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Fritz T, Orth M, Hopp SJ, Briem J, Hahner J, Osche D, Pohlemann T, Pizanis A. A novel minimally invasive and press-fit method for symphysiodesis - a biomechanical analysis. J Exp Orthop 2023; 10:98. [PMID: 37768379 PMCID: PMC10539247 DOI: 10.1186/s40634-023-00660-6] [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: 05/29/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Does the cylindrical shaped bone block allow a stable construct for the arthrodesis of the pubic symphysis compared to a rectangular shaped bone block. The cylindrical shaped bone block stabilized by a 3.5 symphyseal plate is inferior to the stabilization with an internal fixator. METHODS This study analyzed the arthrodesis of the pubic symphysis on 24 synthetic pelvises, using a rectangular shaped bone block (control group) or a cylindrical shaped bone block, stabilized with a symphysis locking plate (n = 8) as the standard clinical procedure. Additionally we analyzed the stability using an internal fixator. RESULTS This study showed that utilizing a cylindrical shaped synthetic bone graft results in a significant higher contact area and compression force compared to the classical rectangular shaped graft. Furthermore, the stabilization with an internal fixator had the tendency for increases of compression force and contact area, yet without a statistical significance, when compared to the plate fixation. CONCLUSION The novel method of cylindrical symphysis resection and cylindrical bone block implantation allowed an increased biomechanical stability compared to using a classical rectangular bone graft, also resulting in higher contact area. Moreover, this technique would also allow a minimally invasive approach for this purpose, which in turn could preserve perisymphyseal ligaments, thereby improving healing in a clinical context.
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Affiliation(s)
- Tobias Fritz
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany.
| | - Marcel Orth
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
| | - Sascha J Hopp
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
- Lutrina Hospital, Kaiserslautern, Brüsseler Str. 7, 67655, Kaiserslautern, Germany
| | - Jeremy Briem
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Jill Hahner
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
| | - David Osche
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
| | - Tim Pohlemann
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
| | - Antonius Pizanis
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, Homburg, Saarland, 66421, Germany
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A novel internal fixation method for open book injuries of the pubic symphysis- A biomechanical analysis. Clin Biomech (Bristol, Avon) 2020; 77:105009. [PMID: 32454345 DOI: 10.1016/j.clinbiomech.2020.105009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic fractures in adults are common injuries and account for up to 3.64% of all fractures. Usually, the treatment of open book injuries (Types B1.1 and B1.2 AO-Classification) is open reduction and plate stabilization using dynamic compression plates, with or without interlocking screws. These implants seem to enhance the outcome of such injuries, but also variety of complications occurs. To reduce complications and achieve appropriate reduction and stabilization, this study compared established stabilization techniques to a novel minimally invasive internal fixation method using an internal fixator system that is already being utilized for spinal fractures. METHODS This study was performed on 32 composite pelvises in a bilateral stance biomechanical model. The pelvises were variously stabilized with an internal fixator, a 4.5 mm dynamic compression plate and a 3.5 mm symphyseal locking dynamic compression plate. The contact area and loading forces were assessed by a sensor film inside the symphyseal gap. FINDINGS This study showed significantly greater reduction and loading capabilities of the internal fixator compared to the other implants (p < 0.05). There was also significantly greater contact area with the use of an internal fixator compared to the other implants (p < 0.05). The 3.5 mm interlocking plate showed significantly greater contact area compared to the 4.5 mm plate (p < 0.05). INTERPRETATION The internal fixator that is already proven in spinal surgery is biomechanically superior to conventional implants used in pelvic surgery. The contact area analysis furthermore showed a more physiological loading pattern, which can improve ligamentous healing in a clinical context.
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Kasapovic A, Bornemann R, Pflugmacher R, Rommelspacher Y. Implants for Vertebral Body Replacement - Which Systems are Available and Have Become Established. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:83-90. [PMID: 31671459 DOI: 10.1055/a-1017-3968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since the first vertebral body replacement operations over 50 years ago until now, there were developed numerous methods and implants. Vertebral body replacement after corpectomy nowadays is a standard procedure in spinal surgery. At the beginning mainly bone grafts were used. Due to continuous development, PMMA and titanium implants were developed. Nowadays various expandable and non-expandable implants are available. Numerous implants can still be justified. The question arises which methods and systems are on the market and which ones have proven themselves? This article describes and compares the advantages and disadvantages of each implant type.
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Affiliation(s)
- Adnan Kasapovic
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
| | - Rahel Bornemann
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
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Wang YL, Wang XY. Improved Bone Graft Method for Upper Cervical Surgery with Posterior Approach: Technical Description and Report of 52 Cases. World Neurosurg 2018; 114:e66-e69. [PMID: 29476998 DOI: 10.1016/j.wneu.2018.02.067] [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: 06/05/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to report a minimum 12 months' follow-up results of our improved bone graft method for upper cervical surgery with the posterior approach. METHODS Among 52 consecutive cases, odontoid nonunion occurred in 33 patients, atlantoaxial instability in 11 patients, and occipitocervical deformity in 8 patients who underwent posterior C1-C2 transarticular screw/screw-rod internal fixation (41 cases) and occipitocervical fusion (11 cases) with the improved bone graft technique. Each surgical procedure was performed by the same senior spine surgeon. We took lateral cervical standing roentgenograms before surgery and immediately after surgery. Then we conducted craniocerebral computed tomography examination with reconstruction at 3, 6, 12, and 24 months and annually thereafter. The postoperative follow-up times are about 12-38 months. RESULTS All cases showed satisfactory screw fixation by radiographic examination, and there were no postoperative neurologic complications. One case had postoperative retropharyngeal infection after the transoral release and posterior reduction by pedicle screw instrumentation. All patients got solid fusions, and no pseudarthrosis occurred. All cases had solid fusions at the 3-month follow-up. CONCLUSION Good bone graft bed, enough bone graft material, solid local fixation, and effective bone graft method are prerequisites for a successful bone graft. By analyzing postoperative follow-up in the consecutive cases in this study, our bone graft method describing a new bone graft structure is a reliable posterior fusion technique. It is worth considering, and further research is needed.
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Affiliation(s)
- Yong-Li Wang
- Department of Orthopaedic Surgery, Huzhou Central Hospital, Huzhou, China
| | - Xiang-Yang Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Wang L, Kang J, Shi L, Fu J, Li D, Guo Z, Liu C, Dong S, Jiang X. Investigation into factors affecting the mechanical behaviours of a patient-specific vertebral body replacement. Proc Inst Mech Eng H 2018; 232:378-387. [PMID: 29383959 DOI: 10.1177/0954411918754926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most vertebral body implants that are currently designed and produced in batches have difficulty meeting the patient-specific demands. Moreover, several complications, including a low fusion rate, subsidence occurrence, and rod displacement, are associated with these implants. This study aims to investigate the effects of patient-specific geometric and clinical parameters on the biomechanics of a vertebral body replacement. A three-dimensional patient-specific vertebral body replacement model was established as the basic model for parametric studies, including the anatomic design of the endplates, tilting angle, thickness, and dislocation of the vertebral body implant. A finite element analysis was applied to determine the stress distribution of the vertebral body implant when under various loading conditions. The model with an anatomical interfacing design generates 75% less stress concentration compared to a flat design; the peak stress of the model with a tilted angle closely matching the replaced vertebra segment is decreased by 30%; and the thickness close to the cortical bone can offer better bone growth capability and long-term stability. Patient-specific geometrical parameters were found to significantly affect the biomechanics of a vertebral body replacement, and therefore, a design customized especially for the endplates is necessary for better stability and long-term longevity of the prostheses. Regardless of such progress, how to balance the stability of a vertebral body implant and the safety of the peripheral nervous system remains a clinical challenge.
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Affiliation(s)
- Ling Wang
- State Key Laboratory for Manufacturing System Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Jianfeng Kang
- State Key Laboratory for Manufacturing System Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Lei Shi
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jun Fu
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zheng Guo
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chaozong Liu
- John Scale Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shuangpeng Dong
- Tianjin Medical Device Supervision and Testing Center, Tianjin, China
| | - Xi Jiang
- Tianjin Medical Device Supervision and Testing Center, Tianjin, China
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Romanos GE, Delgado-Ruiz RA, Gómez-Moreno G, López-López PJ, Mate Sanchez de Val JE, Calvo-Guirado JL. Role of mechanical compression on bone regeneration around a particulate bone graft material: an experimental study in rabbit calvaria. Clin Oral Implants Res 2015; 29:612-619. [DOI: 10.1111/clr.12592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Georgios E. Romanos
- Department of Periodontology; Stony Brook University; School of Dental Medicine; Stony Brook NY USA
| | - Rafael A. Delgado-Ruiz
- Department of Prosthodontics and Digital Technology; Stony Brook University; School of Dental Medicine; Stony Brook New York USA
| | - Gerardo Gómez-Moreno
- Department of Pharmacological Research in Dentistry, Periodontology and Implant Dentistry; Special Care in Dentistry; Faculty of Dentistry; University of Granada; Granada Spain
| | - Patricia J. López-López
- Department of General and Implant Dentistry; Faculty of Medicine and Dentistry; University of Murcia; Murcia Spain
| | | | - Jose Luis Calvo-Guirado
- Department of Implant Dentistry; Faculty of Medicine and Dentistry; University of Murcia; Murcia Spain
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