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Sun M, Hu X, Tian L, Yang X, Min L. Auxetic Biomedical Metamaterials for Orthopedic Surgery Applications: A Comprehensive Review. Orthop Surg 2024; 16:1801-1815. [PMID: 38961661 PMCID: PMC11293933 DOI: 10.1111/os.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Poisson's ratio in auxetic materials shifts from typically positive to negative, causing lateral expansion during axial tension. This scale-independent characteristic, originating from tailored architectures, exhibits specific physical properties, including energy adsorption, shear resistance, and fracture resistance. These metamaterials demonstrate exotic mechanical properties with potential applications in several engineering fields, but biomedical applications seem to be one of the most relevant, with an increasing number of articles published in recent years, which present opportunities ranging from cellular repair to organ reconstruction with outstanding mechanical performance, mechanical conduction, and biological activity compared with traditional biomedical metamaterials. Therefore, focusing on understanding the potential of these structures and promoting theoretical and experimental investigations into the benefits of their unique mechanical properties is necessary for achieving high-performance biomedical applications. Considering the demand for advanced biomaterial implants in surgical technology and the profound advancement of additive manufacturing technology that are particularly relevant to fabricating complex and customizable auxetic mechanical metamaterials, this review focuses on the fundamental geometric configuration and unique physical properties of negative Poisson's ratio materials, then categorizes and summarizes auxetic material applications across some surgical departments, revealing efficacy in joint surgery, spinal surgery, trauma surgery, and sports medicine contexts. Additionally, it emphasizes the substantial potential of auxetic materials as innovative biomedical solutions in orthopedics and demonstrates the significant potential for comprehensive surgical application in the future.
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Affiliation(s)
- Minghao Sun
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Leilei Tian
- Department of AnesthesiologyWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Xiao Yang
- National Engineering Research Center for BiomaterialsSichuan UniversityChengduChina
- Provincial Engineering Research Center for Biomaterials Genome of SichuanSichuan UniversityChengduChina
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
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DeBaun MR, Vanderkarr M, Holy CE, Ruppenkamp JW, Parikh A, Vanderkarr M, Coplan PM, Pean CA, McLaurin TM. Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries. Injury 2024; 55:111696. [PMID: 38945078 DOI: 10.1016/j.injury.2024.111696] [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: 02/09/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation. METHODS Patients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted. RESULTS 5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index. DISCUSSION Fewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.
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Affiliation(s)
- Malcolm R DeBaun
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA.
| | - Mari Vanderkarr
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Chantal E Holy
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Jill W Ruppenkamp
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | | | | | - Paul M Coplan
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Christian A Pean
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA
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Zhao C, Zhu G, Wang Y, Wu X. TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis. J Orthop Surg Res 2022; 17:525. [PMID: 36471345 PMCID: PMC9721051 DOI: 10.1186/s13018-022-03420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The TiRobot is the only robot that has been reported in the literature for posterior pelvic injuries. We aim to compare TiRobot-assisted pelvic screw fixation with the conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation. METHODS We conducted a meta-analysis to identify studies involving TiRobot‑assisted versus conventional percutaneous sacroiliac screw fixation for pelvic ring injuries in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and WanFang database, up to April 2022. The following keywords were used: "TiRobot," "robot," "robotic," "pelvic fracture," "screw fixation," "percutaneous," and "pelvic ring injury." Pooled effects of this meta-analysis were calculated using STATA SE version 15.0. RESULTS Compared with conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation, TiRobot will result in less radiation exposure time of screw implantation (P = 0.000), less frequency of intraoperative fluoroscopy (P = 0.000), fewer guide wire attempts (P = 0.000), less intraoperative blood loss (P = 0.005), better screw accuracy (P = 0.011), better Majeed score (P = 0.031), and higher overall excellent and good rates of Majeed score (P = 0.018). However, there were no significant differences in terms of operative time (P = 0.055), fracture healing time (P = 0.365), and overall excellent and good rate of reduction accuracy (P = 0.426) between the two groups. CONCLUSION TiRobot-assisted fixation has less intraoperative fluoroscopy and intraoperative blood loss, superior screw accuracy, and Majeed score compared with conventional percutaneous sacroiliac screw fixation. TiRobot has no significant effect on operative time, fracture healing time, and reduction accuracy. Given the relevant possible biases in our meta-analysis, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.
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Affiliation(s)
- Chunpeng Zhao
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035 China
| | - Gang Zhu
- Rossum Robot Co., Ltd., Beijing, 100083 China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083 China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083 China
| | - Xinbao Wu
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035 China
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Zhao C, Wang Y, Wu X, Zhu G, Shi S. Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures. J Orthop Surg Res 2022; 17:205. [PMID: 35379278 PMCID: PMC8981738 DOI: 10.1186/s13018-022-03089-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Pelvic fracture is a severe high-energy injury with the highest disability and mortality of all fractures. Traditional open surgery is associated with extensive soft tissue damages and many complications. Minimally invasive surgery potentially mitigates the risks of open surgical procedures and is becoming a new standard for pelvic fracture treatment. The accurate reduction has been recognized as the cornerstone of minimally invasive surgery for pelvic fracture. At present, the closed reduction in pelvic fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces of soft tissue involved in the fragment manipulation, which might result in fracture malreduction. To overcome these shortcomings and facilitate pelvic fracture reduction, we developed an intelligent robot-assisted fracture reduction (RAFR) system for pelvic fracture. Methods The presented method is divided into three parts. The first part is the preparation of 20 pelvic fracture models. In the second part, we offer an automatic reduction algorithm of our robotic reduction system, including Intraoperative real-time 3D navigation, reduction path planning, control and fixation, and robotic-assisted fracture reduction. In the third part, image registration accuracy and fracture reduction accuracy were calculated and analyzed. Results All 20 pelvic fracture bone models were reduced by the RAFR system; the mean registration error E1 of the 20 models was 1.29 ± 0.57 mm. The mean reduction error E2 of the 20 models was 2.72 ± 0.82 mm. The global error analysis of registration and reduction results showed that higher errors are mainly located at the edge of the pelvis, such as the iliac wing. Conclusion The accuracy of image registration error and fracture reduction error in our study was excellent, which could reach the requirements of the clinical environment. Our study demonstrated the precision and effectiveness of our RAFR system and its applicability and usability in clinical practice, thus paving the way toward robot minimally invasive pelvic fracture surgeries.
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Affiliation(s)
- Chunpeng Zhao
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xinbao Wu
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Gang Zhu
- Rossum Robot Co., Ltd., Beijing, 100083, China
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The impact of intercostal nerve block on the necessity of a second chest x-ray in patients with penetrating trauma: A randomised controlled trial. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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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.
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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.)
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Abinaya B, Prasith TP, Ashwin B, Viji Chandran S, Selvamurugan N. Chitosan in Surface Modification for Bone Tissue Engineering Applications. Biotechnol J 2019; 14:e1900171. [DOI: 10.1002/biot.201900171] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/30/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Balakrishnan Abinaya
- Department of BiotechnologySchool of BioengineeringSRM Institute of Science and Technology Kattankulathur 603203 Tamil Nadu India
| | - Tandiakkal Prakash Prasith
- Department of BiotechnologySchool of BioengineeringSRM Institute of Science and Technology Kattankulathur 603203 Tamil Nadu India
| | - Badrinath Ashwin
- Department of BiotechnologySchool of BioengineeringSRM Institute of Science and Technology Kattankulathur 603203 Tamil Nadu India
| | - Syamala Viji Chandran
- Department of BiotechnologySchool of BioengineeringSRM Institute of Science and Technology Kattankulathur 603203 Tamil Nadu India
| | - Nagarajan Selvamurugan
- Department of BiotechnologySchool of BioengineeringSRM Institute of Science and Technology Kattankulathur 603203 Tamil Nadu India
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Controlled Non-Viral Gene Delivery in Cartilage and Bone Repair: Current Strategies and Future Directions. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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CD169 + macrophages are critical for osteoblast maintenance and promote intramembranous and endochondral ossification during bone repair. Biomaterials 2017; 196:51-66. [PMID: 29107337 DOI: 10.1016/j.biomaterials.2017.10.033] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/06/2017] [Accepted: 10/17/2017] [Indexed: 12/23/2022]
Abstract
Osteal macrophages (osteomacs) contribute to bone homeostasis and regeneration. To further distinguish their functions from osteoclasts, which share many markers and growth factor requirements, we developed a rapid, enzyme-free osteomac enrichment protocol that permitted characterization of minimally manipulated osteomacs by flow cytometry. Osteomacs differ from osteoclasts in expression of Siglec1 (CD169). This distinction was confirmed using the CD169-diphtheria toxin (DT) receptor (DTR) knock-in model. DT treatment of naïve CD169-DTR mice resulted in selective and striking loss of osteomacs, whilst osteoclasts and trabecular bone area were unaffected. Consistent with a previously-reported trophic interaction, osteomac loss was accompanied by a concomitant and proportionately striking reduction in osteoblasts. The impact of CD169+ macrophage depletion was assessed in two models of bone injury that heal via either intramembranous (tibial injury) or endochondral (internally-plated femoral fracture model) ossification. In both models, CD169+ macrophage, including osteomac depletion compromised bone repair. Importantly, DT treatment in CD169-DTR mice did not affect osteoclast frequency in either model. In the femoral fracture model, the magnitude of callus formation correlated with the number of F4/80+ macrophages that persisted within the callus. Overall these observations provide compelling support that CD169+ osteomacs, independent of osteoclasts, provide vital pro-anabolic support to osteoblasts during both bone homeostasis and repair.
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Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures. Ann Biomed Eng 2017; 45:2648-2662. [PMID: 28815387 PMCID: PMC5663813 DOI: 10.1007/s10439-017-1901-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/09/2017] [Indexed: 11/03/2022]
Abstract
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.
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Abstract
PURPOSE OF REVIEW Mounting evidence supporting the critical contribution of macrophages, in particular osteal macrophages, to bone regeneration is reviewed. We specifically examine the potential role of macrophages in the basic multicellular units coordinating lifelong bone regeneration via remodelling and bone regeneration in response to injury. We review and discuss the distinctions between macrophage and osteoclast contributions to bone homeostasis, particularly the dichotomous role of the colony-stimulating factor 1-colony-stimulating factor 1 receptor axis. RECENT FINDINGS The impact of inflammation associated with aging and other hallmarks of aging, including senescence, on macrophage function is addressed in the context of osteoporosis and delayed fracture repair. Resident macrophages versus recruited macrophage contributions to fracture healing are also discussed. We identify some of the remaining knowledge gaps that will need to be closed in order to maximise benefits from therapeutically modulating or mimicking the function of macrophages to improve bone health and regeneration over a lifetime.
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Affiliation(s)
- Lena Batoon
- Bones and Immunology Laboratory, Cancer Biology and Care Program, Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia
| | - Susan Marie Millard
- Bones and Immunology Laboratory, Cancer Biology and Care Program, Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia
| | - Liza Jane Raggatt
- Bones and Immunology Laboratory, Cancer Biology and Care Program, Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4092, Australia
| | - Allison Robyn Pettit
- Bones and Immunology Laboratory, Cancer Biology and Care Program, Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4092, Australia.
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Dagnino G, Georgilas I, Morad S, Gibbons P, Tarassoli P, Atkins R, Dogramadzi S. Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery. Int J Comput Assist Radiol Surg 2017; 12:1383-1397. [PMID: 28474269 PMCID: PMC5541125 DOI: 10.1007/s11548-017-1602-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Abstract
Purpose Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS’s navigation system overcoming the earlier version’s issues, aiming to move the RAFS system into a surgical environment. Methods The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Results Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about \documentclass[12pt]{minimal}
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\begin{document}$$1.15\pm 0.8\,\hbox {mm}$$\end{document}1.15±0.8mm (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error \documentclass[12pt]{minimal}
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\begin{document}$$2\pm 1{^{\circ }})$$\end{document}2±1∘). Conclusion Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.
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Affiliation(s)
- Giulio Dagnino
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.
| | - Ioannis Georgilas
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Samir Morad
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.,Aston University, B47ET, Birmingham, UK
| | - Peter Gibbons
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Payam Tarassoli
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Roger Atkins
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Sanja Dogramadzi
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
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Challenges for Cartilage Regeneration. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2017. [DOI: 10.1007/978-3-662-53574-5_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moraes VYD, Belloti JC, Faloppa F, Bhandari M. Collaborative multicenter trials in Latin America: challenges and opportunities in orthopedic and trauma surgery. SAO PAULO MED J 2013; 131:187-92. [PMID: 23903268 PMCID: PMC10852115 DOI: 10.1590/1516-3180.2013.1313555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 07/05/2012] [Accepted: 12/26/2012] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach. DESIGN AND SETTING Exploratory study conducted at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil, and McMaster University, Hamilton, Canada. METHODS We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries. RESULTS The evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action. CONCLUSIONS We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.
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Affiliation(s)
- Vinicius Ynoe de Moraes
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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Ebrahimzadeh MH. National trauma registry center, as a backbone of trauma management and research. ARCHIVES OF TRAUMA RESEARCH 2012; 1:87-8. [PMID: 24396753 PMCID: PMC3876534 DOI: 10.5812/atr.8487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammad Hossein Ebrahimzadeh
- Trauma Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Mohammad Hossein Ebrahimzadeh, Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel.: +98-5118012610, Fax: +98-5118417453, E-mail:
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Cheng X, Yang T, Meng W, Liu H, Zhang T, Shi R. Overexpression of GDF5 through an adenovirus vector stimulates osteogenesis of human mesenchymal stem cells in vitro and in vivo. Cells Tissues Organs 2012; 196:56-67. [PMID: 22287558 DOI: 10.1159/000330791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 02/05/2023] Open
Abstract
The use of stem cells combined with gene therapy could be an important way to facilitate bone regeneration. In this study, the aim was to investigate the potential of growth and differentiation factor-5 (GDF5) to genetically manipulate human mesenchymal stem cells (hMSCs) for bone regeneration. Recombinant adenovirus Ad-GDF5 and Ad-GFP were constructed and identified, and the titer of both were determined. Third-passage hMSCs were infected with adenovirus, and the expression of GDF5 was confirmed by detection of GFP-positive cells, GDF5 mRNA levels, Western blotting, and enzyme-linked immunosorbent assay (ELISA). hMSCs at passage 3 were divided into four groups: (1) an experimental group infected with Ad-GDF5, (2) a positive control group cultured with osteogenic differentiation medium, (3) a control group infected with Ad-GFP cultured with standard medium, and (4) a blank control group cultured with standard medium. Evaluation of cell morphology and proliferation, analysis of the expression of genes related to osteogenic differentiation, von Kossa staining, and immunofluorescent staining of collagen I were used to investigate the osteogenesis of cells among the groups. After culturing the cells for 2 days under each corresponding condition, the cells were detached and subcutaneously injected into the backs of nude mice to evaluate bone formation. Samples were collected for histological staining, protein Western blotting, and micro-computer tomography. When infected with Ad-GDF5, hMSCs could overexpress GDF5 for a prolonged period in vitro and reach a concentration of 160 ng/ml. Cells infected with Ad-GDF5 or cultured in osteogenic medium displayed osteogenic differentiation based on their histological and cellular properties and on their gene and protein expression patterns. Furthermore, Ad-GDF5 showed a better ability to upregulate the expression of collagen I, alkaline phosphatase, and osteocalcin mRNA than the osteogenic medium. Furthermore, Ad-GDF5 expression was associated with enhanced bone formation in vivo. Our findings suggest that hMSCs infected with Ad-GDF5 can differentiate in an osteogenic direction and may be a promising cell source for bone regeneration.
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Affiliation(s)
- Xiangjun Cheng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
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Soundrapandian C, Sa B, Datta S. Organic-inorganic composites for bone drug delivery. AAPS PharmSciTech 2009; 10:1158-71. [PMID: 19842042 DOI: 10.1208/s12249-009-9308-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 09/18/2009] [Indexed: 11/30/2022] Open
Abstract
This review paper attempts to provide an overview in the fabrication and application of organic-inorganic based composites in the field of local drug delivery for bone. The concept of local drug delivery exists for a few decades. However, local drug delivery in bone and specially application of composites for delivery of drugs to bone is an area for potential research interest in the recent time. The advantages attained by an organic-inorganic composite when compared to its individual components include their ability to release drug, adopting to the natural environment and supporting local area until complete bone regeneration, which make them carriers of interest for local drug delivery for bone.
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