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Sabik A, Daszkiewicz K, Witkowski W, Łuczkiewicz P. Comparative analysis of mechanical conditions in bone union following first metatarsophalangeal joint arthrodesis with varied locking plate positions: A finite element analysis. PLoS One 2024; 19:e0303752. [PMID: 38753866 PMCID: PMC11098485 DOI: 10.1371/journal.pone.0303752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND First metatarsophalangeal joint arthrodesis is a typical medical treatment performed in cases of arthritis or joint deformity. The gold standard for this procedure is arthrodesis stabilisation with the dorsally positioned plate. However, according to the authors' previous studies, medially positioned plate provides greater bending stiffness. It is worth to compare the mechanical conditions for bone formation in the fracture callus for both placements of the locking plate. METHODS Two finite element models of the first metatarsophalangeal joint with the dorsally and medially positioned plate were defined in the Abaqus software to simulate differentiation of the fracture callus. A simplified load application, i.e. one single step per each day and the diffusion of the mesenchymal stem cells into the fracture region were assumed in an iterative hardening process. The changes of the mesenchymal stem cells into different phenotypes during the callus stiffening were governed by the octahedral shear strain and interstitial fluid velocity according to Prendergast mechanoregulation theory. Basing on the obtained results the progress of the cartilage and bone tissues formation and their distribution within the callus were compared between two models. FINDINGS The obtained results suggest that after 6 weeks of simulation the healing progress is in general comparable for both plates. However, earlier closing of external callus was observed for the medially positioned plate which had greater vertical bending stiffness. This process enables faster internal callus hardening and promotes symmetrical bridging.
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Affiliation(s)
- Agnieszka Sabik
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Wojciech Witkowski
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Smoluchowskiego, Gdańsk, Poland
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Nayak GS, Roland M, Wiese B, Hort N, Diebels S. Influence of implant base material on secondary bone healing: an in silico study. Comput Methods Biomech Biomed Engin 2024:1-9. [PMID: 38613482 DOI: 10.1080/10255842.2024.2338121] [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: 11/30/2023] [Accepted: 03/28/2024] [Indexed: 04/15/2024]
Abstract
The implant material at the fracture site influences fracture healing not only from biological perspective but also from mechanical perspective. Biodegradable implants such as magnesium (Mg) based alloys have shown faster secondary bone healing properties as compared to bioinert implants such as titanium (Ti). The general reasoning behind this is the benefit of Mg from biocompatibility perspectives. We studied the effect of Ti and Mg as base materials for implants from mechanical perspectives, where we focused on the displacements at the fracture site of the tibia and their influence on the stimulus for bone healing. We found out that in comparison to Ti, Mg implants have minimal stress shielding problem, only which led to better mechanical stimulus at the fracture site.
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Affiliation(s)
| | - Michael Roland
- Chair of Applied Mechanics, Saarland University, Saarbrücken, Germany
| | - Björn Wiese
- Institute of Metallic Biomaterials, Geesthacht, Germany
| | - Norbert Hort
- Institute of Metallic Biomaterials, Geesthacht, Germany
- Leuphana University Lüneburg, Institute of Product and Process Innovation, Lüneburg, Germany
| | - Stefan Diebels
- Chair of Applied Mechanics, Saarland University, Saarbrücken, Germany
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Verma V, Singh S, Pal K. Comprehensive Study on the Age-Strengthened Mg-Zn-Mn-Ca/ZnO Composites for Fracture Fixation: Microstructure, Mechanical, and In Vitro Biocompatibility Evaluation. ACS APPLIED BIO MATERIALS 2024; 7:203-219. [PMID: 38176074 DOI: 10.1021/acsabm.3c00813] [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] [Indexed: 01/06/2024]
Abstract
The present work investigates the use of age-strengthened Mg-Zn-Mn-Ca/xZnO as resorbable materials in temporary orthopedic implants. Quaternary Mg-Zn-Mn-Ca alloy, reinforced with zinc oxide particles, was stir-cast, followed by solution treatment and a range of aging treatments. Optical and electron microscopy, mechanical, electrochemical, immersion, and dynamic mechanical testing, with biocompatibility assessment were carried out. The observed 2θ shift in the (101) peaks of ZMX611/ZnO-ST and ZMX611/ZnO-H indicated lattice shrinkage. The formation of Mg7Zn3 and Ca2Mg6Zn3 in the grain boundary compositions was observed. ZMX611/ZnO-ST had a smaller β-phase fraction, indicating a finer microstructure. ZMX611/ZnO-H had the highest tensile yield strength (102.97 ± 3.92 MPa), and ZMX611/ZnO-ST showed the highest ultimate tensile strength (127.21 ± 7.48 MPa), indicating precipitation hardening of Zn enrichment. The uniformly dispersed secondary phases played a dual role in corrosion behavior. ZMX611/ZnO-ST showed a better cytocompatibility response among all samples. Composite materials exhibited satisfactory biocompatibility and mechanical compatibility as indicated by in silico results of deviatoric strain-based mechanical stimuli at the fracture interface.
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Affiliation(s)
- Vivek Verma
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
| | - Swati Singh
- Centre for Nanotechnology, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
| | - Kaushik Pal
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
- Centre for Nanotechnology, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
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Zdero R, Djuricic A, Schemitsch EH. Mechanical Properties of Synthetic Bones Made by Synbone: A Review. J Biomech Eng 2023; 145:121003. [PMID: 37542709 DOI: 10.1115/1.4063123] [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: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Biomechanical engineers and physicists commonly employ biological bone for biomechanics studies, since they are good representations of living bone. Yet, there are challenges to using biological bone, such as cost, degradation, disease, ethics, shipping, sourcing, storage, variability, etc. Therefore, the Synbone® company has developed a series of synthetic bones that have been used by biomechanical investigators to offset some drawbacks of biological bone. There have been a number of published biomechanical reports using these bone surrogates for dental, injury, orthopedic, and other applications. But, there is no prior review paper that has summarized the mechanical properties of these synthetic bones in order to understand their general performance or how well they represent biological bone. Thus, the goal of this article was to survey the English-language literature on the mechanical properties of these synthetic bones. Studies were included if they quantitatively (a) characterized previously unknown values for synthetic bone, (b) validated synthetic versus biological bone, and/or (c) optimized synthetic bone performance by varying geometric or material parameters. This review of data, pros, cons, and future work will hopefully assist biomechanical engineers and physicists that use these synthetic bones as they develop experimental testing regimes and computational models.
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Affiliation(s)
- Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON N6A-5W9, Canada
| | - Aleksandar Djuricic
- Orthopaedic Biomechanics Lab, Victoria Hospital, Room A6-144, 800 Commissioners Road East, London, ON N6A-5W9, Canada
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON N6A-5W9, Canada; Division of Orthopaedic Surgery, Western University, London, ON N6A-5A5, Canada
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Liu X, Liao J, Patel M, Miramini S, Qu J, Zhang L. Effect of uncertain clinical conditions on the early healing and stability of distal radius fractures. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107774. [PMID: 37651819 DOI: 10.1016/j.cmpb.2023.107774] [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: 01/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVES The healing outcomes of distal radius fracture (DRF) treated with the volar locking plate (VLP) depend on surgical strategies and postoperative rehabilitation. However, the accurate prediction of healing outcomes is challenging due to a range of certainties related to the clinical conditions of DRF patients, including fracture geometry, fixation configuration, and physiological loading. The purpose of this study is to investigate the influence of uncertainty and variability in fracture/fixation parameters on the mechano-biology and biomechanical stability of DRF, using a probabilistic numerical approach based on the results from a series of experimental tests performed in this study. METHODS Six composite radius sawboneses fitted with titanium VLP (VLP 2.0, Austofix) were loaded to failure at a rate of 2 N/s. The testing results of the elastic and plastic behaviour of the VLP were used as inputs for a probabilistic-based computational model of DRF, which simulated mechano-regulated tissue differentiation and fixation elastic capacity at the fracture site. Finally, the probability of success in early indirect healing and fracture stabilisation was predicted. RESULTS The titanium VLP is a strong and ductile fixation whose flexibility and elastic capacity are governed by flexion working length and bone-to-plate distance, respectively. A fixation with optimised designs and configurations is critical to mechanically stabilising the early fracture site. Importantly, the uncertainty and variability in fracture/fixation parameters could compromise early DRF healing. The physiological loading uncertainty is the most adverse factor, followed by the negative impact of uncertainty in fracture geometry. CONCLUSIONS The VRP 2.0 fixation made of grade II titanium is a desirable fixation that is strong enough to resist irreparable deformation during early recovery and is also ductile to deform plastically without implant failure at late rehabilitation.
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Affiliation(s)
- Xuanchi Liu
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - JinJing Liao
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Ji Qu
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
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Liu X, Miramini S, Patel M, Ebeling P, Liao J, Zhang L. Development of numerical model-based machine learning algorithms for different healing stages of distal radius fracture healing. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107464. [PMID: 36905887 DOI: 10.1016/j.cmpb.2023.107464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/06/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Early therapeutic exercises are vital for the healing of distal radius fractures (DRFs) treated with the volar locking plate. However, current development of rehabilitation plans using computational simulation is normally time-consuming and requires high computational power. Thus, there is a clear need for developing machine learning (ML) based algorithms that are easy for end-users to implement in daily clinical practice. The purpose of the present study is to develop optimal ML algorithms for designing effective DRF physiotherapy programs at different stages of healing. METHOD First, a three-dimensional computational model for the healing of DRF was developed by integrating mechano-regulated cell differentiation, tissue formation and angiogenesis. The model is capable of predicting time-dependant healing outcomes based on different physiologically relevant loading conditions, fracture geometries, gap sizes, and healing time. After being validated using available clinical data, the developed computational model was implemented to generate a total of 3600 clinical data for training the ML models. Finally, the optimal ML algorithm for each healing stage was identified. RESULTS The selection of the optimal ML algorithm depends on the healing stage. The results from this study show that cubic support vector machine (SVM) has the best performance in predicting the healing outcomes at the early stage of healing, while trilayered ANN outperforms other ML algorithms in the late stage of healing. The outcomes from the developed optimal ML algorithms indicate that Smith fractures with medium gap sizes could enhance the healing of DRF by inducing larger cartilaginous callus, while Colles fractures with large gap sizes may lead to delayed healing by bringing excessive fibrous tissues. CONCLUSIONS ML represents a promising approach for developing efficient and effective patient-specific rehabilitation strategies. However, ML algorithms at different healing stages need to be carefully chosen before being implemented in clinical applications.
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Affiliation(s)
- Xuanchi Liu
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jinjing Liao
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
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Zhang E, Miramini S, Patel M, Richardson M, Ebeling P, Zhang L. The effects of mechanical instability on PDGF mediated inflammatory response at early stage of fracture healing under diabetic condition. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107319. [PMID: 36586180 DOI: 10.1016/j.cmpb.2022.107319] [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: 10/17/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Mechanical stability plays an important role in fracture healing process. Excessive interfragmentary movement will continuously damage the tissue and newly formed capillaries at the fracture site, which leads to overproduction of platelet-derived growth factor (PDGF) that attracts more macrophages into fracture callus, ultimately persistent and enhanced inflammatory response happens. For diabetic condition, the impact of mechanical instability of fracture site on inflammatory response could be further compliciated and the relevant research in this field is relatively limited. METHODS Building on previous experimental studies, this study presents a numerical model consisting of a system of reactive-transport equations representing the transport as well as interactions of different cells and cytokines within the fracture callus. The model is initially validated by available experimental data, and then implemented to investigate the role of mechanical stability of fracture site in inflammatory response during early stage of healing. It is assumed that there is an increased release of PDGF due to the rupture of blood vessels resulting from mechanical instability, which leads to increased production of inflammatory cytokines (i.e., TNF-α). The bone healing process under three different conditions were investigated, i.e., mechanically stable condition with normal inflammatory response (Control, Case 1), mechanically unstable condition with normal inflammatory response (Case 2) and mechanically unstable condition with diabetes (Case 3). RESULTS Mechanical instability can promote the macrophage infiltration and thus induce an enhanced and prolonged inflammatory response, which could impede the MSCs proliferation during the early fracture healing stage (e.g., compared with the control condition, the MSCs concentration in unstable fracture with normal inflammatory response can be reduced by 3.2% and 5.2% on day 2 and day 10 post-fracture, respectively). Under diabetic condition, the mechanical instability of fracture site could lead to a significant increase of TNF-α concentration in fracture callus (Case 3) in comparison to control (Case 1) (e.g., three-fold increase in TNF-α concentration compared to control). In addition, the results show that the mechanical instability affects the cell differentiation and proliferation in fracture callus in a spatially dependent manner, e.g., for diabetic fracture patients, the mechanical instability could potentially decrease the concentration of MSCs, osteoblasts and chondrocytes by around 39%, 30% and 29% in cortical callus, respectively, in comparison to control. CONCLUSION The mechanical instability together with diabetic condition can significantly affect the natural resolution of inflammation during early stage of healing by turning acute inflammation into chronic inflammation which is characterized by a continuously upregulated TNF-α pathway.
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Affiliation(s)
- Enhao Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Richmond, Victoria, Australia
| | | | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
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Influence of muscle loading on early-stage bone fracture healing. J Mech Behav Biomed Mater 2023; 138:105621. [PMID: 36549248 DOI: 10.1016/j.jmbbm.2022.105621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Designing weight-bearing exercises for patients with lower-limb bone fractures is challenging and requires a systematic approach that accounts for patient-specific loading conditions. However, 'trial-and-error' approaches are commonplace in clinical settings due to the lack of a fundamental understanding of the effect of weight-bearing exercises on the bone healing process. Whilst computational modelling has the potential to assist clinicians in designing effective patient-specific weight-bearing exercises, current models do not explicitly account for the effects of muscle loading, which could play an important role in mediating the mechanical microenvironment of a fracture site. We combined a fracture healing model involving a tibial fracture stabilised with a locking compression plate (LCP) with a detailed musculoskeletal model of the lower limb to determine interfragmentary strains in the vicinity of the fracture site during both full weight-bearing (100% body weight) and partial weight-bearing (50% body weight) standing. We found that muscle loading significantly altered model predictions of interfragmentary strains. For a fractured bone with a standard LCP configuration (bone-plate distance = 2 mm, working length = 30 mm) subject to full weight-bearing, the predicted strains at the near and far cortices were 23% and 11% higher when muscle loading was included compared to the case when muscle loading was omitted. The knee and ankle muscles accounted for 38% of the contact force exerted at the knee joint during quiet standing and contributed significantly to the strains calculated at the fracture site. Thus, models of bone fracture healing ought to account explicitly for the effects of muscle loading. Furthermore, the study indicated that LCP configuration parameters play a crucial role in influencing the fracture site microenvironment. The results highlighted the dominance of working length over bone-plate distance in controlling the flexibility of fracture sites stabilised with LCP devices.
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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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Liu X, Miramini S, Patel M, Liao J, Shidid D, Zhang L. Influence of therapeutic grip exercises induced loading rates in distal radius fracture healing with volar locking plate fixation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 215:106626. [PMID: 35051836 DOI: 10.1016/j.cmpb.2022.106626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/25/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic exercises could potentially enhance the healing of distal radius fractures (DRFs) treated with volar locking plate (VLP). However, the healing outcomes are highly dependant on the patient-specific fracture geometries (e.g., gap size) and the loading conditions at the fracture site (e.g., loading frequency) resulted from different types of therapeutic exercises. The purpose of this study is to investigate the effects of different loading frequencies induced by therapeutic exercises on the biomechanical microenvironment of the fracture site and the transport of cells and growth factors within the fracture callus, ultimately the healing outcomes. This is achieved through numerical modelling and mechanical testing. METHODS Five radius sawbones specimens (Pacific Research Laboratories, Vashon, USA) fixed with VLP (VRP2.0+, Austofix) were mechanically tested using dynamic test instrument (INSTRON E3000, Norwood, MA). The loading protocol used in mechanical testing involved a series of cyclic axial compression tests representing hand and finger therapeutic exercises. The relationship between the dynamic loading rate (i.e., loading frequency) and dynamic stiffness of the construct was established and used as inputs to a developed numerical model for studying the dynamic loading induced cells and growth factors in fracture site and biomechanical stimuli required for healing. RESULTS There is a strong positive linear relationship between the loading rate and axial stiffness of the construct fixed with VLP. The loading rates induced by the moderate frequencies (i.e., 1-2 Hz) could promote endochondral ossification, whereas relatively high loading frequencies (i.e., over 3 Hz) may hinder the healing outcomes or lead to non-union. In addition, a dynamic loading frequency of 2 Hz in combination of a fracture gap size of 3 mm could produce a better healing outcome by enhancing the transport of cells and growth factors at the fracture site in comparison to free diffusion (i.e. without loading), and thereby produces a biomechanical microenvironment which is favourable for healing. CONCLUSION The experimentally validated numerical model presented in this study could potentially contribute to the design of effective patient-specific therapeutic exercises for better healing outcomes. Importantly, the model results demonstrate that therapeutic grip exercises induced dynamic loading could produce a better biomechanical microenvironment for healing without compromising the mechanical stability of the overall volar locking plate fixation construct.
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Affiliation(s)
- Xuanchi Liu
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening and Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - JinJing Liao
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Darpan Shidid
- RMIT Centre for Additive Manufacture, RMIT University, Melbourne, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
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Evaluation of Bone Consolidation in External Fixation with an Electromechanical System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The monitoring of fracture or osteotomy healing is vital for orthopedists to help advise, if necessary, secondary treatments for improving healing outcomes and minimizing patient suffering. It has been decades since osteotomy stiffness has been identified as one main parameter to quantify and qualify the outcome of a regenerated callus. Still, radiographic imaging remains the current standard diagnostic technique of orthopedists. Hence, with recent technological advancements, engineers need to use the new branches of knowledge and improve or innovate diagnostic technologies. An electromechanical system was developed to help diagnose changes in osteotomy stiffness treated with the external fixator LRS Orthofix®. The concept was evaluated experimentally and numerically during fracture healing simulation using two different models: a simplified model of a human tibia, consisting of a nylon bar with a diameter of 30 mm, and a synthetic tibia with the anatomical model from fourth-generation Sawbones®. Moreover, Sawbones® blocks with different densities simulated the mechanical characteristics of the regenerated bone in many stages of bone callus growth. The experimental measurements using the developed diagnostic were compared to the numerically simulated results. For this external fixator, it was possible to show that the displacement in osteotomy was always lower than the displacement prescribed in the elongator. Nevertheless, a relationship was established between the energy consumption by the electromechanical system used to perform callus stimulus and the degree of osteotomy consolidation. Hence, this technology may lead to methodologies of mechanical stimulation for regenerating bone, which will play a relevant role for bedridden individuals with mobility limitations.
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Zhang E, Miramini S, Patel M, Richardson M, Ebeling P, Zhang L. Role of TNF-α in early-stage fracture healing under normal and diabetic conditions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106536. [PMID: 34823199 DOI: 10.1016/j.cmpb.2021.106536] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Inflammatory response plays a crucial role in the early stage of fracture healing. Immediately after fracture, the debris and immune cells (e.g., macrophages), recruited into the fracture callus, lead to the secretion of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), which governs the mesenchymal stem cells (MSCs) mediated healing processes. However, it is still unclear how chronic inflammatory diseases (e.g., diabetes) affect the level of TNF-α in fracture callus, ultimately the healing outcomes at the early stage of healing. Therefore, the purpose of this study is to develop a numerical model for investigating TNF-α mediated bone fracture healing. METHODS A mathematical model consisting of a system of partial differential equations that represent the reactive transport of cells and cytokines in the fracture callus is developed in this study. The model is first calibrated by using available experimental data and then implemented to study the effect of TNF-α on the early stage of fracture healing under normal and diabetic conditions. RESULTS There is a significant elevation of TNF-α level in facture callus during the first 24 h post-fracture in normal condition, and its influence in the concentration of MSCs and cell differentiation becomes significant three days post-fracture (e.g., the absence of TNF-α signaling could reduce the concentration of MSCs more than 20% in cortical callus). In addition, the excessive secretion of TNF-α induced by diabetes could decrease the concentration of MSCs at the initial stage of healing, particularly reduce the concentration of MSCs in cortical callus by around 25%. CONCLUSION The model predictions suggested that there should be an optimal concentration of TNF-α in fracture callus, which enhances the early stage of healing, and excessive or insufficient secretion of TNF-α might significantly hinder the healing process.
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Affiliation(s)
- Enhao Zhang
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, Victoria 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, Victoria 3010, Australia
| | - Minoo Patel
- Centre for Limb Lengthening and Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | | | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, Victoria 3010, Australia.
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Chandra G, Pandey A, Tipan N. Longitudinally centered embossed structure in the locking compression plate for biodegradable bone implant plate: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:603-618. [PMID: 34486894 DOI: 10.1080/10255842.2021.1970145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the current revolution of internal fixation implant in orthopaedics, a biodegradable implant is the most awaited and exceptional medical device where biodegradable material has paid more attention to the success of a biodegradable implant than the design of a biodegradable bone implant plate. By far, LCP is the most traditionally used implant plate (using non-biodegradable material) because of its experimental success, but not with qualified biodegradable material (Mg-alloy). This lack of mechanical performance is a major drawback that can be rectified by better structural design. This will help avoid few other problems as well. Therefore, with proper consideration, the LCP has been added to a semicircular filleted longitudinally centered embossed (LCE) structure to enhance overall mechanical performance that can help emphasize mechanical support even after continuous degradation when applied in a physiological environment. For mechanical verification of this advanced design of biodegradable bone implant plate, four-point bending test (4PBT) and axial compression test (ACT) have been performed using FEM on LCELCP, LCP, continuously degraded (CD)-LCELCP, and CD-LCP. LCELCP showed reduced stress of about 22% and 10% in 4PBT and ACT, respectively, compared to LCP. CD-LCELCP is safe during ACT over 6 months of continuous degradation when the degradation rate is assumed to be 4 mm/year. These results also ensured accuracy using mesh convergence and also mesh checked for quality assurance. Overall, LCELCP can be considered as a biodegradable bone implant plate because of its superior performance, if its ultimate validation is carried out through animal/human trials as future work.
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Affiliation(s)
- Girish Chandra
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh, India
| | - Ajay Pandey
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh, India
| | - Nilesh Tipan
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh, India
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14
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Ganadhiepan G, Miramini S, Mendis P, Patel M, Zhang L. A probabilistic approach for modelling bone fracture healing under Ilizarov circular fixator. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3466. [PMID: 33864429 DOI: 10.1002/cnm.3466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/27/2020] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Bone fracture treatments using Ilizarov circular fixator (ICF) involve dealing with uncertainties about a range of critical factors that control the mechanical microenvironment of the fracture site such as ICF configuration, fracture gap size, physiological loading etc. To date, the effects of the uncertainties about these critical factors on the mechanical microenvironment of the fracture site have not been fully understood. The purpose of this study is to tackle this challenge by using computational modelling in conjunction with engineering reliability analysis. Particularly, the effects of uncertainties in fracture gap size (GS), level of weight-bearing (P), ICF wire pretension (T) and wire diameter (WD) on the fracture site mechanical microenvironment at the beginning of the reparative phase of healing was investigated in this study. The results show that the mechanical microenvironment of fracture site stabilised with ICF is very sensitive to the uncertainties in P and GS. For example, an increase in the coefficient of variation of P (COVP ) from 0.1 to 0.9 (i.e., an increase in the uncertainty in P) could reduce the probability of achieving a favourable mechanical microenvironment within the fracture site (i.e., Probability of Success, PoS) by more than 50%, while an increase in the coefficient of variation of GS (COVGS ) from 0.1 to 0.9 could decrease PoS by around 30%. In contrast, an increase in the uncertainties in T and WD (COV increase from 0.1 to 0.9) has little influence on the fracture site mechanical microenvironment (PoS changes <5%).
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
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15
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Liu X, Miramini S, Patel M, Liao J, Shidid D, Zhang L. Balance Between Mechanical Stability and Mechano-Biology of Fracture Healing Under Volar Locking Plate. Ann Biomed Eng 2021; 49:2533-2553. [PMID: 34189632 DOI: 10.1007/s10439-021-02815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/11/2021] [Indexed: 12/16/2022]
Abstract
The application of volar locking plate (VLP) is promising in the treatment of dorsally comminuted and displaced fracture. However, the optimal balance between the mechanical stability of VLP and the mechanobiology at the fracture site is still unclear. The purpose of this study is to develop numerical models in conjunction with experimental studies to identify the favourable mechanical microenvironment for indirect healing, by optimizing VLP configuration and post-operative loadings for different fracture geometries. The simulation results show that the mechanical behaviour of VLP is mainly governed by the axial compression. In addition, the model shows that, under relatively large gap size (i.e., 3-5 mm), the increase of FWL could enhance chondrocyte differentiation while a large BPD could compromise the mechanical stability of VLP. Importantly, bending moment produced by wrist flexion/extension and torsion moment produced from forearm rotation could potentially hinder endochondral ossification at early stage of healing. The developed model could potentially assist orthopaedic surgeons in surgical pre-planning and designing post-operation physical therapy for treatment of distal radius fractures.
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Affiliation(s)
- Xuanchi Liu
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, VIC, Australia
| | - JinJing Liao
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Darpan Shidid
- RMIT Centre for Additive Manufacture, RMIT University, Melbourne, VIC, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, VIC, Australia.
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16
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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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17
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Ganadhiepan G, Miramini S, Patel M, Mendis P, Zhang L. Optimal time-dependent levels of weight-bearing for bone fracture healing under Ilizarov circular fixators. J Mech Behav Biomed Mater 2021; 121:104611. [PMID: 34082182 DOI: 10.1016/j.jmbbm.2021.104611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/25/2021] [Accepted: 05/23/2021] [Indexed: 02/09/2023]
Abstract
It is known that weight-bearing exercises under Ilizarov circular fixators (ICF) could enhance bone fracture healing by mechano-regulation. However, interfragmentary movements at the fracture site induced by weight-bearing may inhibit angiogenesis and ultimately delay the healing process. To tackle this challenge, a computational model is presented in this study which considers the spatial and temporal changes in mechanical properties of fracture callus to predict optimal levels of weight-bearing during fracture healing under ICF. The study takes sheep fractures as example and shows that the developed model has the capability of predicting patient specific, time-dependent optimal levels of weight-bearing which enhances mechano-regulation mediated healing without hindering the angiogenesis process. The results demonstrate that allowable level of weight-bearing and timings depend on fracture gap size. For normal body weights (BW) and moderate fracture gap sizes (e.g. 3 mm), weight-bearing with 30% BW could start by week 4 post-operation and gradually increase to 100% BW by week 11. In contrast, for relatively large fracture gap sizes (i.e. 6 mm), weight-bearing is recommended to commence in later stages of healing (e.g. week 11 post-operation). Furthermore, increasing ICF stiffness (e.g. using half pins instead of pretension wires) can increase the level of weight-bearing significantly in the early stages up to a certain time point (e.g. week 8 post-operation) beyond which no noticeable benefits could be achieved. The findings of this study have potential applications in designing post-operative weight bearing exercises.
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Affiliation(s)
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Victoria, 3121, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Australia.
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18
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Mohandes Y, Tahani M, Rouhi G, Tahami M. A mechanobiological approach to find the optimal thickness for the locking compression plate: Finite element investigations. Proc Inst Mech Eng H 2021; 235:408-418. [PMID: 33427059 DOI: 10.1177/0954411920985757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed at finding the acceptable range, and the optimal value for the locking compression plate (LCP) thickness (THK), through simulating the osteogenic pathway of bone healing, and by checking bone-plate construct's strength and stability. To attain the goals of this research, a multi-objective approach was adopted, which should trade-off between some conflicting objectives. A finite element model of the long bone-plate construct was made first, and validated against an experimental study. The validated model was then employed to determine the initial strength and stability of the bone-plate construct, for the time right after surgery, for various thicknesses of the LCP. Afterward, coupling with a mechano-regulatory algorithm, the iterative process of bone healing was simulated, and follow up was made for each LCP thickness, over the first 16 post-operative weeks. Results of this study regarding the sequence of tissue evolution inside the fracture gap, showed a similar trend with the existing in-vivo data. For the material and structural properties assigned to the bone-plate construct, in this study, an optimal thickness for the LCP was found to be 4.7 mm, which provides an enduring fixation through secondary healing, whereas for an LCP with a smaller or greater thickness, either bone-implant failure, unstable fixation, impaired fracture consolidation, or primary healing may occur. This result is in agreement with a recent study, that has employed a comprehensive optimization approach to find the optimal thickness.
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Affiliation(s)
- Yousof Mohandes
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Masoud Tahani
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Gholamreza Rouhi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohammad Tahami
- Bone and Joint Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Ghimire S, Miramini S, Edwards G, Rotne R, Xu J, Ebeling P, Zhang L. The investigation of bone fracture healing under intramembranous and endochondral ossification. Bone Rep 2020; 14:100740. [PMID: 33385019 PMCID: PMC7772545 DOI: 10.1016/j.bonr.2020.100740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
After trauma, fractured bone starts healing directly through bone union or indirectly through callus formation process. Intramembranous and endochondral ossification are two commonly known mechanisms of indirect healing. The present study investigated the bone fracture healing under intramembranous and endochondral ossification by developing theoretical models in conjunction with performing a series of animal experiments. Using experimentally determined mean bone densities in sheep tibia stabilized by the Locking Compression Plate (LCP) fixation system, the research outcomes showed that intramembranous and endochondral ossification can be described by Hill Function with two unique sets of function parameters in mechanical stimuli mediated fracture healing. Two different thresholds exist within the range of mechanical simulation index which could trigger significant intramembranous and endochondral ossification, with a relatively higher bone formation rate of endochondral ossification than that of intramembranous ossification. Furthermore, the increase of flexibility of the LCP system and the use of titanium LCP could potentially promote uniform bone formation across the fracture gap, ultimately better healing outcomes.
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Affiliation(s)
- Smriti Ghimire
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Glenn Edwards
- School of Animal & Veterinary Sciences, Charles Sturt University, NSW 2678, Australia
| | - Randi Rotne
- School of Animal & Veterinary Sciences, Charles Sturt University, NSW 2678, Australia
| | - Jiake Xu
- School of Pathology and Laboratory Medicine, University of Western Australia, WA 6009, Australia
| | - Peter Ebeling
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia
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20
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Zhang J, Shang Z, Jiang Y, Zhang K, Li X, Ma M, Li Y, Ma B. Biodegradable metals for bone fracture repair in animal models: a systematic review. Regen Biomater 2020; 8:rbaa047. [PMID: 33732493 PMCID: PMC7947587 DOI: 10.1093/rb/rbaa047] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Biodegradable metals hold promises for bone fracture repair. Their clinical translation requires pre-clinical evaluations including animal studies, which demonstrate the safety and performance of such materials prior to clinical trials. This evidence-based study investigates and analyzes the performance of bone fractures repair as well as degradation properties of biodegradable metals in animal models. Data were carefully collected after identification of population, interventions, comparisons, outcomes and study design, as well as inclusion criteria combining biodegradable metals and animal study. Twelve publications on pure Mg, Mg alloys and Zn alloys were finally included and reviewed after extraction from a collected database of 2122 publications. Compared to controls of traditional non-degradable metals or resorbable polymers, biodegradable metals showed mixed or contradictory outcomes of fracture repair and degradation in animal models. Although quantitative meta-analysis cannot be conducted because of the data heterogeneity, this systematic review revealed that the quality of evidence for biodegradable metals to repair bone fractures in animal models is 'very low'. Recommendations to standardize the animal studies of biodegradable metals were proposed. Evidence-based biomaterials research could help to both identify reliable scientific evidence and ensure future clinical translation of biodegradable metals for bone fracture repair.
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Affiliation(s)
- Jiazhen Zhang
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Zhizhong Shang
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
| | - Yanbiao Jiang
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
| | - Kui Zhang
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Xinggang Li
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Minglong Ma
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Yongjun Li
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (GRINM), No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China.,GRIMAT Engineering Institute Co., Ltd, No. 11, Xingke East St., Yanqi Economic Development Zone, Huairou District, Beijing 101407, P.R. China.,General Research Institute for Nonferrous Metals, No. 2, XinJieKouWai St., HaiDian District, Beijing 100088, P.R. China
| | - Bin Ma
- School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, No 199, Donggang West Road, Chengguan District, Lanzhou 730000, P. R. China
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21
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Mahmoudi M, Mahbadi H. Numerical investigation of mechanical behavior of human femoral diaphysis in normal and defective geometry: experimental evaluation. Comput Methods Biomech Biomed Engin 2020; 24:637-652. [PMID: 33164564 DOI: 10.1080/10255842.2020.1843639] [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] [Indexed: 10/23/2022]
Abstract
Failure and major reoperation after internal fixation (IF) in mature femoral bones are common and proper selection of fixation method may reduce the rate of reoperations. Investigating the mechanical behavior of the human femoral diaphysis, this article studies effect of mechanical properties and geometry of the bone on selection of IF method. To this aim, we calculated the bone mineral density in human femurs, and then, using computed tomography scan, we obtained geometry and nonhomogeneous properties of the bone. Finite element (FE) models of osteotomised femurs were reinforced using four types of screws with a locking compression plate (LCP). We performed buckling and 4-point bending simulations, and results of these simulations represent critical buckling loads, maximum von Mises stresses, and strains around the screws and the central defect. To evaluate FE analysis, we employed the compressive experiments and compared load vs. displacement curves with FE results. Results corresponding to intact, osteotomised, and reinforced states are compared together, and the effect of cortical and unicortical screws in LCPs is studied. The FE results showed that application of identical prophylactic IF for two persons with identical injuries in the same conditions bring quite inverse results. As a consequence, evaluation of osteoporosis, elastic modulus, and morphometric data are required before fixation and screw selection. Besides, for short diaphysis, unicortical screws have maximum strengthening factor in bending. While for long samples, these types of screws can be the worst option, application of cortical screws results to maximum strength in comparison with other types.
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Affiliation(s)
- Moeinoddin Mahmoudi
- Young Researchers and Elite Club, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hossein Mahbadi
- Department of Mechanical Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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22
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Abdul Wahab AH, Wui NB, Abdul Kadir MR, Ramlee MH. Biomechanical evaluation of three different configurations of external fixators for treating distal third tibia fracture: Finite element analysis in axial, bending and torsion load. Comput Biol Med 2020; 127:104062. [PMID: 33096298 DOI: 10.1016/j.compbiomed.2020.104062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
External fixators have been widely used in treating open fractures and have produced excellent outcomes, as they could successfully heal bones. The stability of external fixators lies greatly in their construction. Factors that associated with the stability of the external fixators includes stress, displacement, and relative micromotion. Three-dimensional (3D) models of bone and external fixators were constructed by using 3D modelling software, namely Materialise and SolidWorks, respectively. Three different configurations of external fixators namely Model 1, Model 2, and Model 3 were analysed. Three load cases were simulated to assess the abovementioned factors at the bone, specifically at the fracture site and at the external fixator. Findings showed that the double-cross configuration (Model 3) was the most promising in axial, bending, and torsion load cases as compared to the other two configurations. The no-cross configuration (Model 1) had the highest risk of complication due to high stress, relative micromotion, and displacement in the bending and torsion load cases. On the other hand, the single-cross configuration (Model 2) had the highest risk of complication when applied with axial load. In conclusion, the double-cross locking construct (Model 3) showed the biggest potential to be a new option for medical surgeons in treating patients associated with bone fracture. This new double-cross locking construct showed superior biomechanical stability as compared to single-cross and no-cross configurations in the axial, bending, and torsion load cases.
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Affiliation(s)
- Abdul Hadi Abdul Wahab
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| | - Ng Bing Wui
- Department of Orthopaedics and Traumatology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Mohammed Rafiq Abdul Kadir
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Sport Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| | - Muhammad Hanif Ramlee
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
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23
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Travascio F, Buller LT, Milne E, Latta L. Mechanical performance and implications on bone healing of different screw configurations for plate fixation of diaphyseal tibia fractures: a computational study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:121-130. [PMID: 32725431 DOI: 10.1007/s00590-020-02749-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Diaphyseal tibia fractures may require plate fixation for proper healing to occur. Currently, there is no consensus on the number of screws required for proper fixation or the optimal placement of the screws within the plate. Mechanical stability of the construct is a leading criterion for choosing plate and screws configuration. However, number and location of screws have implications on the mechanical environment at the fracture site and, consequently, on bone healing response: The interfragmentary motion attained with a specific plate and screw construct may elicit mechano-transduction signals influencing cell-type differentiation, which in turn affects how well the fracture heals. This study investigated how different screw configurations affect mechanical performance of a tibia plate fixation construct. Three configurations of an eight-hole plate were considered with the fracture in the center of the plate: eight screws-screws at first, fourth, fifth and eighth hole and screws at first, third, sixth and eighth hole. Constructs' stiffness was compared through biomechanical tests on bone surrogates. A finite element model of tibia diaphyseal fracture was used to conduct a stress analysis on the implanted hardware. Finally, the potential for bone regeneration of each screw configuration was assessed via the computational model through the evaluation of the magnitude of mechano-transduction signals at the bone callus. The results of this study indicate that having screws at fourth and fifth holes represents a preferable configuration since it provides mechanical properties similar to those attained by the stiffest construct (eight screws), and elicits an ideal bone regenerative response.
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Affiliation(s)
- Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, 1251 Memorial Drive, Mc Arthur Engineering Building #276, Coral Gables, FL, USA. .,Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA. .,Max Biedermann Institute for Biomechanics at Mount Sinai, Miami Beach, FL, USA.
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edward Milne
- Max Biedermann Institute for Biomechanics at Mount Sinai, Miami Beach, FL, USA
| | - Loren Latta
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA.,Max Biedermann Institute for Biomechanics at Mount Sinai, Miami Beach, FL, USA
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24
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Black RA, Houston G. 40th Anniversary Issue: Reflections on papers from the archive on "Mechanobiology". Med Eng Phys 2020; 72:76-77. [PMID: 31554582 DOI: 10.1016/j.medengphy.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Richard A Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
| | - Gregor Houston
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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Numerical Study of Prosthetic Knee Replacement Using Finite Element Analysis. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2020. [DOI: 10.4028/www.scientific.net/jbbbe.44.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The knee at times undergoes a surgical process to substitute the weight-bearing surfaces of the knee joint. This procedure relieves the pain and disability around the knee joint. This research paper studied the knee arthroplasty, also referred to as knee replacement. This work was aided with computer vision for visual and accuracy. Autodesk fusion 360 and the stl files were used to generate cemented, posterior stabilised knee prosthesis and imported into the COMSOL Multiphysics software. Then, the three-dimensional models of the total knee arthroplasty (TKA) prosthetic structure are produced. The prosthetic components are modelled as linear isotropic elastic materials. Finite element (FE) simulations using COMSOL Multiphysics on a CAD model of a knee are effectuated to show the effect of several loads and strains on the knee. FE analysis of the model indicates that the orthotropic model depicts a more realistic stress distribution of the knee as it reveals the detailed anatomy of the entire knee structure. The computational results of this work displayed a fair agreement with experimental information from the literature.
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Märdian S, Schmölz W, Schaser KD, Duda GN, Heyland M. Locking plate constructs benefit from interfragmentary lag screw fixation with decreased shear movements and more predictable fracture gap motion in simple fracture patterns. Clin Biomech (Bristol, Avon) 2019; 70:89-96. [PMID: 31445402 DOI: 10.1016/j.clinbiomech.2019.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A mechanical characterisation of lag screw fixation plus locking plate - although clinically widely used as either "mixed fixation concept" or absolutely stable fixation - is so far missing. This study aimed to evaluate the influence of an interfragmentary lag screw on the resulting motion at the fracture site of locking plate constructs using a simple fracture at the distal femur. METHODS Human cadaver femora were in vitro loaded in torsion and axial bending-compression with and without lag screw fixation next to a locking plate fixation. In addition, two plate working lengths were tested. Interfragmentary movement was measured optically. FINDINGS Axial interfragmentary movement is reduced with lag screw (102 mm plate working length, 1000 N, mean): 0.28 mm versus 0.82 mm. With lag screw, the fracture gap stays closed with mean normal interfragmentary movement ≤0.03 mm. Fracture gap tends to open without lag screw: normal interfragmentary movement up to -0.29 mm. Reduction of shear interfragmentary movement was observed throughout all tested loads and groups. Mean true shear remains generally low with lag screw (≤0.42 mm) compared to without lag screw (≤1.46 mm). We also found that interfragmentary movement variance decreases with lag screw, especially for longer plate working length. INTERPRETATION An interfragmentary lag screw next to locking bridge plating reduces fragment motion in vitro for a simple fracture pattern and provides a sufficient tool to decrease detrimental shear movements. Prospective clinical trials with interfragmentary lag screw fixation should prove these findings in wide clinical use to treat simple fracture patterns.
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Affiliation(s)
- Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Werner Schmölz
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Klaus-Dieter Schaser
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Ghiasi MS, Chen JE, Rodriguez EK, Vaziri A, Nazarian A. Computational modeling of human bone fracture healing affected by different conditions of initial healing stage. BMC Musculoskelet Disord 2019; 20:562. [PMID: 31767007 PMCID: PMC6878676 DOI: 10.1186/s12891-019-2854-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background Bone healing process includes four phases: inflammatory response, soft callus formation, hard callus development, and remodeling. Mechanobiological models have been used to investigate the role of various mechanical and biological factors on bone healing. However, the effects of initial healing phase, which includes the inflammatory stage, the granulation tissue formation, and the initial callus formation during the first few days post-fracture, are generally neglected in such studies. Methods In this study, we developed a finite-element-based model to simulate different levels of diffusion coefficient for mesenchymal stem cell (MSC) migration, Young’s modulus of granulation tissue, callus thickness and interfragmentary gap size to understand the modulatory effects of these initial phase parameters on bone healing. Results The results quantified how faster MSC migration, stiffer granulation tissue, thicker callus, and smaller interfragmentary gap enhanced healing to some extent. However, after a certain threshold, a state of saturation was reached for MSC migration rate, granulation tissue stiffness, and callus thickness. Therefore, a parametric study was performed to verify that the callus formed at the initial phase, in agreement with experimental observations, has an ideal range of geometry and material properties to have the most efficient healing time. Conclusions Findings from this paper quantified the effects of the initial healing phase on healing outcome to better understand the biological and mechanobiological mechanisms and their utilization in the design and optimization of treatment strategies. It is also demonstrated through a simulation that for fractures, where bone segments are in close proximity, callus development is not required. This finding is consistent with the concepts of primary and secondary bone healing.
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Affiliation(s)
- Mohammad S Ghiasi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, 360 Huntington Avenue, 334 Snell Engineering Center, Boston, MA, 02115, USA
| | - Jason E Chen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA
| | - Edward K Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, 360 Huntington Avenue, 334 Snell Engineering Center, Boston, MA, 02115, USA.
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA. .,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. .,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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The status and challenges of replicating the mechanical properties of connective tissues using additive manufacturing. J Mech Behav Biomed Mater 2019; 103:103544. [PMID: 32090944 DOI: 10.1016/j.jmbbm.2019.103544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/16/2019] [Indexed: 01/23/2023]
Abstract
The ability to fabricate complex structures via precise and heterogeneous deposition of biomaterials makes additive manufacturing (AM) a leading technology in the creation of implants and tissue engineered scaffolds. Connective tissues (CTs) remain attractive targets for manufacturing due to their "simple" tissue compositions that, in theory, are replicable through choice of biomaterial(s) and implant microarchitecture. Nevertheless, characterisation of the mechanical and biological functions of 3D printed constructs with respect to their host tissues is often limited and remains a restriction towards their translation into clinical practice. This review aims to provide an update on the current status of AM to mimic the mechanical properties of CTs, with focus on arterial tissue, articular cartilage and bone, from the perspective of printing platforms, biomaterial properties, and topological design. Furthermore, the grand challenges associated with the AM of CT replacements and their subsequent regulatory requirements are discussed to aid further development of reliable and effective implants.
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Miramini S, Yang Y, Zhang L. A probabilistic-based approach for computational simulation of bone fracture healing. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 180:105011. [PMID: 31421602 DOI: 10.1016/j.cmpb.2019.105011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/25/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE It is widely known that bone fracture healing is affected by mechanical factors such as fracture geometry, fixation configuration and post-operative weight bearing loading. However, there are several uncertainties associated with the magnitude of the mechanical factors affecting bone healing as it is challenging to adjust and control them in clinical practice. The current bone fracture healing investigations mainly adopt a deterministic approach for identifying the optimal mechanical conditions for a favourable bone healing outcome. However, a probabilistic approach should be used in the analysis to incorporate such uncertainties for prediction of bone healing. METHODS In this study we developed a probabilistic-based computational model to predict the probability of delayed healing or non-union under different fracture treatment mechanical conditions for fractures stabilised by locking plates. RESULTS The results show that there is a strong positive linear correlation between the mechanical stimulations (S) in the fracture gap and the magnitude of weight bearing, the bone-plate distance (BPD) and the plate working length (WL), whereas the fracture gap size has a highly negative and nonlinear correlation with S. While the results show that fracture mechanical microenvironment is more sensitive to the uncertainties in WL compared to BPD, the uncertainty associated with the magnitude of WL is very low and can be resulted from implant manufacturing tolerance. However, there is a high uncertainty associated with the magnitude of BPD as it cannot be accurately adjusted during the surgery. The results show that the tissue differentiation at the far cortex of fracture gap is more sensitive to the variation of BPD compared with that at the near cortex. The probability of delayed healing (fibrous tissue formation) at far cortex is increased from 0% to 40% when coefficient of variation (COV) of BPD rises from 0.1 to 0.9 (for average BPD = 2 mm, WL = 65 mm, fracture gap size = 3 mm and Weight bearing = 150 N). Further, both near and far cortex of fracture site are sensitive to the variation in weight bearing loading. CONCLUSIONS The developed probabilistic model may lead to useful guidelines that could help orthopaedic surgeons identify how reliable a specific fracture treatment strategy is.
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Affiliation(s)
- Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Yi Yang
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Victoria 3010, Australia.
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Effects of dynamic loading on fracture healing under different locking compression plate configurations: A finite element study. J Mech Behav Biomed Mater 2019; 94:74-85. [DOI: 10.1016/j.jmbbm.2019.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 12/30/2022]
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Ganadhiepan G, Miramini S, Patel M, Mendis P, Zhang L. Bone fracture healing under Ilizarov fixator: Influence of fixator configuration, fracture geometry, and loading. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3199. [PMID: 30869195 DOI: 10.1002/cnm.3199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 06/09/2023]
Abstract
This study aims to enhance the understanding of the relationship between Ilizarov fixator configuration and its effects on bone fracture healing. Using Taylor spatial frame (TSF) as an example, the roles of critical parameters (ie, TSF ring diameter, wire pre-tension, fracture gap size, and axial load) that govern fracture healing during the early stages were investigated by using computational modelling in conjunction with mechanical testing involving an advanced 3D optical measurement system. The computational model was first validated using the mechanical test results and then used to simulate mesenchymal stem cell (MSC) differentiations within different regions of the fracture site under various combinations of TSF ring diameter, wire pre-tension, fracture gap size, and axial load values. Predicted spatially dependent MSC differentiation patterns and the influence of each parameter on differentiations were compared with in vivo results, and good agreement was seen between the two. Gap size was identified as the most influential parameter in MSC differentiation, and the influence of axial loading and TSF configuration (ie, ring diameter and wire pre-tension) on cell differentiation was seen to be gap size dependent. Most changes in cell differentiation were predicted in the external callus (periosteal), which is the crucial region of the callus in the early stages. However, for small gap sizes (eg, 1 mm), significant changes were predicted in the endosteal callus as well. The study exhibits the potential of computational models in assessing the performance of Ilizarov fixators as well as assisting surgeons in patient-specific clinical treatment planning.
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
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Ganadhiepan G, Zhang L, Miramini S, Mendis P, Patel M, Ebeling P, Wang Y. The Effects of Dynamic Loading on Bone Fracture Healing Under Ilizarov Circular Fixators. J Biomech Eng 2019; 141:2727816. [DOI: 10.1115/1.4043037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 11/08/2022]
Abstract
Early weight bearing appears to enhance bone fracture healing under Ilizarov circular fixators (ICFs). However, the role of early weight bearing in the healing process remains unclear. This study aims to provide insights into the effects of early weight bearing on healing of bone fractures stabilized with ICFs, with the aid of mathematical modeling. A computational model of fracture site was developed using poro-elastic formulation to simulate the transport of mesenchymal stem cells (MSCs), fibroblasts, chondrocytes, osteoblasts, osteogenic growth factor (OGF), and chondrogenic growth factor (CGF) and MSC differentiation during the early stage of healing, under various combinations of fracture gap sizes (GS), ICF wire pretension forces, and axial loads. 1 h of physiologically relevant cyclic axial loading followed by 23 h of rest in the post-inflammation phase (i.e., callus with granulation tissue) was simulated. The results show that physiologically relevant dynamic loading could significantly enhance cell and growth factor concentrations in the fracture site in a time and spatially dependent manner. 1 h cyclic loading (axial load with amplitude, PA, of 200 N at 1 Hz) increased the content of chondrocytes up to 37% (in all zones of callus), CGF up to 28% (in endosteal and periosteal callus) and OGF up to 50% (in endosteal and cortical callus) by the end of the 24 h period simulated. This suggests that the synergistic effect of dynamic loading-induced advective transport and mechanical stimuli due to early weight bearing is likely to enhance secondary healing. Furthermore, the study suggests that relatively higher PA values or lower ICF wire pretension forces or smaller GS could result in increased chondrocyte and GF content within the callus.
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia e-mail:
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Victoria 3121, Australia
| | - Peter Ebeling
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Yulong Wang
- Rehabilitation Centre, The First Affiliated Hospital, Shenzhen University, Guangdong 518060, China
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Ghimire S, Miramini S, Richardson M, Mendis P, Zhang L. Role of Dynamic Loading on Early Stage of Bone Fracture Healing. Ann Biomed Eng 2018; 46:1768-1784. [DOI: 10.1007/s10439-018-2083-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/23/2018] [Indexed: 12/14/2022]
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Belaid D, Vendeuvre T, Bouchoucha A, Brémand F, Brèque C, Rigoard P, Germaneau A. Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods: A finite element analysis. Clin Biomech (Bristol, Avon) 2018; 56:27-35. [PMID: 29777960 DOI: 10.1016/j.clinbiomech.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing. METHODS A personalized Finite Element (FE) model of the tibial plateau from a clinical case has been developed to analyze stress distribution in the tibial plateau stabilized by balloon osteoplasty and to determine the influence of the cement injected. Stress analysis was performed for different stages after surgery. FINDINGS Just after surgery, the maximum von Mises stresses obtained for the fractured tibia treated with and without CF were 134.9 MPa and 289.9 MPa respectively on the plate. Stress distribution showed an increase of values in the trabecular bone in the treated model with locking plate and CF and stress reduction in the cortical bone in the model treated with locking plate only. INTERPRETATION The computed results of stresses or displacements of the fractured models show that the cement filling of the tibial depression fracture may increase implant stability, and decrease the loss of depression reduction, while the presence of the cement in the healed model renders the load distribution uniform.
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Affiliation(s)
- D Belaid
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers - Constantine, P.O. Box 325, Ain-El-Bey Way, Constantine 25017, Algeria; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - T Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Department of Orthopaedic Surgery and Traumatology, CHU Poitiers, Poitiers, France; Spine & neuromodulation functional unit, Department of neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - A Bouchoucha
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers - Constantine, P.O. Box 325, Ain-El-Bey Way, Constantine 25017, Algeria
| | - F Brémand
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - C Brèque
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; ABS Lab, Université de Poitiers, France
| | - P Rigoard
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine & neuromodulation functional unit, Department of neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - A Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.
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Zhang L, Miramini S, Richardson M, Mendis P, Ebeling P. The role of impairment of mesenchymal stem cell function in osteoporotic bone fracture healing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:603-610. [DOI: 10.1007/s13246-017-0566-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023]
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Computational modelling of bone fracture healing under partial weight-bearing exercise. Med Eng Phys 2017; 42:65-72. [DOI: 10.1016/j.medengphy.2017.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 11/21/2022]
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