1
|
Sulaiman MY, Wicaksono S, Dirgantara T, Mahyuddin AI, Sadputranto SA, Oli'i EM. Influence of bite force and implant elastic modulus on mandibular reconstruction with particulate-cancellous bone marrow grafts healing: An in silico investigation. J Mech Behav Biomed Mater 2024; 157:106654. [PMID: 39042972 DOI: 10.1016/j.jmbbm.2024.106654] [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: 03/28/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
This study aims to investigate tissue differentiation during mandibular reconstruction with particulate cancellous bone marrow (PCBM) graft healing using biphasic mechanoregulation theory under four bite force magnitudes and four implant elastic moduli to examine its implications on healing rate, implant stress distribution, new bone elastic modulus, mandible equivalent stiffness, and load-sharing progression. The finite element model of a half Canis lupus mandible, symmetrical about the midsagittal plane, with two marginal defects filled by PCBM graft and stabilized by porous implants, was simulated for 12 weeks. Eight different scenarios, which consist of four bite force magnitudes and four implant elastic moduli, were tested. It was found that the tissue differentiation pattern corroborates the experimental findings, where the new bone propagates from the superior side and the buccal and lingual sides in contact with the native bone, starting from the outer regions and progressing inward. Faster healing and quicker development of bone graft elastic modulus and mandible equivalent stiffness were observed in the variants with lower bite force magnitude and or larger implant elastic modulus. A load-sharing condition was found as the healing progressed, with M3 (Ti6Al4V) being better than M4 (stainless steel), indicating the higher stress shielding potentials of M4 in the long term. This study has implications for a better understanding of mandibular reconstruction mechanobiology and demonstrated a novel in silico framework that can be used for post-operative planning, failure prevention, and implant design in a better way.
Collapse
Affiliation(s)
- Muhammad Yusril Sulaiman
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Satrio Wicaksono
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia.
| | - Tatacipta Dirgantara
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Andi Isra Mahyuddin
- Dynamics and Control Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Seto Adiantoro Sadputranto
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia
| | - Eka Marwansyah Oli'i
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia; Mechanical Engineering Graduate Program, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| |
Collapse
|
2
|
Wehrle E, Günther D, Mathavan N, Singh A, Müller R. Protocol for preparing formalin-fixed paraffin-embedded musculoskeletal tissue samples from mice for spatial transcriptomics. STAR Protoc 2024; 5:102986. [PMID: 38555590 PMCID: PMC10998190 DOI: 10.1016/j.xpro.2024.102986] [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: 11/26/2023] [Revised: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
Here, we present a protocol for using spatial transcriptomics in bone and multi-tissue musculoskeletal formalin-fixed paraffin-embedded (FFPE) samples from mice. We describe steps for tissue harvesting, sample preparation, paraffin embedding, and FFPE sample selection. We detail procedures for sectioning and placement on spatial slides prior to imaging, decrosslinking, library preparation, and final analyses of the sequencing data. The complete protocol takes ca. 18 days for mouse femora with adjacent muscle; of this time, >50% is required for mineralized tissue decalcification. For complete details on the use and execution of this protocol, please refer to Wehrle et al.1 and Mathavan et al.2.
Collapse
Affiliation(s)
- Esther Wehrle
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; AO Research Institute Davos, Davos Platz, Switzerland.
| | - Denise Günther
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Amit Singh
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Degenhart C, Engelhardt L, Niemeyer F, Erne F, Braun B, Gebhard F, Schütze K. Computer-Based Mechanobiological Fracture Healing Model Predicts Non-Union of Surgically Treated Diaphyseal Femur Fractures. J Clin Med 2023; 12:jcm12103461. [PMID: 37240567 DOI: 10.3390/jcm12103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
As non-unions are still common, a predictive assessment of healing complications could enable immediate intervention before negative impacts for the patient occur. The aim of this pilot study was to predict consolidation with the help of a numerical simulation model. A total of 32 simulations of patients with closed diaphyseal femoral shaft fractures treated by intramedullary nailing (PFNA long, FRN, LFN, and DePuy Synthes) were performed by creating 3D volume models based on biplanar postoperative radiographs. An established fracture healing model, which describes the changes in tissue distribution at the fracture site, was used to predict the individual healing process based on the surgical treatment performed and full weight bearing. The assumed consolidation as well as the bridging dates were retrospectively correlated with the clinical and radiological healing processes. The simulation correctly predicted 23 uncomplicated healing fractures. Three patients showed healing potential according to the simulation, but clinically turned out to be non-unions. Four out of six non-unions were correctly detected as non-unions by the simulation, and two simulations were wrongfully diagnosed as non-unions. Further adjustments of the simulation algorithm for human fracture healing and a larger cohort are necessary. However, these first results show a promising approach towards an individualized prognosis of fracture healing based on biomechanical factors.
Collapse
Affiliation(s)
- Christina Degenhart
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Lucas Engelhardt
- OSORA-Medical Fracture Analytics, Helmholtzstr. 20, 89081 Ulm, Germany
| | - Frank Niemeyer
- OSORA-Medical Fracture Analytics, Helmholtzstr. 20, 89081 Ulm, Germany
| | - Felix Erne
- Department of Trauma and Reconstructive Surgery, Eberhard-Karls-University Tuebingen, BG Unfallklinik, 72076 Tuebingen, Germany
| | - Benedikt Braun
- Department of Trauma and Reconstructive Surgery, Eberhard-Karls-University Tuebingen, BG Unfallklinik, 72076 Tuebingen, Germany
| | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| |
Collapse
|
4
|
de Wildt BWM, Cramer EEA, de Silva LS, Ito K, Gawlitta D, Hofmann S. Evaluating material-driven regeneration in a tissue engineered human in vitro bone defect model. Bone 2023; 166:116597. [PMID: 36280106 DOI: 10.1016/j.bone.2022.116597] [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: 08/15/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
Advanced in vitro human bone defect models can contribute to the evaluation of materials for in situ bone regeneration, addressing both translational and ethical concerns regarding animal models. In this study, we attempted to develop such a model to study material-driven regeneration, using a tissue engineering approach. By co-culturing human umbilical vein endothelial cells (HUVECs) with human bone marrow-derived mesenchymal stromal cells (hBMSCs) on silk fibroin scaffolds with in vitro critically sized defects, the growth of vascular-like networks and three-dimensional bone-like tissue was facilitated. After a model build-up phase of 28 days, materials were artificially implanted and HUVEC and hBMSC migration, cell-material interactions, and osteoinduction were evaluated 14 days after implantation. The materials physiologically relevant for bone regeneration included a platelet gel as blood clot mimic, cartilage spheres as soft callus mimics, and a fibrin gel as control. Although the in vitro model was limited in the evaluation of immune responses, hallmarks of physiological bone regeneration were observed in vitro. These included the endothelial cell chemotaxis induced by the blood clot mimic and the mineralization of the soft callus mimic. Therefore, the present in vitro model could contribute to an improved pre-clinical evaluation of biomaterials while reducing the need for animal experiments.
Collapse
Affiliation(s)
- Bregje W M de Wildt
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Esther E A Cramer
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Leanne S de Silva
- Department of Oral and Maxillofacial Surgery & Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery & Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Sandra Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, the Netherlands.
| |
Collapse
|
5
|
Xu X, Wang H, Cui F, Guo F. Clinical effect of day case arthroscopic surgery in tibial-eminence fracture in adults using button plates. Front Surg 2022; 9:899438. [PMID: 36248368 PMCID: PMC9559727 DOI: 10.3389/fsurg.2022.899438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background The tibial-eminence fracture (TEF) is an anterior cruciate-ligament avulsion fracture with a low incidence. Many surgical techniques have been described, but none of them allow early functional exercise, and there are many postoperative complications. Purposes This study aimed to evaluate the early clinical efficacy and complications of day case arthroscopic-surgery treatment of adult TEF with button plates. Methods We retrospectively analyzed patients with TEF treated with arthroscopic surgery. Clinical subjective evaluation included International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Score, and Visual Analog Scale (VAS) score. Knee joint scores were evaluated by Lysholm score. Clinical objective assessment included the Lachman test, anterior-drawer test (ADT), IKDC, and range of motion. We assessed patient quality of life using a life summary table. Assessment of fracture healing and internal fixation was based on lateral x-rays of the knee joint. We measured and evaluated patient satisfaction at the last follow-up in accordance with Marsh criteria. Results At final follow-up (average follow-up time, 28.23 ± 3.14 months), we evaluated results from 22 patients (22 knees). Average patient age during surgery was 33.64 ± 6.96 years. Average time from injury to surgery was 6.59 ± 1.47 h. Postoperative function was better than pre-operative function in all patients. IKDC subjective score, Lysholm score, and VAS score were better at final follow-up than before surgery. Differences in Lachman test and ADT scores before and after surgery were statistically significant. According to Intra-articular button position classification, 6 patients (6 knees) showed ideal position (A), 16 patients (16 knees) showed nearly ideal position (B), and none of the patients had nonideal position (C). The fractures of 22 patients healed completely; 2 patients had a 5°–10° knee joint dysfunction, and 1 had an abnormal knee sound. According to intra-articular button position classification, the rate of ideal position was 100%. Patient satisfaction rate was 81.8%. Conclusion Day surgery using double-button plates to treat TEF could achieve anatomical reduction, power and stability, as well as good clinical efficacy.
Collapse
Affiliation(s)
- Xiaohui Xu
- Department of Orthopaedics, QiLu Hospital of ShanDong University, Dezhou Hospital, Dezhou, China
| | - Huayi Wang
- Department of Orthopaedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Fengguo Cui
- Department of Orthopaedics, QiLu Hospital of ShanDong University, Dezhou Hospital, Dezhou, China
| | - Feng Guo
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital University of Medical Sciences, Beijing, China
- Correspondence: Feng Guo
| |
Collapse
|
6
|
Potential bioactive coating system for high-performance absorbable magnesium bone implants. Bioact Mater 2022; 12:42-63. [PMID: 35087962 PMCID: PMC8777287 DOI: 10.1016/j.bioactmat.2021.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants. The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled. Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture. In this review, a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process. The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants. In addition to coating, the substrate itself can be made bioactive by alloying magnesium with calcium, zinc, copper, and manganese that were found to promote bone regeneration. Bioactive-coated magnesium implant could accelerate bone fracture healing time to match with magnesium degradation. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are high potential bioactive coating materials. The incorporation of Ca, Zn, Cu, Sr, and Mn in Mg base-metal could further enhance bone formation.
Collapse
|
7
|
Yao CH, Yang BY, Li YCE. Remodeling Effects of the Combination of GGT Scaffolds, Percutaneous Electrical Stimulation, and Acupuncture on Large Bone Defects in Rats. Front Bioeng Biotechnol 2022; 10:832808. [PMID: 35295647 PMCID: PMC8919371 DOI: 10.3389/fbioe.2022.832808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
The regeneration defect of bone is a long-term physiological process after bone injuries. To accelerate the bone remodeling process, the combination of chemical and physical stimulations provides an efficient strategy to allow maturation and to functionalize osteoclasts and osteoblasts. This study aims to investigate the dual effects of a tricalcium phosphate (TCP)-based gelatin scaffold (GGT) in combination with electroacupuncture stimulation on the activation of osteoclasts and osteoblasts, as well as new bone regrowth in vitro and in vivo. We demonstrated that electrical stimulation changes the pH of a culture medium and activates osteoblasts and osteoclasts in an in vitro co-culture system. Furthermore, we showed that electroacupuncture stimulation can enhance osteogenesis and new bone regrowth in vivo and can upregulate the mechanism among parathyroid hormone intact (PTH-i), calcium, osteoclasts, and osteoblasts in the bone-defected rats. Those results showed the potential interest to combine the electroacupuncture technique with GGT scaffolds to improve bone remodeling after injury.
Collapse
Affiliation(s)
- Chun-Hsu Yao
- School of Chinese Medicine, College of Chinese Medicine, Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.,Biomaterials Translational Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Informatics, Asia University, Taichung, Taiwan
| | - Bo-Yin Yang
- School of Chinese Medicine, College of Chinese Medicine, Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yi-Chen Ethan Li
- Department of Chemical Engineering, Feng Chia University, Taichung, Taiwan
| |
Collapse
|
8
|
Fu R, Feng Y, Liu Y, Willie BM, Yang H. The combined effects of dynamization time and degree on bone healing. J Orthop Res 2022; 40:634-643. [PMID: 33913530 DOI: 10.1002/jor.25060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Dynamization, increasing the interfragmentary movement (IFM) by reducing the fixation stiffness from a rigid to a more flexible condition, is widely used clinically to promote fracture healing. However, it remains unknown how dynamization degree (relative change in fixation stiffness/IFM from a rigid to a flexible fixation) affects bone healing at various stages. To address this issue, we used a fuzzy logic-based mechano-regulated tissue differentiation algorithm on published experimental data from a sheep osteotomy healing model. We applied a varied degree of dynamization, from 0 (fully rigid fixation) to 0.9 (90% reduction in stiffness relative to the rigid fixation) after 1, 2, 3, and 4 weeks of osteotomy (R1wF, R2wF, R3wF, and R4wF) and computationally evaluated bone regeneration and biomechanical integrity over the healing process of 8 weeks. Compared with the constant rigid fixation, early dynamization (R1wF and R2wF) led to delays in bone bridging and biomechanical recovery of the osteotomized bone. However, the effect of early dynamization on healing was dependent of the degree of dynamization. Specifically, a higher dynamization degree (e.g., 0.9 for R1wF) led to a prolonged delay in bone bridging and largely unrecovered bending stiffness (48% relative to the intact bone), whereas a moderate degree of dynamization (e.g., 0.5 or 0.7) significantly enhanced bone formation and biomechanical properties of the osteotomized bone. These results suggest that dynamization degree and timing interactively affect the healing process. A combination of early dynamization with a moderate degree could enhance the ultimate biomechanical recovery of the fractured bone.
Collapse
Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bettina M Willie
- Department of Pediatric Surgery, Research Centre, Shriners Hospital for Children-Canada, McGill University, Montreal, Quebec, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| |
Collapse
|
9
|
Dolan CP, Imholt F, Yan M, Yang TJ, Gregory J, Qureshi O, Zimmel K, Sherman KM, Smith HM, Falck A, Leininger E, Yu L, Brunauer R, Suva LJ, Gaddy D, Dawson LA, Muneoka K. Digit specific denervation does not inhibit mouse digit tip regeneration. Dev Biol 2022; 486:71-80. [DOI: 10.1016/j.ydbio.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/26/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
|
10
|
Evaluation of Bone Consolidation in External Fixation with an Electromechanical System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The monitoring of fracture or osteotomy healing is vital for orthopedists to help advise, if necessary, secondary treatments for improving healing outcomes and minimizing patient suffering. It has been decades since osteotomy stiffness has been identified as one main parameter to quantify and qualify the outcome of a regenerated callus. Still, radiographic imaging remains the current standard diagnostic technique of orthopedists. Hence, with recent technological advancements, engineers need to use the new branches of knowledge and improve or innovate diagnostic technologies. An electromechanical system was developed to help diagnose changes in osteotomy stiffness treated with the external fixator LRS Orthofix®. The concept was evaluated experimentally and numerically during fracture healing simulation using two different models: a simplified model of a human tibia, consisting of a nylon bar with a diameter of 30 mm, and a synthetic tibia with the anatomical model from fourth-generation Sawbones®. Moreover, Sawbones® blocks with different densities simulated the mechanical characteristics of the regenerated bone in many stages of bone callus growth. The experimental measurements using the developed diagnostic were compared to the numerically simulated results. For this external fixator, it was possible to show that the displacement in osteotomy was always lower than the displacement prescribed in the elongator. Nevertheless, a relationship was established between the energy consumption by the electromechanical system used to perform callus stimulus and the degree of osteotomy consolidation. Hence, this technology may lead to methodologies of mechanical stimulation for regenerating bone, which will play a relevant role for bedridden individuals with mobility limitations.
Collapse
|
11
|
3D Printing Adjustable Stiffness External Fixator for Mechanically Stimulated Healing of Tibial Fractures. BIOMED RESEARCH INTERNATIONAL 2022; 2021:8539416. [PMID: 34977247 PMCID: PMC8718297 DOI: 10.1155/2021/8539416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
External fixation is a long-standing but well-established method, which has been widely used for the treatment of fractures. To obtain the maximum benefit from the mechanical stimulus, the stiffness of the external fixator should be adjusted properly throughout the treatment phase. Nevertheless, the lack of a valid dynamic adjustable fixation device impedes this possibility. Based on the stiffness adjustment tolerance of the healing callus, this paper proposes an active-dynamic stiffness adjustable external fixator design method to meet stiffness requirements at different stages of the tibial fracture healing process. A novel external fixator with an adjustable stiffness configuration was designed, and the finite element method was used to simulate the stress distribution between fixator and fracture gap. The stiffness adjustment tolerance was determined based on previous studies. According to this tolerance, the optimal block structure dismantling sequence was sought and the corresponding stiffness was calculated through topology optimization for the entire external fixator model. The appropriate amount of variable stiffness at the fracture gap was applied by dismantling the configuration of the block structure external fixator during the healing process. A novel patient-specific adjustable stiffness external fixator for mechanically stimulated tibial fracture reduction and therapy was proposed. This enables surgeons to tailor the construction of the external fixator frame to the clinical needs of each patient. The presented dismantling approach of the block structure to produce conformable stiffness provides a new clinical treatment strategy for tibial fractures.
Collapse
|
12
|
Yanagisawa Y, Shimizu Y, Mukai T, Sano Y, Odashima K, Ikeo N, Saito H, Yamauchi K, Takahashi T, Kumamoto H. Biodegradation behaviors of magnesium(Mg)-based alloy nails in autologous bone grafts: In vivo study in rabbit skulls. J Appl Biomater Funct Mater 2022; 20:22808000221095230. [PMID: 35599624 DOI: 10.1177/22808000221095230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In this study, autologous bone grafts using bone-fixing nails made of magnesium-zinc-calcium ternary alloys were performed using rabbit skulls. MATERIAL AND METHODS Two types of nails for bone fixation were prepared: 2.5 mm width, 3 mm length and 2.5 mm width, 2 mm length. A disk-shaped bone with a diameter of 5 mm was resected from the parietal bone and fixed with a 3 mm long nail. As a control group, a 2 mm long nail was driven into the existing bone. The rabbits were sacrificed at 1, 4, 12, and 24 weeks after surgery. The resected samples were observed with micro X-ray CT, and embedded in methyl methacrylate to prepare non-decalcified specimens. The in vivo localization of elements was examined using energy-dispersive X-ray spectroscopy (EDS). RESULTS Micro X-ray CT images of samples showed volume reduction due to degradation in both the bone graft and control groups. No significant difference in the amount of degradation between the two groups was observed, however characteristic degradation processes were observed in each group. The samples stained with alizarin red S showed amorphous areas around the nails, which were considered as corrosion products and contacted directly with the newly formed bones. EDS analysis showed that corrosion products were mainly composed of magnesium and oxygen at an early stage, while calcium and phosphorus were detected on the surface layer during the long-term observation. CONCLUSIONS The degradation speed of the magnesium alloy nails varied depending on the shapes of the nails and surrounding tissue conditions. A calcium phosphate layer was formed on the surface of magnesium alloy nails, suggesting that the degradation rate of the nail was slow.
Collapse
Affiliation(s)
- Yuta Yanagisawa
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Yoshinaka Shimizu
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Toshiji Mukai
- Department of Mechanical Engineering, Kobe University, Kobe, Hyogo, Japan
| | - Yuya Sano
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kenji Odashima
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Naoko Ikeo
- Department of Mechanical Engineering, Kobe University, Kobe, Hyogo, Japan
| | - Haruka Saito
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| |
Collapse
|
13
|
Andrés Sastre E, Nossin Y, Jansen I, Kops N, Intini C, Witte-Bouma J, van Rietbergen B, Hofmann S, Ridwan Y, Gleeson JP, O'Brien FJ, Wolvius EB, van Osch GJVM, Farrell E. A new semi-orthotopic bone defect model for cell and biomaterial testing in regenerative medicine. Biomaterials 2021; 279:121187. [PMID: 34678648 DOI: 10.1016/j.biomaterials.2021.121187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
In recent decades, an increasing number of tissue engineered bone grafts have been developed. However, expensive and laborious screenings in vivo are necessary to assess the safety and efficacy of their formulations. Rodents are the first choice for initial in vivo screens but their size limits the dimensions and number of the bone grafts that can be tested in orthotopic locations. Here, we report the development of a refined murine subcutaneous model for semi-orthotopic bone formation that allows the testing of up to four grafts per mouse one order of magnitude greater in volume than currently possible in mice. Crucially, these defects are also "critical size" and unable to heal within the timeframe of the study without intervention. The model is based on four bovine bone implants, ring-shaped, where the bone healing potential of distinct grafts can be evaluated in vivo. In this study we demonstrate that promotion and prevention of ossification can be assessed in our model. For this, we used a semi-automatic algorithm for longitudinal micro-CT image registration followed by histological analyses. Taken together, our data supports that this model is suitable as a platform for the real-time screening of bone formation, and provides the possibility to study bone resorption, osseointegration and vascularisation.
Collapse
Affiliation(s)
- E Andrés Sastre
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Y Nossin
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - I Jansen
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - N Kops
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C Intini
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Witte-Bouma
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Y Ridwan
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J P Gleeson
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland; Trinity Center for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - G J V M van Osch
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | - E Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
14
|
A General Mechano-Pharmaco-Biological Model for Bone Remodeling Including Cortisol Variation. MATHEMATICS 2021. [DOI: 10.3390/math9121401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The process of bone remodeling requires a strict coordination of bone resorption and formation in time and space in order to maintain consistent bone quality and quantity. Bone-resorbing osteoclasts and bone-forming osteoblasts are the two major players in the remodeling process. Their coordination is achieved by generating the appropriate number of osteoblasts since osteoblastic-lineage cells govern the bone mass variation and regulate a corresponding number of osteoclasts. Furthermore, diverse hormones, cytokines and growth factors that strongly link osteoblasts to osteoclasts coordinated these two cell populations. The understanding of this complex remodeling process and predicting its evolution is crucial to manage bone strength under physiologic and pathologic conditions. Several mathematical models have been suggested to clarify this remodeling process, from the earliest purely phenomenological to the latest biomechanical and mechanobiological models. In this current article, a general mathematical model is proposed to fill the gaps identified in former bone remodeling models. The proposed model is the result of combining existing bone remodeling models to present an updated model, which also incorporates several important parameters affecting bone remodeling under various physiologic and pathologic conditions. Furthermore, the proposed model can be extended to include additional parameters in the future. These parameters are divided into four groups according to their origin, whether endogenous or exogenous, and the cell population they affect, whether osteoclasts or osteoblasts. The model also enables easy coupling of biological models to pharmacological and/or mechanical models in the future.
Collapse
|
15
|
Brent MB, Brüel A, Thomsen JS. A Systematic Review of Animal Models of Disuse-Induced Bone Loss. Calcif Tissue Int 2021; 108:561-575. [PMID: 33386477 DOI: 10.1007/s00223-020-00799-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Several different animal models are used to study disuse-induced bone loss. This systematic review aims to give a comprehensive overview of the animal models of disuse-induced bone loss and provide a detailed narrative synthesis of each unique animal model. METHODS PubMed and Embase were systematically searched for animal models of disuse from inception to November 30, 2019. In addition, Google Scholar and personal file archives were searched for relevant publications not indexed in PubMed or Embase. Two reviewers independently reviewed titles and abstracts for full-text inclusion. Data were extracted using a predefined extraction scheme to ensure standardization. RESULTS 1964 titles and abstracts were screened of which 653 full-text articles were included. The most common animal species used to model disuse were rats (59%) and mice (30%). Males (53%) where used in the majority of the studies and genetically modified animals accounted for 7%. Twelve different methods to induce disuse were identified. The most frequently used methods were hindlimb unloading (44%), neurectomy (15%), bandages and orthoses (15%), and botulinum toxin (9%). The median time of disuse was 21 days (quartiles: 14 days, 36 days) and the median number of animals per group subjected to disuse was 10 (quartiles: 7, 14). Random group allocation was reported in 43% of the studies. Fewer than 5% of the studies justified the number of animals per group by a sample size calculation to ensure adequate statistical power. CONCLUSION Multiple animal models of disuse-induced bone loss exist, and several species of animals have successfully been studied. The complexity of disuse-induced bone loss warrants rigid research study designs. This systematic review emphasized the need for standardization of animal disuse research and reporting.
Collapse
Affiliation(s)
- Mikkel Bo Brent
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
- Department of Biomedicine, Health, Aarhus University, Wilhelm Meyers Allé 3, 8000, Aarhus C, Denmark.
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
16
|
Nasello G, Vautrin A, Pitocchi J, Wesseling M, Kuiper JH, Pérez MÁ, García-Aznar JM. Mechano-driven regeneration predicts response variations in large animal model based on scaffold implantation site and individual mechano-sensitivity. Bone 2021; 144:115769. [PMID: 33276152 DOI: 10.1016/j.bone.2020.115769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023]
Abstract
It is well founded that the mechanical environment may regulate bone regeneration in orthopedic applications. The purpose of this study is to investigate the mechanical contributions of the scaffold and the host to bone regeneration, in terms of subject specificity, implantation site and sensitivity to the mechanical environment. Using a computational approach to model mechano-driven regeneration, bone ingrowth in porous titanium scaffolds was simulated in the distal femur and proximal tibia of three goats and compared to experimental results. The results showed that bone ingrowth shifted from a homogeneous distribution pattern, when scaffolds were in contact with trabecular bone (max local ingrowth 12.47%), to a localized bone ingrowth when scaffolds were implanted in a diaphyseal location (max local ingrowth 20.64%). The bone formation dynamics revealed an apposition rate of 0.37±0.28%/day in the first three weeks after implantation, followed by limited increase in bone ingrowth until the end of the experiment (12 weeks). According to in vivo data, we identified one animal whose sensitivity to mechanical stimulation was higher than the other two. Moreover, we found that the stimulus initiating bone formation was consistently higher in the femur than in the tibia for all the individuals. Overall, the dependence of the osteogenic response on the host biomechanics means that, from a mechanical perspective, the regenerative potential depends on both the scaffold and the host environment. Therefore, this work provides insights on how the mechanical conditions of both the recipient and the scaffold contribute to meet patient and location-specific characteristics.
Collapse
Affiliation(s)
- Gabriele Nasello
- Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Antoine Vautrin
- Ecole Nationale d'Ingénieurs de Metz, University of Lorraine, Metz, France
| | - Jonathan Pitocchi
- Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium; Materialise NV, Leuven, Belgium
| | | | - Jan Herman Kuiper
- Institute for Science and Technology in Medicine, Keele University, Keele, UK; The Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - María Ángeles Pérez
- Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - José Manuel García-Aznar
- Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain.
| |
Collapse
|
17
|
Malhotra A, Walle M, Paul GR, Kuhn GA, Müller R. Application of subject-specific adaptive mechanical loading for bone healing in a mouse tail vertebral defect. Sci Rep 2021; 11:1861. [PMID: 33479260 PMCID: PMC7820598 DOI: 10.1038/s41598-021-81132-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
Methods to repair bone defects arising from trauma, resection, or disease, continue to be sought after. Cyclic mechanical loading is well established to influence bone (re)modelling activity, in which bone formation and resorption are correlated to micro-scale strain. Based on this, the application of mechanical stimulation across a bone defect could improve healing. However, if ignoring the mechanical integrity of defected bone, loading regimes have a high potential to either cause damage or be ineffective. This study explores real-time finite element (rtFE) methods that use three-dimensional structural analyses from micro-computed tomography images to estimate effective peak cyclic loads in a subject-specific and time-dependent manner. It demonstrates the concept in a cyclically loaded mouse caudal vertebral bone defect model. Using rtFE analysis combined with adaptive mechanical loading, mouse bone healing was significantly improved over non-loaded controls, with no incidence of vertebral fractures. Such rtFE-driven adaptive loading regimes demonstrated here could be relevant to clinical bone defect healing scenarios, where mechanical loading can become patient-specific and more efficacious. This is achieved by accounting for initial bone defect conditions and spatio-temporal healing, both being factors that are always unique to the patient.
Collapse
Affiliation(s)
- Angad Malhotra
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Matthias Walle
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Graeme R Paul
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Gisela A Kuhn
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| |
Collapse
|
18
|
Kumar A, Khan R, Jameel J, Kumar S. Salvaging Chronic Nonunion of Femoral Neck and Infected Nonunion of Ipsilateral Femoral Shaft Fracture Using Intramedullary Antibiotic Cement Spacer and External Fixator Alone. Cureus 2021; 13:e12665. [PMID: 33604205 PMCID: PMC7880828 DOI: 10.7759/cureus.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Concomitant ipsilateral fractures of femoral neck and shaft are rare injuries and pose challenging management. Infected non-unions of such fractures can further complicate the management options and have not been discussed in the literature. We present a case of an eight-month-old atrophic non-union of ipsilateral femoral shaft and femoral neck with evidence of intramedullary infection that was managed using a cost-effective, low strain rail fixator assembly and an intramedullary antibiotic cement spacer. Both fracture non-unions were salvaged without the need for any additional procedure. The patient returned to his regular activities within a year follow-up period. There was no clinical evidence of infection during the last follow-up at 16 months, and inflammatory markers were within normal limits. The current case study suggests that while aggressive debridement and intramedullary antibiotic cement spacer can control the intramedullary infection, and simultaneous union of even atrophic nonunion of femoral shaft and femoral neck, both, can be obtained using a tensioned Schanz pin-based external fixator without the need for any secondary procedure. Such a fixator and cement spacer assembly can thus address the dual purpose of fracture stabilization during infection control as well as the union of the non-union sites.
Collapse
Affiliation(s)
- Arvind Kumar
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Rizwan Khan
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Javed Jameel
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Sandeep Kumar
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| |
Collapse
|
19
|
Iobst CA, Milne E, Khoury A, Ingwer Z, Latta L. A novel way to dynamize a spatial frame and optimize fracture healing. Injury 2021; 52:106-108. [PMID: 33039178 DOI: 10.1016/j.injury.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fracture site motion creates mechanical strains on the healing tissues which influences bone formation. Axial micro-motion maximizes dilatational strains, whereas shearing motions maximize deviatoric strains on the healing tissues. Dilatational strains optimize bone healing, deviatoric strains retard bone healing. Dynamization of external fixation using either an Ilizarov or Spatial Frame platform is used to increase loading on the limb which increases the mechanical stress and strain on the tissues to improve healing. The scientific literature does not address how dynamization of the spatial frame effects fracture site motion. The purpose of this study is to assess the effect of modified shoulder bolts incorporated into a spatial frame during dynamic loading. METHODS Five identical two-ring spatial frame constructed were mounted on Sawbones tibias with an osteotomy performed distal to the tibial tubercle. Sinusoidal load was applied at a rate of 0.25 Hz. Axial force and displacement, in addition to motion of the proximal and distal tibia segments were recorded. Eight constructs were tested: 1) All struts of the Spatial Frame rigid, 2) Strut #1 loose, 3) Struts #1 and #3 loose, 4) Struts #1, #3 and #5 loose, 5) All struts loose, 6) All struts rigid with dynamization bolts on the proximal end, 7) All struts rigid with dynamization bolts on alternating sides, 8) Threaded rods between the rings with two millimeters of dynamization. RESULTS No difference in vertical displacement was observed between the Ilizarov and all struts locked. No significant difference in shear values between all struts locked and modified shoulder bolt struts was observed. Increase in vertical movement with the modified shoulder bolts was an average of 1.83 mm. Significant shear forces at the fracture site were observed with unlocking single or multiple struts of the spatial frame. CONCLUSION Modified shoulder bolts can be used for spatial frame dynamization without increasing shear motion.
Collapse
Affiliation(s)
- Christopher A Iobst
- Nationwide Children's Hospital, 700 Children's Drive, Suite T2E-A2700, Columbus, OH, United States.
| | - Edward Milne
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United States
| | - Anthony Khoury
- Department of Biomedical Engineering, University of Miami, College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States; Arthrex, Inc., 1370 Creekside Blvd., Naples, Florida 34108 United States
| | - Zachary Ingwer
- Department of Biomedical Engineering, University of Miami, College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States; Arthrex, Inc., 1370 Creekside Blvd., Naples, Florida 34108 United States
| | - Loren Latta
- Nationwide Children's Hospital, 700 Children's Drive, Suite T2E-A2700, Columbus, OH, United States; Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United States
| |
Collapse
|
20
|
Barcik J, Ernst M, Dlaska CE, Drenchev L, Zeiter S, Epari DR, Windolf M. Programable Active Fixator System for Systematic In Vivo Investigation of Bone Healing Processes. SENSORS (BASEL, SWITZERLAND) 2020; 21:E17. [PMID: 33375087 PMCID: PMC7792812 DOI: 10.3390/s21010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
This manuscript introduces a programable active bone fixator system that enables systematic investigation of bone healing processes in a sheep animal model. In contrast to previous systems, this solution combines the ability to precisely control the mechanical conditions acting within a fracture with continuous monitoring of the healing progression and autonomous operation of the system throughout the experiment. The active fixator system was implemented on a double osteotomy model that shields the experimental fracture from the influence of the animal's functional loading. A force sensor was integrated into the fixator to continuously measure stiffness of the repair tissue as an indicator for healing progression. A dedicated control unit was developed that allows programing of different loading protocols which are later executed autonomously by the active fixator. To verify the feasibility of the system, it was implanted in two sheep with different loading protocols, mimicking immediate and delayed weight-bearing, respectively. The implanted devices operated according to the programmed protocols and delivered seamless data over the whole course of the experiment. The in vivo trial confirmed the feasibility of the system. Hence, it can be applied in further preclinical studies to better understand the influence of mechanical conditions on fracture healing.
Collapse
Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Constantin E. Dlaska
- Orthopaedic Research Institute of Queensland, 7 Turner Street, Townsville, QLD 4812, Australia;
| | - Ludmil Drenchev
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Devakara R. Epari
- Institute of Health and Biomedical Innovation, Queensland University of Technology, George Street 2, Brisbane City, QLD 4000, Australia;
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| |
Collapse
|
21
|
Abdul Wahab AH, Wui NB, Abdul Kadir MR, Ramlee MH. Biomechanical evaluation of three different configurations of external fixators for treating distal third tibia fracture: Finite element analysis in axial, bending and torsion load. Comput Biol Med 2020; 127:104062. [PMID: 33096298 DOI: 10.1016/j.compbiomed.2020.104062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
External fixators have been widely used in treating open fractures and have produced excellent outcomes, as they could successfully heal bones. The stability of external fixators lies greatly in their construction. Factors that associated with the stability of the external fixators includes stress, displacement, and relative micromotion. Three-dimensional (3D) models of bone and external fixators were constructed by using 3D modelling software, namely Materialise and SolidWorks, respectively. Three different configurations of external fixators namely Model 1, Model 2, and Model 3 were analysed. Three load cases were simulated to assess the abovementioned factors at the bone, specifically at the fracture site and at the external fixator. Findings showed that the double-cross configuration (Model 3) was the most promising in axial, bending, and torsion load cases as compared to the other two configurations. The no-cross configuration (Model 1) had the highest risk of complication due to high stress, relative micromotion, and displacement in the bending and torsion load cases. On the other hand, the single-cross configuration (Model 2) had the highest risk of complication when applied with axial load. In conclusion, the double-cross locking construct (Model 3) showed the biggest potential to be a new option for medical surgeons in treating patients associated with bone fracture. This new double-cross locking construct showed superior biomechanical stability as compared to single-cross and no-cross configurations in the axial, bending, and torsion load cases.
Collapse
Affiliation(s)
- Abdul Hadi Abdul Wahab
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| | - Ng Bing Wui
- Department of Orthopaedics and Traumatology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Mohammed Rafiq Abdul Kadir
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Sport Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| | - Muhammad Hanif Ramlee
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| |
Collapse
|
22
|
Xu GP, Zhang XF, Sun L, Chen EM. Current and future uses of skeletal stem cells for bone regeneration. World J Stem Cells 2020; 12:339-350. [PMID: 32547682 PMCID: PMC7280866 DOI: 10.4252/wjsc.v12.i5.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023] Open
Abstract
The postnatal skeleton undergoes growth, modeling, and remodeling. The human skeleton is a composite of diverse tissue types, including bone, cartilage, fat, fibroblasts, nerves, blood vessels, and hematopoietic cells. Fracture nonunion and bone defects are among the most challenging clinical problems in orthopedic trauma. The incidence of nonunion or bone defects following fractures is increasing. Stem and progenitor cells mediate homeostasis and regeneration in postnatal tissue, including bone tissue. As multipotent stem cells, skeletal stem cells (SSCs) have a strong effect on the growth, differentiation, and repair of bone regeneration. In recent years, a number of important studies have characterized the hierarchy, differential potential, and bone formation of SSCs. Here, we describe studies on and applications of SSCs and/or mesenchymal stem cells for bone regeneration.
Collapse
Affiliation(s)
- Guo-Ping Xu
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiang-Feng Zhang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Lu Sun
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, United States
| | - Er-Man Chen
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| |
Collapse
|
23
|
Koolen M, Amin Yavari S, Lietaert K, Wauthle R, Zadpoor AA, Weinans H. Bone Regeneration in Critical-Sized Bone Defects Treated with Additively Manufactured Porous Metallic Biomaterials: The Effects of Inelastic Mechanical Properties. MATERIALS 2020; 13:ma13081992. [PMID: 32344664 PMCID: PMC7215733 DOI: 10.3390/ma13081992] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023]
Abstract
Additively manufactured (AM) porous metallic biomaterials, in general, and AM porous titanium, in particular, have recently emerged as promising candidates for bone substitution. The porous design of such materials allows for mimicking the elastic mechanical properties of native bone tissue and showed to be effective in improving bone regeneration. It is, however, not clear what role the other mechanical properties of the bulk material such as ductility play in the performance of such biomaterials. In this study, we compared the bone tissue regeneration performance of AM porous biomaterials made from the commonly used titanium alloy Ti6Al4V-ELI with that of commercially pure titanium (CP-Ti). CP-Ti was selected because of its high ductility as compared to Ti6Al4V-ELI. Critical-sized (6 mm diameter) femoral defects in rats were treated with implants made from both Ti6Al4V-ELI and CP-Ti. Bone regeneration was assessed up to 11 weeks using micro-CT scanning. The regenerated bone volume was assessed ex vivo followed by histology and biomechanical testing to assess osseointegration of the implants. The bony defects treated with AM CP-Ti implants generally showed higher volumes of regenerated bone as compared to those treated with AM Ti6Al4V-ELI. The torsional strength of the two titanium groups were similar however, and both considerably lower than those measured for intact bony tissue. These findings show the importance of material type and ductility of the bulk material in the ability for bone tissue regeneration of AM porous biomaterials.
Collapse
Affiliation(s)
- Marianne Koolen
- Department of Orthopaedics, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Saber Amin Yavari
- Department of Orthopaedics, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Karel Lietaert
- 3D Systems Healthcare, 3D Systems Leuven, 3001 Leuven, Belgium
| | - Ruben Wauthle
- 3D Systems Healthcare, 3D Systems Leuven, 3001 Leuven, Belgium
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CN Delft, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CN Delft, The Netherlands
| |
Collapse
|
24
|
Peña Fernández M, Black C, Dawson J, Gibbs D, Kanczler J, Oreffo ROC, Tozzi G. Exploratory Full-Field Strain Analysis of Regenerated Bone Tissue from Osteoinductive Biomaterials. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E168. [PMID: 31906343 PMCID: PMC6981952 DOI: 10.3390/ma13010168] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/02/2019] [Accepted: 12/28/2019] [Indexed: 12/25/2022]
Abstract
Biomaterials for bone regeneration are constantly under development, and their application in critical-sized defects represents a promising alternative to bone grafting techniques. However, the ability of all these materials to produce bone mechanically comparable with the native tissue remains unclear. This study aims to explore the full-field strain evolution in newly formed bone tissue produced in vivo by different osteoinductive strategies, including delivery systems for BMP-2 release. In situ high-resolution X-ray micro-computed tomography (microCT) and digital volume correlation (DVC) were used to qualitatively assess the micromechanics of regenerated bone tissue. Local strain in the tissue was evaluated in relation to the different bone morphometry and mineralization for specimens (n = 2 p/treatment) retrieved at a single time point (10 weeks in vivo). Results indicated a variety of load-transfer ability for the different treatments, highlighting the mechanical adaptation of bone structure in the early stages of bone healing. Although exploratory due to the limited sample size, the findings and analysis reported herein suggest how the combination of microCT and DVC can provide enhanced understanding of the micromechanics of newly formed bone produced in vivo, with the potential to inform further development of novel bone regeneration approaches.
Collapse
Affiliation(s)
- Marta Peña Fernández
- School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK;
| | - Cameron Black
- Bone & Joint Research Group, Centre for Human Development Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (J.D.); (D.G.); (J.K.); (R.O.C.O.)
| | - Jon Dawson
- Bone & Joint Research Group, Centre for Human Development Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (J.D.); (D.G.); (J.K.); (R.O.C.O.)
| | - David Gibbs
- Bone & Joint Research Group, Centre for Human Development Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (J.D.); (D.G.); (J.K.); (R.O.C.O.)
- School of Maritime Science and Engineering, Solent University, Southampton SO14 0YN, UK
| | - Janos Kanczler
- Bone & Joint Research Group, Centre for Human Development Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (J.D.); (D.G.); (J.K.); (R.O.C.O.)
| | - Richard O. C. Oreffo
- Bone & Joint Research Group, Centre for Human Development Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (J.D.); (D.G.); (J.K.); (R.O.C.O.)
| | - Gianluca Tozzi
- School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK;
| |
Collapse
|
25
|
Abstract
This article reviews the biomechanical parameters of fracture repair that influence construct stiffness and strength. The stiffness influences the relative motion between fracture fragments, known as gap strain, and, thus, callus development. Construct strength determines the magnitude and number of load events that the repair can resist before failure. Surgeons must optimize these parameters in order to achieve satisfactory outcomes for the patients.
Collapse
Affiliation(s)
- Simon Roe
- Small Animal Orthopaedics, Department of Clinical Sciences, College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC 27607, USA.
| |
Collapse
|
26
|
Schreivogel S, Kuchibhotla V, Knaus P, Duda GN, Petersen A. Load-induced osteogenic differentiation of mesenchymal stromal cells is caused by mechano-regulated autocrine signaling. J Tissue Eng Regen Med 2019; 13:1992-2008. [PMID: 31359634 DOI: 10.1002/term.2948] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022]
Abstract
Mechanical boundary conditions critically influence the bone healing process. In this context, previous in vitro studies have demonstrated that cyclic mechanical compression alters migration and triggers osteogenesis of mesenchymal stromal cells (MSC), both processes being relevant to healing. However, it remains unclear whether this mechanosensitivity is a direct consequence of cyclic compression, an indirect effect of altered supply or a specific modulation of autocrine bone morphogenetic protein (BMP) signaling. Here, we investigate the influence of cyclic mechanical compression (ε = 5% and 10%, f = 1 Hz) on human bone marrow MSC (hBMSC) migration and osteogenic differentiation in a 3D biomaterial scaffold, an in vitro system mimicking the mechanical environment of the early bone healing phase. The open-porous architecture of the scaffold ensured sufficient supply even without cyclic compression, minimizing load-associated supply alterations. Furthermore, a large culture medium volume in relation to the cell number diminished autocrine signaling. Migration of hBMSCs was significantly downregulated under cyclic compression. Surprisingly, a decrease in migration was not associated with increased osteogenic differentiation of hBMSCs, as the expression of RUNX2 and osteocalcin decreased. In contrast, BMP2 expression was significantly upregulated. Enabling autocrine stimulation by increasing the cell-to-medium ratio in the bioreactor finally resulted in a significant upregulation of RUNX2 in response to cyclic compression, which could be reversed by rhNoggin treatment. The results indicate that osteogenesis is promoted by cyclic compression when cells condition their environment with BMP. Our findings highlight the importance of mutual interactions between mechanical forces and BMP signaling in controlling osteogenic differentiation.
Collapse
Affiliation(s)
- Sophie Schreivogel
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center and School for Regenerative Therapies, Berlin, Germany
| | | | - Petra Knaus
- Berlin-Brandenburg Center and School for Regenerative Therapies, Berlin, Germany
- Institute for Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center and School for Regenerative Therapies, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ansgar Petersen
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center and School for Regenerative Therapies, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
27
|
Grivas KN, Vavva MG, Polyzos D, Carlier A, Geris L, Van Oosterwyck H, Fotiadis DI. Effect of ultrasound on bone fracture healing: A computational mechanobioregulatory model. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 145:1048. [PMID: 30823826 DOI: 10.1121/1.5089221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
Bone healing process is a complicated phenomenon regulated by biochemical and mechanical signals. Experimental studies have shown that ultrasound (US) accelerates bone ossification and has a multiple influence on cell differentiation and angiogenesis. In a recent work of the authors, a bioregulatory model for providing bone-healing predictions was addressed, taking into account for the first time the salutary effect of US on the involved angiogenesis. In the present work, a mechanobioregulatory model of bone solidification under the US presence incorporating also the mechanical environment on the regeneration process, which is known to affect cellular processes, is presented. An iterative procedure is adopted, where the finite element method is employed to compute the mechanical stimuli at the linear elastic phases of the poroelastic callus region and a coupled system of partial differential equations to simulate the enhancement by the US cell angiogenesis process and thus the oxygen concentration in the fractured area. Numerical simulations with and without the presence of US that illustrate the influence of progenitor cells' origin in the healing pattern and the healing rate and simultaneously demonstrate the salutary effect of US on bone repair are presented and discussed.
Collapse
Affiliation(s)
- Konstantinos N Grivas
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Maria G Vavva
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Demosthenes Polyzos
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Aurélie Carlier
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Liesbet Geris
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Hans Van Oosterwyck
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece
| |
Collapse
|
28
|
Effect of ultrasound on bone fracture healing: A computational bioregulatory model. Comput Biol Med 2018; 100:74-85. [DOI: 10.1016/j.compbiomed.2018.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/23/2018] [Accepted: 06/23/2018] [Indexed: 12/22/2022]
|
29
|
Klosterhoff BS, Ghee Ong K, Krishnan L, Hetzendorfer KM, Chang YH, Allen MG, Guldberg RE, Willett NJ. Wireless Implantable Sensor for Noninvasive, Longitudinal Quantification of Axial Strain Across Rodent Long Bone Defects. J Biomech Eng 2018; 139:2654844. [PMID: 28975256 DOI: 10.1115/1.4037937] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Indexed: 11/08/2022]
Abstract
Bone development, maintenance, and regeneration are remarkably sensitive to mechanical cues. Consequently, mechanical stimulation has long been sought as a putative target to promote endogenous healing after fracture. Given the transient nature of bone repair, tissue-level mechanical cues evolve rapidly over time after injury and are challenging to measure noninvasively. The objective of this work was to develop and characterize an implantable strain sensor for noninvasive monitoring of axial strain across a rodent femoral defect during functional activity. Herein, we present the design, characterization, and in vivo demonstration of the device's capabilities for quantitatively interrogating physiological dynamic strains during bone regeneration. Ex vivo experimental characterization of the device showed that it possessed promising sensitivity, signal resolution, and electromechanical stability for in vivo applications. The digital telemetry minimized power consumption, enabling extended intermittent data collection. Devices were implanted in a rat 6 mm femoral segmental defect model, and after three days, data were acquired wirelessly during ambulation and synchronized to corresponding radiographic videos, validating the ability of the sensor to noninvasively measure strain in real-time. Together, these data indicate the sensor is a promising technology to quantify tissue mechanics in a specimen specific manner, facilitating more detailed investigations into the role of the mechanical environment in dynamic bone healing and remodeling processes.
Collapse
Affiliation(s)
- Brett S Klosterhoff
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Keat Ghee Ong
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Kevin M Hetzendorfer
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Young-Hui Chang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mark G Allen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Nick J Willett
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332.,Department of Orthopaedics, Emory University, Atlanta, GA 30303.,Atlanta Veteran's Affairs Medical Center, Department of Orthopaedics, Decatur, GA 30033.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
| |
Collapse
|
30
|
Staines KA, Madi K, Javaheri B, Lee PD, Pitsillides AA. A Computed Microtomography Method for Understanding Epiphyseal Growth Plate Fusion. FRONTIERS IN MATERIALS 2018; 4:48. [PMID: 29417047 PMCID: PMC5798587 DOI: 10.3389/fmats.2017.00048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The epiphyseal growth plate is a developmental region responsible for linear bone growth, in which chondrocytes undertake a tightly regulated series of biological processes. Concomitant with the cessation of growth and sexual maturation, the human growth plate undergoes progressive narrowing, and ultimately disappears. Despite the crucial role of this growth plate fusion "bridging" event, the precise mechanisms by which it is governed are complex and yet to be established. Progress is hindered by the current methods for growth plate visualization; these are invasive and largely rely on histological procedures. Here, we describe our non-invasive method utilizing synchrotron X-ray computed microtomography for the examination of growth plate bridging, which ultimately leads to its closure coincident with termination of further longitudinal bone growth. We then apply this method to a dataset obtained from a benchtop micro computed tomography scanner to highlight its potential for wide usage. Furthermore, we conduct finite element modeling at the micron-scale to reveal the effects of growth plate bridging on local tissue mechanics. Employment of these 3D analyses of growth plate bone bridging is likely to advance our understanding of the physiological mechanisms that control growth plate fusion.
Collapse
Affiliation(s)
- Katherine A. Staines
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Kamel Madi
- School of Materials, The University of Manchester, Manchester, United Kingdom
| | - Behzad Javaheri
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Peter D. Lee
- School of Materials, The University of Manchester, Manchester, United Kingdom
| | | |
Collapse
|
31
|
Rosa N, Marta M, Vaz M, Tavares S, Simoes R, Magalhães FD, Marques AT. Recent developments on intramedullary nailing: a biomechanical perspective. Ann N Y Acad Sci 2017; 1408:20-31. [DOI: 10.1111/nyas.13524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Natacha Rosa
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Miguel Marta
- Department of Orthopedics; Centro Hospitalar de São João; Porto Portugal
| | - Mário Vaz
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
- INEGI, Faculty of Engineering; University of Porto; Porto Portugal
| | - S.M.O. Tavares
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Ricardo Simoes
- Polytechnic Institute of Cávado and Ave; Barcelos Portugal
- Institute for Polymers and Composites IPC/I3N; University of Minho; Guimarães Portugal
| | | | | |
Collapse
|
32
|
Zeng Y, Wu J, He X, Li L, Liu X, Liu X. Mechanical microenvironment regulation of age-related diseases involving degeneration of human skeletal and cardiovascular systems. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 148:54-59. [PMID: 28958683 DOI: 10.1016/j.pbiomolbio.2017.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/24/2017] [Accepted: 09/25/2017] [Indexed: 02/05/2023]
Abstract
Age-related diseases involving degeneration of human skeletal and cardiovascular systems are now critical problems worldwide. The current review focuses on a common pathophysiological association between primary osteoporosis and vascular calcification, and reviews the mechanical response of bone cells and vascular cells to mechanical stress, as well as the coordination mechanism for intercellular signaling. With aging, calcium is lost from bones but deposited in the cardiovascular system. Bone metabolism-related molecules, such as alkaline phosphatase, matrix Gla protein, osteocalcin, osteopontin, and collagen type I; inflammatory cytokines, such as interleukin-1, -6, and tumor necrosis factor; and lipid metabolism related molecules, such as oxidized low density lipoprotein; mediate signaling in primary osteoporosis and vascular calcification. The mechanical microenvironment is a common pathophysiological basis for primary osteoporosis and vascular calcification. Mobilization of calcium from bone to vessel determines the regression rate, which could be controlled using a mechanical microenvironment. We highlight several issues: (1) linked features between primary osteoporosis and vascular calcification, and detailed changes of the mechanical microenvironment in degenerative bone or blood vessels, (2) signaling coordination mechanism between bone and vascular wall cells, and (3) calcium translocation mechanism. The degree to which these issues can be solved will help develop prevention and treatment strategies for age-related regression.
Collapse
Affiliation(s)
- Ye Zeng
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China.
| | - Jiang Wu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Xueling He
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; Laboratory Animal Center of Sichuan University, Chengdu 610041, China
| | - Liang Li
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China.
| | - Xiaojing Liu
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoheng Liu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
33
|
Schwartz AM, Schenker ML, Ahn J, Willett NJ. Building better bone: The weaving of biologic and engineering strategies for managing bone loss. J Orthop Res 2017; 35:1855-1864. [PMID: 28467648 DOI: 10.1002/jor.23592] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost-sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice-changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell-based strategies. Despite an ever-evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled "Building better bone: The weaving of biologic and engineering strategies for managing bone loss," was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering-clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855-1864, 2017.
Collapse
Affiliation(s)
| | - Mara L Schenker
- Department of Orthopaedics, Emory University, Decatur, Georgia
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nick J Willett
- Department of Orthopaedics, Emory University, Decatur, Georgia.,Atlanta Veteran's Affairs Medical Center, Decatur, Georgia.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| |
Collapse
|
34
|
Ghiasi MS, Chen J, Vaziri A, Rodriguez EK, Nazarian A. Bone fracture healing in mechanobiological modeling: A review of principles and methods. Bone Rep 2017; 6:87-100. [PMID: 28377988 PMCID: PMC5365304 DOI: 10.1016/j.bonr.2017.03.002] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/15/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023] Open
Abstract
Bone fracture is a very common body injury. The healing process is physiologically complex, involving both biological and mechanical aspects. Following a fracture, cell migration, cell/tissue differentiation, tissue synthesis, and cytokine and growth factor release occur, regulated by the mechanical environment. Over the past decade, bone healing simulation and modeling has been employed to understand its details and mechanisms, to investigate specific clinical questions, and to design healing strategies. The goal of this effort is to review the history and the most recent work in bone healing simulations with an emphasis on both biological and mechanical properties. Therefore, we provide a brief review of the biology of bone fracture repair, followed by an outline of the key growth factors and mechanical factors influencing it. We then compare different methodologies of bone healing simulation, including conceptual modeling (qualitative modeling of bone healing to understand the general mechanisms), biological modeling (considering only the biological factors and processes), and mechanobiological modeling (considering both biological aspects and mechanical environment). Finally we evaluate different components and clinical applications of bone healing simulation such as mechanical stimuli, phases of bone healing, and angiogenesis.
Collapse
Affiliation(s)
- Mohammad S. Ghiasi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Jason Chen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Edward K. Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
35
|
Abstract
Bone, despite its relatively inert appearance, is a tissue that is capable of adapting to its environment. Wolff’s law, first described in the 19th century, describes the ability of bone to change structure depending on the mechanical forces applied to it. The mechanostat model extended this principle and suggested that the amount of strain a bone detects depends on bone strength and the amount of muscle force applied to the bone. Experimental studies have found that low-magnitude, high-frequency mechanical loading is considered to be the most effective at increasing bone formation. The osteocyte is considered to be the master regulator of the bone response to mechanical loading. Deformation of bone matrix by mechanical loading is thought to result in interstitial fluid flow within the lacunar–canalicular system, which may activate osteocyte mechanosensors, leading to changes in osteocyte gene expression and ultimately increased bone formation and decreased bone resorption. However, repetitive strain applied to bone can result in microcracks, which may propagate and coalesce, and if not repaired predispose to catastrophic fracture. Osteocytes are a key component in this process, whereby apoptotic osteocytes in an area of microdamage promote targeted remodeling of the damaged bone. If fractures do occur, fracture repair can be divided into 2 types: primary and secondary healing. Secondary fracture repair is the most common and is a multistage process consisting of hematoma formation and acute inflammation, callus formation, and finally remodeling, whereby bone may return to its original form.
Collapse
|
36
|
Giorgi M, Verbruggen SW, Lacroix D. In silico bone mechanobiology: modeling a multifaceted biological system. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 8:485-505. [PMID: 27600060 PMCID: PMC5082538 DOI: 10.1002/wsbm.1356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/27/2016] [Accepted: 07/27/2016] [Indexed: 12/04/2022]
Abstract
Mechanobiology, the study of the influence of mechanical loads on biological processes through signaling to cells, is fundamental to the inherent ability of bone tissue to adapt its structure in response to mechanical stimulation. The immense contribution of computational modeling to the nascent field of bone mechanobiology is indisputable, having aided in the interpretation of experimental findings and identified new avenues of inquiry. Indeed, advances in computational modeling have spurred the development of this field, shedding new light on problems ranging from the mechanical response to loading by individual cells to tissue differentiation during events such as fracture healing. To date, in silico bone mechanobiology has generally taken a reductive approach in attempting to answer discrete biological research questions, with research in the field broadly separated into two streams: (1) mechanoregulation algorithms for predicting mechanobiological changes to bone tissue and (2) models investigating cell mechanobiology. Future models will likely take advantage of advances in computational power and techniques, allowing multiscale and multiphysics modeling to tie the many separate but related biological responses to loading together as part of a larger systems biology approach to shed further light on bone mechanobiology. Finally, although the ever‐increasing complexity of computational mechanobiology models will inevitably move the field toward patient‐specific models in the clinic, the determination of the context in which they can be used safely for clinical purpose will still require an extensive combination of computational and experimental techniques applied to in vitro and in vivo applications. WIREs Syst Biol Med 2016, 8:485–505. doi: 10.1002/wsbm.1356 For further resources related to this article, please visit the WIREs website.
Collapse
Affiliation(s)
- Mario Giorgi
- Department of Oncology and Metabolism and INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | | | - Damien Lacroix
- INSIGNEO Institute for In Silico Medicine, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK.
| |
Collapse
|
37
|
A computational model to explore the role of angiogenic impairment on endochondral ossification during fracture healing. Biomech Model Mechanobiol 2016; 15:1279-94. [DOI: 10.1007/s10237-016-0759-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 01/07/2016] [Indexed: 01/11/2023]
|
38
|
Morgan EF, Lei J. Toward Clinical Application and Molecular Understanding of the Mechanobiology of Bone Healing. Clin Rev Bone Miner Metab 2015. [DOI: 10.1007/s12018-015-9197-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
39
|
|