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Hetreau C, Mischler D, Schlatter J, Valenti A, Ernst M, Varga P, Schwarzenberg P. Longitudinal CT-based finite element analyses provide objective fracture healing measures in an ovine tibia model. J Orthop Res 2024; 42:1762-1770. [PMID: 38483000 DOI: 10.1002/jor.25838] [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: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 07/04/2024]
Abstract
Measuring the healing status of a bone fracture is important to determine the clinical care a patient receives. Implantable devices can directly and continuously assess the healing status of fracture fixation constructs, while subject-specific virtual biomechanical tests can noninvasively determine callus structural integrity at single time points. Despite their potential for objectification, both methods are not yet integrated into clinical practice with further evidence of their benefits required. This study correlated continuous data from an implantable sensor assessing healing status through implant load monitoring with computer tomography (CT) based longitudinal finite element (FE) simulations in a large animal model. Eight sheep were part of a previous preclinical study utilizing a tibial osteotomy model and equipped with such a sensor. Sensor signal was collected over several months, and CT scans were acquired at six interim time points. For each scan, two FE analyses were performed: a virtual torsional rigidity test of the bone and a model of the bone-implant construct with the sensor. The longitudinal simulation results were compared to the sensor data at corresponding time points and a cohort-specific empirical healing rule was employed. Healing status predicted by both in silico simulations correlated significantly with the sensor data at corresponding time points and correctly identified a delayed and a nonunion in the cohort. The methodology is readily translatable with the potential to be applied to further preclinical or clinical cohorts to find generalizable healing criteria. Virtual mechanical tests can objectively measure fracture healing progressing using longitudinal CT scans.
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Affiliation(s)
| | | | | | | | | | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Milan JL, Manifacier I, Rousseau N, Pithioux M. In silico modelling of long bone healing involving osteoconduction and mechanical stimulation. Comput Methods Biomech Biomed Engin 2023; 26:174-186. [PMID: 35312400 DOI: 10.1080/10255842.2022.2052051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A lot of evidence has shown the importance of stimulating cell mechanically during bone repair. In this study, we modeled the challenging fracture healing of a large bone defect in tibial diaphysis. To fill the fracture gap, we considered the implantation of a porous osteoconductive biomaterial made of poly-lactic acid wrapped by a hydrogel membrane mimicking osteogenic properties of the periosteum. We identified the optimal loading case that best promotes the formation and differentiation into bone tissue. Our results support the idea that a patient's rehabilitation program should be adapted to reproduce optimal mechanical stimulations.
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Affiliation(s)
- Jean-Louis Milan
- Aix Marseille University, CNRS, ISM, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Institute of Movement Science (ISM), Sainte Marguerite Hospital, IML, Department of Orthopedics and Traumatology, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Anatomic laboratory, Timone, Marseille, France.,Aix Marseille University, Mecabio Platform, French National Center for Scientific Research (CNRS), Marseille, France
| | - Ian Manifacier
- Aix Marseille University, CNRS, ISM, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Institute of Movement Science (ISM), Sainte Marguerite Hospital, IML, Department of Orthopedics and Traumatology, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Anatomic laboratory, Timone, Marseille, France.,Aix Marseille University, Mecabio Platform, French National Center for Scientific Research (CNRS), Marseille, France
| | - Nicolas Rousseau
- Aix Marseille University, CNRS, ISM, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Institute of Movement Science (ISM), Sainte Marguerite Hospital, IML, Department of Orthopedics and Traumatology, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Anatomic laboratory, Timone, Marseille, France.,Aix Marseille University, Mecabio Platform, French National Center for Scientific Research (CNRS), Marseille, France.,Selenium Medical, La Rochelle, France
| | - Martine Pithioux
- Aix Marseille University, CNRS, ISM, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Institute of Movement Science (ISM), Sainte Marguerite Hospital, IML, Department of Orthopedics and Traumatology, Marseille, France.,Aix Marseille University, Marseille Public University Hospital System (APHM), French National Center for Scientific Research (CNRS), Anatomic laboratory, Timone, Marseille, France.,Aix Marseille University, Mecabio Platform, French National Center for Scientific Research (CNRS), Marseille, France
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Marcucio R, Miclau T, Bahney C. A Shifting Paradigm: Transformation of Cartilage to Bone during Bone Repair. J Dent Res 2023; 102:13-20. [PMID: 36303415 PMCID: PMC9791286 DOI: 10.1177/00220345221125401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
While formation and regeneration of the skeleton have been studied for a long period of time, significant scientific advances in this field continue to emerge based on an unmet clinical need to improve options to promote bone repair. In this review, we discuss the relationship between mechanisms of bone formation and bone regeneration. Data clearly show that regeneration is not simply a reinduction of the molecular and cellular programs that were used for development. Instead, the mechanical environment exerts a strong influence on the mode of repair, while during development, cell-intrinsic processes drive the mode of skeletal formation. A major advance in the field has shown that cell fate is flexible, rather than terminal, and that chondrocytes are able to differentiate into osteoblasts and other cell types during development and regeneration. This is discussed in a larger context of regeneration in vertebrates as well as the clinical implication that this shift in understanding presents.
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Affiliation(s)
- R.S. Marcucio
- University of California, San Francisco (UCSF), Orthopaedic Trauma Institute, San Francisco, CA, USA
| | - T. Miclau
- University of California, San Francisco (UCSF), Orthopaedic Trauma Institute, San Francisco, CA, USA
| | - C.S. Bahney
- University of California, San Francisco (UCSF), Orthopaedic Trauma Institute, San Francisco, CA, USA
- Steadman Philippon Research Institute, Vail, CO, USA
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