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Xing K, Tan G, Ying L, Ye H, Xing T, Chen L, Yang F, Liang T, Gu L, Xie X, Wang R, Zhang Q, Chen W, Zhang Y, Wu L. Digital smart internal fixation surgery for coronal process basal fracture with normal joint spaces or radius-shortening: Occult factor of radius-ulna load sharing. Ann Anat 2024; 254:152267. [PMID: 38649115 DOI: 10.1016/j.aanat.2024.152267] [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: 01/28/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Reasonable postoperative humeroradial and humeroulnar joint spaces maybe an important indicator in biomechanical stability of smart internal fixation surgery for coronoid process basal fractures (CPBF). The aim of this study is to compare elbow articular stresses and elbow-forearm stability under smart internal fixations for the CPBF between normal elbow joint spaces and radius-shortening, and to determine the occult factor of radius-ulna load sharing. METHODS CT images of 70 volunteers with intact elbow joints were retrospectively collected for accurate three-dimensional reconstruction to measure the longitudinal and transverse joint spaces. Two groups of ten finite element (FE) models were established prospectively between normal joint space and radius-shortening with 2.0 mm, including intact elbow joint and forearm, elbow-forearm with CPBF trauma, anterior or posterior double screws-cancellous bone fixation, mini-plate-cancellous bone fixation. Three sets of physiological loads (compression, valgus, varus) were used for FE intelligent calculation, FE model verification, and biomechanical and motion analysis. RESULTS The stress distribution between coronoid process and radial head, compression displacements and valgus angles of elbow-forearm in the three smart fixation models of the normal joint spaces were close to those of corresponding intact elbow model, but were significantly different from those of preoperative CPBF models and fixed radius-shortening models. The maximum stresses of three smart fixation instrument models of normal joint spaces were significantly smaller than those of the corresponding fixed radius-shortening models. CONCLUSIONS On the basis of the existing trauma of the elbow-forearm system in clinical practice, which is a dominant factor affecting radius-ulna load sharing, the elbow joint longitudinal space has been found to be the occult factor affecting radius-ulna load sharing. The stability and load sharing of radius and ulna after three kinds of smart fixations of the CPBF is not only related to the anatomical and biomechanical stability principles of smart internal fixations, but also closely related to postoperative elbow joint longitudinal space.
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Affiliation(s)
- Kaiyan Xing
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Guirong Tan
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Linshuo Ying
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Hao Ye
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Tingyang Xing
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Lei Chen
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Fangjia Yang
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Tianjie Liang
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Lingzhi Gu
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Xin Xie
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Renbo Wang
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China
| | - Qi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, China; NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, China; NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, China; NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
| | - Lijun Wu
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou 325035, China.
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Wu H, Chen X, Kong L, Liu P. Mechanical and Biological Properties of Titanium and Its Alloys for Oral Implant with Preparation Techniques: A Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6860. [PMID: 37959457 PMCID: PMC10649385 DOI: 10.3390/ma16216860] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
Dental implants have revolutionised restorative dentistry, offering patients a natural-looking and durable solution to replace missing or severely damaged teeth. Titanium and its alloys have emerged as the gold standard among the various materials available due to their exceptional properties. One of the critical advantages of titanium and its alloys is their remarkable biocompatibility which ensures minimal adverse reactions within the human body. Furthermore, they exhibit outstanding corrosion resistance ensuring the longevity of the implant. Their mechanical properties, including hardness, tensile strength, yield strength, and fatigue strength, align perfectly with the demanding requirements of dental implants, guaranteeing the restoration's functionality and durability. This narrative review aims to provide a comprehensive understanding of the manufacturing techniques employed for titanium and its alloy dental implants while shedding light on their intrinsic properties. It also presents crucial proof-of-concept examples, offering tangible evidence of these materials' effectiveness in clinical applications. However, despite their numerous advantages, certain limitations still exist necessitating ongoing research and development efforts. This review will briefly touch upon these restrictions and explore the evolving trends likely to shape the future of titanium and its alloy dental implants.
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Affiliation(s)
| | | | | | - Ping Liu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China; (H.W.); (X.C.); (L.K.)
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Wang C, Liu SJ, Chang CH. Thickness of simple calcaneal tuberosity avulsion fractures influences the optimal fixation method employed. Bone Joint Res 2023; 12:504-511. [PMID: 37607719 PMCID: PMC10444534 DOI: 10.1302/2046-3758.128.bjr-2023-0060.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Aims This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model. Methods A total of 36 porcine calcanea were sawed to create simple avulsion fractures with three different fragment thicknesses (5, 10, and 15 mm). They were randomly fixed with either two suture anchors or one headless screw. Load-to-failure and cyclic loading tension tests were performed for the biomechanical analysis. Results This biomechanical study predicts that headless screw fixation is a better option if fragment thickness is over 15 mm in terms of the comparable peak failure load to suture anchor fixation (headless screw: 432.55 N (SD 62.25); suture anchor: 446.58 N (SD 84.97)), and less fracture fragment displacement after cyclic loading (headless screw: 3.94 N (SD 1.76); suture anchor: 8.68 N (SD 1.84)). Given that the fragment thickness is less than 10 mm, suture anchor fixation is a safer option. Conclusion Fracture fragment thickness helps in making the decision of either using headless screw or suture anchor fixation in treating calcaneal tuberosity avulsion fracture, based on the regression models of our study.
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Affiliation(s)
- Chunliang Wang
- Material Department, Imperial College London, London, UK
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Hsun Chang
- Orthopaedic Department, National Taiwan University Hospital, Taipei City, Taiwan
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Salunke P, Karthigeyan M, Uniyal P, Mishra K, Gupta T, Kumar N. A Novel Pedicle Screw Design with Variable Thread Geometry: Biomechanical Cadaveric Study with Finite Element Analysis. World Neurosurg 2023; 172:e144-e150. [PMID: 36587893 DOI: 10.1016/j.wneu.2022.12.120] [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: 10/20/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pedicle screw fixation provides one of the most stable spinal constructs. Their designs together with osseous characteristics have been known to influence the screw-bone interplay during surgical maneuvers and thereafter the fusion process. Various technical modifications to enhance screw performance have been suggested. This study evaluated the pull-out strength and axial stiffness of a novel pedicle screw design with variable thread geometry and pitch. METHODS The newly designed triple threaded pedicle screw is tapered, and has unique out-turned flanges to hold the cancellous bone and a finer pitch at its distal and proximal end to engage the cortical bone. Five lumbar and 4 lower thoracic cadaveric vertebrae were divided into hemivertebrae. A standard cancellous pedicle screw and the newly designed pedicle screw were inserted into each hemivertebra. Axial stiffness and peak pull-out force between the screw types were compared; a finite element analysis was also performed to additionally compare the pull out under toggle forces. RESULTS In cadaveric study, the axial stiffness of the new screw was significantly better than that of the standard screw. However, the peak load between the screws was not statistically different. Finite element analyses suggested lesser stress at bone-implant interface for the new screw along with better axial stiffness under both co-axial and toggle forces. CONCLUSIONS Our novel pedicle screw design with variable thread geometry demonstrates greater axial stiffness compared with the standard screws, and therefore is likely to withstand a greater surgical manipulation.
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Affiliation(s)
- Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Piyush Uniyal
- Department of Mechanical Engineering, Indian Institute of Technology (IIT), Ropar, Punjab, India
| | - Keshav Mishra
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology (IIT), Ropar, Punjab, India
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Ye H, Yang Y, Xing T, Tan G, Jin S, Zhao Z, Zhang W, Li Y, Zhang L, Wang J, Zheng R, Lu Y, Wu L. Anatomical and Biomechanical Stability of Single/Double Screw-Cancellous Bone Fixations of Regan-Morry Type III Ulnar Coronoid Fractures in Adults: CT Measurement and Finite Element Analysis. Orthop Surg 2023; 15:1072-1084. [PMID: 36647280 PMCID: PMC10102310 DOI: 10.1111/os.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE At present, it is still uncertain whether single screw has the same stability as double screws in the treatment of ulnar coronal process basal fracture (Regan-Morry type III). So, we aimed to compare the pull-out force and anti-rotation torque of anterior single/double screw-cancellous bone fixation (aSSBF, aDSBF) in this fracture, and further study the influencing factors on anatomical and biomechanical stability of smart screw internal fixations. METHODS A total of 63 adult volunteers with no history of elbow injury underwent elbow CT scanning with associated three-dimensional reconstruction that enabled the measurements of bone density and fixed length of the proximal ulna and coronoid. The models of coronal process basal fracture, aSSBF and aDSBF, were developed and validated. Using the finite element model test, the sensitivity analysis of pull-out force and rotational torque was carried out. RESULTS The pull-out force of aSSBF model was positively correlated with the density of the cancellous bone and linearly related to the fixed depth of the screw. The load pattern of pull-out force of aDSBF model was similar to that of aSSBF model. The ultimate torque of aDSBF model was higher than that of aSSBF model, but the load pattern of ultimate torque of both models was similar to each other when the fracture reset was satisfactory, and the screw nut attaches closely to coronoid process. Moreover, with enhancement of initial pre-tightening force, the increase of ultimate torque of both models was small. CONCLUSIONS In addition to three pull-out stability factors of smart screw fixations, fracture surface fitting degree and nut fitting degree are the other two important anatomical and biomechanical stability factors of smart screw fixations both for rotational stability. When all pull-out stability and rotational stability factors meet reasonable conditions simultaneously, single or double screw fixation methods are stable for the treatments of ulnar coronoid basal fractures.
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Affiliation(s)
- Hao Ye
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Yongchao Yang
- Department of Orthopedics, Tianjin Teda Hospital, Tianjin, China
| | - Tingyang Xing
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Guirong Tan
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Shuxun Jin
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Zhichao Zhao
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Weikang Zhang
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Yanyan Li
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Lei Zhang
- Department of Orthopedics, The Third Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jianshun Wang
- Department of Orthopedics, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rongmei Zheng
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
| | - Yun Lu
- Department of Orthopedics, Tianjin Teda Hospital, Tianjin, China
| | - Lijun Wu
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, China
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Feng X, Zhang S, Luo Z, Liang H, Chen B, Leung F. Development and initial validation of a novel thread design for nonlocking cancellous screws. J Orthop Res 2022; 40:2813-2821. [PMID: 35267202 DOI: 10.1002/jor.25305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
High failure rates have been associated with nonlocking cancellous screws with a typical buttress thread in patients with osteoporotic bone. This study aimed to develop a novel thread design and compare its fixation stability with that of a typical buttress thread. Nonlocking cancellous screws with a novel thread design (proximal flank angle of 120 degrees, a flat crest feature, a tip-facing undercut feature) and nonlocking cancellous screws with a typical buttress thread were manufactured using stainless steel. Fixation stabilities were evaluated individually by the axial pullout and lateral migration tests, and they were evaluated in pairs together with a dynamic compression plate in an osteoporotic bone substitute (10 PCF polyurethane foam per ASTM F1839) under cyclic craniocaudal and torsional loadings. Pullout strength and lateral migration resistance for the individual screw test and the force, torque, and number of cycles required to achieve specific displacement and torsion for the multi-screw test were comparatively analyzed between both screw types. A finite element analysis model was constructed to analyze the stress distributions in the bone tissue adjacent to the threads. The biomechanical test revealed the novel undercut thread had superior axial pullout strength, lateral migration resistance, and superior fixation stability when applied to a dynamic compression plate under cyclic craniocaudal loading and torsional loading than those in the typical buttress thread. The finite element analysis simulation revealed that the novel thread can distribute stress more evenly without high-stress concentration at the adjacent bone tissue when compared to that of a typical buttress thread.
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Affiliation(s)
- Xiaoreng Feng
- Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China.,Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Guangzhou, China
| | - Sheng Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Guangzhou, China
| | - Zhaopei Luo
- Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Hongfeng Liang
- Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Guangzhou, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Liu F, Feng X, Zheng J, Leung F, Chen B. Biomechanical comparison of the undercut thread design versus conventional buttress thread for the lag screw of the dynamic hip screw system. Front Bioeng Biotechnol 2022; 10:1019172. [PMID: 36394045 PMCID: PMC9649579 DOI: 10.3389/fbioe.2022.1019172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/17/2022] [Indexed: 09/19/2023] Open
Abstract
Objective: To compare the fixation stability of the lag screw with a undercut thread design for the dynamic hip screw (DHS) system versus the lag screw with the conventional buttress thread. Methods: The lag screws with the undercut thread (a flat crest feature, a tip-facing undercut feature) and buttress thread were both manufactured. Fixation stability was investigated using cyclic compressive biomechanical testing on custom osteoporotic femoral head sawbone. The forces required for the same vertical displacement in the two types of lag screw were collected to evaluate the resistance to migration. Varus angle was measured on X-ray images to assess the ability in preventing varus collapse. Finite element analysis (FEA) was performed to analyze the stress and strain distribution at the bone-screw interface of the two types of lag screws. Results: The biomechanical test demonstrated that the force required to achieve the same vertical displacement of the lag screw with the undercut thread was significantly larger than the lag screw with conventional buttress thread (p < 0.05). The average varus angles generated by the undercut and buttress threads were 3.38 ± 0.51° and 5.76 ± 0.38°, respectively (p < 0.05). The FEA revealed that the region of high-stress concentration in the bone surrounding the undercut thread was smaller than that surrounding the buttress thread. Conclusion: The proposed DHS system lag screw with the undercut thread had higher migration resistance and superior fixation stability than the lag screw with the conventional buttress thread.
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Affiliation(s)
- Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopaedics and Traumatology, Yangjiang People’s Hospital, Yangjiang, China
| | - Jianxiong Zheng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Feng X, Qi W, Zhang T, Fang C, Liang H, Chen B, Leung F. Lateral migration resistance of screw is essential in evaluating bone screw stability of plate fixation. Sci Rep 2021; 11:12510. [PMID: 34131183 PMCID: PMC8206340 DOI: 10.1038/s41598-021-91952-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/31/2021] [Indexed: 11/09/2022] Open
Abstract
Conventional evaluation of the stability of bone screws focuses on pullout strength, while neglecting lateral migration resistance. We measured pullout strength and lateral migration resistance of bone screws and determined how these characteristics relate to screw stability of locking plate (LP) and dynamic compression plate (DCP) fixation. Pullout strength and lateral migration resistance of individual bone screws with buttress, square, and triangular thread designs were evaluated in polyurethane foam blocks. The screw types with superior performance in each of these characteristics were selected. LP and DCP fixations were constructed using the selected screws and tested under cyclic craniocaudal and torsional loadings. Subsequently, the association between individual screws’ biomechanical characteristics and fixation stability when applied to plates was established. Screws with triangular threads had superior pullout strength, while screws with square threads demonstrated the highest lateral migration resistance; they were selected for LP and DCP fixations. LPs with square-threaded screws required a larger force and more cycles to trigger the same amount of displacement under both craniocaudal and torsional loadings. Screws with triangular and square threads showed no difference in DCP fixation stability under craniocaudal loading. However, under torsional loading, DCP fixation with triangular-threaded screws demonstrated superior fixation stability. Lateral migration resistance is the primary contributor to locking screw fixation stability when applied to an LP in resisting both craniocaudal and torsional loading. For compression screws applied to a DCP, lateral migration resistance and pullout strength work together to resist craniocaudal loading, while pullout strength is the primary contributor to the ability to resist torsional loading.
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Affiliation(s)
- Xiaoreng Feng
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pok Fu Lam, Hong Kong, SAR, China.,Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.,Yangjiang People's Hospital, Yangjiang, 529500, China
| | - Weichen Qi
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pok Fu Lam, Hong Kong, SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pok Fu Lam, Hong Kong, SAR, China
| | - Christian Fang
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pok Fu Lam, Hong Kong, SAR, China
| | | | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pok Fu Lam, Hong Kong, SAR, China.
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