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Yang Q, Xu M, Fang H, Gao Y, Zhu D, Wang J, Chen Y. Targeting micromotion for mimicking natural bone healing by using NIPAM/Nb 2C hydrogel. Bioact Mater 2024; 39:41-58. [PMID: 38800718 PMCID: PMC11127186 DOI: 10.1016/j.bioactmat.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Natural fracture healing is most efficient when the fine-tuned mechanical force and proper micromotion are applied. To mimick this micromotion at the fracture gap, a near-infrared-II (NIR-II)-activated hydrogel was fabricated by integrating two-dimensional (2D) monolayer Nb2C nanosheets into a thermally responsive poly(N-isopropylacrylamide) (NIPAM) hydrogel system. NIR-II-triggered deformation of the NIPAM/Nb2C hydrogel was designed to generate precise micromotion for co-culturing cells. It was validated that micromotion at 1/300 Hz, triggering a 2.37-fold change in the cell length/diameter ratio, is the most favorable condition for the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Moreover, mRNA sequencing and verification revealed that micromotion-induced augmentation was mediated by Piezo1 activation. Suppression of Piezo1 interrupts the mechano-sensitivity and abrogates osteogenic differentiation. Calvarial and femoral shaft defect models were established to explore the biocompatibility and osteoinductivity of the Micromotion Biomaterial. A series of research methods, including radiography, micro-CT scanning, and immunohistochemical staining have been performed to evaluate biosafety and osteogenic efficacy. The in vivo results revealed that tunable micromotion strengthens the natural fracture healing process through the sequential activation of endochondral ossification, promotion of neovascularization, initiation of mineral deposition, and combinatory acceleration of full-thickness osseous regeneration. This study demonstrated that Micromotion Biomaterials with controllable mechanophysical characteristics could promote the osteogenic differentiation of BMSCs and facilitate full osseous regeneration. The design of NIPAM/Nb2C hydrogel with highly efficient photothermal conversion, specific features of precisely controlled micromotion, and bionic-mimicking bone-repair capabilities could spark a new era in the field of regenerative medicine.
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Affiliation(s)
- Qianhao Yang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Mengqiao Xu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Haoyu Fang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Daoyu Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jing Wang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Yixuan Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
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Siverino C, Metsemakers WJ, Sutter R, Della Bella E, Morgenstern M, Barcik J, Ernst M, D'Este M, Joeris A, Chittò M, Schwarzenberg P, Stoddart M, Vanvelk N, Richards G, Wehrle E, Weisemann F, Zeiter S, Zalavras C, Varga P, Moriarty TF. Clinical management and innovation in fracture non-union. Expert Opin Biol Ther 2024:1-19. [PMID: 39126182 DOI: 10.1080/14712598.2024.2391491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/18/2024] [Accepted: 08/08/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION With the introduction and continuous improvement in operative fracture fixation, even the most severe bone fractures can be treated with a high rate of successful healing. However, healing complications can occur and when healing fails over prolonged time, the outcome is termed a fracture non-union. Non-union is generally believed to develop due to inadequate fixation, underlying host-related factors, or infection. Despite the advancements in fracture fixation and infection management, there is still a clear need for earlier diagnosis, improved prediction of healing outcomes and innovation in the treatment of non-union. AREAS COVERED This review provides a detailed description of non-union from a clinical perspective, including the state of the art in diagnosis, treatment, and currently available biomaterials and orthobiologics.Subsequently, recent translational development from the biological, mechanical, and infection research fields are presented, including the latest in smart implants, osteoinductive materials, and in silico modeling. EXPERT OPINION The first challenge for future innovations is to refine and to identify new clinical factors for the proper definition, diagnosis, and treatment of non-union. However, integration of in vitro, in vivo, and in silico research will enable a comprehensive understanding of non-union causes and correlations, leading to the development of more effective treatments.
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Affiliation(s)
- C Siverino
- AO Research Institute Davos, Davos Platz, Switzerland
| | - W-J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - R Sutter
- Radiology Department, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - E Della Bella
- AO Research Institute Davos, Davos Platz, Switzerland
| | - M Morgenstern
- Center for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - J Barcik
- AO Research Institute Davos, Davos Platz, Switzerland
| | - M Ernst
- AO Research Institute Davos, Davos Platz, Switzerland
| | - M D'Este
- AO Research Institute Davos, Davos Platz, Switzerland
| | - A Joeris
- AO Innovation Translation Center, Davos Platz, Switzerland
| | - M Chittò
- AO Research Institute Davos, Davos Platz, Switzerland
| | | | - M Stoddart
- AO Research Institute Davos, Davos Platz, Switzerland
| | - N Vanvelk
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - G Richards
- AO Research Institute Davos, Davos Platz, Switzerland
| | - E Wehrle
- AO Research Institute Davos, Davos Platz, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - F Weisemann
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - S Zeiter
- AO Research Institute Davos, Davos Platz, Switzerland
| | - C Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - P Varga
- AO Research Institute Davos, Davos Platz, Switzerland
| | - T F Moriarty
- AO Research Institute Davos, Davos Platz, Switzerland
- Center for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Wähnert D, Miersbach M, Colcuc C, Brianza S, Vordemvenne T, Plecko M, Schwarz A. Promoting bone callus formation by taking advantage of the time-dependent fracture gap strain modulation. Front Surg 2024; 11:1376441. [PMID: 38756355 PMCID: PMC11096559 DOI: 10.3389/fsurg.2024.1376441] [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: 01/25/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
Delayed union and non-union of fractures continue to be a major problem in trauma and orthopedic surgery. These cases are challenging for the surgeon. In addition, these patients suffer from multiple surgeries, pain and disability. Furthermore, these cases are a major burden on healthcare systems. The scientific community widely agrees that the stability of fixation plays a crucial role in determining the outcome of osteosynthesis. The extent of stabilization affects factors like fracture gap strain and fluid flow, which, in turn, influence the regenerative processes positively or negatively. Nonetheless, a growing body of literature suggests that during the fracture healing process, there exists a critical time frame where intervention can stimulate the bone's return to its original form and function. This article provides a summary of existing evidence in the literature regarding the impact of different levels of fixation stability on the strain experienced by newly forming tissues. We will also discuss the timing and nature of this "window of opportunity" and explore how current knowledge is driving the development of new technologies with design enhancements rooted in mechanobiological principles.
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Affiliation(s)
- Dirk Wähnert
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Marco Miersbach
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Christian Colcuc
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | | | - Thomas Vordemvenne
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Michael Plecko
- Department of Orthopaedics and Traumatology, Trauma Hospital Graz (UKH), Graz, Austria
| | - Angelika Schwarz
- Department of Orthopaedics and Traumatology, Trauma Hospital Graz (UKH), Graz, Austria
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Knorr IJ, Tix L, Liu W, Talbot SR, Schulz M, Bell L, Kögel B, Tolba R, Ernst L. Refinement in Post-Operative Care for Orthopaedic Models: Implementing a Sheep Walking Cast (SWC) for Effective Tibial Fracture Management. Biomedicines 2024; 12:343. [PMID: 38397945 PMCID: PMC10886840 DOI: 10.3390/biomedicines12020343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
In the healthcare system, lower leg fractures remain relevant, incurring costs related to surgical treatment, hospitalization, and rehabilitation. The duration of treatment may vary depending on the individual case and its severity. Casting as a post-surgical fracture treatment is a common method in human and experimental veterinary medicine. Despite the high importance of sheep in preclinical testing materials for osteosynthesis, there is no standardised cast system ensuring proper stabilisation and functionality of hind limbs during the healing of tibia fractures or defects. Existing treatment approaches for tibial osteosynthesis in laboratory animal science include sling hanging, external fixators, or former Achilles tendon incision. These methods restrict animal movement for 4-6 weeks, limit species-typical behaviour, and impact social interactions. Our pilot study introduces a Standardised Walking Cast (SWC) for sheep, enabling immediate physiological movement post surgery. Seven Rhone sheep (female, 63.5 kg ± 6.45 kg) each with a single tibia defect (6 mm mechanical drilled defect) underwent SWC application for 4 weeks after plate osteosynthesis. The animals bore weight on their operated leg from day one, exhibiting slight lameness (grade 1-2 out of 5). Individual step lengths showed good uniformity (average deviation: 0.89 cm). Group housing successfully started on day three after surgery. Weekly X-rays and cast changes ensured proper placement, depicting the healing process. This study demonstrates the feasibility of using an SWC for up to 72 kg of body weight without sling hanging via ceiling mounting or external fixation techniques. Allowing species-typical movement and social behaviour can significantly improve the physiological behaviour of sheep in experiments, contributing to refinement.
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Affiliation(s)
- Ivonne Jeanette Knorr
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Leonie Tix
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Wenjia Liu
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Steven R. Talbot
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, 30625 Hannover, Germany;
| | - Mareike Schulz
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Laura Bell
- Audiovisual Media Center, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Babette Kögel
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Rene Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Lisa Ernst
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
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Rechenmacher AJ, Helmkamp J, Brown M, Paul AV, Campbell ST, Pean CA, DeBaun MR. Interfragmentary strain measurement post-fixation to guide intraoperative decision making: a narrative review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3299-3305. [PMID: 37284986 DOI: 10.1007/s00590-023-03605-y] [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: 03/08/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Interfragmentary strain influences whether a fracture will undergo direct and indirect fracture healing. Orthopedic trauma surgeons modulate strain and create optimal biomechanical environments for specific fracture patterns using fixation constructs. However, objective intraoperative interfragmentary strain measurement does not currently inform fixation strategy in common practice. This review identifies potential methods and technologies to enable intraoperative strain measurement for guiding optimal fracture fixation strategies. METHODS PubMed, Scopus, and Web of Science were methodologically queried for manuscripts containing terms related to "bone fracture," "strain," "measurement," and "intraoperative." Manuscripts were systematically screened for relevance and adjudicated by three reviewers. Relevant articles describing methods to measure interfragmentary strain intraoperatively were summarized. RESULTS After removing duplicates, 1404 records were screened initially. There were 49 manuscripts meeting criteria for in-depth review. Of these, four reports were included in this study that described methods applicable to measuring interfragmentary strain intraoperatively. Two of these reports described a method using instrumented staples, one described optical tracking of Kirschner wires, and one described using a digital linear variable displacement transducer with a custom external fixator. CONCLUSION The four reports identified by this review describe potential methods to quantify interfragmentary strain after fixation. However, further studies are needed to confirm the precision and accuracy of these measurements across a range of fractures and fixation methods. Additionally, described methods require the insertion and likely removal of additional implants into the bone. Ideally, innovations that measure interfragmentary strain intraoperatively would provide dynamic biomechanical feedback for the surgeon to proactively modulate construct stability.
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Affiliation(s)
- Albert J Rechenmacher
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA.
| | - Joshua Helmkamp
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Matthew Brown
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Sean T Campbell
- UC Davis Medical Center, Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 1700, Sacramento, CA, 95817, USA
| | - Christian A Pean
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Malcolm R DeBaun
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
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Barcik J, Ernst M, Buchholz T, Constant C, Mys K, Epari DR, Zeiter S, Windolf M. The absence of immediate stimulation delays bone healing. Bone 2023; 175:116834. [PMID: 37385428 DOI: 10.1016/j.bone.2023.116834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
AIM Secondary bone healing requires an adequate level of mechanical stimulation expressed by the extent of interfragmentary motion in the fracture. However, there is no consensus about when the mechanical stimulation should be initiated to ensure a timely healing response. Therefore, this study aims to compare the effect of the immediate and delayed application of mechanical stimulation in a large animal model. METHODS Twelve Swiss White Alpine sheep underwent partial osteotomy of a tibia that was stabilised with an active fixator inducing well-controlled mechanical stimulation. Animals were randomly assigned into two groups with different stimulation protocols. The immediate group received daily stimulation (1000 cycles/day) from the first day post-operation, while in the delayed group, stimulation began only on the 22nd day post-operation. Healing progression was evaluated daily by measuring the in vivo stiffness of the repair tissue and by quantifying callus area on weekly radiographs. All animals were euthanised five weeks post-op. Post-mortem callus volume was determined from high-resolution computer tomography (HRCT). RESULTS Fracture stiffness (p < 0.05) and callus area (p < 0.01) were significantly larger for the immediate group compared to the delayed stimulation group. In addition, the callus volume measured on the post-mortem HRCT showed 319 % greater callus volume for the immediate stimulation group (p < 0.01). CONCLUSIONS This study demonstrates that a delay in the onset of mechanical stimulation retards fracture callus development and that mechanical stimulation already applied in the early post-op phase promotes bone healing.
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Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Tim Buchholz
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Caroline Constant
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Karen Mys
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Devakara R Epari
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, George Street 2, Brisbane, QLD 4000, Australia
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
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Hu M, Zeng W, Zhang J, Feng Y, Ma L, Huang F, Cai Q. Fixators dynamization for delayed union and non-union of femur and tibial fractures: a review of techniques, timing and influence factors. J Orthop Surg Res 2023; 18:577. [PMID: 37550732 PMCID: PMC10405409 DOI: 10.1186/s13018-023-04054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
The optimal balance between mechanical environment and biological factors is crucial for successful bone healing, as they synergistically affect bone development. Any imbalance between these factors can lead to impaired bone healing, resulting in delayed union or non-union. To address this bone healing disorder, clinicians have adopted a technique known as "dynamization" which involves modifying the stiffness properties of the fixator. This technique facilitates the establishment of a favorable mechanical and biological environment by changing a rigid fixator to a more flexible one that promotes bone healing. However, the dynamization of fixators is selective for certain types of non-union and can result in complications or failure to heal if applied to inappropriate non-unions. This review aims to summarize the indications for dynamization, as well as introduce a novel dynamic locking plate and various techniques for dynamization of fixators (intramedullary nails, steel plates, external fixators) in femur and tibial fractures. Additionally, Factors associated with the effectiveness of dynamization are explored in response to the variation in dynamization success rates seen in clinical studies.
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Affiliation(s)
- Minhua Hu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenxing Zeng
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingtao Zhang
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanlan Feng
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Luyao Ma
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feng Huang
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Qunbin Cai
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Guareschi AS, Hoch C, Reid JJ, Scott DJ, Gross CE. Surgical Construct Type Is Associated With Time to Fusion and Reoperation Rate in Double and Isolated Talonavicular Arthrodeses. Foot Ankle Spec 2023:19386400231162422. [PMID: 37002611 DOI: 10.1177/19386400231162422] [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] [Indexed: 06/19/2023]
Abstract
BACKGROUND This study evaluates the effect of surgical construct on postoperative outcomes in patients undergoing isolated talonavicular (TN) or double (TN and subtalar ST) arthrodesis. TN constructs included plate and screw, screw and staple, and isolated staple constructs. Subtalar constructs included 1- and 2-screw constructs. METHODS Retrospective chart review identified 52 patients who underwent double or isolated TN arthrodesis between 2016 and 2021 by a single fellowship-trained foot and ankle surgeon with minimum 6 months of follow-up (mean = 1.62 years, range = 0.50-4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures. RESULTS Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, time to ST (P = .026) and TN (P = .018) fusion was significantly slower among patients receiving a plate and screw construct. Complication rate did not differ, but reoperation rate was significantly higher for plate and screw TN constructs (P = .039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (P = .028) and Total (P = .016) scores were significantly better among plate and screw TN constructs. CONCLUSION Utilization of screw and staple or isolated staple construct have significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
| | - Caroline Hoch
- Medical University of South Carolina, Charleston, South Carolina
| | - Jared J Reid
- Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Medical University of South Carolina, Charleston, South Carolina
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Inglis B, Schwarzenberg P, Klein K, von Rechenberg B, Darwiche S, Dailey HL. Biomechanical duality of fracture healing captured using virtual mechanical testing and validated in ovine bones. Sci Rep 2022; 12:2492. [PMID: 35169187 PMCID: PMC8847550 DOI: 10.1038/s41598-022-06267-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
Bone fractures commonly repair by forming a bridging structure called callus, which begins as soft tissue and gradually ossifies to restore rigidity to the bone. Virtual mechanical testing is a promising technique for image-based assessment of structural bone healing in both preclinical and clinical settings, but its accuracy depends on the validity of the material model used to assign tissue mechanical properties. The goal of this study was to develop a constitutive model for callus that captures the heterogeneity and biomechanical duality of the callus, which contains both soft tissue and woven bone. To achieve this, a large-scale optimization analysis was performed on 2363 variations of 3D finite element models derived from computed tomography (CT) scans of 33 osteotomized sheep under normal and delayed healing conditions. A piecewise material model was identified that produced high absolute agreement between virtual and physical tests by differentiating between soft and hard callus based on radiodensity. The results showed that the structural integrity of a healing long bone is conferred by an internal architecture of mineralized hard callus that is supported by interstitial soft tissue. These findings suggest that with appropriate material modeling, virtual mechanical testing is a reliable surrogate for physical biomechanical testing.
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Affiliation(s)
- Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
| | - Peter Schwarzenberg
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA
| | - Karina Klein
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
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Xie T, Liu Q, Xue G, Zhang Y, Zhou J, Zhu Z, Gou X. Experimental-numerical analysis of cell adhesion-mediated electromechanical stimulation on piezoelectric nanofiber scaffolds. J Biomech 2021; 129:110777. [PMID: 34601217 DOI: 10.1016/j.jbiomech.2021.110777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
Electrospun nanofibers exhibiting piezoelectricity are a specific class of smart materials which could provide electric stimulation to cells in a noninvasive way and contribute to tissue regeneration. During cell-material interaction, the materials display electromechanical behavior by transforming cell adhesion force into surface charge. In the process, how the cell adhesion states and the electromechanical properties of scaffolds determine the actual piezoelectric potential implemented on a cell is still unclear. Herein, we fabricated piezoelectric poly(vinylidene fluoride) (PVDF) nanofiber scaffolds with different topographies, and investigated their influences on cell morphology and cell adhesion-mediated electromechanical stimulation of mesenchymal stem cell (MSC). Our results demonstrated that MSC seeded on aligned piezoelectric nanofibers exhibited elongated morphology combined with higher intracellular calcium activity than those adhered on random nanofibers with rounded shape. The underlying mechanism was further quantitatively analyzed using a three-dimensional (3D) finite element method with respect to cell adhesion states and architecture parameters of nanofiber scaffolds. The results suggested that cell morphology and cell adhesion force influenced the piezoelectric output through modulating the location and magnification of force implemented on the scaffolds. In addition, the change of alignment, pore size and diameter of the nanofiber network could alter the mechanical property of the scaffolds, and then bias the actual piezoelectric output experienced by a cell. These findings provide new insights for probing the mechanism of cell self-stimulation on piezoelectric scaffolds, and pave the way for rational design of piezoelectric scaffolds for cell regulation and tissue regeneration.
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Affiliation(s)
- Tianpeng Xie
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Qingjie Liu
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Guilan Xue
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Yimeng Zhang
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Junyu Zhou
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Zixin Zhu
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China
| | - Xue Gou
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031. PR China.
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Barcik J, Ernst M, Balligand M, Dlaska CE, Drenchev L, Zeiter S, Epari DR, Windolf M. Short-Term Bone Healing Response to Mechanical Stimulation-A Case Series Conducted on Sheep. Biomedicines 2021; 9:988. [PMID: 34440192 PMCID: PMC8392136 DOI: 10.3390/biomedicines9080988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
It is well known that mechanical stimulation promotes indirect fracture healing by triggering callus formation. We investigated the short-term response of healing tissue to mechanical stimulation to compare the changes in tissue stiffness during stimulation and resting phases in a preclinical case-series. Four sheep underwent a tibial osteotomy and were instrumented with a custom-made active fixator which applied a mechanical stimulation protocol of 1000 cycles/day, equally distributed over 12 h, followed by 12 h of rest. During each cycle, a surrogate metric for tissue stiffness was measured, enabling a continuous real-time monitoring of the healing progression. A daily stiffness increase during stimulation and an increase during resting were evaluated for each animal. One animal had to be excluded from the evaluation due to technical reasons. For all included animals, the stiffness began to increase within the second week post-op. A characteristic pattern was observed during daily measurements: the stiffness dropped considerably within the first stimulation cycles followed by a steady rise throughout the rest of the stimulation phase. However, for all included animals, the average daily stiffness increase within the first three weeks post operation was larger during resting than during stimulation (Sheep I: 16.9% vs. -5.7%; Sheep II: 14.7% vs. -1.8%; Sheep III: 8.9% vs. 1.6%). A continuous measurement of tissue stiffness together with a controlled fracture stimulation enabled the investigation of the short-term effects of specific stimulatory parameters, such as resting periods. Resting was identified as a potentially determining factor for bone healing progression. Optimizing the ratio between stimulation and resting may contribute to more robust fracture healing in the future.
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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.)
| | - Marc Balligand
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, Avenue de Cureghem 7A–7D, 4000 Liège, Belgium;
| | | | - 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, QLD 4000, Australia;
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
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