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Matsuura Y, Suzuki T, Akasaka T, Kanazuka A, Ozawa Y, Shiko Y, Ohtori S. Recovery of Forearm Bone Strength After Plate Removal: A Finite Element Analysis Study. J Hand Surg Am 2024; 49:608.e1-608.e8. [PMID: 36123221 DOI: 10.1016/j.jhsa.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to estimate the bone strength after plate removal over time and to investigate the progression of bone strength recovery. METHODS A consecutive series of 31 patients was investigated to evaluate bone strength before and after forearm plate removal. Patients who were included underwent plate fixation for forearm diaphyseal fractures and were scheduled for plate removal. Computed tomography (CT) scans of the entire length of the bilateral forearms were taken before plate removal and at 1, 3, and 6 months after surgery. Patient-specific CT-based finite element analysis was used to predict the forearm bone fracture strength against an axial load (N), defined as the bone strength. Bone strength was estimated by patient-specific CT-based finite element analysis at each time point. RESULTS The mean age of the patients was 40.4 years. The mean time between plate fixation and removal was 27.5 months. Bone strength before the removal was estimated as reduced to 47% of that of the uninjured side. This was constant regardless of age group, involvement of the radius or ulna, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture, or type of plate. Bone strength at 1, 3, and 6 months after removal was estimated to be 66%, 85%, and 97%, respectively. The bone strength of the distal ulna was weaker than that at the other sites in the forearm and showed delayed recovery. CONCLUSIONS Bone strength after plate removal showed recovery within 3-6 months and was fully recovered by 6 months. The degree of recovery of bone atrophy varies from site to site, and patients should be careful about refracture after removal. CLINICAL RELEVANCE Clinicians should be aware that bone strength may not be sufficiently restored even 6 months after plate removal of forearm fractures.
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Affiliation(s)
- Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan.
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | - Tomoyo Akasaka
- Department of Rehabilitation Medicine, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | - Aya Kanazuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | | | - Yuki Shiko
- Clinical Research Center, University of Chiba, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
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ANGGORO D, PURBA MS, JIANG F, NISHIDA N, ITOH H, ITAMOTO K, NEMOTO Y, NAKAICHI M, SUNAHARA H, TANI K. Elucidation of the radius and ulna fracture mechanisms in toy poodle dogs using finite element analysis. J Vet Med Sci 2024; 86:575-583. [PMID: 38556325 PMCID: PMC11144531 DOI: 10.1292/jvms.23-0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
Fractures occurring in the distal radius and ulna of toy breed dogs pose distinctive challenges for veterinary practitioners, requiring specialized treatment approaches primarily based on anatomical features. Finite Element Analysis (FEA) was applied to conduct numerical experiments to determine stress distribution across the bone. This methodology offers an alternative substitute for directly investigating these phenomena in living dog experiments, which could present ethical obstacles. A three-dimensional bone model of the metacarpal, carpal, radius, ulna, and humerus was reconstructed from Computed Tomography (CT) images of the toy poodle and dachshund forelimb. The model was designed to simulate the jumping and landing conditions from a vertical distance of 40 cm to the ground within a limited timeframe. The investigation revealed considerable variations in stress distribution patterns between the radius and ulna of toy poodles and dachshunds, indicating notably elevated stress levels in toy poodles compared to dachshunds. In static and dynamic stress analysis, toy poodles exhibit peak stress levels at the distal radius and ulna. The Von Mises stresses for toy poodles reach 90.07 MPa (static) and 1,090.75 MPa (dynamic) at the radius and 1,677.97 MPa (static) and 1,047.98 MPa (dynamic) at the ulna. Conversely, dachshunds demonstrate lower stress levels for 5.39 MPa (static) and 231.79 MPa (dynamic) at the radius and 390.56 MPa (static) and 513.28 MPa (dynamic) at the ulna. The findings offer valuable insights for modified treatment approaches in managing fractures in toy breed dogs, optimizing care and outcomes.
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Affiliation(s)
- Dito ANGGORO
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Melpa Susanti PURBA
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Fei JIANG
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Japan
| | - Norihiro NISHIDA
- Department of Orthopedic Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Harumichi ITOH
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuhito ITAMOTO
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yuki NEMOTO
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Munekazu NAKAICHI
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Hiroshi SUNAHARA
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kenji TANI
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
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Anggoro D, Purba MS, Jiang F, Nishida N, Itoh H, Itamoto K, Nemoto Y, Nakaichi M, Sunahara H, Tani K. Finite element study on post-screw removal stress in toy poodle radius with different plate designs and screw arrangements. Open Vet J 2024; 14:885-894. [PMID: 38682140 PMCID: PMC11052620 DOI: 10.5455/ovj.2024.v14.i3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 05/01/2024] Open
Abstract
Background The study employs finite element analysis to investigate stress distribution in the radius of toy poodles after screw removal. The examination focuses on the biomechanical implications of varied screw hole configurations using 1.5 and 2.0-mm locking compression plates (LCPs) with notched head T-Plates. Aim To provide a noninvasive approach to analyzing the immediate consequences of screw removal from the radius bone in toy poodles. Specifically, it explores the impact of varied plate designs and screw arrangements on stress distribution within the forelimb bones. Methods The study constructs a three-dimensional bone model of the toy poodle's forelimb based on computed tomography (CT) images. Simulations were designed to replicate jumping and landing from a 40 cm height, comparing stress distribution in the radius post-screw removal. Results The analysis reveals significant variations in stress distribution patterns between the two LCPs. The radius implanted with the 2.0-mm LCP displays a uniform stress distribution, contrasting with the 1.5-mm plates. Localized stress concentration is observed around the screw holes, while trabecular bone regions near the screw holes exhibit lower stress levels. Conclusion The study highlights the plate designs and screw configurations that affect bone stress in toy poodle forelimbs post-screw removal. The findings provide valuable insights for veterinarians, aiding informed decisions in veterinary orthopedic practices.
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Affiliation(s)
- Dito Anggoro
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Japan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, Gadjah Mada University, Indonesia
| | - Melpa Susanti Purba
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Japan
| | - Fei Jiang
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, Yamaguchi University, Japan
| | - Harumichi Itoh
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
| | - Kazuhito Itamoto
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
| | - Yuki Nemoto
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
| | - Munekazu Nakaichi
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
| | - Hiroshi Sunahara
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
| | - Kenji Tani
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Japan
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Bowers KM, Terrones LD, Sun X, Rifkin R, Croy E, Adair HS, Mulon PY, Hecht S, Anderson DE. Changes in tibial cortical dimensions and density associated with long-term locking plate fixation in goats. J Exp Orthop 2023; 10:111. [PMID: 37934300 PMCID: PMC10634227 DOI: 10.1186/s40634-023-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Cortical porosis, secondary to either vascular injury or stress-shielding, is a comorbidity of fracture fixation using compression bone plating. Locking plate constructs have unique mechanics of load transmission and lack of reliance on contact pressures for fixation stability, so secondary cortical porosis adjacent to the plate has not been widely investigated. Therefore, this study aimed to assess the effects of long-term locking plate fixation on cortical dimensions and density in a caprine tibial segmental ostectomy model. METHODS Data was acquired from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over periods of 3, 6, 9, and 12 months. Quantitative data included tibial cortical width measurements and three-dimensionally reconstructed slab density measurements, both assessed using computed tomographic examinations performed at the time of plate removal. Additional surgical and demographic variables were analyzed for effect on cortical widths and density, and all cis-cortex measurements were compared to both the trans-cortex and to the contralateral limbs. RESULTS The tibial cis-cortex was significantly wider and more irregular than the trans-cortex at the same level. This width asymmetry differed in both magnitude and direction from the contralateral limb. The bone underlying the plate was significantly less dense than the trans-cortex, and this cortical density difference was significantly greater than that of the contralateral limb. These cortical changes were independent of both duration of fixation and degree of ostectomy bone healing. CONCLUSIONS This study provides evidence that cortical bone loss consistent with cortical porosity is a comorbidity of locking plate fixation in a caprine tibial ostectomy model. Further research is necessary to identify risk factors for locking-plate-associated bone loss and to inform clinical decisions in cases necessitating long-term locking plate fixation.
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Affiliation(s)
- Kristin M Bowers
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA.
| | - Lori D Terrones
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, USA
| | - Rebecca Rifkin
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Elizabeth Croy
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Henry S Adair
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Silke Hecht
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - David E Anderson
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
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Noda M, Adachi K, Takahara S. A Scientific Proposal for Surgical Decision-Making in Occult Intertrochanteric Fractures Based on Finite Element Analysis. Cureus 2023; 15:e44491. [PMID: 37791154 PMCID: PMC10544485 DOI: 10.7759/cureus.44491] [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] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Background In the treatment of femoral intertrochanteric fractures, there is still a lack of consensus on the optimal approach for isolated greater trochanteric fractures and insufficient intertrochanteric fractures. The limited number of patients and restricted access to accurate assessment of fracture extension using magnetic resonance imaging contribute to the unclear treatment strategy. This study aims to utilize finite element (FE) analysis to analyze stress values at the fracture line and investigate their influence on intertrochanteric fracture extension under different loading conditions. The hypothesis is that fracture extension occurs following certain conditions, supporting the need for surgery based on scientific evidence. Methodology Osseous data from a computed tomography (CT) scan was used to create a proximal femur FE model using FEA software. CT scan data were converted to Digital Imaging and Communications in Medicine format and used to generate the FE model. Trabecular bone and cortex were meshed into tetrahedral elements. The model consisted of 1,592,642 elements and 282,530 nodes. Two models were created, namely, healthy proximal femur (HF) and femoral insufficient intertrochanteric fracture (FIF). Material properties were assigned based on CT values and conversion equations. The distal end of the femur was constrained. Stress analysis using the dynamic explicit approach was performed. Von Mises stresses were calculated for the proximal femur. The number of elements exceeding yield stress was counted to predict fracture risk by focusing on fracture line spots. In this study, the distribution of von Mises stress was compared between the HF and the FIF models. Six loading combinations were considered, namely, two weight-bearing conditions (3 W loading simulating for walking and 1/3 W for touch-down standing) and three hip flexion angles (0°, 15°, and 23°). Results Under 3 W loading, no significant stress elevations were observed in the HF model at any flexion angles. However, the FIF model exhibited increased stress at the site of the posterior fracture line extension. This stress-induced element destruction was observed in both cortical and cancellous bone. For the 1/3 W loading condition, only minimal stress elevation was observed in both HF and FIF models. To assess the influence on fracture extension, the number of yielded elements was evaluated along the fracture line edges (greater trochanter and middle of the intertrochanteric ridge). Under 3 W loading, the HF model had only one yielded element, indicating minimal fracture risk. In contrast, the FIF model exhibited a notable presence of yield elements in various regions (total/greater trochanter/shaft) at different flexion angles: 0° (115/16/28), 15° (265/158/23), and 23° (446/233/34). Under the 1/3 W loading condition, neither the HF nor the FIF models showed any yielding elements, regardless of the direction of external force. Conclusions The results demonstrated elevated stress levels at the fracture line in the FIF model, particularly during walking, indicating a higher risk of fracture extension at the flex position. However, under reduced weight-bearing conditions, the stress at the fracture site remained within the yield stress range, suggesting a relatively low risk of fracture extension. These findings hold significant clinical implications for developing surgical protocols that consider patients' compliance with weight-bearing restrictions.
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Affiliation(s)
| | - Kazuhiko Adachi
- Department of Mechanical Engineering, Chubu University, Kasugai, JPN
| | - Shunsuke Takahara
- Department of Orthopaedics, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, JPN
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Yoshiyama T. Navigating Challenges and Treatment Options in Diaphyseal Forearm Fractures Among Adolescents: Case Series and Narrative Review. Cureus 2023; 15:e40669. [PMID: 37485145 PMCID: PMC10356996 DOI: 10.7759/cureus.40669] [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] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
In this paper, we recount the medical trajectories of two male patients, both fourteen years of age, who sustained re-fractures of their radius and ulna six months post their primary diaphyseal fractures. Owing to the limited capacity for growth of the forearm bones between the ages of ten to sixteen years, many queries are engendered concerning apt treatment strategies. The pressing questions are whether these should be conservative or surgical and the precise method to be employed in surgical interventions. This discourse endeavors to demarcate preferred therapeutic options and shed light on a series of standard clinical dilemmas physicians encounter, along with an exhaustive scrutiny of existing literature.
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Pramudita JA, Hiroki W, Yoda T, Tanabe Y. Variations in Strain Distribution at Distal Radius under Different Loading Conditions. Life (Basel) 2022; 12:life12050740. [PMID: 35629407 PMCID: PMC9144860 DOI: 10.3390/life12050740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Distal radial fractures exhibit various fracture patterns. By assuming that the strain distribution at the distal radius affects the diversification of the fracture pattern, a parameter study using the finite element model of a wrist developed from computed tomography (CT) images was performed under different loading conditions. The finite element model of the wrist consisted of the radius, ulna, scaphoid, lunate, triquetrum, and major carpal ligaments. The material properties of the bone models were assigned on the basis of the Hounsfield Unit (HU) values of the CT images. An impact load was applied to the scaphoid, lunate, and triquetrum to simulate boundary conditions during fall accidents. This study considered nine different loading conditions that combine three different loading directions and three different load distribution ratios. According to the analysis results, the strain distribution at the distal radius changed with respect to the change in the loading condition. High strain concentration occurred in regions where distal radius fractures are commonly developed. The direction and distribution of the load acting on the radius were considered to be factors that may cause variations in the fracture pattern of distal radius fractures.
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Affiliation(s)
- Jonas A. Pramudita
- College of Engineering, Nihon University, Koriyama 963-8642, Japan
- Correspondence:
| | - Wataru Hiroki
- Graduate School of Science and Technology, Niigata University, Niigata 950-2181, Japan
| | - Takuya Yoda
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-2181, Japan;
| | - Yuji Tanabe
- Management Strategy Section, President Office, Niigata University, Niigata 950-2181, Japan;
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