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Bliemel C, Cornelius J, Lehmann V, Oberkircher L, Visser D, Pass B, Ruchholtz S, Bäumlein M. Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1524. [PMID: 39336565 DOI: 10.3390/medicina60091524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/21/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57-91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629-3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257-2834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel.
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Affiliation(s)
- Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
| | - Jakob Cornelius
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
| | - Valerie Lehmann
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
| | - Ludwig Oberkircher
- Philipps-University Marburg, 35037 Marburg, Germany
- Clinic for Trauma and Orthopaedic Surgery and Joint Replacement, Medical Campus Bodensee, 88048 Friedrichshafen, Germany
| | - Denis Visser
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital Essen, 45131 Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Philipps-University Marburg, 35037 Marburg, Germany
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Hollensteiner M, Sandriesser S, Libert J, Spitzer-Vanech L, Baumeister D, Greinwald M, Mühling M, Augat P. Biomechanical validation of novel polyurethane-resin synthetic osteoporotic femoral bones in axial compression, four-point bending and torsion. Med Eng Phys 2024; 130:104210. [PMID: 39160032 DOI: 10.1016/j.medengphy.2024.104210] [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: 12/04/2023] [Revised: 06/08/2024] [Accepted: 07/16/2024] [Indexed: 08/21/2024]
Abstract
In addition to human donor bones, bone models made of synthetic materials are the gold standard substitutes for biomechanical testing of osteosyntheses. However, commercially available artificial bone models are not able to adequately reproduce the mechanical properties of human bone, especially not human osteoporotic bone. To overcome this issue, new types of polyurethane-based synthetic osteoporotic bone models have been developed. Its base materials for the cancellous bone portion and for the cortical portion have already been morphologically and mechanically validated against human bone. Thus, the aim of this study was to combine the two validated base materials for the two bone components to produce femur models with real human geometry, one with a hollow intramedullary canal and one with an intramedullary canal filled with synthetic cancellous bone, and mechanically validate them in comparison to fresh frozen human bone. These custom-made synthetic bone models were fabricated from a computer-tomography data set in a 2-step casting process to achieve not only the real geometry but also realistic cortical thicknesses of the femur. The synthetic bones were tested for axial compression, four-point bending in two planes, and torsion and validated against human osteoporotic bone. The results showed that the mechanical properties of the polyurethane-based synthetic bone models with hollow intramedullary canals are in the range of those of the human osteoporotic femur. Both, the femur models with the hollow and spongy-bone-filled intramedullary canal, showed no substantial differences in bending stiffness and axial compression stiffness compared to human osteoporotic bone. Torsional stiffnesses were slightly higher but within the range of human osteoporotic femurs. Concluding, this study shows that the innovative polyurethane-based femur models are comparable to human bones in terms of bending, axial compression, and torsional stiffness.
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Affiliation(s)
- Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria.
| | - Sabrina Sandriesser
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Jessica Libert
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Faculty of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Badstraße 24, 77652 Offenburg, Germany
| | - Lily Spitzer-Vanech
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Northeastern University, Bioengineering Department, 805 Columbus Avenue, Boston, MA 02120, USA
| | - Dirk Baumeister
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Markus Greinwald
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Mischa Mühling
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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Light JJ, Firoved AB, Rocchi VJ, Wellman LL, Bonner KF. Femoral Fixation Strength as a Function of Bone Plug Length in Anterior Cruciate Ligament Reconstruction Utilizing Interference Screws. J Knee Surg 2024; 37:444-451. [PMID: 37848048 DOI: 10.1055/s-0043-1775983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE To determine femoral construct fixation strength as bone plug length decreases in anterior cruciate ligament reconstruction (ACLR). METHODS Sixty fresh-frozen bone-patellar tendon-bone allografts were utilized and divided into 20-, 15-, and 10-mm length bone plug groups, subdivided further so that half utilized the patella side (P) for testing and half used the tibial side (T). Ten mm diameter recipient tunnels were created within the anatomic anterior cruciate ligament footprint of 60 cadaveric femurs. All bone plugs were 10 mm in diameter; grafts were fixed using a 7 × 23 mm metal interference screw. An Instron was used to determine the load to failure of each group. A one-way multivariate analysis of variance (MANOVA) was conducted to test the hypothesis that there would be one or more mean differences in fixation stability between 20- or 15-mm plug lengths (P or T) versus 10 mm T plug lengths when cross-compared, with no association between other P or T subgroups. RESULTS The mean load to failure of the 20 mm plugs (20 P + T) was 457 ± 66N, 15 mm plugs (15 P + T) was 437 ± 74N, and 10 mm plugs (10 P + T) was 407 ± 107N. There was no significant difference between P + T groups: 20-versus 15-mm (p = 1.000), 15-versus 10-mm (p = 0.798), and 20-versus 10-mm (p = 0.200); P + T MANOVA (p = 0.291). Within groups, there was no significant difference between patella and tibial bone plug subgroups with a pullout force range between 469 ± 56N and 374 ± 116N and p-value ranging from p = 1.000 for longer bone plugs to p = 0.194 for shorter bone plugs; P versus T MANOVA (p = 0.113). CONCLUSION In this human time zero cadaver model, there was no significant difference in construct failure between 20-,15-, and 10-mm bone plugs when fixed with an interference screw within the femoral tunnel, although fixation strength did trend down when from 20- to 15- to 10-mm bone plugs. CLINICAL RELEVANCE There is a balance between optimal bone plug length on the femoral side for achieving adequate fixation as well as minimizing donor site morbidity and facilitating graft passage in ACLR. This study reveals utilizing shorter plugs with interference screw fixation is potentially acceptable on the femoral side if shorter plugs are harvested.
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Affiliation(s)
- Jonathan J Light
- Eastern Virginia Medical School, School of Medicine, Norfolk, Virginia
| | - Amanda B Firoved
- Jordan Young Institute, Orthopaedic Surgery, Sports Medicine, Virginia Beach, Virginia
| | - Vanna J Rocchi
- Eastern Virginia Medical School, School of Medicine, Norfolk, Virginia
- Naval Medicine Center Portsmouth, Orthopaedics, Portsmouth, Virginia
| | - Laurie L Wellman
- Eastern Virginia Medical School, School of Medicine, Norfolk, Virginia
| | - Kevin F Bonner
- Eastern Virginia Medical School, School of Medicine, Norfolk, Virginia
- Jordan Young Institute, Orthopaedic Surgery, Sports Medicine, Virginia Beach, Virginia
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Zdero R, Djuricic A, Schemitsch EH. Mechanical Properties of Synthetic Bones Made by Synbone: A Review. J Biomech Eng 2023; 145:121003. [PMID: 37542709 DOI: 10.1115/1.4063123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Biomechanical engineers and physicists commonly employ biological bone for biomechanics studies, since they are good representations of living bone. Yet, there are challenges to using biological bone, such as cost, degradation, disease, ethics, shipping, sourcing, storage, variability, etc. Therefore, the Synbone® company has developed a series of synthetic bones that have been used by biomechanical investigators to offset some drawbacks of biological bone. There have been a number of published biomechanical reports using these bone surrogates for dental, injury, orthopedic, and other applications. But, there is no prior review paper that has summarized the mechanical properties of these synthetic bones in order to understand their general performance or how well they represent biological bone. Thus, the goal of this article was to survey the English-language literature on the mechanical properties of these synthetic bones. Studies were included if they quantitatively (a) characterized previously unknown values for synthetic bone, (b) validated synthetic versus biological bone, and/or (c) optimized synthetic bone performance by varying geometric or material parameters. This review of data, pros, cons, and future work will hopefully assist biomechanical engineers and physicists that use these synthetic bones as they develop experimental testing regimes and computational models.
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Affiliation(s)
- Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON N6A-5W9, Canada
| | - Aleksandar Djuricic
- Orthopaedic Biomechanics Lab, Victoria Hospital, Room A6-144, 800 Commissioners Road East, London, ON N6A-5W9, Canada
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON N6A-5W9, Canada; Division of Orthopaedic Surgery, Western University, London, ON N6A-5A5, Canada
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Zdero R, Brzozowski P, Schemitsch EH. Biomechanical properties of artificial bones made by Sawbones: A review. Med Eng Phys 2023; 118:104017. [PMID: 37536838 DOI: 10.1016/j.medengphy.2023.104017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
Biomedical engineers and physicists frequently use human or animal bone for orthopaedic biomechanics research because they are excellent approximations of living bone. But, there are drawbacks to biological bone, like degradation over time, ethical concerns, high financial costs, inter-specimen variability, storage requirements, supplier sourcing, transportation rules, etc. Consequently, since the late 1980s, the Sawbones® company has been one of the world's largest suppliers of artificial bones for biomechanical testing that counteract many disadvantages of biological bone. There have been many published reports using these bone analogs for research on joint replacement, bone fracture fixation, spine surgery, etc. But, there exists no prior review paper on these artificial bones that gives a comprehensive and in-depth look at the numerical data of interest to biomedical engineers and physicists. Thus, this paper critically reviews 25 years of English-language studies on the biomechanical properties of these artificial bones that (a) characterized unknown or unreported values, (b) validated them against biological bone, and/or (c) optimized different design parameters. This survey of data, advantages, disadvantages, and knowledge gaps will hopefully be useful to biomedical engineers and physicists in developing mechanical testing protocols and computational finite element models.
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Affiliation(s)
- Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
| | - Pawel Brzozowski
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada
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Adanty K, Bhagavathula KB, Tronchin O, Li DX, Rabey KN, Doschak MR, Adeeb S, Hogan J, Ouellet S, Plaisted TA, Satapathy SS, Romanyk DL, Dennison CR. The Mechanical Characterization and Comparions of Male and Female Calvaria Under Four-Point Bending Impacts. J Biomech Eng 2023; 145:1153590. [PMID: 36511109 DOI: 10.1115/1.4056459] [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: 07/02/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
The circumstances in which we mechanically test and critically assess human calvarium tissue would find relevance under conditions encompassing real-world head impacts. These conditions include, among other variables, impact velocities, and strain rates. Compared to quasi-static loading on calvaria, there is less reporting on the impact loading of the calvaria and consequently, there are relatively fewer mechanical properties on calvaria at relevant impact loading rates available in the literature. The purpose of this work was to report on the mechanical response of 23 human calvarium specimens subjected to dynamic four-point bending impacts. Impacts were performed using a custom-built four-point impact apparatus at impact velocities of 0.86-0.89 m/s resulting in surface strain rates of 2-3/s-representative of strain rates observed in vehicle collisions and blunt impacts. The study revealed comparable effective bending moduli (11-15 GPa) to the limited work reported on the impact mechanics of calvaria in the literature, however, fracture bending stress (10-47 MPa) was relatively less. As expected, surface strains at fracture (0.21-0.25%) were less compared to studies that performed quasi-static bending. Moreover, the study revealed no significant differences in mechanical response between male and female calvaria. The findings presented in this work are relevant to many areas including validating surrogate skull fracture models in silico or laboratory during impact and optimizing protective devices used by civilians to reduce the risk of a serious head injury.
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Affiliation(s)
- Kevin Adanty
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Kapil B Bhagavathula
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Olivia Tronchin
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - David X Li
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Karyne N Rabey
- Department of Surgery, Division of Anatomy, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, AB T6G 2R7, Canada; Department of Anthropology, Faculty of Arts, University of Alberta, 13-15 Tory Building, Edmonton, AB T6G 2H4, Canada
| | - Michael R Doschak
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Medical Sciences Building, 8613 114 Street NW, Edmonton, AB T6G 2H7, Canada
| | - Samer Adeeb
- Donadeo Innovation Centre for Engineering, Department of Civil and Environmental Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 1H9, Canada
| | - James Hogan
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Simon Ouellet
- Defense Research and Development Canada, Valcartier Research Centre, 2459, de la, Route de la Bravoure, Quebec City, QC G3J 1X5, Canada
| | - Thomas A Plaisted
- U.S. Army Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, MD 21005
| | - Sikhanda S Satapathy
- U.S. Army Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, MD 21005
| | - Dan L Romanyk
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada; School of Dentistry, University of Alberta, 7-020 H Katz Group Centre for Pharmacy and Health Research, 87 Ave 114 Street, Edmonton, AB T6G 2E1, Canada
| | - Christopher R Dennison
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada; Department of Mechanical Engineering, University of Victoria, Engineering Office Wing, Room 548 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada
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Qiu J, Liao Z, Xiang H, Li H, Yuan D, Jiang C, Xie J, Qin M, Li K, Zhao H. Effects of different preservation on the mechanical properties of cortical bone under quasi-static and dynamic compression. Front Bioeng Biotechnol 2023; 11:1082254. [PMID: 36911185 PMCID: PMC9995777 DOI: 10.3389/fbioe.2023.1082254] [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: 10/28/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Mechanical properties of biological tissue are important for numerical simulations. Preservative treatments are necessary for disinfection and long-term storage when conducting biomechanical experimentation on materials. However, few studies have been focused on the effect of preservation on the mechanical properties of bone in a wide strain rate. The purpose of this study was to evaluate the influence of formalin and dehydration on the intrinsic mechanical properties of cortical bone from quasi-static to dynamic compression. Methods: Cube specimens were prepared from pig femur and divided into three groups (fresh, formalin, and dehydration). All samples underwent static and dynamic compression at a strain rate from 10-3 s-1 to 103 s-1. The ultimate stress, ultimate strain, elastic modulus, and strain-rate sensitivity exponent were calculated. A one-way ANOVA test was performed to determine if the preservation method showed significant differences in mechanical properties under at different strain rates. The morphology of the macroscopic and microscopic structure of bones was observed. Results: The results show that ultimate stress and ultimate strain increased as the strain rate increased, while the elastic modulus decreased. Formalin fixation and dehydration did not affect elastic modulus significantly whereas significantly increased the ultimate strain and ultimate stress. The strain-rate sensitivity exponent was the highest in the fresh group, followed by the formalin group and dehydration group. Different fracture mechanisms were observed on the fractured surface, with fresh and preserved bone tending to fracture along the oblique direction, and dried bone tending to fracture along the axial direction. Discussion: In conclusion, preservation with both formalin and dehydration showed an influence on mechanical properties. The influence of the preservation method on material properties should be fully considered in developing a numerical simulation model, especially for high strain rate simulation.
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Affiliation(s)
- Jinlong Qiu
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Zhikang Liao
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Hongyi Xiang
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Haocheng Li
- Department of Medical Engineering, General Hospital of Central Theater Command, Wuhan, China
| | - Danfeng Yuan
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Chengyue Jiang
- School of Vehicle Engineering, Chongqing University of Technology, Chongqing, China
| | - Jingru Xie
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Army Medical University, PLA, Chongqing, China
| | - Kui Li
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Hui Zhao
- Daping Hospital of Army Medical University, PLA, Chongqing, China
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Vogels S, Ritchie ED, de Vries D, Kleinrensink GJ, Verhofstad MHJ, Hoencamp R. Applicability of devices available for the measurement of intracompartmental pressures: a cadaver study. J Exp Orthop 2022; 9:98. [PMID: 36166161 PMCID: PMC9515326 DOI: 10.1186/s40634-022-00529-0] [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: 06/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The indication for surgical treatment of the chronic exertional compartment syndrome is evaluated by measuring intracompartmental pressures. The validity of these invasive intracompartmental pressure measurements are increasingly questioned in the absence of a standardized test protocol and uniform cut-off values. The aim of the current study was to test compartment pressure monitors and needles for uniformity, thereby supporting the physician’s choice in the selection of appropriate test materials. Methods A compartment syndrome was simulated in embalmed above-knee cadaveric leg specimen. Four different terminal devices (Compass manometer, Stryker device, Meritrans transduce, and arterial line) were tested with 22 different needle types. Legs were pressurized after introduction of the four terminal devices in the anterior compartment, using the same needle type. Pressure was recorded at a 30-second interval for 11 minutes in total. Before and after pressurization, the intravenous bag of saline was weighed. Results The simulation of a compartment syndrome resulted in intracompartmental pressure values exceeding 100 mmHg in 17 of the 22 legs (77%). In the other five legs, a smaller built-up of pressure was seen, although maximum intracompartmental pressure was in between 70 and 100 mmHg. The intraclass correlation coefficient was above 0.700 for all possible needle types. Excellent to good resemblance was seen in 16 out of 22 instrumental setups (73%). The mean volume of saline infusion required in runs that exceeded 100 mmHg (309 ± 116 ml) was significantly lower compared to the legs in which 100 mmHg was not achieved (451 ± 148 ml; p = 0.04). Conclusion The intracompartmental pressure recordings of the four terminal devices were comparable, when tested with a standardized pressurization model in a human cadaver model. None of the included terminal devices or needle types were found to be superior. The results provide evidence for more diverse material selection when logistic choices for intracompartmental pressure measurement devices are warranted. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00529-0.
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Affiliation(s)
- Sanne Vogels
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands. .,Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Ewan D Ritchie
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands
| | - Djuna de Vries
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands
| | | | - Michiel H J Verhofstad
- Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands.,Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Song YK, Jo DH. Current and potential use of fresh frozen cadaver in surgical training and anatomical education. ANATOMICAL SCIENCES EDUCATION 2022; 15:957-969. [PMID: 34538016 DOI: 10.1002/ase.2138] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 05/22/2023]
Abstract
As surgical procedures continue to be more complex, the need for more effective training in anatomy has increased. The study of anatomy plays a significant role in the understanding of the human body as well as in basic and advanced clinical training. Among the different cadaver models, fresh frozen cadavers (FFCs) are known for their realistic tissue quality. The purpose of this article was to review and summarize the preparation procedures for and reported cases involving FFCs. PubMed, Scopus, Medline, and Web of Science were searched for relevant studies. The preparation procedures were divided into five steps: washing, irrigation, freezing, defrosting, and arterial infusion. Not all steps were reported to be mandatory, but omitting one or more could result in a loss of quality. FFCs were reported to be used for various purposes: undergraduate education, general surgery training, vascular surgery training, minimal access surgery (laparoscopic surgery) training, and microsurgery training. In all categories, expert opinions and statistical analyses indicated successful outcomes. The reasons for high satisfaction with FFCs included realistic texture, capability of reenacting actual operations, and accuracy of anatomical locations. The results also revealed the importance and advantages of the dissection courses in surgical training. Since the direct comparison between cadaver models is insufficient, future studies regarding this topic are deemed necessary. In addition, it would be advantageous to develop methods to improve FFC quality, or ideas to optimize this model for certain purposes.
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Affiliation(s)
- Yong Keun Song
- Department of Preliminary Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Jo
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lamb JN, Coltart O, Adekanmbi I, Pandit HG, Stewart T. Comparison of axial-rotational postoperative periprosthetic fracture of the femur in composite osteoporotic femur versus human cadaveric specimens: A validation study. Proc Inst Mech Eng H 2022; 236:973-978. [PMID: 35603754 PMCID: PMC9289970 DOI: 10.1177/09544119221092842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative periprosthetic femoral fracture following hip replacement has been the subject of many varied experimental approaches. Cadaveric samples offer realistic fit and fracture patterns but are subject to large between-sample variation. Composite femurs have not yet been validated for this purpose. We compared the results of composite femurs to cadaveric femurs using an established methodology. In vitro postoperative periprosthetic fracture results using axial-rotational loading were compared between 12 composite femurs and nine fresh frozen femurs, which were implanted with an otherwise identical collarless (6 composite vs 4 cadaveric) or collared (6 composite vs 5 cadaveric) cementless femoral stem using identical methodology. Fracture torque and rotational displacement were measured and torsional stiffness and rotational work prior to fracture were estimated. Fractures patterns were graded according to the Unified Classification System. Fracture torque, displacement, torsional stiffness and fracture patterns for cadaveric and composite femurs were similar between groups. There was a trend for a greater rotational displacement in the cadaveric groups, which lead to a decrease in torsional stiffness and a significantly greater rotational work prior to fracture for all cadaveric specimens (collarless stems: 10.51 [9.71 to 12.57] vs 5.21 [4.25 to 6.04], p = 0.01 and for collared stems: 15.38 [14.01 to 17.05] vs 5.76 [4.92 to 6.64], p = 0.01). Given comparable fracture torque and the similarity in fracture patterns for fracture trials using composite samples versus cadaveric femurs, the use of composite femur models may be a reasonable choice for postoperative periprosthetic femoral fracture studies within certain limitations.
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Affiliation(s)
- Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Leeds, UK
| | - Oliver Coltart
- School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Leeds, UK
| | - Todd Stewart
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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11
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Influence of moisture content of frozen and embalmed human cadavers for identification of dentinal microcracks using micro-computed tomography. J Mech Behav Biomed Mater 2022; 133:105310. [PMID: 35696968 DOI: 10.1016/j.jmbbm.2022.105310] [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: 04/24/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
The aim of this study was to investigate the influence of moisture content in frozen and embalmed human cadavers on the detection of dentinal microcracks using micro-computed tomography (micro-CT). The group of embalmed specimens included three mandibular and two maxillary segments each containing one tooth. The group of frozen cadavers consisted of two frozen mandibular bone-blocks with two teeth and one mandibular segment containing one tooth. The final number of teeth for each preservation method was n = 5. All specimens were scanned with eight different moisture conditions: 48 h wet, 2 h dry, 48 h wet, 24 h dry, 48 h wet, 1 wk dry, 48 h wet, 1 wk dry. Micro-CT images were screened for the presence of dentinal microcracks. Statistical analysis was performed by nonparametric analysis of variance (α = 5%). Only few microcracks were observed in wet and in 2 h dried bone-blocks with no significant differences (p = 0.63 and p = 0.23, respectively). There was a significant and steady increase of microcracks within the groups of dried specimens as follows: 2 h dry < 24 h dry < first wk dry < second wk dry (all p < 0.008). Preservation method had no significant influence on the visibility of microcracks (p = 0.98). Identification of dentinal microcracks on micro-CT images is influenced by moisture content of cadaveric bone-blocks irrespective of the preservation method.
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Hong DY, Berube ER, Strauch RJ. Ring finger metacarpal fracture iatrogenic rotation using an ulnar gutter splint: A cadaveric study. J Hand Ther 2022; 35:80-85. [PMID: 33279361 DOI: 10.1016/j.jht.2020.10.018] [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: 05/06/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cohort cadaveric study. INTRODUCTION Ring finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic "molding", resulting in a crossover deformity of the ring finger over the small finger. PURPOSE OF THE STUDY The goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. METHODS Transverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. RESULTS There was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). CONCLUSIONS Application of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.
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Affiliation(s)
- Daniel Y Hong
- Columbia University Medical Center, New York City, NY, USA.
| | - Emma R Berube
- Columbia University Medical Center, New York City, NY, USA
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Dubé-Cyr R, Aubin CÉ, Villemure I, Arnoux PJ. Biomechanical analysis of the number of implants for the immediate sacroiliac joint fixation. Spine Deform 2021; 9:1267-1273. [PMID: 33755927 DOI: 10.1007/s43390-021-00325-3] [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: 09/02/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The fusion of the sacroiliac joint (SIJ) is the last treatment option for chronic pain resulting from sacroiliitis. With the various implant systems available, there are different possible surgical strategies in terms of the type and number of implants and trajectories. The aim was to quantify the effect of the number of cylindrical threaded implants on SIJ stabilization. METHODS Six cadaveric pelvises were embedded in resin simulating a double-leg stance. Compression loads were applied to the sacral plate. The pelvises were tested non-instrumented and instrumented progressively with up to three cylindrical threaded implants (12-mm diameter, 60-mm length) with a posterior oblique trajectory. Vertical (VD) and angular (AD) displacements of the SIJ were measured locally using high-precision cameras and digital image correlation. RESULTS Compared to the non-instrumented initial state, instrumentation with one implant significantly decreased the VD (- 24% ± 15%, p = 0.028), while the AD decreased on average by - 9% (± 15%; p = 0.345). When compared to the one-implant configuration, adding a second implant further statistically decreased VD (- 10% ± 7%, p = 0.046) and AD (- 19% ± 15, p = 0.046). Adding a third implant did not lead to additional stabilization for VD nor AD (p > 0.5). CONCLUSION Compared to the non-instrumented initial state, the two-implant configuration reduces both vertical and angular displacements the most, while minimizing the number of implants.
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Affiliation(s)
- Roxanne Dubé-Cyr
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Aix-Marseille Université, Boulevard Pierre Dramard, Marseille Cedex, France
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada. .,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada. .,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada.
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada
| | - Pierre-Jean Arnoux
- iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Aix-Marseille Université, Boulevard Pierre Dramard, Marseille Cedex, France
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Saeidi M, Kelly PA, Netzel C, Scadeng M, Kumar P, Prendergast D, Neitzert T, Ramezani M. Preliminary biomechanical cadaver study investigating a new load-sharing knee implant. J Exp Orthop 2021; 8:61. [PMID: 34392435 PMCID: PMC8364593 DOI: 10.1186/s40634-021-00379-2] [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: 05/11/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose One of the major contributors to the progression of knee osteoarthritis (OA) is the condition of loading in the knee joint. Innovatively designed load-sharing implants may be effective in terms of reducing joint load. The effects of these implants on contact joint mechanics can be evaluated through cadaver experiments. In this work, a case study is carried out with cadaver knee specimens to carry out a preliminary investigation into a novel load-sharing knee implant, in particular to study the surgical procedures required for attachment, and to determine the contact pressures in the joint with and without the implant. Methods Contact pressure in the tibiofemoral joint was measured using pressure mapping sensors, with and without the implant, and radiographs were conducted to investigate the influence of the implant on joint space. The implant was designed from a 3D model of the specimen reconstructed by segmenting MR images of the knee, and it was manufactured by CNC machining. Results It was observed that attachment of the implant does not affect the geometry of the hard/soft tissues. Radiographs showed that the implant led to an increase in the joint space on the medial side. Contact pressure measurements showed that the implant reduced the load on the medial side by approximately 18% under all tested loading conditions. By increasing the load from 800 to 1600 N, the percentage of load reduction in the lateral side was decreased by 8%. After applying 800, 1200, and 1600 N load it was observed that the peak contact pressures were 3.7, 4.6, and 5.5 MPa, respectively. Conclusions This new knee implant shows some promise as a treatment for OA, through its creation of a conducive loading environment in the knee joint, without sacrificing or damaging any of the hard or soft tissues. This device could be as effective as, for example, the Atlas® system, but without some complications seen with other devices; this would need to be validated through similar results being observed in an appropriate in vivo study.
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Affiliation(s)
- Mehdi Saeidi
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Piaras A Kelly
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.
| | - Christian Netzel
- Centre for Advanced Composite Materials, Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand.,Centre for Functional MRI, Department of Radiology, University of California, San Diego, USA
| | - Pranesh Kumar
- Department of Orthopaedic Surgery, Whanganui Hospital, Whanganui, New Zealand
| | - Deborah Prendergast
- Department of Anatomy and Medical Imaging, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Thomas Neitzert
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
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15
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Adanty K, Rabey KN, Doschak MR, Bhagavathula KB, Hogan JD, Romanyk DL, Adeeb S, Ouellet S, Plaisted TA, Satapathy SS, Dennison CR. Cortical and trabecular morphometric properties of the human calvarium. Bone 2021; 148:115931. [PMID: 33766803 DOI: 10.1016/j.bone.2021.115931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
There is currently a gap in the literature that quantitatively describes the complex bone microarchitecture within the diploë (trabecular bone) and cortical layers of the human calvarium. The purpose of this study was to determine the morphometric properties of the diploë and cortical tables of the human calvarium in which key interacting factors of sex, location on the calvarium, and layers of the sandwich structure were considered. Micro-computed tomography (micro-CT) was utilized to capture images at 18 μm resolution of male (n = 26) and female (n = 24) embalmed calvarium specimens in the frontal and parietal regions (N = 50). All images were post-processed and analyzed using vendor bundled CT-Analyzer software to determine the morphometric properties of the diploë and cortical layers. A two-way mixed (repeated measures) analysis of variance (ANOVA) was used to determine diploë morphometric properties accounting for factors of sex and location. A three-way mixed ANOVA was performed to determine cortical morphometric properties accounting for factors of cortical layer (inner and outer table), sex, and location. The study revealed no two-way interaction effects between sex and location on the diploë morphometry except for fractal dimension. Trabecular thickness and separation in the diploë were significantly greater in the male specimens; however, females showed a greater number of trabeculae and fractal dimension on average. Parietal specimens revealed a greater porosity, trabecular separation, and deviation from an ideal plate structure, but a lesser number of trabeculae and connectivity compared to the frontal location. Additionally, the study observed a lower density and greater porosity in the inner cortical layer than the outer which may be due to clear distinctions between each layer's physiological environment. The study provides valuable insight into the quantitative morphometry of the calvarium in which finite element modelers of the skull can refer to when designing detailed heterogenous or subject-specific skull models to effectively predict injury. Furthermore, this study contributes towards the recent developments on physical surrogate models of the skull which require approximate measures of calvarium bone architecture in order to effectively fabricate a model and then accurately simulate a traumatic head impact event.
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Affiliation(s)
- Kevin Adanty
- The Biomedical Instrumentation Laboratory, Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada; Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
| | - Karyne N Rabey
- Department of Surgery, Division of Anatomy, University of Alberta. Postal Address: 2J2.00 WC Mackenzie Health Sciences Centre, 8440-112 St. NW, Edmonton T6G 2R7, Alberta, Canada; Department of Anthropology, Faculty of Arts, University of Alberta. Postal Address: 13-15 Tory Building, Edmonton T6G 2H4, Alberta, Canada.
| | - Michael R Doschak
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta. Postal Address: 2-35, Medical Sciences Building, 8613 - 114 Street, Edmonton T6G 2H7, Alberta, Canada.
| | - Kapil B Bhagavathula
- Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
| | - James D Hogan
- Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
| | - Dan L Romanyk
- Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Postal Address: 7-203 Danadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
| | - Simon Ouellet
- Defence Research and Development Canada, Postal Address: Valcartier Research Centre, 2459, Route de la Bravoure, Quebec City, Quebec G3J 1X5, Canada.
| | - Thomas A Plaisted
- US Army Combat Capabilities Development Command - Army Research Laboratory, Aberdeen Proving Ground, MD 21005, United States of America.
| | - Sikhanda S Satapathy
- US Army Combat Capabilities Development Command - Army Research Laboratory, Aberdeen Proving Ground, MD 21005, United States of America.
| | - Christopher R Dennison
- The Biomedical Instrumentation Laboratory, Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada; Department of Mechanical Engineering, University of Alberta, Postal Address: 10-203 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton T6G 1H9, Alberta, Canada.
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16
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Henry Goodnough L, Salazar BP, Chen MJ, Storaci H, Guzman R, Heffner M, Tam K, DeBaun MR, Gardner MJ. Supplemental medial small fragment fixation adds stability to distal femur fixation: A biomechanical study. Injury 2021; 52:1670-1672. [PMID: 33985754 DOI: 10.1016/j.injury.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bridge plating of distal femur fractures with lateral locking plates is susceptible to varus collapse, fixation failure, and nonunion. While medial and lateral dual plating has been described in clinical series, the biomechanical effects of dual plating of distal femur fractures have yet to be clearly defined. The purpose of this study was to compare dual plating to lateral locked bridge plating alone in a cadaveric distal femur gap osteotomy model. MATERIALS AND METHODS Gap osteotomies were created in eight matched pairs of cadaveric female distal femurs (average age: 64 yrs (standard deviation ± 4.4 yrs); age range: 57-68 yrs;) to simulate comminuted extraarticular distal femur fractures (AO/OTA 33A). Eight femurs underwent fixation with lateral locked plates alone and were matched with eight femurs treated with dual plating: lateral locked plates with supplemental medial small fragment non-locking fixation. Mechanical testing was performed on an ElectroPuls E10000 materials testing system using a 10 kN/100 Nm biaxial load cell. Specimens were subject to 25,000 cycles of cyclic loading from 100-1000 N at 2 Hz. RESULTS Two (2/8) specimens in the lateral only group failed catastrophically prior to completion of testing. All dual plated specimens survived the testing regimen. Dual plated specimens demonstrated significantly less coronal plane displacement (median 0.2 degrees, interquartile range [IQR], 0.0-0.5 degrees) compared to 2.0 degrees (IQR 1.9-3.3, p = 0.02) in the lateral plate only group. Dual plated specimens demonstrated greater bending stiffness compared to the lateral plated group (median 29.0 kN/degree, IQR 1.5-68.2 kN/degree vs median 0.50 kN/degree, IQR 0.23-2.28 kN/degree, p = 0.03). CONCLUSION Contemporary fixation methods with a distal femur fractures are susceptible to mechanical failure and nonunion with lateral plates alone. Dual plate fixation in a cadaveric model of distal femur fractures underwent significantly less displacement under simulated weight bearing conditions and demonstrated greater stiffness than lateral plating alone. Given the significant clinical failure rates of lateral bridge plating in distal femur fractures, supplemental fixation should be considered, and dual plating of distal femurs augments mechanical stability in a clinically relevant magnitude.
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Affiliation(s)
- L Henry Goodnough
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 300 Pasteur Drive, Room R144, Stanford CA, United States.
| | - Brett P Salazar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Hunter Storaci
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Robert Guzman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Michael Heffner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Kaysie Tam
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Malcolm R DeBaun
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 300 Pasteur Drive, Room R144, Stanford CA, United States
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 300 Pasteur Drive, Room R144, Stanford CA, United States
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Pekedis M, Yoruk MD, Binboga E, Yildiz H, Bilge O, Celik S. Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen. Surg Radiol Anat 2021; 43:1933-1943. [PMID: 33954823 DOI: 10.1007/s00276-021-02762-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Although the fresh frozen (FF) cadaver is preferred for surgical applications, it is limited due to short usage time, unsuitable for reuse and the risk of infection. Due to its limited use, FF cadavers, which are covered by import in countries with insufficient body donation cause low-cost effectiveness. With the increase of real human tissue specimen necessities for surgical training, long-term preservation of the cadavers is crucial due to changes in mechanical properties. Therefore, studies on embalming solutions have increased in recent years. METHODS We quantify the biomechanical properties of human parietal bones preserved via modified larssen solution (MLS) and compare the results with the specimens preserved as FF and fixed with 10% formalin-based solution (F10). The rectangular samples of 24 parietal bones of male individuals were resected from MLS-embalmed, F10-embalmed and FF cadavers to form three groups each containing eight samples. These specimens were tested longitudinally to identify mechanical properties. RESULTS The tensile test results showed that there is not a significant difference between the groups in terms of stiffness, elastic modulus, strain at ultimate stress, failure strain and effective plastic strain. However, the yield stress, ultimate stress, yield strain, failure stress and total energy and post-yield properties are significantly lower in F10 than MLS and FF groups. CONCLUSION It is observed that the mechanical properties of MLS preserved and FF parietal bones have almost similar properties. Thus, it can be concluded that MLS is a suitable fixative solution for bone studies and bone-related surgical anatomy training applications.
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Affiliation(s)
- Mahmut Pekedis
- Faculty of Engineering Department of Mechanical Engineering, Ege University, 35100, Bornova, Izmir, Turkey
| | - Mustafa Deniz Yoruk
- Faculty of Medicine Department of Anatomy, Mugla Sitki Kocman University, Kotekli quarter, Marmaris road boulevard, No:50, 48000, Mentese-Mugla, Turkey
| | - Erdal Binboga
- Faculty of Medicine Department of Biophysics, Ege University, 35100, Bornova-Izmir, Turkey
| | - Hasan Yildiz
- Faculty of Engineering Department of Mechanical Engineering, Ege University, 35100, Bornova, Izmir, Turkey
| | - Okan Bilge
- Faculty of Medicine Department of Anatomy, Ege University, 35100, Bornova-Izmir, Turkey
| | - Servet Celik
- Faculty of Medicine Department of Anatomy, Ege University, 35100, Bornova-Izmir, Turkey.
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Three-Dimensional Quantification of Bone Mineral Density in the Distal Femur and Proximal Tibia Based on Computed Tomography: In Vitro Evaluation of an Extended Standardization Method. J Clin Med 2021; 10:jcm10010160. [PMID: 33466413 PMCID: PMC7796434 DOI: 10.3390/jcm10010160] [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] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
While alterations in bone mineral density (BMD) are of interest in a number of musculoskeletal conditions affecting the knee, their analysis is limited by a lack of tools able to take full advantage of modern imaging modalities. This study introduced a new method, combining computed tomography (CT) and computational anatomy algorithms, to produce standardized three-dimensional BMD quantification in the distal femur and proximal tibia. The method was evaluated on ten cadaveric knees CT-scanned twice and processed following three different experimental settings to assess the influence of different scans and operators. The median reliability (intraclass correlation coefficient (ICC)) ranged from 0.96 to 0.99 and the median reproducibility (precision error (RMSSD)) ranged from 3.97 to 10.75 mg/cc for the different experimental settings. In conclusion, this paper presented a method to standardize three-dimensional knee BMD with excellent reliability and adequate reproducibility to be used in research and clinical applications. The perspectives offered by this novel method are further reinforced by the fact it relies on conventional CT scan of the knee. The standardization method introduced in this work is not limited to BMD and could be adapted to quantify other bone parameters in three dimension based on CT images or images acquired using different modalities.
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Bliemel C, Anrich D, Knauf T, Oberkircher L, Eschbach D, Klasan A, Debus F, Ruchholtz S, Bäumlein M. More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures. Arch Orthop Trauma Surg 2021; 141:1197-1205. [PMID: 32856181 PMCID: PMC8215035 DOI: 10.1007/s00402-020-03586-1] [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: 04/17/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Surgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure. This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures. MATERIALS AND METHODS On eight pairs of non-osteoporotic human femora (mean age 74 years; range 57-95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode. RESULTS Specimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996-2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662-3538 N) (p = 0.018). Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035). CONCLUSIONS An additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.
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Affiliation(s)
- Christopher Bliemel
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Dan Anrich
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Tom Knauf
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Ludwig Oberkircher
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Daphne Eschbach
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Antonio Klasan
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Florian Debus
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Steffen Ruchholtz
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Martin Bäumlein
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
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Zhan S, Jiang D, Xu J, Ling M, Yang K, Li Y, Jia W, Hu H, Zhang C. Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis. BMC Musculoskelet Disord 2020; 21:842. [PMID: 33308185 PMCID: PMC7733615 DOI: 10.1186/s12891-020-03853-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However, the biomechanical influence of the use or non-use of the proximal screws of buttress plates on vFNFs stability remains unclear. This study aims to analyse the biomechanics of buttress plate fixation with or without the use of proximal screws through finite element analysis (FEA) to further understand this approach. Methods We built five vFNFs (Pauwels angle 70°) finite element models treated using three cannulated screws (CS group) or three cannulated screws plus a locking buttress plate (buttress group). In the buttress group, use or non-use of proximal screws was carried out on two types of plates (4-hole & 6-hole). The following seven parameters were analysed to compare biomechanical properties of the five models: the stiffness; the maximal stress of the plate system (plate and screws), CSs and bone (MPS, MCS, MBS); the maximal displacement of internal fixations (plate system & CSs) and bone (MIFD, MBD); and the maximal relative displacement of interfragments (MID). Results Compared with CS model, the buttress models exhibited improved biomechanical properties, with increased stiffness and decreased MCS, MBS, MIFD, MBD and MID. The models fixed using buttress plates combined with a proximal screw showed greater stiffness (+ 3.75% & + 8.31% vs + 0.98% & + 4.57%) and MPS (795.6 & 947.2 MPa vs 294.9 & 556.2 MPa) values, and smaller MCS, MBS, MIFD, MBD and MID (− 3.41% to − 15.35% vs − 0.07% to − 4.32%) values than those using the same length plates without a proximal screw. Conclusions Based on the FEA results, buttress plates can improve construct mechanics, help to resist shear force and prevent varus collapse; under the modelling conditions, the use of a proximal screw on buttress plate may be a key technical feature in improving anti-shearing ability; additionally, this screw may be essential to reduce stress and prevent re-displacement of cannulated screws and fracture fragments.
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Affiliation(s)
- Shi Zhan
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Dajun Jiang
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Jian Xu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Ming Ling
- Department of Orthopedic, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Kai Yang
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Yuehua Li
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Hai Hu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China. .,Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Changqing Zhang
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China. .,Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
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Huntington LS, Mandaleson A, Hik F, Ek ETH, Ackland DC, Tham SKY. Measurement of Scaphoid Bone Microarchitecture: A Computed Tomography Imaging Study and Implications for Screw Placement. J Hand Surg Am 2020; 45:1185.e1-1185.e8. [PMID: 32723573 DOI: 10.1016/j.jhsa.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE High bone density and quality is associated with improved screw fixation in fracture fixation. The objective of this study was to assess bone density and quality in the proximal and distal scaphoid to determine optimum sites for placement of 2 screws in scaphoid fracture fixation. METHODS Twenty-nine cadaveric human scaphoid specimens were harvested and scanned using micro-computed tomography. Bone density (bone volume fraction) and bone quality (relative bone surface area, trabecular number, and trabecular thickness) were evaluated in 4 quadrants within each of the proximal and distal scaphoid. RESULTS The proximal radial quadrant of the scaphoid had significantly greater bone volume than the distal ulnar (mean difference, 33.2%) and distal volar quadrants (mean difference, 32.3%). There was a significantly greater trabecular number in the proximal radial quadrant than in the distal ulnar (mean difference, 16.7%) and in the distal volar quadrants (mean difference, 15.9%) and between the proximal ulnar and the distal ulnar quadrants (mean difference, 12%). There was a significantly greater bone surface area in the proximal radial and distal radial quadrants than in the distal ulnar and distal volar quadrants. There were no significant differences in trabecular thickness between the 8 analyzed quadrants CONCLUSIONS: Although there are differences in bone volume, trabecular number, and bone surface area between the proximal pole of the scaphoid and that of the distal pole, there were no significant differences in the bone quality (trabecular thickness, trabecular number, and relative bone surface area) and density (bone volume fraction) between the 4 quadrants of the proximal or distal pole of the cadaveric scaphoids studied. CLINICAL RELEVANCE Insertion of 2 headless compression screws can be determined by ease of surgical access and ease of screw positioning and not by differences in bone quality or density of the proximal or distal scaphoid.
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Affiliation(s)
- Lachlan S Huntington
- Department of Biomedical Engineering, University of Melbourne, Parkville; Melbourne Medical School, University of Melbourne, Parkville
| | - Avanthi Mandaleson
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Freya Hik
- Department of Biomedical Engineering, University of Melbourne, Parkville
| | - Eugene T H Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville
| | - Stephen K Y Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria.
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Hack J, Kranz Y, Knauf T, Bäumlein M, Malcherczyk D, Ruchholtz S, Oberkircher L. Stability of internal versus external fixation in osteoporotic pelvic fractures - a biomechanical analysis. Injury 2020; 51:2460-2464. [PMID: 32800315 DOI: 10.1016/j.injury.2020.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 07/22/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model. MATERIALS AND METHODS A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP type-IIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand. RESULTS Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515). CONCLUSIONS Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use.
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Affiliation(s)
- J Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany.
| | - Y Kranz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - T Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - M Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - D Malcherczyk
- Clinic for Orthopaedics and Trauma Surgery, Klinikum Fulda, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - L Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Ceynowa M, Zerdzicki K, Klosowski P, Pankowski R, Roclawski M, Mazurek T. Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples. PLoS One 2020; 15:e0241143. [PMID: 33119661 PMCID: PMC7595401 DOI: 10.1371/journal.pone.0241143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/08/2020] [Indexed: 11/18/2022] Open
Abstract
This study was designed to compare compressive strength of cancellous bone retrieved from the femoral head in a specimen with and without guide wire hole, with comparison to synthetic bone samples. Femoral heads retrieved from 33 patients who sustained femoral neck fractures and underwent hip arthroplasty were cut into cuboids leaving two matching samples from the same femoral head. Similar samples were prepared from synthetic femurs. One of the matching samples was chosen at random and was drilled with a guide wire for cancellous screws. The uniaxial compression tests of bone blocks were carried out using the Zwick-Roell Z020 strength testing machine. The mean loss of sample cross section area due to drilling was 24%. The force at failure in drilled specimens was significantly smaller by 18% in human (median: 26%) and by 25% in synthetic bone (median 27%). The strength of human specimens was almost 2 times greater, and their stiffness nearly 4 times greater than in synthetic samples. The study shows that the weakening of the bone after drilling is roughly proportional to the loss of sample cross section area. The percentage decrease in strength was similar in human and artificial bone, but human samples were stronger and stiffer. The comparison shows that forces measured in biomechanical studies on artificial bone cannot be directly attributed to humans, but the relative differences in mechanical properties of synthetic samples after some damage may be accurate and resemble that of human bones.
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Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
- * E-mail:
| | - Krzysztof Zerdzicki
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdańsk, Poland
| | - Pawel Klosowski
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdańsk, Poland
| | - Rafal Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Roclawski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
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Hopf JC, Nowak TE, Mehler D, Arand C, Gruszka D, Westphal R, Rommens PM. Nailing vs. plating in comminuted proximal ulna fractures - a biomechanical analysis. BMC Musculoskelet Disord 2020; 21:616. [PMID: 32943020 PMCID: PMC7495877 DOI: 10.1186/s12891-020-03637-z] [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: 02/06/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating. Methods A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N – 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis. Results The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters. Conclusions Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.
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Affiliation(s)
- Johannes Christof Hopf
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tobias Eckhard Nowak
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dominik Gruszka
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ruben Westphal
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
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Experimental characterization and micromechanical modeling of the elastic response of the human humerus under bending impact. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 117:111276. [PMID: 32919640 DOI: 10.1016/j.msec.2020.111276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/15/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Abstract
This paper investigates the characterization and numerical modeling of the elastic behavior of the human humerus bone using a recently developed micromechanical approach coupled to nanoindentation measurements. At first, standard three-point bending experiments were conducted under low static loading, using several humerus diaphysis in order to identify the apparent elastic modulus of the bone in static regime. Then, a drop tower impact experiment was used on the same set of humerus diaphysis specimens, in order to assess the elastic modulus in dynamic regime. These measurements will be used as reference bases for comparison purpose. The originality of this work, lies in the coupling between a two-phase micromechanical approach based on Mori-Tanaka homogenization scheme for cylindrical voids and nanoindentation measurements of the elastic modulus of the bone matrix phase. This model has been implemented using a user defined material subroutine VMAT in ABAQUS© Explicit code. The bone mechanical response prediction using the proposed methodology was validated against previous standard experimental data. Finally, it was shown that the numerical predictions are consistent with the physical measurements obtained on human humerus via the good estimation of the ultimate impact load.
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Bäumlein M, Klasan A, Klötzer C, Bockmann B, Eschbach D, Knobe M, Bücking B, Ruchholtz S, Bliemel C. Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures - biomechanical investigation of a new fixation device. BMC Musculoskelet Disord 2020; 21:226. [PMID: 32278344 PMCID: PMC7149902 DOI: 10.1186/s12891-020-03215-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Implant anchorage in highly osteoporotic bone is challenging, since it often leads to osteosynthesis failure in geriatric patients with supracondylar femoral fractures. Cementation of screws is presumed to prevent such osteosynthesis failure. This study aimed to investigate the effect of a newly designed, cementable fenestrated condylar screw for plate fixation in a biomechanical setting. Methods Eight pairs of osteoporotic cadaver femora with an average age of 77 years, ranging between 62 and 88 years, were randomly assigned to either an augmented or a non-augmented group. In both groups an instable 33-A3 fracture according to the AO / OTA classification was fixed with an angular stable locking plate. All right samples received a cement augmentation of their fenestrated condylar screws with calcium phosphate bone cement (CPC). Mechanical testing was performed at a load to failure mode by cyclic axial loading, using a servohydraulic testing machine. Results With a mean of 2475 N (95% CI: 1727–3223 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimen with cemented condylar screws as compared to non-cemented samples (1875 N (95% CI: 1320–2430 N)) (p = 0.024). In both groups the deformation of the constructs, with the distal screws cutting through the condylar bone, were the most frequent cause for failure. Analysis of axial stiffness (p = 0.889) and irreversible deformity of the specimens revealed no differences between the both groups (p = 0.161). No cement leakage through the joint line or the medial cortex was observed. Conclusion Based on the present study results, the newly introduced, cementable condylar screw could be an encouraging feature for the fixation of supracondylar femoral fractures in patients with reduced bone quality in terms of load to failure accuracy of the cement application.
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Affiliation(s)
- Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Antonio Klasan
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christine Klötzer
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Benjamin Bücking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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Varghese V, Krishnan V, Kumar GS. Comparison of pullout strength of pedicle screws following revision using larger diameter screws. Med Eng Phys 2019; 74:180-185. [DOI: 10.1016/j.medengphy.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/06/2019] [Accepted: 09/08/2019] [Indexed: 02/03/2023]
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Hopf JC, Nowak TE, Mehler D, Arand C, Gruszka D, Rommens PM. Nailing of proximal ulna fractures: biomechanical comparison of a new locked nail with angular stable plating. Eur J Trauma Emerg Surg 2019; 47:795-802. [PMID: 31677007 DOI: 10.1007/s00068-019-01254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Proximal ulna fractures are common injuries and frequently treated with angular stable plating. This surgical option shows good functional results. Relevant drawbacks such as large soft tissue exposure, compromised blood supply of fracture fragments and disturbing osteosynthetic material are described. The aim of this study was to compare a new locked proximal ulna nail with angular stable plating in a biomechanical testing setup for extraarticular proximal ulna fractures. METHODS Ten pairs of sawbones with a Jupiter type IIB proximal ulna fracture (OTA 2U1A3.1) were tested after osteosynthesis with the mentioned implants in a servo-pneumatic testing machine. The testing setup simulates physiological joint motion (0°-90°) under cyclic loading (30-300 N). Primary stability and loosening of both constructs were quantified using micromotion video-analysis after 608 test cycles. RESULTS The micromotion analysis showed significantly higher primary stability of the locked nail (0.29 ± 0.13 mm) compared to the angular stable plate (0.97 ± 0.30 mm, p < 0.001). Both implants showed a low amount of loosening after completion of the test cycles. The construct with the locked nail (0.08 ± 0.06 mm) showed significantly lower dislocation of the fragments measured at the anterior cortex (plate 0.24 ± 0.13 mm, p < 0.001). CONCLUSION Nailing of proximal ulna fractures shows significantly higher primary stability and lower loosening compared to angular stable plating in our testing setup.
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Affiliation(s)
- Johannes Christof Hopf
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tobias Eckhard Nowak
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dominik Gruszka
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
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Klasan A, Bäumlein M, Dworschak P, Bliemel C, Neri T, Schofer MD, Heyse TJ. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res 2019; 8:472-480. [PMID: 31728187 PMCID: PMC6825045 DOI: 10.1302/2046-3758.810.bjr-2019-0051.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objectives Periprosthetic femoral fractures (PFFs) have a higher incidence with cementless stems. The highest incidence among various cementless stem types was observed with double-wedged stems. Short stems have been introduced as a bone-preserving alternative with a higher incidence of PFF in some studies. The purpose of this study was a direct load-to-failure comparison of a double-wedged cementless stem and a short cementless stem in a cadaveric fracture model. Methods Eight hips from four human cadaveric specimens (age mean 76 years (60 to 89)) and eight fourth-generation composite femurs were used. None of the cadaveric specimens had compromised quality (mean T value 0.4 (-1.0 to 5.7)). Each specimen from a pair randomly received either a double-wedged stem or a short stem. A materials testing machine was used for lateral load-to-failure test of up to a maximal load of 5000 N. Results Mean load at failure of the double-wedged stem was 2540 N (1845 to 2995) and 1867 N (1135 to 2345) for the short stem (p < 0.001). All specimens showed the same fracture pattern, consistent with a Vancouver B2 fracture. The double-wedged stem was able to sustain a higher load than its short-stemmed counterpart in all cases. Failure force was not correlated to the bone mineral density (p = 0.718). Conclusion Short stems have a significantly lower primary load at failure compared with double-wedged stems in both cadaveric and composite specimens. Surgeons should consider this biomechanical property when deciding on the use of short femoral stem. Cite this article: A. Klasan, M. Bäumlein, P. Dworschak, C. Bliemel, T. Neri, M. D. Schofer, T. J. Heyse. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res 2019;8:489–494. DOI: 10.1302/2046-3758.810.BJR-2019-0051.R1.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany; Sydney Orthopaedic Research Institute, Australia
| | - Martin Bäumlein
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital St Etienne, Saint-Étienne, France
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Klasan A, Bäumlein M, Bliemel C, Putnis SE, Neri T, Schofer MD, Heyse TJ. Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study. Acta Orthop 2019; 90:445-449. [PMID: 31282247 PMCID: PMC6746255 DOI: 10.1080/17453674.2019.1634331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - To date, there is not a single clinical or mechanical study directly comparing a cemented and a cementless version of the same stem. We investigated the load-to-failure force of a cementless and a cemented version of a double tapered stem. Material and methods - 10 femurs from 5 human cadaveric specimens, mean age 74 years (68-79) were extracted. Bone mineral density (BMD) was measured using peripheral quantitative computed tomography. None of the specimens had a compromised quality (average T value 0.0, -1.0 to 1.4). Each specimen from a pair randomly received a cemented or a cementless version of the same stem. A material testing machine was used for lateral load-to-failure test of up to a maximal load of 5.0 kN. Results - Average load-to-failure of the cemented stem was 2.8 kN (2.3-3.2) and 2.2 kN (1.8-2.8) for the cementless stem (p = 0.002). The cemented version of the stem sustained a higher load than its cementless counterpart in all cases. Failure force was not statistically significantly correlated to BMD (p = 0.07). Interpretation - Implanting a cemented version of the stem increases the load-to-failure force by 25%.
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Affiliation(s)
- Antonio Klasan
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany; ,Correspondence:
| | - Martin Bäumlein
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany;
| | - Christopher Bliemel
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany;
| | | | - Thomas Neri
- University Hospital St. Etienne, Department of Orthopaedic Surgery, Saint-Priest-en-Jatez, France;
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Grevenstein D, Meyer C, Wegmann K, Hackl M, Bredow J, Eysel P, Prescher A, Scheyerer MJ. First results of multicortical screw anchoring compared with conventional bicortical screw placement in the sacrum: A biomechanical investigation of a new screw design. Clin Biomech (Bristol, Avon) 2019; 65:100-104. [PMID: 31005693 DOI: 10.1016/j.clinbiomech.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bicortical screw fixation is an established technique to increase screw strength in vertebral bodies, although it is associated with several complications, for example screw-loosening. Cement augmentation can increase stability of screw-fixation but can also cause various complications, such as cement-leakage or cement embolism. In this study, we tested a new, multicortical screw fixation technique in the sacrum. METHODS Four fresh-frozen sacrums were used. In group 1, standard screw insertion, with sagittal parallel and axial convergent screw-drive was performed. In group 2, the screw-drive of the first screw was similar to the screw-drive in group 1. In addition, a second screw was inserted descending into the intended hole in the head of the screw and at a stable angle. Therefore, the screws of the multiloc humerus nail-system (Synthes) were used. The specimens were connected to a testing-machine and underwent cyclic axial loading with an increase in the load after each completed stage. FINDINGS Multicortical screw fixation leads to a significant increase in the number of completed cycles and a significantly increased load until failure. INTERPRETATION Multicortical screw fixation in the sacrum offers a stronger attachment of the screws. In the future, multicortical implants, which fulfil the criteria demanded in spine surgery, can offer higher stability and may decrease the loosening rates of the implanted screws.
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Affiliation(s)
- David Grevenstein
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Carolin Meyer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Kilian Wegmann
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Michael Hackl
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Jan Bredow
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Max J Scheyerer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University Hospital of Cologne, Joseph-Stelzmann Strasse 24, 50931 Cologne, Germany.
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Liao P, Wang Z. Thiel-embalming technique: investigation of possible modification in embalming tissue as evaluation model for radiofrequency ablation. J Biomed Res 2019; 33:280. [PMID: 30956232 PMCID: PMC6813523 DOI: 10.7555/jbr.32.20160148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/20/2017] [Indexed: 11/03/2022] Open
Abstract
Contrary to freezing preservation and formalin embalming, Thiel embalmed cadaver presents soft texture and color very close to that of living organism, and many applications based on Thiel embalmed cadavers have been reported. However, Thiel embalmed cadavers cannot be used as reliable evaluation model for radiofrequency ablation (RFA) due to dramatic changes of electrical conductivity in the embalmed tissue. To address this issue, we investigated various modifications of the original Thiel embalming solution. By altering the chemicals' species and concentration we figured out a formula that can greatly reduce the embalming fluid's electrical conductivity without significantly compromising the 18-day embalmed kidney samples' suppleness and color. We also investigated a two-stage embalming technique by first submerging the kidney sample into original Thiel's tank fluid for 28 days, then the sample was withdrawn from the tank fluid and placed into modified dilution fluids for additional two weeks. Stiffening and discoloration occurred in these diluted samples implying the reversibility of Thiel-embalmed tissues' suppleness and color with the removal of the strong electrolytes. This study presents a modified embalming method which could be used for RFA evaluation and also helps our understanding of the mechanism of embalmment process.
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Affiliation(s)
- Peiyu Liao
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland DD2 1FD, United Kingdom
- School of Engineering, Physics and Mathematics, University of Dundee, Dundee, Scotland DD1 4HN, United Kingdom
- College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan 410000, China
- College of Engineering, Peking University, Beijing 100671, China
| | - Zhigang Wang
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland DD2 1FD, United Kingdom
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Zhang G, Wang S, Xu S, Guan F, Bai Z, Mao H. The Effect of Formalin Preservation Time and Temperature on the Material Properties of Bovine Femoral Cortical Bone Tissue. Ann Biomed Eng 2019; 47:937-952. [DOI: 10.1007/s10439-019-02197-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
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Wright B, Ragan L, Niratisairak S, Høiseth A, Strømsøe K, Steen H, Brattgjerd JE. High correlation between mechanical properties and bone mineral parameters in embalmed femurs after long-term storage. Clin Biomech (Bristol, Avon) 2018; 59:136-142. [PMID: 30232057 DOI: 10.1016/j.clinbiomech.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fresh frozen human femurs are considered "the gold standard" in biomechanical studies of hip fractures, resembling the in vivo situation mostly. A more readily available alternative is formalin embalmed femurs. However, to which extent formalin affects key features of bone; its mechanical properties, bone mineral content and their mutual relationship over time, remains unknown. Accordingly, we measured the mineral parameters and related them to the mechanical properties of formalin fixed femurs after long-term storage. METHODS 36 paired femurs from human donors, fixed in formalin and stored for a mean period of 4.6 (3.5-6) years. Quantitative CT was performed to measure the bone mineral density and mass at the mainly cortical mid shaft and the center of the mainly cancellous condyles. Each pair was subjected to local tests by three-point bending and screw pullout of the shaft and lateral punch and metaphyseal cube compression of the condyles. FINDINGS Neither mechanical nor bone mineral data were significantly correlated to storage time. Well-known associations for bone parameters with age and gender were retrieved. Maximum force of the cortical bone tests was highly correlated to the diaphyseal bone mass; (r = 0.80-0.87, p = 0.01), while maximum force of the cancellous bone tests correlated well to the density of the condylar bone; (r = 0.70, p = 0.01). INTERPRETATION Our results indicate that mechanical and bone mineral data and their mutual relationship are conserved in formalin fixed femurs even after long-term storage. Formalin fixed femurs may serve as an alternative to fresh frozen femurs in biomechanical testing.
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Affiliation(s)
- Bryan Wright
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway; Ringerike Hospital, Hønefoss, Norway.
| | - Lydia Ragan
- Division of Anatomy, Institute of Basic Medical Sciences, University of Oslo, Norway; Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway
| | - Sanyalak Niratisairak
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway; Institute for Clinical Medicine, University of Oslo, Norway
| | - Arne Høiseth
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway
| | - Knut Strømsøe
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway
| | - Harald Steen
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway
| | - Jan Egil Brattgjerd
- Biomechanics Laboratory, Orthopaedic Division, Oslo University Hospital, Norway; Institute for Clinical Medicine, University of Oslo, Norway
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The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Han S, Li D, Zhang P, Yin X, Kou Y, Han N, Fu Z. A Biomechanical Study of an Alternative Internal Fixation Method for Transverse Patella Fractures. Orthopedics 2018; 41:e643-e648. [PMID: 30011055 DOI: 10.3928/01477447-20180711-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/03/2018] [Indexed: 02/03/2023]
Abstract
Pain and reoperation after fixation using tension band wiring and K-wires is not uncommon. A novel hook plate was designed to improve the treatment of patella fractures. The aim of this study was to compare the stability of the hook plate with that of tension band wiring and K-wires in a simulated patellar transverse fracture model (AO/OTA classification 34-C1.1). The authors tested 16 embalmed cadaver knee joints fixed with the hook plate and tension band wiring and K-wires under cyclic loading. Specimens underwent 100 cycles extending the knee joint from 90° of flexion to full extension at a velocity of 50 mm/min. The fracture gap was measured after the initial and last cycles. Data were assessed statistically using the t test, with significance set as P<.05. The fatigue test showed that the fracture gap after 100 cycles was 2.97±1.39 mm using tension band wiring and K-wires and 1.53±0.93 mm for the hook plate (P=.029). Six of 8 specimens in the tension band wiring and K-wires group met the failure criterion of fracture gap greater than 2 mm vs 1 in the hook plate group (P=.041). From a biomechanical point of view, the hook plate is a valid alternative to tension band wiring and K-wires for fixing patella transverse fractures. Compared with tension band wiring and K-wires, the hook plate may have superior ability in sustaining a reduced transverse patella fracture. [Orthopedics. 2018; 41(5):e643-e648.].
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Hohmann E, Keough N, Glatt V, Tetsworth K, Putz R, Imhoff A. The mechanical properties of fresh versus fresh/frozen and preserved (Thiel and Formalin) long head of biceps tendons: A cadaveric investigation. Ann Anat 2018; 221:186-191. [PMID: 29879483 DOI: 10.1016/j.aanat.2018.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/09/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022]
Abstract
Human cadaveric specimens commonly serve as mechanical models and as biological tissue donors in basic biomechanical research. Although these models are used to explain both in vitro and in vivo behavior, the question still remains whether the specimens employed reflect the normal in vivo situation. The mechanical properties of fresh-frozen or preserved cadavers may differ, and whether they can be used to reliably investigate pathology could be debated. The purpose of this study was to therefore examine the mechanical properties of cadaveric long biceps tendons, comparing fresh (n=7) with fresh-frozen (n=8), formalin embalmed (n=15), and Thiel-preserved (n=6) specimens using a Universal Testing Machine. The modulus of elasticity and the ultimate tensile strength to failure was recorded. Tensile failure occurred at an average of 12N/mm2 in the fresh group, increasing to 40.1N/mm2 in the fresh-frozen group, 50.3N/mm2 in the formalin group, and 52N/mm2 in the Thiel group. The modulus of elasticity/stiffness of the tendon increased from fresh (25.6MPa), to fresh-frozen (55.3MPa), to Thiel (82.5MPa), with the stiffest being formalin (510.6MPa). Thiel-preserved and formalin-embalmed long head of biceps tendons and fresh-frozen tendons have a similar load to failure. Either the Thiel or formalin preserved tendon could therefore be considered as alternatives for load to failure studies. However, the Young's modulus of embalmed tendons were significantly stiffer than fresh or fresh frozen specimens, and these methods might be less suitable alternatives when viscoelastic properties are being investigated.
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Affiliation(s)
- Erik Hohmann
- School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Valiant Clinic, Houston Methodist Group.
| | - Natalie Keough
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Reinhard Putz
- Institute of Anatomy, Ludwig-Maximilian-University, Munich, Germany
| | - Andreas Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
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Zhang GJ, Yang J, Guan FJ, Chen D, Li N, Cao L, Mao H. Quantifying the Effects of Formalin Fixation on the Mechanical Properties of Cortical Bone Using Beam Theory and Optimization Methodology With Specimen-Specific Finite Element Models. J Biomech Eng 2017; 138:2538222. [PMID: 27447849 DOI: 10.1115/1.4034254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Indexed: 11/08/2022]
Abstract
The effects of formalin fixation on bone material properties remain debatable. In this study, we collected 36 fresh-frozen cuboid-shaped cortical specimens from five male bovine femurs and immersed half of the specimens into 4% formalin fixation liquid for 30 days. We then conducted three-point bending tests and used both beam theory method and an optimization method combined with specimen-specific finite element (FE) models to identify material parameters. Through the optimization FE method, the formalin-fixed bones showed a significantly lower Young's modulus (-12%) compared to the fresh-frozen specimens, while no difference was observed using the beam theory method. Meanwhile, both the optimization FE and beam theory methods revealed higher effective failure strains for formalin-fixed bones compared to fresh-frozen ones (52% higher through the optimization FE method and 84% higher through the beam theory method). Hence, we conclude that the formalin fixation has a significant effect on bovine cortical bones at small, elastic, as well as large, plastic deformations.
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Dragomir-Daescu D, Rezaei A, Uthamaraj S, Rossman T, Bronk JT, Bolander M, Lambert V, McEligot S, Entwistle R, Giambini H, Jasiuk I, Yaszemski MJ, Lu L. Proximal Cadaveric Femur Preparation for Fracture Strength Testing and Quantitative CT-based Finite Element Analysis. J Vis Exp 2017. [PMID: 28362373 DOI: 10.3791/54925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Cadaveric fracture testing is routinely used to understand factors that affect proximal femur strength. Because ex vivo biological tissues are prone to lose their mechanical properties over time, specimen preparation for experimental testing must be performed carefully to obtain reliable results that represent in vivo conditions. For that reason, we designed a protocol and a set of fixtures to prepare the femoral specimens such that their mechanical properties experienced minimal changes. The femora were kept in a frozen state except during preparation steps and mechanical testing. The relevant clinical measures of total hip and femoral neck bone mineral density (BMD) were obtained with a clinical dual X-ray absorptiometry (DXA) bone densitometer, and the 3D geometry and distribution of bone mineral were obtained using CT with a calibration phantom for quantitative estimations based on the greyscale values. Any possible bone disease, fracture, or the presence of implants or artifacts affecting the bone structure, was ruled out with X-ray scans. For preparation, all bones were carefully cleaned of excess soft tissue, and were cut and potted at the internal rotation angle of interest. A cutting fixture allowed the distal end of the bone to be cut off leaving the proximal femur at a desired length. To allow positioning of the femoral neck at prescribed angles during later CT scanning and mechanical testing, the proximal femoral shafts were potted in polymethylmethacrylate (PMMA) using a fixture designed specifically for desired orientations. The data collected from our experiments were then used for validation of quantitative computed tomography (QCT)-based finite element analysis (FEA), as described in a different protocol. In this manuscript, we present the protocol for the precise bone preparation for mechanical testing and subsequent QCT/FEA modeling. The current protocol was successfully applied to prepare about 200 cadaveric femora over a 6-year time period.
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Affiliation(s)
- Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Division of Engineering, Mayo Clinic;
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Division of Engineering, Mayo Clinic
| | | | | | | | | | | | | | | | | | - Iwona Jasiuk
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
| | | | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Department of Orthopedic Surgery, Mayo Clinic
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Xavier F, Jauregui JJ, Cornish N, Jason-Rousseau R, Chatterjee D, Feuer G, Hayes W, Kapadia BH, Carter JN, Yoshihara H, Saha S. Regional Variations in Shear Strength and Density of the Human Thoracic Vertebral Endplate and Trabecular Bone. Int J Spine Surg 2017; 11:7. [PMID: 28377865 DOI: 10.14444/4007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Previous studies investigated the overall mechanical strength of the vertebral body; however, limited information is available on the biomechanical properties of different regions within the vertebral endplate and cancellous bone. In addition, the correlation between mechanical strength and various density measurements has not been studied yet. METHODS Thoracic (T10) vertebrae were harvested from fifteen human cadaveric spines (average age: 77 years old). Twelve cylindrical cores of 7.2 mm (diameter) by 3.2 mm (height) were prepared from each vertebral body. Shear was produced using a stainless steel tubular blade and measured with a load cell from a mechanical testing machine. Optical and bulk densities were calculated before mechanical testing. Apparent, material, and ash densities were measured after testing. RESULTS Material density and shear strength increased from anterior to lateral regions of both endplate and cancellous bone. Endplate shear strength was significantly lower in the anterior (0.52 ± 0.08 MPa) than in the lateral region (2.72 ± 0.59 MPa) (p=0.017). Trabecular bone maximum load carrying capacity was 5 times higher in the lateral (12 ± 2.74 N) (p=0.09) and 4.5 times higher in the central (10 ± 2.24 N) (p=0.2) than in the anterior (2 ± 0.60 N) regions. Mechanical strength positively correlated with ash density, and even moreso with material density. CONCLUSION Shear strength was the lowest at the anterior region and highest at the lateral region for both endplate and cancellous bone. Material density had the best correlation with mechanical strength. Newer spinal implants could optimize the loading in the lateral aspects of both endplate and cancellous bone to reduce the likelihood of screw loosening and the subsidence of disc replacement devices. This study was reviewed by the SUNY Downstate Medical Center IRB Committee; IRB#: 533603-2.
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Affiliation(s)
- Fred Xavier
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | - Julio J Jauregui
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | - Nathan Cornish
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | | | - Dipal Chatterjee
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | - Gavriel Feuer
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | - Westley Hayes
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | | | - John N Carter
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
| | | | - Subrata Saha
- SUNY Downstate Medical Center, Brooklyn, New York, New York 11203
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Leuridan S, Goossens Q, Roosen J, Pastrav L, Denis K, Mulier M, Desmet W, Vander Sloten J. A biomechanical testing system to determine micromotion between hip implant and femur accounting for deformation of the hip implant: Assessment of the influence of rigid body assumptions on micromotions measurements. Clin Biomech (Bristol, Avon) 2017; 42:70-78. [PMID: 28110243 DOI: 10.1016/j.clinbiomech.2017.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate pre-clinical evaluation of the initial stability of new cementless hip stems using in vitro micromotion measurements is an important step in the design process to assess the new stem's potential. Several measuring systems, linear variable displacement transducer-based and other, require assuming bone or implant to be rigid to obtain micromotion values or to calculate derived quantities such as relative implant tilting. METHODS An alternative linear variable displacement transducer-based measuring system not requiring a rigid body assumption was developed in this study. The system combined advantages of local unidirectional and frame-and-bracket micromotion measuring concepts. The influence and possible errors that would be made by adopting a rigid body assumption were quantified. Furthermore, as the system allowed emulating local unidirectional and frame-and-bracket systems, the influence of adopting rigid body assumptions were also analyzed for both concepts. Synthetic and embalmed bone models were tested in combination with primary and revision implants. Single-legged stance phase loading was applied to the implant - bone constructs. FINDINGS Adopting a rigid body assumption resulted in an overestimation of mediolateral micromotion of up to 49.7μm at more distal measuring locations. Maximal average relative rotational motion was overestimated by 0.12° around the anteroposterior axis. Frontal and sagittal tilting calculations based on a unidirectional measuring concept underestimated the true tilting by an order of magnitude. INTERPRETATION Non-rigid behavior is a factor that should not be dismissed in micromotion stability evaluations of primary and revision femoral implants.
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Affiliation(s)
- Steven Leuridan
- Department of Mechanical Engineering, Biomechanics Division. KU Leuven, Celestijnenlaan 300c, Box 2419, 3001 Leuven, Belgium.
| | - Quentin Goossens
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Jorg Roosen
- Department of Orthopedic Surgery, Leuven University Hospitals, Weligerveld 1, 3212 Pellenberg, Belgium
| | - Leonard Pastrav
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Kathleen Denis
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Michiel Mulier
- Department of Orthopedic Surgery, Leuven University Hospitals, Weligerveld 1, 3212 Pellenberg, Belgium
| | - Wim Desmet
- Department of Mechanical Engineering, PMA, KU Leuven, Celestijnenlaan 300c, 3001 Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Biomechanics Division. KU Leuven, Celestijnenlaan 300c, Box 2419, 3001 Leuven, Belgium
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Bliemel C, Oberkircher L, Bockmann B, Petzold E, Aigner R, Heyse TJ, Ruchholtz S, Buecking B. Impact of cement-augmented condylar screws in locking plate osteosynthesis for distal femoral fractures - A biomechanical analysis. Injury 2016; 47:2688-2693. [PMID: 27773369 DOI: 10.1016/j.injury.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Compromised bone quality and the need for early mobilization continue to lead to implant failure in elderly patients with distal femoral fractures. The cement augmentation of screws might facilitate improving implant anchorage. The aim of this study was to analyse the impact of cement augmentation of the condylar screws on implant fixation in a human cadaveric bone model. MATERIAL AND METHODS Ten pairs of osteoporotic femora (mean age: 90 years, range: 84-99 years) were used. A 2-cm gap osteotomy was created in the metaphyseal region to simulate an unstable AO/OTA 33-A3 fracture. All specimens were treated with a polyaxial locking plate. Specimens randomly assigned to the augmented group received an additional cement augmentation of the condylar screws using bone cement. A servohydraulic testing machine was used to perform incremental cyclic axial loading using a load-to-failure mode. RESULTS All specimens survived at least 800N of axial compressive force. The mean compressive forces leading to failure were 1620N (95% CI: 1382-1858N) in the non-augmented group and 2420N (95% CI: 2054-2786N) in the group with cement-augmented condylar screws (p=0.005). Deformation with cutting out of the condylar screws and condylar fracture were the most common reasons for failure in both groups. Whereas axial stiffness was comparable between both osteosyntheses (p=0.508), significant differences were observed for the plastic deformation of the constructs (p=0.014). CONCLUSION The results of the present study showed that the cement augmentation of the condylar screws might be a promising technique for the fixation of distal femoral fractures in elderly patients with osteoporotic bones.
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Affiliation(s)
- Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Benjamin Bockmann
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Eric Petzold
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Thomas Jan Heyse
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
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Comparison of DNA yield and STR success rates from different tissues in embalmed bodies. Int J Legal Med 2016; 131:61-66. [DOI: 10.1007/s00414-016-1405-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
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Gürses İA, Coşkun O, Gürtekin B, Kale A. The amount of information provided in articles published in clinical anatomy and surgical and radiologic anatomy regarding human cadaveric materials and trends in acknowledging donors/cadavers. Surg Radiol Anat 2016; 38:1225-1231. [PMID: 27151088 DOI: 10.1007/s00276-016-1684-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022]
Abstract
AIM Appreciating the contribution of donor-cadavers to medical education is a well observed practice among anatomists. However, the appreciation of their contribution in research and scientific articles remains dubious. We aimed to evaluate how much data anatomists provide about specimens they have used and how frequently anatomists acknowledge their cadavers in published articles. MATERIALS AND METHODS We evaluated all articles performed on human cadaveric specimens that were published in Clinical Anatomy and Surgical and Radiologic Anatomy between January 2011 and December 2015. We evaluated how much data on the demographics, preservation method(s), source, and ethical/legal permissions regarding cadavers were provided. We also evaluated the number of articles that acknowledged donor-cadavers. RESULTS The majority of articles provided demographic data (age and sex) and preservation method used in the article. The source of the specimens was not mentioned in 45.6 % of the articles. Only 26.2 % of the articles provided a degree of consent and only 32.4 % of the articles reported some form of ethical approval for the study. The cadavers and their families were acknowledged in 17.7 % of the articles. We observed that no standard method for reporting data has been established. CONCLUSIONS Anatomists should collaborate to create awareness among the scientific community for providing adequate information regarding donor-cadavers, including source and consent. Acknowledging donor-cadavers and/or their families should also be promoted. Scientific articles should be used to create a transparent relationship of trust between anatomists and their society.
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Affiliation(s)
- İlke Ali Gürses
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi, Fatih, Istanbul, 34093, Turkey.
| | - Osman Coşkun
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
| | - Başak Gürtekin
- Department of Biostatistics and Medical Informatics, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi, 34093, Fatih, Istanbul, Turkey
| | - Ayşin Kale
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
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Pascart T, Cortet B, Olejnik C, Paccou J, Migaud H, Cotten A, Delannoy Y, During A, Hardouin P, Penel G, Falgayrac G. Bone Samples Extracted from Embalmed Subjects Are Not Appropriate for the Assessment of Bone Quality at the Molecular Level Using Raman Spectroscopy. Anal Chem 2016; 88:2777-83. [DOI: 10.1021/acs.analchem.5b04400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Tristan Pascart
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
- Department
of Rheumatology, Saint-Philibert Hospital, Lille University, 59160 Lomme, France
| | - Bernard Cortet
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
| | - Cecile Olejnik
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
| | - Julien Paccou
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
| | - Henri Migaud
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
| | - Anne Cotten
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
| | - Yann Delannoy
- Lille University − ULCO, PMOI, EA 4490, 59000 Lille, France
- Lille University, Taphonomy Unit, EA 7367, 59000 Lille, France
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Delannoy Y, Colard T, Le Garff E, Humez S, Gosset D, Hedouin V. The mechanism of the keyhole lesion reassessed: An experimental approach. J Forensic Leg Med 2016; 37:1-7. [DOI: 10.1016/j.jflm.2015.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/19/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
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Schaefer TK, Spross C, Stoffel KK, Yates PJ. Biomechanical properties of a posterior fully threaded positioning screw for cannulated screw fixation of displaced neck of femur fractures. Injury 2015; 46:2130-3. [PMID: 26342555 DOI: 10.1016/j.injury.2015.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/11/2015] [Accepted: 07/10/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Displaced intracapsular neck of femur fractures (NOF) in younger patients are usually fixed with partially-threaded cannulated screws. However posterior comminution may lead to construct failure. We hypothesised that a posterior fully threaded positioning screw would enhance stability. METHODS A total of 16 left composite femora (Sawbone) were used for testing. To mimic a subcapital fracture with posterior comminution, a subcaptial osteotomy was performed and a posterior wedge was resected from the neck. Group A (n=8) was fixed using 3 partially threaded cancellous screws. In Group B (n=8), a fully threaded positioning screw instead of a partially threaded was used posteriorly. The specimens were tested for bending (antero-posterior=A-P) and axial stiffness. Finally, they were axially loaded up to failure or up to 10,000 cycles and the final displacement was measured at the site of the resected neck. More than 5mm of displacement was considered as a failure of the construct. RESULTS Group B showed significantly higher average A-P stiffness (665±17N/mm compared to 414±41N/mm, p=0.0004); whereas axial stiffness did not significantly differ between the two groups (p=0.301). In Group B, the mean final displacement after cyclic axial loading was 0.51±0.13mm and none of the specimens failed, whereas 7 of 8 constructs failed in Group A (p=0.001). CONCLUSIONS This biomechanical study points out a potential benefit of replacing the posterior partially threaded cancellous screw with a fully threaded positioning screw in subcapital NOF with posterior comminution. The construct with the fully threaded screw significantly improved the A-P stiffness and reduced the collapse of the fracture.
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Affiliation(s)
- Thomas K Schaefer
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia Australia
| | - Christian Spross
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia Australia
| | - Karl K Stoffel
- Department of Orthopaedic Surgery, Kantonssptial Baselland, Switzerland
| | - Piers J Yates
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia Australia.
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Beason DP, Shah JP, Duckett JW, Jost PW, Fleisig GS, Cain EL. Torsional Fracture of the Humerus after Subpectoral Biceps Tenodesis with an Interference Screw: A Biomechanical Cadaveric Study. Clin Biomech (Bristol, Avon) 2015; 30:915-20. [PMID: 26255072 DOI: 10.1016/j.clinbiomech.2015.07.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Humeral fracture following subpectoral biceps tenodesis has been previously reported; however, there are no published biomechanical studies reporting the resulting torsional strength of the humerus. Our purpose was to determine if there is an increased risk of humerus fracture after subpectoral biceps tenodesis with an interference screw and to determine if screw size is also a factor. We hypothesized that limbs receiving the procedure would have reduced failure torque and rotation under external rotation compared to untreated controls and that the larger screw size would result in inferior mechanical properties compared to the smaller. METHODS Twenty matched pairs of embalmed cadaveric humeri were subjected to subpectoral biceps tenodesis using either a 6.25 or 8.0mm interference screw, with the untreated contralateral limb serving as a control. Each humerus was mechanically tested in torsional external rotation to failure. FINDINGS Maximum torque and rotation to failure were reduced in the tenodesis group compared to controls; however, there was no difference between screw sizes. When both screw sizes were combined into a single group, paired t-tests also showed similar differences. INTERPRETATION Based on our experiment, there is an increased risk for humerus spiral fracture when subjected to torsional external rotation after subpectoral biceps tenodesis with an interference screw compared to an intact humerus; however, there is not a significant difference between a 6.25mm and 8.0mm screw. Surgeons may elect to use alternative fixation methods in patients at high risk (e.g., overhead throwing athletes, etc.) for torsional loads and fracture.
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Affiliation(s)
- David P Beason
- American Sports Medicine Institute, Birmingham, AL, USA.
| | - Jay P Shah
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, AL, USA
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Jakubowitz E, Seeger JB. Periprosthetic fractures: concepts of biomechanical in vitro investigations. INTERNATIONAL ORTHOPAEDICS 2015; 39:1971-9. [PMID: 26294001 DOI: 10.1007/s00264-015-2954-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Experimental in vitro studies investigating periprosthetic fractures after joint replacement are used increasingly. The purpose of this review was to deliver a condensed survey of studies in order to provide researchers with an overview of relevant scientific results and their clinical relevance. METHODS A literature search was conducted to obtain all available papers dealing with periprosthetic fractures, with particular attention being paid to articles with an experimental research design. Study goals, scientific methods and results, their interpretation and clinical relevance were assessed and compared. The main focus was on comparability with clinical fracture patterns and physiological joint loads. RESULTS Excluding duplicates, 24 studies with regard to artificial hip, knee and shoulder joints were found dating back to August 2000. Almost all studies were performed quasi-statically and without consideration of muscle forces and thus reflect selected loading conditions and no dynamic situation during activities of daily living (ADL). Various experimental protocols were used, differing in the choice of experimental material, implant and fixation system and load application. CONCLUSIONS In vitro studies regarding periprosthetic fracture research allow controlling for disturbances, such as clinically occurring risk factors like reduced bone mineral density (BMD) or greater patient age. Notwithstanding, due to methodological differences, comparisons between studies were possible to a limited degree only. For this reason, and because of quasi-static loading typically applied, results can only be partially applied to clinical practice.
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Affiliation(s)
- Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30628, Hannover, Germany.
| | - Jörn Bengt Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
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Affiliation(s)
- Trude Basso
- Orthopedic Research Centre St. Olavs hospital Trondheim University Hospital Postbox 3250 Sluppen NO-7006 Trondheim Norway
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