malaysia (HUKM), Cheras, 56000, Federal Territory of Kuala Lumpur, Malaysia
| | - Hong-Seng Gan
- School of AI and Advanced Computing, XJTLU Entrepreneur College (Taicang), Xi'an Jiaotong-Liverpool University, Suzhou, 215400, Jiangsu, China
| | - Mohammed Rafiq Abdul Kadir
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, 50603, Federal Territory of Kuala Lumpur, Malaysia
| | - Muhammad Hanif Ramlee
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru, 81310, Johor, Malaysia
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Zainal Abidin NA, Ramlee MH, Ab Rashid AM, Ng BW, Gan HS, Abdul Kadir MR. Biomechanical effects of cross-pin's diameter in reconstruction of anterior cruciate ligament - A specific case study via finite element analysis. Injury 2022; 53:2424-2436. [PMID: 35641332 DOI: 10.1016/j.injury.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
For anterior cruciate ligament reconstruction (ACL-R), one of the crucial aspects of treatment is the fixator selection that could provide initial graft fixation post-operatively. Literature on biomechanical stabilities of different sizes of fixators as femoral graft fixation is limited. Therefore, this study aims to analyse the influence of different diameters of cross-pins on the stability of graft fixations after ACL-R via finite element analysis (FEA). In the methodology, three-dimensional (3D) models of three different diameters of cross-pins were developed, of which anterior tibial loads (ATL) were applied onto the tibia. From the findings, the cross-pin with a smaller diameter (4 mm) provided optimum stability than larger diameter cross-pins, whereby it demonstrated acceptable stresses at the fixators (both cross-pin and interference screw) with a different percentage of 28%, while the stresses at the corresponding bones were favourable for osseointegration to occur. Besides, the strains of the knee joint with 4 mm diameter cross-pin were also superior in providing a good biomechanical environment for bone healing, while the recorded strain values at fixators were comparable with a larger diameter of cross-pins without being inferior in terms of deformation. To conclude, the cross-pin with 4 mm diameter depicted the best biomechanical aspects in graft fixation for ACL-R since it allows better assistance for the osseointegration process and can minimise the possibility of the breakage and migration of fixators. This study is not only useful for medical surgeons to justify their choices of pin diameter to treat patients, but also for researchers to conduct future studies.
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Affiliation(s)
- Nur Afikah Zainal Abidin
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Hanif Ramlee
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Amir Mustakim Ab Rashid
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Bing Wui Ng
- Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Hong Seng Gan
- Department of Data Science, Universiti Malaysia Kelantan, 16100 UMK City Campus, Pengkalan Chepa, Kelantan, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
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Zhang Z, Yang J, Zou H, Wang W, Wu X, Lin X. Mathematical Analysis of Application of a Three-Dimensional Printing Fixator in the Fracture of Multiple Ribs. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5626228. [PMID: 34630610 PMCID: PMC8500754 DOI: 10.1155/2021/5626228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 11/23/2022]
Abstract
Data were obtained from 66 clinical patients. The patients were divided into a non-3D printing group (control group) and a 3D printing group (intervention group) in a 1 : 1 ratio, with 33 patients in each group. The information including gender, age, incision length, number of surgical roots, bleeding volume, operation time, and intraoperative blood transfusion was collected for SPSS analysis. The results showed the following: (1) The paired t-test was used to test the difference of experimental data. There was a significant difference of 0.01 between the incision length/surgical root number in the intervention group and the incision length/surgical root number in the control group. The incision length/surgical root number in the intervention group was significantly lower than that in the control group. (2) Surgical time, intraoperative blood transfusion, age, and incision length/surgical root number in the intervention group had a significant positive impact on the amount of bleeding. Gender did not affect the amount of bleeding. (3) A total of 1 item of operation time in the intervention group had a significant positive impact on intraoperative blood transfusion. (4) The incision length/number of surgical roots in the intervention group had a noteworthy negative impact on blood transfusion during the operation.
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Affiliation(s)
- Zhigong Zhang
- Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Jinsong Yang
- Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Haoyu Zou
- Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Wen Wang
- Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Xiangyi Wu
- Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Xiaojuan Lin
- Department of Paediatrics, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, China
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