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Oldhoff MGE, Kamal Z, Ten Duis K, Wubs FW, de Vries JPPM, Kraeima J, IJpma FFA. Semi-automated finite element analyses of surgically treated acetabular fractures to investigate the biomechanical behaviour of patient-specific compared to conventional implants. J Orthop Surg Res 2024; 19:541. [PMID: 39237975 PMCID: PMC11378568 DOI: 10.1186/s13018-024-04957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND In acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants. METHODS A computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant. RESULTS The finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel. CONCLUSION This study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted.
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Affiliation(s)
- M G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Z Kamal
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F W Wubs
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - J P P M de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tripathi S, Nishida N, Soehnlen S, Kelkar A, Kumaran Y, Seki T, Sakai T, Goel VK. Pelvic Ring Fractures: A Biomechanical Comparison of Sacral and Lumbopelvic Fixation Techniques. Bioengineering (Basel) 2024; 11:348. [PMID: 38671770 PMCID: PMC11048038 DOI: 10.3390/bioengineering11040348] [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: 02/01/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND CONTEXT Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. METHODS A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. RESULTS Trans-iliac-trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. CONCLUSIONS Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique.
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Affiliation(s)
- Sudharshan Tripathi
- Engineering Center for Orthopedic Research (E-CORE), Department of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH 43606, USA; (S.T.); (S.S.); (A.K.); (Y.K.)
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Yamaguchi, Yamaguchi Prefecture, Japan; (N.N.); (T.S.); (T.S.)
| | - Sophia Soehnlen
- Engineering Center for Orthopedic Research (E-CORE), Department of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH 43606, USA; (S.T.); (S.S.); (A.K.); (Y.K.)
| | - Amey Kelkar
- Engineering Center for Orthopedic Research (E-CORE), Department of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH 43606, USA; (S.T.); (S.S.); (A.K.); (Y.K.)
| | - Yogesh Kumaran
- Engineering Center for Orthopedic Research (E-CORE), Department of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH 43606, USA; (S.T.); (S.S.); (A.K.); (Y.K.)
| | - Toshihiro Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Yamaguchi, Yamaguchi Prefecture, Japan; (N.N.); (T.S.); (T.S.)
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Yamaguchi, Yamaguchi Prefecture, Japan; (N.N.); (T.S.); (T.S.)
| | - Vijay K. Goel
- Engineering Center for Orthopedic Research (E-CORE), Department of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH 43606, USA; (S.T.); (S.S.); (A.K.); (Y.K.)
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Martin L, Jain P, Ferguson Z, Gholamalizadeh T, Moshfeghifar F, Erleben K, Panozzo D, Abramowitch S, Schneider T. A systematic comparison between FEBio and PolyFEM for biomechanical systems. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107938. [PMID: 38056313 PMCID: PMC10843651 DOI: 10.1016/j.cmpb.2023.107938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Finite element simulations are widely employed as a non-invasive and cost-effective approach for predicting outcomes in biomechanical simulations. However, traditional finite element software, primarily designed for engineering materials, often encountered limitations in contact detection and enforcement, leading to simulation failure when dealing with complex biomechanical configurations. Currently, a lot of model tuning is required to get physically accurate finite element simulations without failures. This adds significant human interaction to each iteration of a biomechanical model. This study addressed these issues by introducing PolyFEM, a novel finite element solver that guarantees inversion- and intersection-free solutions with completely automatic collision detection. The objective of this research is to validate PolyFEM's capabilities by comparing its results with those obtained from a well-established finite element solver, FEBio. METHODS To achieve this goal, five comparison scenarios were formulated to assess and validate PolyFEM's performance. The simulations were reproduced using both PolyFEM and FEBio, and the final results were compared. The five comparison scenarios included: (1) reproducing simulations from the FEBio test suite, consisting of static, dynamic, and contact-driven simulations; (2) replicating simulations from the verification paper published alongside the original release of FEBio; (3) a biomechanically based contact problem; (4) creating a custom simulation involving high-energy collisions between soft materials to highlight the difference in collision methods between the two solvers; and (5) performing biomechanical simulations of biting and quasi-stance. RESULTS We found that PolyFEM was capable of replicating all simulations previously conducted in FEBio. Particularly noteworthy is PolyFEM's superiority in high-energy contact simulations, where FEBio fell short, unable to complete over half of the simulations in Scenario 4. Although some of the simulations required significantly more simulation time in PolyFEM compared to FEBio, it is important to highlight that PolyFEM achieved these results without the need for any additional model tuning or contact declaration. DISCUSSION Despite being in the early stages of development, PolyFEM currently provides verified solutions for hyperelastic materials that are consistent with FEBio, both in previously published workflows and novel finite element scenarios. PolyFEM exhibited the ability to tackle challenging biomechanical problems where other solvers fell short, thus offering the potential to enhance the accuracy and realism of future finite element analyses.
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Affiliation(s)
- Liam Martin
- University of Pittsburgh Swanson School of Engineering, USA
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Turbucz M, Pokorni AJ, Bigdon SF, Hajnal B, Koch K, Szoverfi Z, Lazary A, Eltes PE. Patient-specific bone material modelling can improve the predicted biomechanical outcomes of sacral fracture fixation techniques: A comparative finite element study. Injury 2023; 54:111162. [PMID: 37945416 DOI: 10.1016/j.injury.2023.111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate and compare the biomechanical efficacy of six iliosacral screw fixation techniques for treating unilateral AO Type B2 (Denis Type II) sacral fractures using literature-based and QCT-based bone material properties in finite element (FE) models. METHODS Two FE models of the intact pelvis were constructed: the literature-based model (LBM) with bone material properties taken from the literature, and the patient-specific model (PSM) with QCT-derived bone material properties. Unilateral transforaminal sacral fracture was modelled to assess different fixation techniques: iliosacral screw (ISS) at the first sacral vertebra (S1) (ISS1), ISS at the second sacral vertebra (S2) (ISS2), ISS at S1 and S2 (ISS12), transverse iliosacral screws (TISS) at S1 (TISS1), TISS at S2 (TISS2), and TISS at S1 and S2 (TISS12). A 600 N vertical load with both acetabula fixed was applied. Vertical stiffness (VS), relative interfragmentary displacement (RID), and the von Mises stress values in the screws and fracture interface were analysed. RESULTS The lowest and highest normalised VS was given by ISS1 and TISS12 techniques for LBM and PSM, with 137 % and 149 %, and 375 % and 472 %, respectively. In comparison with the LBM, the patient-specific bone modelling increased the maximum screw stress values by 19.3, 16.3, 27.8, 2.3, 24.4 and 7.8 % for ISS1, ISS2, ISS12, TISS1, TISS2 and TISS12, respectively. The maximum RID values were between 0.10 mm and 0.47 mm for all fixation techniques in both models. The maximum von Mises stress results on the fracture interface show a substantial difference between the two models, as PSM (mean ± SD of 15.76 ± 8.26 MPa) gave lower stress values for all fixation techniques than LBM (mean ± SD of 28.95 ± 6.91 MPa). CONCLUSION The differences in stress distribution underline the importance of considering locally defined bone material properties when investigating internal mechanical parameters. Based on the results, all techniques demonstrated clinically sufficient stability, with TISS12 being superior from a biomechanical standpoint. Both LBM and PSM models indicated a consistent trend in ranking the fixation techniques based on stability. However, long-term clinical trials are recommended to confirm the findings of the study.
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Affiliation(s)
- Mate Turbucz
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Agoston Jakab Pokorni
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Switzerland
| | - Benjamin Hajnal
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Kristof Koch
- School of PhD Studies, Semmelweis University, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
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Cintean R, Fritzsche C, Zderic I, Gueorguiev-Rüegg B, Gebhard F, Schütze K. Sacroiliac versus transiliac-transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. Eur J Trauma Emerg Surg 2023; 49:2553-2560. [PMID: 37535095 PMCID: PMC10728224 DOI: 10.1007/s00068-023-02341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Pelvic fractures were often associated with high-energy trauma in young patients, but data show a significant increase in osteoporotic pelvic fractures in old age due to the progressive demographic change. There is an ongoing discussion about the best fixation techniques, which are ranging from lumbopelvic fixation to sacral bars or long transiliac-transsacral (TITS) screws. This study analyzes TITS screw osteosynthesis and sacroiliac screw osteosynthesis (SI), according to biomechanical criteria of fracture stability in osteoporotic human pelvic cadavers ex vivo. METHODS Ten osteoporotic cadaveric pelvises were randomized into two groups of 5 pelvises each. An FFP-IIc fracture was initially placed unilaterally and subsequently surgically treated with a navigated SI screw or a TITS screw. The fractured side was loaded in a one-leg stance test setup until failure. Interfragmentary movements were assessed by means of optical motion tracking. RESULTS No significant difference in axial stiffness were found between the SI and the TITS screws (21.2 ± 4.9 N and 18.4 ± 4.1 N, p = 0.662). However, there was a significantly higher stability of the fracture treatment in the cohort with TITS-screws for gap angle, flexion, vertical movement and overall stability. The most significant difference in the cycle interval was between 6.000 and 10.000 for the gap angle (1.62 ± 0.25° versus 4.60 ± 0.65°, p = 0.0001), for flexion (4.15 ± 0.39 mm versus 7.60 ± 0.81 mm, p = 0.0016), interval 11.000-15.000 for vertical shear movement (7.34 ± 0.51 mm versus 13.99 ± 0.97 mm, p < 0.0001) and total displacement (8.28 ± 0.66 mm versus 15.53 ± 1.07 mm, p < 0.0001) for the TITS and the SI screws. CONCLUSIONS The results of this biomechanical study suggest a clear trend towards greater fracture stability of the TITS screw with significantly reduced interfragmentary movement. The application of a TITS screw for the treatment of the osteoporotic pelvic ring fracture may be prioritized to ensure the best possible patient care.
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Affiliation(s)
- Raffael Cintean
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Cornelius Fritzsche
- Department of Handsurgery, Upper Extremities and Foot Surgery, Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Ivan Zderic
- AO Research Institute (ARI), Clavandelerstrasse 8, 7270, Davos Platz, Switzerland
| | | | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Yimin W, Jingtao L, Lei H, Lihai Z. Analysis and multiple index evaluation of SPO distribution of bone traction needles for pelvic fracture reduction. Med Eng Phys 2023; 119:104031. [PMID: 37634913 DOI: 10.1016/j.medengphy.2023.104031] [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: 01/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023]
Abstract
For robot-assisted pelvic fracture reduction, at least two bone needles need to be inserted into the ilium of the affected pelvis, and the robot clamping device is connected with the bone needles. The biomechanical properties of the pelvic musculoskeletal tissues are different with the different Spatial Position and Orientation (SPO) of the bone needles. In order to determine the optimal SPO of bone needle pairs, the constraints between the bone needles and the pelvis are analyzed, and the SPO vectors of 150 groups bone needles are obtained by the KNN-hierarchical clustering method; a batch modeling method of bone needles with different SPO is proposed. 150 finite element models of damaged pelvic musculoskeletal tissue with different SPO of bone needles are established and simulated. The stress and strain distribution homogenization of musculoskeletal tissue with bone needles as evaluation index, the simulation results of 150 models are evaluated. Results show that, the anterior superior iliac spine and the anterior inferior iliac spine are suitable regions to place bone needles in the pelvis, and the optimal distribution of the needle combination is found in this region. The overall stress and strain distribution of the damaged pelvic musculoskeletal tissue under the large reduction force is the best.
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Affiliation(s)
- Wei Yimin
- Department of Precision Machinery, School of Mechatronic Engineering and Automation, 200444, Shanghai University, Shanghai, China
| | - Lei Jingtao
- Department of Precision Machinery, School of Mechatronic Engineering and Automation, 200444, Shanghai University, Shanghai, China.
| | - Hu Lei
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Zhang Lihai
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
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Duan P, Ding X, Xiong M, Wang P, Xu S, Du W. Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis. J Orthop Surg Res 2023; 18:251. [PMID: 36973727 PMCID: PMC10044380 DOI: 10.1186/s13018-023-03736-2] [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: 11/23/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Treatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator. METHODS A patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis. RESULTS Under the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3-13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases. CONCLUSIONS The acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.
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Affiliation(s)
- Pengyun Duan
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xiaohong Ding
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China.
| | - Min Xiong
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Panfeng Wang
- Department of Orthopaedics, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Shipeng Xu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Wei Du
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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Wu C, Zeng B, Deng J, Qin B, Shen D, Wang X, Hu H, Huang L, Liu X, Qiu G. Finite Element Analysis and Transiliac-Transsacral Screw Fixation for Posterior Pelvic Ring with Sacrum Dysplasia. Orthop Surg 2022; 15:337-346. [PMID: 36424734 PMCID: PMC9837241 DOI: 10.1111/os.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Posterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and intraoperative screw insertion of the dysplastic sacrum and sacroiliac screw. This study investigated the biomechanical performance of oblique sacroiliac screws (OSS) in S1 combined with transiliac-transsacral screws (TTSs) in S2 for pelvic fracture or sacroiliac dislocation with dysplastic sacrum and evaluated the safety of screw placement assisted by the navigation template. METHODS Six models were established, including one OSS fixation in the S2 segment, one transverse sacroiliac screw (TSS) fixation in the S2 segment, one TTS fixation in the S2 segment, one OSS fixation in the S1 and S2 segments, one OSS fixation in the S1 segment and one TSS fixation in the S2 segment, one OSS fixation in the S1 segment and one TTS fixation in the S2 segment. Then, finite element analysis (FEA) was performed. Twelve dysplastic sacrum patients with pelvis fracture or sacroiliac dislocation underwent OSS insertion in the S1 combined with TTS insertion in the S2 under the assistance of the patient-specific locked navigation template. Grading and Matta scores were evaluated after surgery. RESULTS In the one-screw fixation group, the vertical displacements of the sacrum surface of S2 OSS, S2 TSS and S2 TTS were 1.23, 1.42, and 1.22 mm, respectively, and the maximum stress of screw were 139.45 MPa, 144.81 MPa, 126.14 MPa, respectively. In the two-screw fixation group, the vertical displacements of the sacrum surface of the S1 OSS + S2 OSS, S1 OSS + S2 TSS and S1 OSS + S2 TTS were 0.91, 1.06, and 0.75 mm, respectively, and the maximum stress of screw were 149.26 MPa, 167.13 Pa, 136.76 MPa, respectively. Clinically, a total of 12 TTS and OSS were inserted under the assistance of navigation templates, with a surgical time of 55 ± 7.69 min, bleeding of 57.5 ± 18.15 ml and radiation times of 14.5 ± 4.95. One of the TTS and one of the OSS were grade 1, and the other screws were grade 0. The Matta scores of nine patients were excellent, and three patents were good. CONCLUSION OSS in the S1 combined with TTS in the S2 had the best mechanical stability in six models, and it is safe for screw insertion assisted by the patient-specific locked navigation template.
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Affiliation(s)
- Chao Wu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Baifang Zeng
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Department of OrthopaedicsAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Jiayan Deng
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Binwei Qin
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Department of OrthopaedicsAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Danwei Shen
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Xiangyu Wang
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
| | - Haigang Hu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
| | - Li Huang
- Operation CenterZigong Fourth People's HospitalZigongChina
| | - Xin Liu
- Health Management CenterZigong Fourth People's HospitalZigongChina
| | - Guigang Qiu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
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Different Lengths of Percutaneous Transverse Iliosacral Screw in Geometric Osseous Fixation Pathway: A Finite-Element Analysis. Indian J Orthop 2022; 56:1354-1362. [PMID: 35923306 PMCID: PMC9283617 DOI: 10.1007/s43465-022-00656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the biomechanical performances of the sacroiliac screw fixation of the first sacral vertebra with different lengths of screws using the Finite-Element Method. METHODS First, pelvic CT images were generated from a healthy volunteer, and multislice sagittal views were produced to determine the axis for the first sacral vertebra geometric osseous fixation pathway (GOFP). Subsequently, according to the geometric size and mechanical parameters of the iliosacral screw, the screw models with the same diameter of 7.3 mm and different lengths of 80 mm, 90 mm, 100 mm, 110 mm, 120 mm, 130 mm and 140 mm were built. Then the seven screws were assembled with the pelvic model. The maximum von Mises stress and the shape variables were evaluated for the pelvis and the screws. RESULTS Results are shown for the pelvic and GOFP screw, respectively. The simulation results show that the maximum von Mises stress in the cortex of the pelvic ring of the pelvis with the 130-mm length screw is the lowest among the pelvic models with different screws. Moreover, the peak displacement of the pelvis with the 130-mm length screw is the smallest. These results indicate that under the standing condition, a 130-mm length screw can decrease the stress concentration and result in a more effective transfer of stress within the reconstructed pelvis. In addition, the displacement of the screw with a 130-mm length is the smallest among all the considered screws. The peak von Mises stresses in the 130-mm length screw and the cortex are still within a low and elastic range below the yielding strengths of the materials. CONCLUSION Through the finite element analysis, the GOFP can be used as a safe and effective way for iliosacral screw fixation. The optimal length of the screw may be 130 mm length.
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Applicable safety analysis and biomechanical study of iliosacral triangular osteosynthesis. BMC Musculoskelet Disord 2021; 22:971. [PMID: 34814887 PMCID: PMC8609831 DOI: 10.1186/s12891-021-04856-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the applicable safety and biomechanical stability of iliosacral triangular osteosynthesis (ITO) through 3D modeling and finite element (FE) analysis. METHODS Pelvic CT imaging data from 100 cases were imported into Mimics software for the construction of 3D pelvic models. The S2-alar-iliac (S2AI) screws and S2 sacroiliac screws were placed in the S2 segment with optimal distribution and their compatibility rate on the S2 safe channel was observed and analyzed. In the FE model, the posterior pelvic ring was fixed with two transsacral screws (TTS), triangular osteosynthesis (TO) and ITO, respectively. Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending, and left twisting, respectively. The relative displacement and change in relative displacement of the three fixing methods were recorded and analyzed. RESULTS The theoretical compatibility rate of S2AI screw and S2 sacroiliac screw in S2 segment was 94%, of which 100% were in males and 88% in females. In the FE model, in terms of overall relative displacement, TTS group showed the smallest relative displacement, the ITO group showed the second smallest, and the TO group the largest relative displacement. The change in relative displacement of the TTS group displayed the smaller fluctuations in motion. The change in relative displacement of the TO group under right bending and left twisting displayed larger fluctuations, while the ITO group under flexion displayed larger fluctuations. CONCLUSIONS The simultaneous placement of S2AI screw and S2 sacroiliac screw in the S2 segment is theoretically safe. Although the biomechanical stability of ITO is slightly lower than TTS, it is better than TO, and can be used as a new method for the treatment of posterior pelvic ring injuries.
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Zheng J, Feng X, Xiang J, Liu F, Leung FKL, Chen B. S2-alar-iliac screw and S1 pedicle screw fixation for the treatment of non-osteoporotic sacral fractures: a finite element study. J Orthop Surg Res 2021; 16:651. [PMID: 34717718 PMCID: PMC8557573 DOI: 10.1186/s13018-021-02805-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics. Methods Denis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed. Results As predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations. Conclusion Compared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02805-8.
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Affiliation(s)
- Jianxiong Zheng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.,Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.,Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Jie Xiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Frankie K L Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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黄 伟, 罗 云, 杨 二. [Application of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:973-977. [PMID: 34387424 PMCID: PMC8403993 DOI: 10.7507/1002-1892.202103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion. METHODS Between January 2017 and May 2020, 11 patients with pelvic fractures complicated with severe Morel-Lavallée lesions were treated with channel screw combined with skin-stretching technique. There were 8 males and 3 females, with an average age of 39.2 years (range, 28-58 years). Causes of injury included traffic accident in 9 cases and falling from hight in 2 cases. The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.7 days). According to the Tile classification, the pelvic fractures were rated as type C1 in 7 cases, type C2 in 3 cases, and type C3 in 1 case. The sites of Morel-Lavallée lesions were buttocks in 8 cases, hips in 2 cases, and thigh in 1 case. There was 1 case of rectal injury, 1 case of splenic rupture, 3 cases of craniocerebral injury, 2 cases of chest injury, 4 cases of spinal fracture, and 6 cases of sacral nerve injury. X-ray films were performed to observe reduction and healing of fracture. The quality of fracture reduction was evaluated by Matta standard at 1 week after operation. Wound healing and complications were observed. Majeed scoring was used to evaluate hip function and Gibbons sacral nerve injury grading was used to evaluate neurological function recovery. RESULTS The patients underwent 4-7 operations, with an average of 5.8 operations. The time of first operation (pelvic fracture fixation, debridement, and skin distractor installation) was 115-275 minutes, with an average of 186.5 minutes. The amount of intraoperative blood loss was 30-80 mL, with an average of 45.5 mL. All patients were followed up 6-12 months, with an average of 8.3 months. The quality of fracture reduction according to the Matta standard was excellent in 7 cases, good in 2 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. All fractures healed at 3-6 months after operation, with an average of 4.5 months. At last follow-up, the hip functions were excellent in 7 cases and good in 4 cases according to Majeed scoring, with an excellent and good rate of 100%. Among the 6 patients complicated with sacral nerve injury, the Gibbons sacral nerve injury grading reached gradeⅠ for 4 cases, gradeⅡ for 1 case, and grade Ⅲ for 1 case. The wounds of 9 cases were sutured directly after skin-stretching treatment for 25-32 days, with an average of 28 days. The dermal edge necrosis occurred in 1 case, and the defect was repaired by free skin grafting. The skin superficial dry necrosis of the wound occurred in 1 case, and healed by dressing change. CONCLUSION In the treatment of pelvic fracture complicated with severe Morel-Lavallée lesion, the channel screw and skin-stretching technique showed their own advantages, which can obtain early fracture fixation and good wound healing.
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Affiliation(s)
- 伟 黄
- 黄冈市中心医院骨科(湖北黄冈 438000)Department of Orthopedics, Huanggang Central Hospital, Huanggang Hubei, 438000, P.R.China
| | - 云蔓 罗
- 黄冈市中心医院骨科(湖北黄冈 438000)Department of Orthopedics, Huanggang Central Hospital, Huanggang Hubei, 438000, P.R.China
| | - 二平 杨
- 黄冈市中心医院骨科(湖北黄冈 438000)Department of Orthopedics, Huanggang Central Hospital, Huanggang Hubei, 438000, P.R.China
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Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2020; 47:37-45. [PMID: 33104870 PMCID: PMC7851100 DOI: 10.1007/s00068-020-01498-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
Purpose Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. Methods 53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature. Results Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6–90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55–99). Conclusion We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.
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Kim CH, Kim JW. Plate versus sacroiliac screw fixation for treating posterior pelvic ring fracture: a Systematic review and meta-analysis. Injury 2020; 51:2259-2266. [PMID: 32646648 DOI: 10.1016/j.injury.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether plate fixation or sacroiliac (SI) screw fixation is the better treatment for posterior pelvic ring disruption is controversial. The aim of this systematic review and meta-analysis was to compare the two fixation methods. MATERIAL AND METHODS The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies comparing plate and SI screw fixations in posterior pelvic ring injuries. Intraoperative variables, postoperative complications, and clinical/radiological scores were compared between the techniques. RESULTS Eleven studies were included in the qualitative synthesis, and nine in the meta-analysis. The meta-analysis included 202 patients who underwent plate fixation and 258 patients who underwent SI screw fixation. The incision length and mean blood loss were greater in the plate group than in the SI screw group (standard mean difference (SMD) = 7.29, 95% confidence interval (CI): 3.18-11.40; SMD = 5.09, 95% CI: 2.08-8.09, respectively). Patients in the SI screw group had more X-ray exposure than those in the plate group (SMD = -5.96, 95% CI: -7.95-3.97). There were no differences in operation time and intraoperative complications (SMD = -1.42, 95% CI: -3.90-1.05; OR = 0.92, 95% CI: 0.05-18.60, respectively). The duration of hospital stay was longer in the plate group (SMD = 2.21, 95% CI: 1.74-2.68). There were no differences in postoperative neurological complications, infection rate, and nonunion rate (OR = 1.62, 95% CI: 0.20-13.21; OR = 2.10, 95% CI: 0.74-5.94; OR = 1.12, 95% CI: 0.26-4.87, respectively), but implant loosening was more common in the SI screw group (OR = 0.18, 95% CI: 0.04-0.87). There was no difference in revision surgery (OR = 0.23, 95% CI: 0.02-2.14). The total excellent rating according to the postoperative Majeed functional and Matta scores was higher in the SI screw group (OR = 0.43, 95% CI: 0.20-0.91; OR = 0.24, 95% CI: 0.08-0.74, respectively). CONCLUSIONS SI screw fixation was superior to plate fixation in the functional and radiological scores, but implant loosening was more common for the treatment posterior pelvic ring injuries.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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