1
|
Su Z, Ding M, Zhu N, Cheung JCW, Wong DWC, Sun W, Ni M. Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106278. [PMID: 38821036 DOI: 10.1016/j.clinbiomech.2024.106278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/28/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach. METHODS A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated. FINDINGS Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively. INTERPRETATION Our finite element prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.
Collapse
Affiliation(s)
- Zhihao Su
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ding
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China.
| | - Ning Zhu
- School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Wanju Sun
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ni
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China; Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
| |
Collapse
|
2
|
Zhang X, Yang Y, Shen YW, Zhang KR, Ma LT, Ding C, Wang BY, Meng Y, Liu H. Biomechanical performance of the novel assembled uncovertebral joint fusion cage in single-level anterior cervical discectomy and fusion: A finite element analysis. Front Bioeng Biotechnol 2023; 11:931202. [PMID: 36970630 PMCID: PMC10031026 DOI: 10.3389/fbioe.2023.931202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.
Collapse
|
3
|
Li H, Wang D, Zhang W, Xu C, Xiong D, Li J, Zhang L, Tang P. Evaluating the biomechanical performance of Ti6Al4V volar plates in patients with distal radius fractures. Front Bioeng Biotechnol 2023; 11:1141790. [PMID: 36923459 PMCID: PMC10009098 DOI: 10.3389/fbioe.2023.1141790] [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: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
Purpose: This study aimed to investigate the biomechanical performance of three Ti6Al4V volar plates with the latest designs using a finite element model. Methods: An AO type 23-A3 distal radius fracture and the models of T plate (2.4 mm LCP Volar Distal Radius Plate), V plate (2.4 mm LCP Two-Column Volar Distal Radius Plate) and π Plate (2.4 mm Volar Rim Distal Radius Plate) (all from Depuy Synthes, West Chester, PA, USA, Ti6Al4V) were built in 3D-matic software. After assembling the internal fixation and fractures, we imported these models into the finite element analysis software (ABAQUS). An axial loading of 100 N was added to the distal end of each model. The displacements of total models and implants, the principal strains and the von Mises stresses in the plates were calculated and compared to capture the biomechanical features of the three plates. Results: The T plate, V plate and π plate represented a model displacement of 0.8414 mm, 1.134 mm and 1.936 mm, respectively. The T plate was with the implant displacement of 0.7576 mm, followed by the V plate (0.8802 mm) and the π plate (1.545 mm). The T plate had the smallest principal strain of 0.23%, the V plate showed an intermediate level of 0.28%, and the π plate had a value of 0.72%. The least peak von Mises stress was observed in the V plate with 263.6MPa, and this value was 435.6 MPa and 1050 MPa in the T plate and π plate, respectively. Conclusion: The biomechanical features of three Ti6Al4V volar locking plates in an AO type 23-A3 fracture were described in our analysis. The T plate and the V plate showed similar biomechanical performance while the π plate represented worse performance than the other two plates.
Collapse
Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Dou Xiong
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| |
Collapse
|
4
|
Xu Z, Sun W, Li P, Wang Y, Wong DWC, Cheung JCW, Niu W, Zhang H, Ni M. Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study. Injury 2022; 53:3904-3911. [PMID: 36182591 DOI: 10.1016/j.injury.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We have proposed a novel intramedullary nail (Ni-Nail) by incorporating a sustentaculum tali screw to improve the fixation stability of minimally invasive treatment for calcaneal fractures. This study aimed to evaluate the biomechanical characters of the Ni-Nail system and compare it with traditional C-Nail system. METHODS A finite element model of a Sanders type-IIIAB calcaneal fracture was reconstructed and fixed using two intramedullary nail systems, which was validated by a cadaver study. A vertical loading of 700 N was applied to the subtalar joint surfaces, and 525 N Achilles tendon tension was applied to the superior border of the Achilles tuberosity. The von Mises stresses and fracture displacements of both fixation models were evaluated. RESULTS The maximum von Mises stress of the screws of Ni-Nail and C-Nail were 27.92 MPa and 57.42 MPa, respectively, while that of the main nail were 67.44 MPa and 53.01 MPa. In addition, the maximum fracture displacement of the Ni-Nail was larger than that of C-Nail by 15.6% (0.37 mm vs.0.32 mm). CONCLUSIONS Our static simulation analysis showed that both Ni-Nail and C-Nail demonstrated similar biomechanical stability for calcaneal fixation. The Ni-Nail features a simple structure that is easier to operate and less traumatizing. Future studies may consider to further evaluate the clinical effectiveness by clinical trials and follow-ups.
Collapse
Affiliation(s)
- Zihuan Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China
| | - Pengfei Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yongqin Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wenxin Niu
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619 China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Haowei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ming Ni
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| |
Collapse
|