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Wang M, Jiang G, Yang H, Jin X. Computational models of bone fracture healing and applications: a review. BIOMED ENG-BIOMED TE 2024; 69:219-239. [PMID: 38235582 DOI: 10.1515/bmt-2023-0088] [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: 03/02/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
Fracture healing is a very complex physiological process involving multiple events at different temporal and spatial scales, such as cell migration and tissue differentiation, in which mechanical stimuli and biochemical factors assume key roles. With the continuous improvement of computer technology in recent years, computer models have provided excellent solutions for studying the complex process of bone healing. These models not only provide profound insights into the mechanisms of fracture healing, but also have important implications for clinical treatment strategies. In this review, we first provide an overview of research in the field of computational models of fracture healing based on CiteSpace software, followed by a summary of recent advances, and a discussion of the limitations of these models and future directions for improvement. Finally, we provide a systematic summary of the application of computational models of fracture healing in three areas: bone tissue engineering, fixator optimization and clinical treatment strategies. The application of computational models of bone healing in clinical treatment is immature, but an inevitable trend, and as these models become more refined, their role in guiding clinical treatment will become more prominent.
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Affiliation(s)
- Monan Wang
- School of Mechanical and Power Engineering, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Guodong Jiang
- School of Mechanical and Power Engineering, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Haoyu Yang
- School of Mechanical and Power Engineering, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Xin Jin
- School of Mechanical and Power Engineering, Harbin University of Science and Technology, Harbin, Heilongjiang, China
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Zhang E, Miramini S, Zhang L. The impact of osteoporosis and diabetes on fracture healing under different loading conditions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107952. [PMID: 38039922 DOI: 10.1016/j.cmpb.2023.107952] [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: 07/15/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Osteoporosis and diabetes are two prevalent conditions among the elderly population. Each of these conditions can profoundly influence the fracture healing process by disturbing the associated inflammatory process. However, the combined effects of osteoporosis and diabetes on fracture healing remain unclear. Therefore, the purpose of the present study is to investigate the role of osteoporosis and diabetes in fracture healing and the underlying mechanisms by developing numerical models. METHOD This study introduces a numerical model that consists of a three-dimensional model of a tibia fracture stabilized by a Locking Compression Plate (LCP), coupled with a two-dimensional axisymmetric model which illustrates the transport and reactions of cells and cytokines throughout the inflammatory phase in early fracture healing. First, the model parameters were calibrated using available experimental data. The model was then implemented to predict the healing outcomes of fractures under five varied conditions, consisting of both osteoporotic and non-osteoporotic bones, each subjected to different physiological loads. RESULTS The instability of the fracture callus can significantly escalate in osteoporotic fractures (e.g., when a 150 N physiological load is applied, the unstable region of the osteoporotic fracture callus can reach 26 %, in contrast to 12 % in non-osteoporotic fractures). Additionally, the mesenchymal stem cells (MSCs) proliferation and differentiation can be disrupted in osteoporotic fracture compared to non-osteoporotic fractures (e.g., on the 10th day post-fracture, the decrease in the concentration of MSCs, osteoblasts, and chondrocytes in osteoporotic fractures is nearly double that in non-osteoporotic fractures under a 150 N). Finally, the healing process of fractures can suffer significant impairment when osteoporosis coexists with diabetes (e.g., the concentration of MSCs can be drastically reduced by nearly 37 % in osteoporotic fractures under diabetic conditions when subjected to a load of 200 N) CONCLUSIONS: Fracture calluses destabilized by osteoporosis can negatively affect the fracture healing process by disrupting the proliferation and differentiation of mesenchymal stem cells (MSCs). Moreover, when osteoporosis coexists with diabetes, the fracture healing process can severely impair the fracture healing outcomes.
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Affiliation(s)
- Enhao Zhang
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, VIC 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, VIC 3010, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, 700 Swanston St, Parkville, VIC 3010, Australia.
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Steppe L, Megafu M, Tschaffon-Müller ME, Ignatius A, Haffner-Luntzer M. Fracture healing research: Recent insights. Bone Rep 2023; 19:101686. [PMID: 38163010 PMCID: PMC10757288 DOI: 10.1016/j.bonr.2023.101686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 01/03/2024] Open
Abstract
Bone has the rare capability of scarless regeneration that enables the complete restoration of the injured bone area. In recent decades, promising new technologies have emerged from basic, translational and clinical research for fracture treatment; however, 5-10 % of all bone fractures still fail to heal successfully or heal in a delayed manner. Several comorbidities and risk factors have been identified which impair bone healing and might lead to delayed bone union or non-union. Therefore, a considerable amount of research has been conducted to elucidate molecular mechanisms of successful and delayed fracture healing to gain further insights into this complex process. One focus of recent research is to investigate the complex interactions of different cell types and the action of progenitor cells during the healing process. Of particular interest is also the identification of patient-specific comorbidities and how these affect fracture healing. In this review, we discuss the recent knowledge about progenitor cells for long bone repair and the influence of comorbidities such as diabetes, postmenopausal osteoporosis, and chronic stress on the healing process. The topic selection for this review was made based on the presented studies at the 2022 annual meeting of the European Calcified Tissue Society (ECTS) in Helsinki.
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Affiliation(s)
- Lena Steppe
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Germany
| | - Michael Megafu
- A.T. Still University Kirksville College of Osteopathic Medicine, USA
| | | | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Germany
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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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Li L, Liu X, Patel M, Zhang L. Depth camera-based model for studying the effects of muscle loading on distal radius fracture healing. Comput Biol Med 2023; 164:107292. [PMID: 37544250 DOI: 10.1016/j.compbiomed.2023.107292] [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: 04/18/2023] [Revised: 06/24/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Distal radius fractures (DRFs) treated with volar locking plates (VLPs) allows early rehabilitation exercises favourable to fracture recovery. However, the role of rehabilitation exercises induced muscle forces on the biomechanical microenvironment at the fracture site remains to be fully explored. The purpose of this study is to investigate the effects of muscle forces on DRF healing by developing a depth camera-based fracture healing model. METHOD First, the rehabilitation-related hand motions were captured by a depth camera system. A macro-musculoskeletal model is then developed to analyse the data captured by the system for estimating hand muscle and joint reaction forces which are used as inputs for our previously developed DRF model to predict the tissue differentiation patterns at the fracture site. Finally, the effect of different wrist motions (e.g., from 60° of extension to 60° of flexion) on the DRF healing outcomes will be studied. RESULTS Muscle and joint reaction forces in hands which are highly dependent on hand motions could significantly affect DRF healing through imposed compressive and bending forces at the fracture site. There is an optimal range of wrist motion (i.e., between 40° of extension and 40° of flexion) which could promote mechanical stimuli governed healing while mitigating the risk of bony non-union due to excessive movement at the fracture site. CONCLUSION The developed depth camera-based fracture healing model can accurately predict the influence of muscle loading induced by rehabilitation exercises in distal radius fracture healing outcomes. The outcomes from this study could potentially assist osteopathic surgeons in designing effective post-operative rehabilitation strategies for DRF patients.
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Affiliation(s)
- Lunjian Li
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Xuanchi Liu
- 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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Li Q, Miramini S, Smith DW, Gardiner BS, Zhang L. Osteochondral junction leakage and cartilage joint lubrication. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107353. [PMID: 36736148 DOI: 10.1016/j.cmpb.2023.107353] [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: 07/01/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that there is potentially interstitial fluid exchange between cartilage tissue and the subarticular spongiosa region in the case of injury or disease (e.g., osteoarthritis and osteoporosis). Interstitial flow is also required for cartilage lubrication under joint load. A key question then is how cartilage lubrication is modified by increased interstitial fluid leakage across the osteochondral junction. Thus, the purpose of this study is to develop a numerical model to investigate changes in cartilage lubrication with changes in osteochondral junction leakage. METHODS The multi-phase coupled model includes domains corresponding to the contact gap, cartilage tissue and subchondral bone plate region (ScBP). Each of these domains are treated as poroelastic systems, with their coupling implemented through mass and pressure continuity. The effects of osteochondral junction leakage on lubrication were investigated with a parametric study on the relative permeability between the ScBP and cartilage tissue. RESULTS Significant effects of ScBP permeability were predicted, especially during the early stage of the junction leakage development (early stage of the disease). There is a significant reduction in mixed-mode lubrication duration under the effect of increased junction leakage (the cartilage tissue mixed-mode lubrication duration is about 33% decrease for a relative permeability ratio of 0.1 between ScBP and cartilage tissue, and about 52% decrease under the osteoarthritis condition). In addition, the time for cartilage to reach steady-state consolidation is significantly reduced when ScBP permeability increases (the consolidation time reduces from roughly 2 h to 1.2 h when the relative permeability ratio increases from 0.001 to 0.1, and it reduces to 0.8 h for an advanced osteoarthritis condition). It is predicted that the initial friction coefficient could increase by over 60% when the ScBP permeability is consistent with an advanced osteoarthritis (OA) condition. CONCLUSION Increased osteochondral junction leakage induced by joint injury and disease could result in increased cartilage surface wear rates due to more rapid interstitial fluid depressurization within articular cartilage.
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Affiliation(s)
- Qin Li
- Department of Infrastructure Engineering, The University of Melbourne, VIC 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, VIC 3010, Australia
| | - David W Smith
- School of Physics, Mathematics and Computing, The University of Western Australia, WA 6009, Australia
| | - Bruce S Gardiner
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, WA 6150, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, VIC 3010, 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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Xu D, Zhang N, Wang S, Zhang P, Li Y, Yang H. A method for generating dynamic compression shear coupled stress loading on living cells. Front Bioeng Biotechnol 2022; 10:1002661. [PMID: 36213067 PMCID: PMC9532543 DOI: 10.3389/fbioe.2022.1002661] [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: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
Changes in the mechanical properties of single cells are related to the physiological state and fate of cells. The construction of cell constitutive equations is essential for understanding the material characteristics of single cells. With the help of atomic force microscopy, bio-image processing algorithms, and other technologies, research investigating the mechanical properties of cells during static/quasi-static processes has developed rapidly. A series of equivalent models, such as viscoelastic models, have been proposed to describe the constitutive behaviors of cells. The stress-strain relations under dynamic processes are essential to completing the constitutive equations of living cells. To explore the dynamic mechanical properties of cells, we propose a novel method to generate a controllable dynamical compression shear coupling stress on living cells. A CFD model was established to visualize this method and display the theories, as well as assess the scope of the application. As the requirements or limitations are met, researchers can adjust the details of this model according to their lab environment or experimental demands. This micro-flow channel-based method is a new tool for approaching the dynamic mechanical properties of cells.
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Affiliation(s)
- Dasen Xu
- School of Aeronautics, Northwestern Polytechnical University, Xi’an, China
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
| | - Nu Zhang
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
- School of Life Science, Northwestern Polytechnical University, Xi’an, China
| | - Sijie Wang
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
- School of Life Science, Northwestern Polytechnical University, Xi’an, China
| | - Pan Zhang
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
- School of Life Science, Northwestern Polytechnical University, Xi’an, China
| | - Yulong Li
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
- School of Civil Aviation, Northwestern Polytechnical University, Xi’an, China
- Joint International Research Laboratory of Impact Dynamic and Its Engineering Application, Xi’an, China
- *Correspondence: Yulong Li, ; Hui Yang,
| | - Hui Yang
- Center of Special Environmental Biomechanics; Biomedical Engineering, Northwestern Polytechnical University, Xi’an, China
- School of Life Science, Northwestern Polytechnical University, Xi’an, China
- *Correspondence: Yulong Li, ; Hui Yang,
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Wang F, Guo J, Wang Y, Hu Y, Zhang H, Chen J, Jing Y, Cao L, Chen X, Su J. Loss of Bcl-3 delays bone fracture healing through activating NF-κB signaling in mesenchymal stem cells. J Orthop Translat 2022; 35:72-80. [PMID: 36186660 PMCID: PMC9471962 DOI: 10.1016/j.jot.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022] Open
Abstract
Background Bone fracture healing is a postnatal regenerative process in which fibrocartilaginous callus formation and bony callus formation are important. Bony callus formation requires osteoblastic differentiation of MSCs. Materials and methods The formation of callus was assessed by μCT, Safranin-O, H&E and Masson trichrome staining. Osteogenesis of MSCs was analyzed by ALP staining, ARS staining, qRT-PCR and WB. And we also used IF and TOP/FOP Flash luciferase reporter to assess the nuclear translocation of PP65. Results In this study, we found Bcl-3 showed a significant correlation with bone fracture healing. Results of μCT showed that loss of Bcl-3 delays bone fracture healing. Safranin-O, H&E and Masson trichrome staining confirmed that loss of Bcl-3 impacted the formation of cartilage and woven bone in callus. Further experiments in vitro manifested that Bcl-3-knockdown could inhibit MSCs osteoblastic differentiation through releasing the inhibition on NF-κB signaling by Co-IP, IF staining and luciferase reporter assay. Conclusions We unveiled that loss of Bcl-3 could lead to inhibited osteogenic differentiation of MSCs via promoting PP65 nuclear translocation. The translational potential of this article Our data demonstrated that overexpression of Bcl-3 accelerates bone fracture healing, which serves as a promising therapeutic target for bone fracture treatment.
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Biomechanical evaluation on a novel design of biodegradable embossed locking compression plate for orthopaedic applications using finite element analysis. Biomech Model Mechanobiol 2022; 21:1371-1392. [PMID: 35717547 DOI: 10.1007/s10237-022-01596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/19/2022] [Indexed: 11/02/2022]
Abstract
In orthopaedics, conventional implant plates such as locking compression plate (LCP) made from non-biodegradable materials play a vital role in the fixation to support bone fractures, but also create a complication such as stress shielding. These again require a painful surgery to remove/replace after they have healed as it does not degrade into the physiological environment (PE). Currently, there has already been enough discovery of biodegradable materials that, despite being mechanically inefficient compared to non-biodegradable materials, can completely be biodegraded in PE during and after healing to avoid such problems. While there has been insufficient research on the design of biodegradable implant plates, the implementation of which may help achieve the goal with an effort of high mechanical strength. A novel design of biodegradable embossed locking compression plate (BELCP) is designed for biodegradable materials to approach superior mechanical performance and complete degradation over time, considering all such parameters and factors. For biomechanical evaluation, four-point bending test (4PBT), axial compressive and tensile test (ACTT) and torsion test (TT) have been performed on LCP, BELCP and its continuously degraded forms made of biodegradable material (Mg-alloy) using finite element method. BELCP has found 50%, 100% and 100% higher mechanical performance and safer in 4PBT, ACTT and TT, respectively, than LCP. Moreover, BELCP has also observed safe during continuous degradation up to 6 months after implantation under these three tests, considering an approximate sustained degradation rate of about 4 mm/year. Even Mg-alloy made BELCP can be sufficient and safer to support fractured bone than SS-alloy made LCP, but not Ti-alloy made LCP. BELCP can be a successful biodegradable bone implant plate after human/animal trials in the future.
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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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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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Zhang Y, Wang P, Jin J, Li L, He SY, Zhou P, Jiang Q, Wen C. In silico and in vivo studies of the effect of surface curvature on the osteoconduction of porous scaffolds. Biotechnol Bioeng 2021; 119:591-604. [PMID: 34723387 DOI: 10.1002/bit.27976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
Recent evidence shows that the curvature of porous scaffold plays a significant role in guiding tissue regeneration. However, the underlying mechanism remains controversial to date. In this study, we developed an in silico model to simulate the effect of surface curvature on the osteoconduction of scaffold implants, which comprises the primary aspects of bone regeneration. Selective laser melting was used to manufacture a titanium scaffold with channels representative of different strut curvatures for in vivo assessment. The titanium scaffold was implanted in the femur condyles of rabbits to validate the mathematical model. Simulation results suggest that the curvature affected the distribution of growth factors and subsequently induced the migration of osteoblast lineage cells and bone deposition to the locations with higher curvature. The predictions of the mathematical model are in good agreement with the in vivo assessment results, in which newly formed bone first appeared adjacent to the vertices of the major axes in elliptical channels. The mechanism of curvature-guided osteoconduction may provide a guide for the design optimization of scaffold implants to achieve enhanced bone ingrowth.
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Affiliation(s)
- Yun Zhang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Peng Wang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Department of Sports Medicine and Adult Reconstructive Surgery, State Key Laboratory of Pharmaceutical Biotechnology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiyong Jin
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Lan Li
- Department of Sports Medicine and Adult Reconstructive Surgery, State Key Laboratory of Pharmaceutical Biotechnology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Si-Yuan He
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Ping Zhou
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, State Key Laboratory of Pharmaceutical Biotechnology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuie Wen
- School of Aerospace Mechanical and Manufacturing Engineering, RMIT University, Melbourne, Victoria, Australia
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14
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Wolynski JG, Labus KM, Easley JT, Notaroš BM, Ilić MM, Puttlitz CM, McGilvray KC. Diagnostic prediction of ovine fracture healing outcomes via a novel multi-location direct electromagnetic coupling antenna. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1223. [PMID: 34532360 PMCID: PMC8421979 DOI: 10.21037/atm-21-1853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
Background Expedient prediction of adverse bone fracture healing (delayed- or non-union) is necessary to advise secondary treatments for improving healing outcome to minimize patient suffering. Radiographic imaging, the current standard diagnostic, remains largely ineffective at predicting nonunions during the early stages of fracture healing resulting in mean nonunion diagnosis times exceeding six months. Thus, there remains a clinical deficit necessitating improved diagnostic techniques. It was hypothesized that adverse fracture healing expresses impaired biological progression at the fracture site, thus resulting in reduced temporal progression of fracture site stiffness which may be quantified prior to the appearance of radiographic indicators of fracture healing (i.e., calcified tissue). Methods A novel multi-location direct electromagnetic coupling antenna was developed to diagnose relative changes in the stiffness of fractures treated by metallic orthopaedic hardware. The efficacy of this diagnostic was evaluated during fracture healing simulated by progressive destabilization of cadaveric ovine metatarsals treated by locking plate fixation (n=8). An ovine in vivo comparative fracture study (n=8) was then utilized to better characterize the performance of the developed diagnostic in a clinically translatable setting. In vivo measurements using the developed diagnostic were compared to weekly radiographic images and postmortem biomechanical, histological, and micro computed tomography analyses. Results For all cadaveric samples, the novel direct electromagnetic coupling antenna displayed significant differences at the fracture site (P<0.05) when measuring a fully fractured sample versus partially intact and fully intact fracture states. In subsequent in vivo fracture models, this technology detected significant differences (P<0.001) in fractures trending towards delayed healing during the first 30 days post-fracture. Conclusions This technology, relative to traditional X-ray imaging, exhibits potential to greatly expedite clinical diagnosis of fracture nonunion, thus warranting additional technological development.
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Affiliation(s)
- Jakob G Wolynski
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kevin M Labus
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Branislav M Notaroš
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO, USA
| | - Milan M Ilić
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
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15
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Wang Y, Xiong M, Wang M, Chen H, Li W, Zhou X. Quercetin promotes locomotor function recovery and axonal regeneration through induction of autophagy after spinal cord injury. Clin Exp Pharmacol Physiol 2021; 48:1642-1652. [PMID: 34407225 DOI: 10.1111/1440-1681.13573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022]
Abstract
Quercetin (Que), one of the flavonoids, exerts numerous actions on the central nervous system. However, the roles and underlying mechanism of Que in locomotor function recovery and axonal regeneration following spinal cord injury (SCI) have not been fully elucidated. A rat model of spinal cord injury (SCI) was established at T10 using the modified Allen's method. The results in our study indicated that Basso, Beattie and Bresnahan (BBB) locomotor scores were significantly higher after Que treatment. Additionally, Que administration cut down the latency of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP), increased the amplitude of MEP and SEP following SCI. Hematoxylin-eosin (HE) staining demonstrated that Que administration reduced lesion size and cavity formation. Biotinylated dextran amine (BDA) anterograde tracing revealed that BDA positive fibres were increased by Que following SCI. Immunofluorescence staining revealed that Que elevated 5-hydroxytryptamine (5-HT) positive nerve fibres and neurofilament-200 (NF-200) positive neurons, reduced glial fibrillary acidic protein (GFAP) positive astrocytes. In addition, Que inhibited GFAP expression, increased both NeuN and NF-200 expression and facilitated the spinal cord energy metabolism. Moreover, Que increased 18 F-FDG uptake in a time-dependent manner. Furthermore, Que increased Beclin 1 and LC3 II expression, blocked the phosphorylation of Akt, mTOR and p70S6K. 3-methyladenine (3-MA) partly abolished the neuro-protective roles of Que following SCI. Taken together, our study suggested that Que might promote locomotor function recovery, axonal regeneration and energy metabolism through induction of autophagy via Akt/mTOR/p70S6K pathway.
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Affiliation(s)
- Yeyang Wang
- Department of Spine, Orthopaedic Center, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Man Xiong
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Mingsen Wang
- Department of Orthopedic, Traditional Chinese Medicine Hospital of Puning City, Orthopaedic Hospital of Puning City, Puning, China
| | - Hongdong Chen
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenjun Li
- Department of Joint, Orthopaedic Center, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaozhong Zhou
- Department of Spine, Orthopaedic Center, Guangdong Second Provincial General Hospital, Guangzhou, China
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16
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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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17
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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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18
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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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19
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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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20
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The Application of Digital Volume Correlation (DVC) to Evaluate Strain Predictions Generated by Finite Element Models of the Osteoarthritic Humeral Head. Ann Biomed Eng 2020; 48:2859-2869. [PMID: 32572730 PMCID: PMC7723934 DOI: 10.1007/s10439-020-02549-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/12/2020] [Indexed: 01/29/2023]
Abstract
Continuum-level finite element models (FEMs) of the humerus offer the ability to evaluate joint replacement designs preclinically; however, experimental validation of these models is critical to ensure accuracy. The objective of the current study was to quantify experimental full-field strain magnitudes within osteoarthritic (OA) humeral heads by combining mechanical loading with volumetric microCT imaging and digital volume correlation (DVC). The experimental data was used to evaluate the accuracy of corresponding FEMs. Six OA humeral head osteotomies were harvested from patients being treated with total shoulder arthroplasty and mechanical testing was performed within a microCT scanner. MicroCT images (33.5 µm isotropic voxels) were obtained in a pre- and post-loaded state and BoneDVC was used to quantify full-field experimental strains (≈ 1 mm nodal spacing, accuracy = 351 µstrain, precision = 518 µstrain). Continuum-level FEMs with two types of boundary conditions (BCs) were simulated: DVC-driven and force-driven. Accuracy of the FEMs was found to be sensitive to the BC simulated with better agreement found with the use of DVC-driven BCs (slope = 0.83, r2 = 0.80) compared to force-driven BCs (slope = 0.22, r2 = 0.12). This study quantified mechanical strain distributions within OA trabecular bone and demonstrated the importance of BCs to ensure the accuracy of predictions generated by corresponding FEMs.
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21
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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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22
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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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23
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Chang Y, Cho B, Kim S, Kim J. Direct conversion of fibroblasts to osteoblasts as a novel strategy for bone regeneration in elderly individuals. Exp Mol Med 2019; 51:1-8. [PMID: 31073120 PMCID: PMC6509166 DOI: 10.1038/s12276-019-0251-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/24/2018] [Accepted: 01/28/2019] [Indexed: 12/31/2022] Open
Abstract
Mortality caused by age-related bone fractures or osteoporosis is steadily increasing worldwide as the population ages. The pace of the development of bone regeneration engineering to treat bone fractures has consequently increased in recent years. A range of techniques for bone regeneration, such as immunotherapy, allografts, and hydrogel therapy, have been devised. Cell-based therapies using bone marrow-derived mesenchymal stem cells and induced pluripotent stem cells derived from somatic cells are considered to be suitable approaches for bone repair. However, these cell-based therapies suffer from a number of limitations in terms of efficiency and safety. Somatic cells can also be directly differentiated into osteoblasts by several transcription factors. As osteoblasts play a central role in the process of bone formation, the direct reprogramming of fibroblasts into osteoblasts may hence be a new way to treat bone fractures in elderly individuals. Here, we review recent developments regarding the therapeutic potential of the direct reprogramming of cells for bone regeneration. Reprogramming cells that produce connective tissue to form bone instead could help prevent fractures in the elderly. Bones weaken with age, and fractures are a significant health risk in ageing populations. Most current bone regeneration treatments use stem cells, which can differentiate into any type of cell and have infinite capacity to divide; however, they are difficult to source and can lead to tumor formation. Jongpil Kim at Dongguk University in South Korea and coworkers have reviewed a new method that uses genetic signals to transform connective tissue-forming cells into bone-producing cells. The reprogrammed cells have been shown to generate new bone at the desired site, and because they have already lost their capacity for infinite division, tumor formation risk is greatly reduced. This method shows promise to expand treatment options for fractures and osteoporosis.
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Affiliation(s)
- Yujung Chang
- Department of Biomedical Engineering, Dongguk University, Pildong-ro 1-gil 30, Jung-gu, Seoul, 04620, Republic of Korea
| | - Byounggook Cho
- Department of Biomedical Engineering, Dongguk University, Pildong-ro 1-gil 30, Jung-gu, Seoul, 04620, Republic of Korea
| | - Siyoung Kim
- Department of Biomedical Engineering, Dongguk University, Pildong-ro 1-gil 30, Jung-gu, Seoul, 04620, Republic of Korea
| | - Jongpil Kim
- Department of Biomedical Engineering, Dongguk University, Pildong-ro 1-gil 30, Jung-gu, Seoul, 04620, Republic of Korea. .,Department of Chemistry, Dongguk University, 30, Pildong-ro 1-gil 30, Jung-gu, Seoul, 04620, Republic of Korea.
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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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25
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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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26
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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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27
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An intramembranous ossification model for the in silico analysis of bone tissue formation in tooth extraction sites. J Theor Biol 2016; 401:64-77. [PMID: 27113783 DOI: 10.1016/j.jtbi.2016.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 01/10/2023]
Abstract
The accurate modeling of biological processes allows us to predict the spatiotemporal behavior of living tissues by computer-aided (in silico) testing, a useful tool for the development of medical strategies, avoiding the expenses and potential ethical implications of in vivo experimentation. A model for bone healing in mouth would be useful for selecting proper surgical techniques in dental procedures. In this paper, the formulation and implementation of a model for Intramembranous Ossification is presented aiming to describe the complex process of bone tissue formation in tooth extraction sites. The model consists in a mathematical description of the mechanisms in which different types of cells interact, synthesize and degrade extracellular matrices under the influence of biochemical factors. Special attention is given to angiogenesis, oxygen-dependent effects and growth factor-induced apoptosis of fibroblasts. Furthermore, considering the depth-dependent vascularization of mandibular bone and its influence on bone healing, a functional description of the cell distribution on the severed periodontal ligament (PDL) is proposed. The developed model was implemented using the finite element method (FEM) and successfully validated by simulating an animal in vivo experiment on dogs reported in the literature. A good fit between model outcome and experimental data was obtained with a mean absolute error of 3.04%. The mathematical framework presented here may represent an important tool for the design of future in vitro and in vivo tests, as well as a precedent for future in silico studies on osseointegration and mechanobiology.
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Gómez-Barrena E, Rosset P, Lozano D, Stanovici J, Ermthaller C, Gerbhard F. Bone fracture healing: cell therapy in delayed unions and nonunions. Bone 2015; 70:93-101. [PMID: 25093266 DOI: 10.1016/j.bone.2014.07.033] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 12/14/2022]
Abstract
Bone fracture healing impairment related to mechanical problems has been largely corrected by advances in fracture management. Better protocols, more strict controls of time and function, and hardware and surgical technique evolution have contributed to better prognosis, even in complex fractures. However, atrophic nonunion persists in clinical cases where, for different reasons, the osteogenic capability is impaired. When this is the case, a better understanding of the basic mechanisms under bone repair and augmentation techniques may put in perspective the current possibilities and future opportunities. Among those, cell therapy particularly aims to correct this insufficient osteogenesis. However, the launching of safe and efficacious cell therapies still requires substantial amount of research, especially clinical trials. This review will envisage the current clinical trials on bone healing augmentation based on cell therapy, with the experience provided by the REBORNE Project, and the insight from investigator-driven clinical trials on advanced therapies towards the future. This article is part of a Special Issue entitled Stem Cells and Bone.
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Affiliation(s)
- Enrique Gómez-Barrena
- Dept. of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Philippe Rosset
- Service of Orthopaedic Surgery and Traumatology, CHU Tours, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Inserm U957, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives (LPRO), Faculté de Médecine, Université de Nantes, France
| | - Daniel Lozano
- Metabolic Bone Research Unit, Instituto de Investigación Sanitaria FJD, Madrid, Spain
| | - Julien Stanovici
- Service of Orthopaedic Surgery and Traumatology, CHU Tours, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Inserm U957, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives (LPRO), Faculté de Médecine, Université de Nantes, France
| | - Christian Ermthaller
- Klinik für Unfallchirurgie-, Hand-, Plastische und Wiederherstellungschirurgie Zentrum für Chirurgie Universitätsklinikum Ulm, Ulm, Germany
| | - Florian Gerbhard
- Klinik für Unfallchirurgie-, Hand-, Plastische und Wiederherstellungschirurgie Zentrum für Chirurgie Universitätsklinikum Ulm, Ulm, Germany
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Zhang L, Miramini S, Smith DW, Gardiner BS, Grodzinsky AJ. Time Evolution of Deformation in a Human Cartilage Under Cyclic Loading. Ann Biomed Eng 2014; 43:1166-77. [DOI: 10.1007/s10439-014-1164-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Miramini S, Zhang L, Richardson M, Pirpiris M, Mendis P, Oloyede K, Edwards G. Computational simulation of the early stage of bone healing under different configurations of locking compression plates. Comput Methods Biomech Biomed Engin 2013; 18:900-13. [PMID: 24261957 DOI: 10.1080/10255842.2013.855729] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Flexible fixation or the so-called 'biological fixation' has been shown to encourage the formation of fracture callus, leading to better healing outcomes. However, the nature of the relationship between the degree of mechanical stability provided by a flexible fixation and the optimal healing outcomes has not been fully understood. In this study, we have developed a validated quantitative model to predict how cells in fracture callus might respond to change in their mechanical microenvironment due to different configurations of locking compression plate (LCP) in clinical practice, particularly in the early stage of healing. The model predicts that increasing flexibility of the LCP by changing the bone-plate distance (BPD) or the plate working length (WL) could enhance interfragmentary strain in the presence of a relatively large gap size (> 3 mm). Furthermore, conventional LCP normally results in asymmetric tissue development during early stage of callus formation, and the increase of BPD or WL is insufficient to alleviate this problem.
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Affiliation(s)
- Saeed Miramini
- a Department of Infrastructure Engineering , The University of Melbourne , VIC 3010 , Australia
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Zhang L, Miramini S, Mendis P, Richardson M, Pirpiris M, Oloyede K. The Effects of Flexible Fixation on Early Stage Bone Fracture Healing. ACTA ACUST UNITED AC 2013. [DOI: 10.3850/s2010428613000597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Liu JP, Xu J. Introduction: Understanding the signalling mechanisms in molecular physiology and diseases. Clin Exp Pharmacol Physiol 2012; 39:658-60. [PMID: 22831391 DOI: 10.1111/j.1440-1681.2012.05740.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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