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Su Z, Ding M, Zhu N, Cheung JCW, Wong DWC, Sun W, Ni M. Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106278. [PMID: 38821036 DOI: 10.1016/j.clinbiomech.2024.106278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/28/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach. METHODS A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated. FINDINGS Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively. INTERPRETATION Our finite element prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.
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Affiliation(s)
- Zhihao Su
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ding
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China.
| | - Ning Zhu
- School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Wanju Sun
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ni
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China; Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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Lu M, Wang Z, Yuan B, Tang Y, Gu C, Zhou S, Chen X. The C2 isthmus screw provided sufficient biomechanical stability in the setting of atlantoaxial dislocation-a finite element study. BMC Musculoskelet Disord 2024; 25:423. [PMID: 38811940 PMCID: PMC11138020 DOI: 10.1186/s12891-024-07470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The emerging of the C2 isthmus screw fixation technique is gaining popularity in the setting of atlantoaxial dislocation or other conditions requiring fixation of C2. However, the biomechanical stability of this fixation is poorly understood. PURPOSE To compare and elucidate the biomechanical stability of C2 pedicle screw (C2PS), C2 isthmus screw (C2IS) and C2 short isthmus screw (C2SIS) fixation techniques in atlantoaxial dislocation (AAD). METHOD A three-dimensional finite element model (FEM) from occiput to C3 was established and validated from a healthy male volunteer. Three FEMs, C1 pedicle screw (PS)-C2PS, C1PS-C2IS, C1PS-C2SIS were also constructed. The range of motion (ROM) and the maximum von Mises stress under flexion, extension, lateral bending and axial rotation loading were analyzed and compared. The pullout strength of the three fixations for C2 was also evaluated. RESULT C1PS-C2IS model showed the greatest decrease in ROM with flexion, extension, lateral bending and axial rotation. C1PS-C2PS model showed the least ROM reduction under all loading conditions than both C2IS and C2SIS. The C1PS-C2PS model had the largest von Mises stress on the screw under all directions followed by C1PS-C2SIS, and lastly the C1PS-C2IS. Under axial rotation and lateral bending loading, the three models showed the maximum and minimum von Mises stress on the screw respectively. The stress of the three models was mainly located in the connection of the screw and rod. Overall, the maximum screw pullout strength for C2PS, C2IS and C2SIS were 729.41N, 816.62N, 640.54N respectively. CONCLUSION In patients with atlantoaxial dislocations, the C2IS fixation provided comparable stability, with no significant stress concentration. Furthermore, the C2IS had sufficient pullout strength when compared with C2PS and C2SIS. C2 isthmus screw fixation may be a biomechanically favourable option in cases with AAD. However, future clinical trials are necessary for the evaluation of the clinical outcomes of this technique.
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Affiliation(s)
- Minming Lu
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Zhenqiang Wang
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Bo Yuan
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Yifan Tang
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Changjiang Gu
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital Naval Medical University, (Second Military Medical University), Shanghai, 200003, P.R. China.
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Zhang Y, Weng Q, Chen J, Yang Y. Design and Biomechanical Finite Element Analysis of Spatial Weaving Infracalcaneal Fixator System. Orthop Surg 2024; 16:976-983. [PMID: 38438142 PMCID: PMC10984816 DOI: 10.1111/os.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE Traditional internal fixation of calcaneus fractures, involving lateral L-shaped incisions and plate fixation, has disadvantages such as increased operative exposure, eccentric plate fixation, and complications. The aim of this study was to design a Spatial Weaving Intra-calcaneal Fixator System (SWIFS) for the treatment of complex calcaneal fractures and to compare its biomechanical properties with those of traditional calcaneal plates. METHODS The computed tomography (CT) data of the normal adult calcaneus was used for modeling, and the largest trapezoidal column structure was cut and separated from the model and related parameters were measured. The SWIFS was designed within the target trapezoid, according to the characteristics of the fracture of the calcaneus. The Sanders model classification type IV calcaneal fracture was established in finite element software, and fixation with calcaneal plate and the SWIFS examined. Overall structural strength distribution and displacement in the two groups were compared. RESULTS The maximum 3D trapezoidal column in the calcaneus was constructed, and the dimensions were measured. The SWIFS and the corresponding guide device were successfully designed. In the one-legged erect position state, the SWIFS group exhibited a peak von Mises equivalent stress of 96.00 MPa, a maximum displacement of 0.31 mm, and a structural stiffness of 2258.06 N/mm. The conventional calcaneal plate showed a peak von Mises equivalent stress of 228.66 Mpa, a maximum displacement of 1.26 mm, and a structural stiffness of 555.56 N/mm. The SWIFS group exhibited a 75.40% decrease in displacement and a 306.45% increase in stiffness. CONCLUSION Compared with fixation by conventional calcaneal plate, the SWIFS provides better structural stability and effective stress distribution.
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Affiliation(s)
- Yong Zhang
- Department of Trauma Orthopedics SurgeryThe 6th Hospital of NingboNingboPeople's Republic of China
| | - Qiuyan Weng
- Department of NeurologyThe Affiliated Hospital of Medical School of Ningbo UniversityZhejiangPeople's Republic of China
| | - Jianming Chen
- Department of Trauma Orthopedics SurgeryThe 6th Hospital of NingboNingboPeople's Republic of China
| | - Yunfeng Yang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
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Subasi O, Sharma S, Karaismailoglu B, Hresko A, Waryasz G, Ashkani-Esfahani S, Bejarano-Pineda L. In silico comparative biomechanical analysis of oblique and chevron medial displacement calcaneal osteotomies for pes planus deformity. Comput Biol Med 2024; 169:107945. [PMID: 38199207 DOI: 10.1016/j.compbiomed.2024.107945] [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: 11/01/2023] [Revised: 12/04/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Medializing displacement calcaneal osteotomy is commonly performed as part of reconstructive surgery for patients with valgus hindfoot and progressive pes planus deformity. Among several types of calcaneal osteotomies, the oblique and Chevron osteotomy patterns have been commonly described in the literature and gained popularity as they are easily reproducible through percutaneous techniques. Currently, there is scarce evidence in the literature on which cut pattern is superior in terms of stability. To investigate the impact of cut pattern and posterior fragment medialization level on foot biomechanics, computational methods are employed. METHODS Ankle weightbearing computer tomography (CT) scans of seven patients diagnosed with stage II pes planus deformity are segmented and converted into 3D computational models. Oblique and Chevron osteotomy patterns are modeled independently for each patient. The posterior fragments are medially translated by 8-, 10- and 12-mm and subsequently fixated to the anterior calcaneus with two screws. A total of 42 models are exported to finite element software for biomechanical simulations. Among the investigated parameters, the higher stiffness and lower von Mises stress at the osteotomy interface and the screw site are assumed to be precursors of better stability. RESULTS It is recorded that as the medialization level increases, the stiffness decreases, and overall stresses increase. Also, it is observed that the Chevron cut produces a stiffer construct while the overall stresses are lower, indicating better stability when compared to the oblique cut. The statistical comparisons of the relevant groups that support these trends are found to be significant (p < 0.05). CONCLUSION Chevron osteotomy showed superior stability compared to the oblique osteotomy while underscoring the negative impact of increased medialization of the posterior fragment. CLINICAL RELEVANCE Opting for a lower medialization level and implementing the Chevron technique may facilitate union and earlier weightbearing.
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Affiliation(s)
- Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA.
| | - Siddartha Sharma
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bedri Karaismailoglu
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; CAST (Cerrahpasa Research Simulation and Design) Laboratory, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Andrew Hresko
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Harvard Combined Orthopaedic Residency Program (HCORP), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
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Song G, Gu W, Shi Z, Li X, Fu S, Yu X, Song F. Finite element analyses of three minimally invasive fixation techniques for treating Sanders type II intra-articular calcaneal fractures. J Orthop Surg Res 2023; 18:902. [PMID: 38012759 PMCID: PMC10683123 DOI: 10.1186/s13018-023-04244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. METHODS A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. RESULTS After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. CONCLUSION All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.
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Affiliation(s)
- Guoxun Song
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Wenqi Gu
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Zhongmin Shi
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Xueqian Li
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Shaoling Fu
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Xiaowei Yu
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Facheng Song
- National Key Laboratory for Manufacturing Systems Engineering, Xian Jiaotong University, Xi'an, 710054, Shanxi Province, People's Republic of China.
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Wu C, Wang X, Zhang H, Xie S, He J. Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis. Injury 2023:110917. [PMID: 37400327 DOI: 10.1016/j.injury.2023.110917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. METHODS Finite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. RESULTS Group A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. CONCLUSION Combining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).
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Affiliation(s)
- Chaomeng Wu
- Jiangxi university of Traditional Chinese Medicine, Nanchang 33004, China
| | - Xingyu Wang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Hao Zhang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Shuihua Xie
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Jianhua He
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China.
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Pînzaru RM, Pavăl SD, Perțea M, Alexa O, Sîrbu PD, Filip A, Carp AC, Savin L, Forna N, Veliceasa B. Biomechanical Comparison of Conventional Plate and the C-Nail® System for the Treatment of Displaced Intra-Articular Calcaneal Fractures: A Finite Element Analysis. J Pers Med 2023; 13:jpm13040587. [PMID: 37108973 PMCID: PMC10141664 DOI: 10.3390/jpm13040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
The C-Nail® system is a novel intramedullary fixation method for displaced intra-articular calcaneal fractures. The aim of this study was to evaluate the biomechanical performance of the C-Nail® system and compare it with conventional plate fixation for the treatment of displaced intra-articular calcaneal fractures using finite element analysis. The geometry of a Sanders type-IIB fracture was constructed using the computer-aided design software Ansys SpaceClaim. The C-Nail® system (Medin, Nové Mesto n. Morave, Czech Republic) and the calcaneal locking plate (Auxein Inc., 35 Doral, Florida) and screws were designed according to the manufacturer specifications. Vertical loading of 350 N and 700 N were applied to the subtalar joint surfaces to simulate partial weight bearing and full weight bearing. Construct stiffness, total deformation, and von Mises stress were assessed. The maximum stress on the C-Nail® system was lower compared with the plate (110 MPa vs. 360 MPa). At the bone level the stress was found to have higher values in the case of the plate compared to the C-Nail® system. The study suggests that the C-Nail® system can provide sufficient stability, making it a viable option for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Roxana Maria Pînzaru
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Silviu Dumitru Pavăl
- Department of Computer Science and Engineering, “Gheorghe Asachi” Technical University, 27, Dimitrie Mangeron, 700050 Iasi, Romania
- Correspondence: (S.D.P.); (M.P.)
| | - Mihaela Perțea
- Department of Plastic Surgery and Reconstructive Microsurgery, Surgical Science (I), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
- Correspondence: (S.D.P.); (M.P.)
| | - Ovidiu Alexa
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Paul Dan Sîrbu
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Alexandru Filip
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Adrian Claudiu Carp
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Liliana Savin
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Norin Forna
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Bogdan Veliceasa
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
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Delmon R, Vendeuvre T, Pries P, Aubert K, Germaneau A, Severyns M. Percutaneous balloon calcaneoplasty versus open reduction and internal fixation (ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method. Injury 2023:S0020-1383(23)00272-3. [PMID: 36997362 DOI: 10.1016/j.injury.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Fractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. MATERIALS AND METHODS Eight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. RESULTS Analyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. CONCLUSION Balloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.
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Affiliation(s)
- Romain Delmon
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Tanguy Vendeuvre
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France; Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Pierre Pries
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Kevin Aubert
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Mathieu Severyns
- Orthopedic and traumatology department, Clinique Porte Océane, Les Sables d'Olonne, France.
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Cai YT, Song YK, He MC, He XM, Wei QS, He W. Global research trends and hotspots in calcaneal fracture: A bibliometric analysis (2000-2021). Front Surg 2023; 9:940432. [PMID: 36684285 PMCID: PMC9852496 DOI: 10.3389/fsurg.2022.940432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background Calcaneal fracture is common and carries high morbidity and disability. Its treatment is therefore of vital concern. Many topics concerning calcaneal fracture remain controversial, and the subject has not yet been well-researched. We aim to analyze and illustrate the trends in development, overall knowledge structure, "hotspots," and research frontiers on the topic of calcaneal fracture. Methods Literature relating to calcaneal fracture published between 2000 and 2021 was retrieved from Science Citation Index Expanded (SCIE) database of the Web of Science. Three bibliometric tools (Bibliometrix, CiteSpace, and VOSviewer software) were used for analysis and the generation of knowledge maps. Annual trends in publication counts and the relative contributions of different countries, regions, institutions, authors, and journals, as well as keyword clusters, "hot topics," and research frontiers, were analyzed. Results A total of 1,687 publications were included in the analysis. The number of calcaneal fracture articles published worldwide each year was highest in 2019, with a total of 128 articles. The United States has made the greatest contribution to the field, with the largest number of publications and the highest H-index. Foot & Ankle International was the most productive journal, publishing a total of 167 articles on calcaneal fracture during the study period. Hebei Medical University of China and the University of California, San Francisco were the most prolific institutions. Professors T. Schepers, S. Rammelt, H. Zwipp, and Y. Z. Zhang have made remarkable contributions to the field. However, the degree of collaboration between researchers and among institutions was relatively low, and took place mainly in Europe and the Americas. All relevant keywords could be categorized into three clusters: studies of internal fixation, studies of fractures, and studies of osteoporosis. A trend of balanced and diversified development could be seen within these clusters. Keywords with ongoing "citation bursts," such as sinus tarsi approach, wound complications, minimally invasive technique, extensile lateral approach, surgical treatment, and plate, may continue to be research "hotspots" in the near future. Conclusion Based on current global trends, the number of publications on calcaneal fracture will continue to increase. Topics such as minimally invasive techniques and complications have become important hotspots of research. We recommend enhancing international communication and collaboration for future research in this field.
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Affiliation(s)
- Yang-Ting Cai
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu-Ke Song
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Min-Cong He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Xiao-Ming He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Qiu-Shi Wei
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China,Correspondence: Qiu-Shi Wei Wei He
| | - Wei He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China,Correspondence: Qiu-Shi Wei Wei He
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10
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Xu Z, Sun W, Li P, Wang Y, Wong DWC, Cheung JCW, Niu W, Zhang H, Ni M. Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study. Injury 2022; 53:3904-3911. [PMID: 36182591 DOI: 10.1016/j.injury.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We have proposed a novel intramedullary nail (Ni-Nail) by incorporating a sustentaculum tali screw to improve the fixation stability of minimally invasive treatment for calcaneal fractures. This study aimed to evaluate the biomechanical characters of the Ni-Nail system and compare it with traditional C-Nail system. METHODS A finite element model of a Sanders type-IIIAB calcaneal fracture was reconstructed and fixed using two intramedullary nail systems, which was validated by a cadaver study. A vertical loading of 700 N was applied to the subtalar joint surfaces, and 525 N Achilles tendon tension was applied to the superior border of the Achilles tuberosity. The von Mises stresses and fracture displacements of both fixation models were evaluated. RESULTS The maximum von Mises stress of the screws of Ni-Nail and C-Nail were 27.92 MPa and 57.42 MPa, respectively, while that of the main nail were 67.44 MPa and 53.01 MPa. In addition, the maximum fracture displacement of the Ni-Nail was larger than that of C-Nail by 15.6% (0.37 mm vs.0.32 mm). CONCLUSIONS Our static simulation analysis showed that both Ni-Nail and C-Nail demonstrated similar biomechanical stability for calcaneal fixation. The Ni-Nail features a simple structure that is easier to operate and less traumatizing. Future studies may consider to further evaluate the clinical effectiveness by clinical trials and follow-ups.
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Affiliation(s)
- Zihuan Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China
| | - Pengfei Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yongqin Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wenxin Niu
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619 China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Haowei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ming Ni
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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11
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Bernasconi A, Iorio P, Ghani Y, Argyropoulos M, Patel S, Barg A, Smeraglia F, Balato G, Welck M. Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence? Arch Orthop Trauma Surg 2022; 142:1911-1922. [PMID: 33977313 DOI: 10.1007/s00402-021-03944-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety. METHODS Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. RESULTS Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality. CONCLUSIONS Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results. LEVEL OF EVIDENCE Level V - Review of Level III to V studies.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy. .,Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Paolino Iorio
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Yaser Ghani
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg , Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Francesco Smeraglia
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Giovanni Balato
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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12
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Lv ML, Ni M, Sun W, Wong DWC, Zhou S, Jia Y, Zhang M. Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures. Front Bioeng Biotechnol 2022; 10:791554. [PMID: 35356772 PMCID: PMC8959616 DOI: 10.3389/fbioe.2022.791554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ming Ni
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shuren Zhou
- School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha, China
| | - Yongwei Jia
- Department of Spine Surgery, Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yongwei Jia,
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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13
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Jiang D, Zhan S, Wang L, Shi LL, Ling M, Hu H, Jia W. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res 2021; 39:1669-1680. [PMID: 33034914 PMCID: PMC8451753 DOI: 10.1002/jor.24881] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Vertical femoral neck fractures in patients younger than 65 years of age often require hip-conserving surgeries. However, traditional fixation strategies using three parallel cannulated screws often fail in such patients due to an unfavorable biomechanical environment. This study compared different cannulated screw fixation techniques in patients via patient-specific finite element analysis with linear tetrahedral (C3D4) elements. Forty vertical femoral neck fracture models were created based on computed tomography images obtained from eight healthy participants. Five different fixation strategies: alpha, buttress, rhomboid, inverted triangle, and triangle were assessed in walking status. Biomechanical parameters including stiffness, interfragmentary motion in two directions (detachment and shearing), compression force, and maximal implant stress were evaluated. The mean relative coefficient of strain distribution between the finite element analysis and experiment was from 0.78 to 0.94. Stiffness was highest (p < .05) in the buttress group (923.1 N/mm), while interfragmentary motion was lowest (p < .05) in the alpha group. Maximal stress was highest (p < .05) in the buttress group and lowest in the alpha group. Shearing values were significantly lower in the alpha group than in the rhomboid group (p = .004). Moreover, Shearing values were significantly higher (p = .027), while detachment values were significantly lower (p = .027), in the inverted triangle than in the triangle group. Clinical significance: Our results suggest that alpha fixation is the most reliable and biomechanically efficient strategy for young patients with vertical femoral neck fractures. Regular and inverted triangular fixation strategies may be suitable for fractures of different skeletal constructions due to antidetachment/shearing abilities.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Shi Zhan
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lei Wang
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lewis L. Shi
- Department of OrthopaedicsUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Ming Ling
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Hai Hu
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Weitao Jia
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
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14
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Yao Y, Mo Z, Wu G, Guo J, Li J, Wang L, Fan Y. A personalized 3D-printed plate for tibiotalocalcaneal arthrodesis: Design, fabrication, biomechanical evaluation and postoperative assessment. Comput Biol Med 2021; 133:104368. [PMID: 33864971 DOI: 10.1016/j.compbiomed.2021.104368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022]
Abstract
Personalized plates (P-Plates) could provide improved clinical outcomes in joint fusion by enabling perfect geometric matching between irregular bone and implants. However, there is no unified application framework for P-Plates for joint fusion. The objective of this study was to develop such a framework for P-Plates for tibiotalocalcaneal arthrodesis. A patient-specific bone model was constructed based on CT images, and the P-Plate was preliminarily designed to match the bones. Finite element method was used to optimize the stress distribution and to evaluate the biomechanical performance of the P-Plate by comparing it with a traditional plate (T-Plate). Then, the P-Plate was manufactured via electron beam melting and implanted into the foot of a patient. Increasing the size of the preliminary designed plate alleviated the stress concentration and reduced the risk of failure. The maximum stresses of the plate and screw (214.3 MPa, 99.05 MPa) and the maximum tensile force of the screw in the P-Plate (181.4 N) fixation system were lower than those in the T-Plate (217.4 MPa, 255.4 MPa, and 230.1 N, respectively). The P-Plate was well-matched to the bone, and no complications occurred. The P-Plate achieved American Orthopaedic Foot & Ankle Society and Short-Form-36 scores of 64 and 75, respectively, 36 months post operation, which suggests that it could improve clinical outcomes. The design and fabrication methods, as well as mechanical and postoperative performance evaluation methods, for the P-Plate were systematically developed and provide a reference for constructing a unified application framework for P-Plate use in tibiotalocalcaneal arthrodesis.
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Affiliation(s)
- Yan Yao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Zhongjun Mo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Gang Wu
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China; Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Junchao Guo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Jian Li
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China.
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, China; Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, 100176, Beijing, China; School of Engineering Medicine, Beihang University, 100191, Beijing, China.
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15
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Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DWC, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation. Clin Biomech (Bristol, Avon) 2020; 80:105143. [PMID: 32829234 DOI: 10.1016/j.clinbiomech.2020.105143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive fixation using crossing screws was believed to produce satisfactory clinical outcome whereas its stability in early weight-bearing remained controversial. This study aimed to analyze the biomechanical stability of minimally invasive fixation during balanced standing and walking stance, and provide evidence for early rehabilitation. METHODS A finite element model of foot-ankle-shank complex was reconstructed based on computed tomography and magnetic resonance images, and validated by plantar pressure of the model participant. A Sanders III calcaneal fracture was created on the model, and then fixed using crossing screws. The predicted stress distribution, fracture displacement, Bohler's angle and Gissane's angle were compared between the intact calcaneus and fracture model with the fixation. FINDINGS Postoperatively, the concentrated stress appeared at the junction of the calcaneus and its surrounding tissues (especially Achilles tendon, plantar fascia and ligaments) during standing and walking stances, and the stress exceeded the yield strength of trabecular bone. The longitudinal screws sustained the highest stresses and concentrated at the tips and the calcaneal tuberosity junction. The displacement of posterior joint facet, Bohler's angle, and Gissane's angle were within the acceptable range either standing or walking after the fixation. INTERPRETATION Early weight-bearing standing and walking after minimally invasive fixation may cause high stress concentration thereby induce calcaneus stress fractures and other complications like plantar fasciitis and heel pain, so it should not be supported. The peri-calcaneus tendons, i.e., Achilles tendon and plantar fascia, play key roles in the stabilization of the calcaneal fracture after operation.
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Affiliation(s)
- Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yin Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China
| | - Wenxin Niu
- Department of Rehabilitation, Medical College of Tongji University, Shanghai 200092, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China.
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
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16
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Wong DWC, Wang Y, Chen TLW, Yan F, Peng Y, Tan Q, Ni M, Leung AKL, Zhang M. Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion). Front Bioeng Biotechnol 2020; 8:571192. [PMID: 33015022 PMCID: PMC7505935 DOI: 10.3389/fbioe.2020.571192] [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: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.
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Affiliation(s)
- Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Yan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples’ Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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