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Bowers KM, Terrones LD, Sun X, Rifkin R, Croy E, Adair HS, Mulon PY, Hecht S, Anderson DE. Changes in tibial cortical dimensions and density associated with long-term locking plate fixation in goats. J Exp Orthop 2023; 10:111. [PMID: 37934300 PMCID: PMC10634227 DOI: 10.1186/s40634-023-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Cortical porosis, secondary to either vascular injury or stress-shielding, is a comorbidity of fracture fixation using compression bone plating. Locking plate constructs have unique mechanics of load transmission and lack of reliance on contact pressures for fixation stability, so secondary cortical porosis adjacent to the plate has not been widely investigated. Therefore, this study aimed to assess the effects of long-term locking plate fixation on cortical dimensions and density in a caprine tibial segmental ostectomy model. METHODS Data was acquired from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over periods of 3, 6, 9, and 12 months. Quantitative data included tibial cortical width measurements and three-dimensionally reconstructed slab density measurements, both assessed using computed tomographic examinations performed at the time of plate removal. Additional surgical and demographic variables were analyzed for effect on cortical widths and density, and all cis-cortex measurements were compared to both the trans-cortex and to the contralateral limbs. RESULTS The tibial cis-cortex was significantly wider and more irregular than the trans-cortex at the same level. This width asymmetry differed in both magnitude and direction from the contralateral limb. The bone underlying the plate was significantly less dense than the trans-cortex, and this cortical density difference was significantly greater than that of the contralateral limb. These cortical changes were independent of both duration of fixation and degree of ostectomy bone healing. CONCLUSIONS This study provides evidence that cortical bone loss consistent with cortical porosity is a comorbidity of locking plate fixation in a caprine tibial ostectomy model. Further research is necessary to identify risk factors for locking-plate-associated bone loss and to inform clinical decisions in cases necessitating long-term locking plate fixation.
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Affiliation(s)
- Kristin M Bowers
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA.
| | - Lori D Terrones
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, USA
| | - Rebecca Rifkin
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Elizabeth Croy
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Henry S Adair
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Silke Hecht
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - David E Anderson
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
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Bowers KM, Wright EM, Terrones LD, Sun X, Rifkin R, Grzeskowiak R, Croy E, Seddighi R, Kleine S, Hampton C, Hecht S, Adair HS, Anderson DE, Mulon PY. In vitro analysis and in vivo assessment of fracture complications associated with use of locking plate constructs for stabilization of caprine tibial segmental defects. J Exp Orthop 2023; 10:38. [PMID: 37010659 PMCID: PMC10070588 DOI: 10.1186/s40634-023-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE Locking plate fixation of caprine tibial segmental defects is widely utilized for translational modeling of human osteopathology, and it is a useful research model in tissue engineering and orthopedic biomaterials research due to its inherent stability while maintaining unobstructed visualization of the gap defect and associated healing. However, research regarding surgical technique and long-term complications associated with this fixation method are lacking. The goal of this study was to assess the effects of surgeon-selected factors including locking plate length, plate positioning, and relative extent of tibial coverage on fixation failure, in the form of postoperative fracture. METHODS In vitro, the effect of plate length was evaluated using single cycle compressive load to failure mechanical testing of locking plate fixations of caprine tibial gap defects. In vivo, effects of plate length, positioning, and relative tibial coverage were evaluated using data from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over 3, 6, 9, and 12 months. RESULTS In vitro, no significant differences in maximum compressive load or total strain were noted between fixations using 14 cm locking plates and 18 cm locking plates. In vivo, both plate length and tibial coverage ratio were significantly associated with postoperative fixation failure. The incidence of any cortical fracture in goats stabilized with a 14 cm plate was 57%, as compared with 3% in goats stabilized with an 18 cm plate. Craniocaudal and mediolateral angular positioning variables were not significantly associated with fixation failure. Decreasing distance between the gap defect and the proximal screw of the distal bone segment was associated with increased incidence of fracture, suggesting an effect on proximodistal positioning on overall fixation stability. CONCLUSIONS This study emphasizes the differences between in vitro modeling and in vivo application of surgical fixation methods, and, based on the in vivo results, maximization of plate-to-tibia coverage is recommended when using locking plate fixation of the goat tibial segmental defect as a model in orthopedic research.
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Affiliation(s)
- Kristin M Bowers
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA.
| | - Ellis M Wright
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Lori D Terrones
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, USA
| | - Rebecca Rifkin
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Remi Grzeskowiak
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Elizabeth Croy
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Reza Seddighi
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Stephanie Kleine
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Chiara Hampton
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Silke Hecht
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Henry S Adair
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - David E Anderson
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
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Lee HJ, Park YU, Kim SJ, Kim HN. Screw stripping and its prevention in the hexagonal socket of 3.5-mm titanium locking screws. Sci Rep 2021; 11:21324. [PMID: 34716380 PMCID: PMC8556383 DOI: 10.1038/s41598-021-00720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022] Open
Abstract
There have been several reports about the difficulties in removing 3.5-mm titanium locking screws from plates due to the stripping or rounding of the hexagonal screw socket. We investigated whether stripping the locking screw sockets can be prevented by using different screwdrivers or interposing materials into the socket during removal. We overtightened 120 3.5-mm titanium locking screws (Depuy Synthes, Paoli, PA) equally into locking plates on sawbone tibia models, applying a uniform torque of 4.5 Nm, exceeding the recommended torque of 1.5 Nm. Twenty screws each were removed using a straight-handle 2.5-mm screwdriver, T-handle screwdriver, hex key wrench, and straight-handle screwdriver with a non-dominant hand. In addition, 20 screws were removed using foil from a suture packet inserted into the screw socket or using parts of a latex glove inserted into the screw socket. The incidence rates of screw stripping using the straight-handle screwdriver, T-handle screwdriver, hex key wrench, non-dominant hand, foil interposition, and latex glove interposition were 75%, 40%, 35%, 90%, 60%, and 70%, respectively. When a T-handle screwdriver or hex key wrench was used, the probability of screw stripping was 4.50 times (odds ratio = 4.50, 95% confidence interval = 1.17 to 17.37, p = 0.03) and 5.57 times (odds ratio = 5.57, 95% confidence interval = 1.42 to 21.56, p = 0.01) lower than that with the straight-handle screwdriver, respectively. Foil or latex glove interpositions did not prevent screw stripping. Thus, in the current experimental study, T-handle screwdriver or hex key wrench usage decreased the incidence rate of screw stripping during removal compared to straight-handle screwdriver use.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, Republic of Korea.
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Lope-Huaman RJ, Curasco-Ayma A, Fernandez-Apaza J. Osteosíntesis con placa mínimamente invasiva (OPMI) para fractura completa de tibia y peroné en canino ( Canis lupus familiar): Pre - Planificación virtual. JOURNAL OF THE SELVA ANDINA ANIMAL SCIENCE 2021. [DOI: 10.36610/j.jsaas.2021.080200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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