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Hollensteiner M, Traweger A, Augat P. Anatomic variability of the human femur and its implications for the use of artificial bones in biomechanical testing. BIOMED ENG-BIOMED TE 2024; 0:bmt-2024-0158. [PMID: 38997222 DOI: 10.1515/bmt-2024-0158] [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: 03/25/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
Aside from human bones, epoxy-based synthetic bones are regarded as the gold standard for biomechanical testing os osteosyntheses. There is a significant discrepancy in biomechanical testing between the determination of fracture stability due to implant treatment in experimental methods and their ability to predict the outcome of stability and fracture healing in a patient. One possible explanation for this disparity is the absence of population-specific variables such as age, gender, and ethnicity in artificial bone, which may influence the geometry and mechanical properties of bone. The goal of this review was to determine whether commercially available artificial bones adequately represent human anatomical variability for mechanical testing of femoral osteosyntheses. To summarize, the availability of suitable bone surrogates currently limits the validity of mechanical evaluations of implant-bone constructs. The currently available synthetic bones neither accurately reflect the local mechanical properties of human bone, nor adequately represent the necessary variability between various populations, limiting their generalized clinical relevance.
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Affiliation(s)
- Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University Salzburg, Salzburg, Austria
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Zdero R, Brzozowski P, Schemitsch EH. Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6015794. [PMID: 38966093 PMCID: PMC11223906 DOI: 10.1155/2024/6015794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/25/2024] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English-language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone "stress shielding," which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate-to-plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or "stress shielding"), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).
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Affiliation(s)
- Radovan Zdero
- Orthopaedic Biomechanics LabVictoria Hospital, London, Ontario, Canada
| | - Pawel Brzozowski
- Orthopaedic Biomechanics LabVictoria Hospital, London, Ontario, Canada
| | - Emil H. Schemitsch
- Orthopaedic Biomechanics LabVictoria Hospital, London, Ontario, Canada
- Division of Orthopaedic SurgeryWestern University, London, Ontario, Canada
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Yadav P, Shah R, Roy A, Jani S, Chatterjee K, Saini DK. Cellular Senescence Program is Sensitive to Physical Differences in Polymeric Tissue Scaffolds. ACS MATERIALS AU 2024; 4:35-44. [PMID: 38221924 PMCID: PMC10786134 DOI: 10.1021/acsmaterialsau.3c00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 01/16/2024]
Abstract
A typical cellular senescence program involves exposing cells to DNA-damaging agents such as ionization radiation or chemotherapeutic drugs, which cause multipronged changes, including increased cell size and volume, the onset of enhanced oxidative stress, and inflammation. In the present study, we examined if the senescence onset decision is sensitive to the design, porosity, and architecture of the substrate. To address this, we generated a library of polymeric scaffolds widely used in tissue engineering of varied stiffness, architecture, and porosity. Using irradiated A549 lung cancer cells, we examined the differences between cellular responses in these 3D scaffold systems and observed that senescence onset is equally diminished. When compared to the two-dimensional (2D) culture formats, there were profound changes in cell size and senescence induction in three-dimensional (3D) scaffolds. We further establish that these observed differences in the senescence state can be attributed to the altered cell spreading and cellular interactions on these substrates. This study elucidates the role of scaffold architecture in the cellular senescence program.
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Affiliation(s)
- Parul Yadav
- Department
of Bioengineering, Indian Institute of Science, C.V Raman Avenue, Bangalore, India 560012
| | - Rahul Shah
- Department
of Materials Engineering, Indian Institute
of Science, C.V Raman
Avenue, Bangalore, India 560012
| | - Anindo Roy
- Department
of Materials Engineering, Indian Institute
of Science, C.V Raman
Avenue, Bangalore, India 560012
| | - Sibani Jani
- Department
of Bioengineering, Indian Institute of Science, C.V Raman Avenue, Bangalore, India 560012
| | - Kaushik Chatterjee
- Department
of Bioengineering, Indian Institute of Science, C.V Raman Avenue, Bangalore, India 560012
- Department
of Materials Engineering, Indian Institute
of Science, C.V Raman
Avenue, Bangalore, India 560012
| | - Deepak Kumar Saini
- Department
of Bioengineering, Indian Institute of Science, C.V Raman Avenue, Bangalore, India 560012
- Department
of Developmental Biology and Genetics, C.V Raman Avenue, Indian Institute of Science, Bangalore, India 560012
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Major JW, Ernst AJ, Kallevang JK, Kaeck A, Grijalva SD, Douglas TJ, Wilson AW, Garry CB. A radiologic determination of the different screw cutting patterns in cut and uncut orthopedic cortical screws using a novel imaging technique. Skeletal Radiol 2023; 52:2461-2467. [PMID: 37237173 DOI: 10.1007/s00256-023-04368-7] [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: 01/17/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We hypothesize that cut screws will deform in a manner that increases the core and outer diameters of the screw hole compared to uncut controls, and effects will be more pronounced in titanium screws. MATERIALS AND METHODS We used biomechanical polyurethane foam blocks to simulate cortical bone. We organized four groups of stainless steel and titanium cut and uncut screws. Blocks were fitted with a jig to ensure perpendicular screw insertion. We imaged the blocks using digital mammography and measured them using PACS software. Power analysis determined a power of 0.95 and an alpha error of 0.05. RESULTS Highly statistically significant differences in core diameter were found after cutting stainless steel and titanium screws. Cutting stainless steel screws increased core diameter by 0.30 mm (95% CI, 0.16 to 0.45; p < .001). Titanium screws' core diameter increased by 0.45 mm (95% CI, 0.30 to 0.61; p < .001). No significant differences were found in the outer diameters of stainless steel and titanium screws after cutting. CONCLUSION Titanium and stainless steel screw tracts demonstrated screw core diameter and screw thread pattern deformation after cutting. Titanium screws demonstrated more significant effects.
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Affiliation(s)
- Joshua W Major
- Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA.
| | - Andrew J Ernst
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Jonathan K Kallevang
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Alexander Kaeck
- Department of Radiation Physics, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Stephen D Grijalva
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Thomas J Douglas
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Andrew W Wilson
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Conor B Garry
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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Ock J, Seo J, Koh KH, Kim N. Comparing the biomechanical properties of conventional suture and all-suture anchors using patient-specific and realistic osteoporotic and non-osteoporotic phantom using 3D printing. Sci Rep 2023; 13:20976. [PMID: 38017064 PMCID: PMC10684536 DOI: 10.1038/s41598-023-48392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023] Open
Abstract
Conventional suture anchors (CAs) and all-suture anchors (ASAs) are used for rotator cuff repair. Pull-out strength (POS) is an important factor that affects surgical outcomes. While the fixation mechanism differs between the anchor types and relies on the quality, few studies have compared biomechanical properties of anchors based on bone quality. This study aimed to compare the biomechanical properties of anchors using osteoporotic bone (OB) and non-osteoporotic bone (NOB) simulators. Humerus simulators were fabricated using fused deposition modeling of 3D printing and acrylonitrile butadiene styrene adjusting the thickness of cortical bone and density of cancellous bone based on CT images. Cyclic loading from 10 to 50 N, 10 to 100 N, and 10 to 150 N for 10 cycles was clinically determined at each anchor because the supraspinatus generates a force of 67-125 N in daily activities of normal control. After cyclic loading, the anchor was extruded at a load of 5 mm/min. Displacement, POS, and stiffness were measured. In OB simulators, CAs revealed bigger gap displacement than ASAs with cyclic loading of 10-150 N. ASA showed higher values for POS and stiffness. In NOB simulators, ASAs revealed bigger gap displacement than CAs with cyclic loading of 10-150 N. ASA showed higher values for POS and CA showed higher values for stiffness. POS of anchors depends on anchors 'displacement and bone stiffness. In conclusion, ASA demonstrated better biomechanical performance than CA in terms of stability under cyclic loading and stiffness with similar POS in OB.
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Affiliation(s)
- Junhyeok Ock
- Department of Biomedical Engineering, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Junghyun Seo
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
| | - Namkug Kim
- Department of Biomedical Engineering, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Pungnap2-dong, Songpa-gu, Seoul, South Korea.
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea.
- Department of Convergence Medicine, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
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DiVella M, Cecora A, Duell B, Fogel J, Ruotolo C. Krackow Stitch and Whipstitch Use in Distal Biceps Tendon Rupture Repair: A Porcine Composite Bone Biomechanical Study. Orthopedics 2023; 46:224-229. [PMID: 36779732 DOI: 10.3928/01477447-20230207-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The suture combination of a Krackow stitch plus a whipstitch can be used to strengthen a tendon rupture repair. We compared biomechanical outcomes of suture repair techniques for distal biceps tendon ruptures using a single Krackow stitch with and without a whipstitch and a whip-stitch alone. Data were obtained from 36 thawed porcine flexor profundus tendons. A cortical button was secured to fourth-generation composite bone using No. 2 FiberWire (Arthrex) and No. 2 FiberLoop (Arthrex). The primary outcome was maximum load to failure. Secondary outcomes were displacement at the bone-tendon interface, total construct elongation, and stiffness. The Krackow plus whipstitch group (mean, 493.82 N; SD, 209.44 N) had a greater maximum load to failure as compared with the single Krackow group (mean, 333.71 N; SD, 172.32 N) (P=.01) and single whipstitch group (mean, 207.27 N; SD, 66.42 N) (P<.001). The single Krackow group (mean, 1.67 mm; SD, 0.89 mm) had a greater bone-tendon interface displacement (P=.01) after preloading and before cyclic loading than the single whipstitch group (mean, 0.83 mm; SD, 0.58 mm). There were no other secondary outcome differences between groups. A repair using Krackow plus whipstitch is biomechanically stronger with no difference in bone-tendon interface displacement, total construct elongation, or stiffness when compared with a single Krackow or single whipstitch. We recommend this repair technique for distal biceps tendon rupture repair, which may accelerate rehabilitation and decrease re-rupture rate. [Orthopedics. 2023;46(4):224-229.].
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Berk T, Zderic I, Schwarzenberg P, Pastor T, Pfeifer R, Halvachizadeh S, Richards G, Gueorguiev B, Pape HC. Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study. J Orthop Surg Res 2023; 18:401. [PMID: 37268974 DOI: 10.1186/s13018-023-03879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The incidence of acetabular fractures (AFs) is increasing in all industrial nations, with posterior column fractures (PCFs) accounting for 18.5-22% of these cases. Treating displaced AFs in elderly patients is a known challenge. The optimal surgical strategy implementing open reduction and internal fixation (ORIF), total hip arthroplasty (THA), or percutaneous screw fixation (SF), remains debated. Additionally, with either of these treatment methods, the post-surgical weight bearing protocols are also ambiguous. The aim of this biomechanical study was to evaluate construct stiffness and failure load following a PCF fixation with either standard plate osteosynthesis, SF, or using a screwable cup for THA under full weight bearing conditions. METHODS Twelve composite osteoporotic pelvises were used. A PCF according to the Letournel Classification was created in 24 hemi-pelvis constructs stratified into three groups (n = 8) as follows: (i) posterior column fracture with plate fixation (PCPF); (ii) posterior column fracture with SF (PCSF); (iii) posterior column fracture with screwable cup fixation (PCSC). All specimens were biomechanically tested under progressively increasing cyclic loading until failure, with monitoring of the interfragmentary movements via motion tracking. RESULTS Initial construct stiffness (N/mm) was 154.8 ± 68.3 for PCPF, 107.3 ± 41.0 for PCSF, and 133.3 ± 27.5 for PCSC, with no significant differences among the groups, p = 0.173. Cycles to failure and failure load were 7822 ± 2281 and 982.2 ± 428.1 N for PCPF, 3662 ± 1664 and 566.2 ± 366.4 N for PCSF, and 5989 ± 3440 and 798.9 ± 544.0 N for PCSC, being significantly higher for PCPF versus PCSF, p = 0.012. CONCLUSION Standard ORIF of PCF with either plate osteosynthesis or using a screwable cup for THA demonstrated encouraging results for application of a post-surgical treatment concept with a full weight bearing approach. Further biomechanical cadaveric studies with larger sample size should be initiated for a better understanding of AF treatment with full weight bearing and its potential as a concept for PCF fixation.
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Affiliation(s)
- Till Berk
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | | | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
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Riegger M, Habib N, Testa EA, Müller J, Guidi M, Candrian C. The modified Lapidus fusion: a systematic review of biomechanical studies. EFORT Open Rev 2023; 8:162-174. [PMID: 37097047 PMCID: PMC10155126 DOI: 10.1530/eor-22-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Purpose The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results. Methods A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated. Results Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated. Conclusion The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.
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Affiliation(s)
- Martin Riegger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Nermine Habib
- Department of Orthopedic Surgery, Hopital fribourgeois (HFR) – Freiburger Spital (HFR), Fribourg, Switzerland
| | - Enrique Adrian Testa
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Bellinzona, Switzerland
| | - Jochen Müller
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marco Guidi
- Department of Plastic Surgery and Hand Surgery, Kantonsspital, Aarau, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Berk T, Zderic I, Varga P, Schwarzenberg P, Lesche F, Halvachizadeh S, Richards G, Gueorguiev B, Pape HC. Evaluation of Cannulated Compression Headless Screw (CCHS) as an alternative implant in comparison to standard S1-S2 screw fixation of the posterior pelvis ring: a biomechanical study. BMC Musculoskelet Disord 2023; 24:215. [PMID: 36949409 PMCID: PMC10035201 DOI: 10.1186/s12891-023-06312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND/PURPOSE Posterior pelvis ring injuries represent typical high-energy trauma injuries in young adults. Joint stabilization with two cannulated sacroiliac (SI) screws at the level of sacral vertebrae S1 and S2 is a well-established procedure. However, high failure- and implant removal (IR) rates have been reported. Especially, the washer recovery can pose the most difficult part of the IR surgery, which is often associated with complications. The aim of this biomechanical study was to evaluate the stability of S1-S2 fixation of the SI joint using three different screw designs. METHODS Eighteen artificial hemi-pelvises were assigned to three groups (n = 6) for SI joint stabilization through S1 and S2 corridors using either two 7.5 mm cannulated compression headless screws (group CCH), two 7.3 mm partially threaded SI screws (group PT), or two 7.3 mm fully threaded SI screws (group FT). An SI joint dislocation injury type III APC according to the Young and Burgess classification was simulated before implantation. All specimens were biomechanically tested to failure in upright standing position under progressively increasing cyclic loading. Interfragmentary and bone-implant movements were captured via motion tracking and evaluated at four time points between 4000 and 7000 cycles. RESULTS Combined interfragmentary angular displacement movements in coronal and transverse plane between ilium and sacrum, evaluated over the measured four time points, were significantly bigger in group FT versus both groups CCH and PT, p ≤ 0.047. In addition, angular displacement of the screw axis within the ilium under consideration of both these planes was significantly bigger in group FT versus group PT, p = 0.038. However, no significant differences were observed among the groups for screw tip cutout movements in the sacrum, p = 0.321. Cycles to failure were highest in group PT (9885 ± 1712), followed by group CCH (9820 ± 597), and group FT (7202 ± 1087), being significantly lower in group FT compared to both groups CCH and PT, p ≤ 0.027. CONCLUSION From a biomechanical perspective, S1-S2 SI joint fixation using two cannulated compression headless screws or two partially threaded SI screws exhibited better interfragmentary stability compared to two fully threaded SI screws. The former can therefore be considered as a valid alternative to standard SI screw fixation in posterior pelvis ring injuries. In addition, partially threaded screw fixation was associated with less bone-implant movements versus fully threaded screw fixation. Further human cadaveric biomechanical studies with larger sample size should be initiated to understand better the potential of cannulated compression headless screw fixation for the therapy of the injured posterior pelvis ring in young trauma patients.
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Affiliation(s)
- Till Berk
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | | | - Felix Lesche
- Department of Gynecology and Obstetrics, Asklepios Clinic Wandsbek, Alphonsstraße 14, 22043, Hamburg, Germany
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091, Zurich, Switzerland
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Kim YS, Baek JW, Jin Z, Jeon HC, Han MW, Lim JY. Mechanical Properties of a Bone-like Bioceramic-Epoxy-Based Composite Material with Nanocellulose Fibers. MATERIALS (BASEL, SWITZERLAND) 2023; 16:739. [PMID: 36676477 PMCID: PMC9863595 DOI: 10.3390/ma16020739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Several composite materials are being investigated as reinforcement fillers for surgery simulations. This study presents an artificial composite material with properties similar to those of the human bone, which may be used in surgery simulations. Moreover, considering the potential toxicity of debris generated during sawing, a safe epoxy-based composite material was synthesized using cellulose nanocrystals (CNCs) and bioceramics (i.e., hydroxyapatite, Yttria stabilized zirconia oxide, Zirconia oxide), which were used to mimic the stiffness of human bone. To examine the change in mechanical properties according to the composition, 1, 3, and 5 wt% of CNCs were mixed with 5 wt% of the bioceramics. When CNCs were added at 1 wt%, there was a confirmed change in the non-linear stiffness and ductility. The CNC-added specimen fractured when forming a nano-network around the local CNCs during curing. In contrast, the specimen without CNCs was more densely structured, and combined to form a network of all specimens such that a plastic region could exist. Thus, this study successfully manufactured a material that could mimic longitudinal and transverse characteristics similar to those of real human bone, as well as exhibit mechanical properties such as strength and stiffness. Bioceramics are harmless to the human body, and can be used by controlling the added quantity of CNCs. We expect that this material will be suitable for use in surgery simulations.
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Affiliation(s)
- Young-Seong Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul 04620, Republic of Korea
| | - Jin Woo Baek
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul 04620, Republic of Korea
| | - Zhengyun Jin
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul 04620, Republic of Korea
| | - Hee Chang Jeon
- Quantum Functional Semiconductor Research Center, Dongguk University, Seoul 04620, Republic of Korea
| | - Min-Woo Han
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul 04620, Republic of Korea
| | - Joong Yeon Lim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul 04620, Republic of Korea
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Comparison of fibula strut and calcium phosphate cement augmentation of the medial buttress in 2-part proximal humerus fractures reconstruction: a biomechanical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:67-72. [PMID: 34739600 DOI: 10.1007/s00590-021-03147-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/11/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Augmentation strategies for surgical fixation of proximal humerus fractures (PHF) are available to address their relatively high failure rate. The purpose of this study was to compare two medial-buttress augmentation strategies for PHF fixation. METHODS A two-part PHF model with loss of medial buttress was created in 16 synthetic bones. The PHFs were fixed with locking plates and either calcium phosphate cement (CPC) or fibula strut (FS) augmentation. After cadaveric validations, the fixation constructs were subjected to nondestructive axial compression tests, followed by a cyclic test. Construct stiffness and angular displacement of the humerus head were recorded. RESULTS Humeral head angular displacement was statistically greater in the CPC group than in the FS group at the applied force of 300 N and higher (p < 0.05). Axial stiffness was statistically greater in the FS fixation group than in the CPC group at initial and final phases of cyclic loading protocol (p < 0.05). CONCLUSIONS In an osteoporotic cadaveric model of a 2-part PHF with loss of a medial buttress, locked plate constructs augmented with FS have a higher resistance to varus collapse compared to those augmented with CPC.
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Huang S, Ji T, Tang X, Guo W. Novel axial compressive endoprosthesis ACE can enhance metaphyseal fixation and facilitate osseointegration: A biomechanical study. Front Bioeng Biotechnol 2022; 10:1004849. [DOI: 10.3389/fbioe.2022.1004849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Metaphyseal fixation for endoprosthetic reconstruction after bone tumor resection is difficult due to the short residual bone length and reverse funnel shape of the metaphysis. In the current study, 3D-printed axial compressive endoprosthesis (ACE) with a short stem and intramedullary axial compressive mechanism is proposed to improve metaphyseal fixation. The rationales of ACE are that 1) intramedullary axial compress enhances the stability of endoprosthesis and facilitates bone ingrowth at the osteotomy site; 2) 3D printed porous metallic surface at osteotomy surface and stem allows bone ingrowth to achieve osseointegration.Methods: A biomechanical study was performed to explore the initial stability using Sawbones. A diaphysis and metaphyseal segmental defect were created and four fixation structures were simulated: 1) ACE; 2) ACE + lateral plate; 3) stem prosthesis + unilateral plate; 4) stem prosthesis + bilateral plates. Bending and torsional stiffness were determined with a material testing machine. The relationship between the torque of the compression nut and the axial compression force of the bone-implant surface was measured using a round gasket load sensor.Results: ACE + lateral plate was the stiffest in the bending test (sagittal 324.3 ± 110.8 N/mm, coronal 307.7 ± 8.7 N/mm). ACE + lateral plate and stem prosthesis + bilateral plates had the highest torsional stiffness (10.9 ± 1.3 Nm/° and 10.7 ± 0.2 Nm/° respectively). The bending stiffness of ACE was equivalent to stem prosthesis + bilateral plates (sagittal 196 ± 10 N/mm vs. 200 ± 7 N/mm, coronal 197 ± 14 N/mm vs. 209 ± 3 N/mm), but the torsional stiffness of ACE was inferior to stem prosthesis + bilateral plates (6.1 ± 1.3 Nm/° vs. 10.7 ± 0.2 Nm/°). Stem prosthesis + unilateral plate was the least stiff both in bending and torsion. The relationship between torque (T/Nm) and axial pressure (F/N) was F = 233.5T.Conclusion: The axial compressive design of ACE enhances primary stability and facilitates osseointegration, which provides an alternative option of metaphyseal fixation for endoprosthetic reconstruction.
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Metzner F, Neupetsch C, Carabello A, Pietsch M, Wendler T, Drossel WG. Biomechanical validation of additively manufactured artificial femoral bones. BMC Biomed Eng 2022; 4:6. [PMID: 35927720 PMCID: PMC9354338 DOI: 10.1186/s42490-022-00063-1] [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] [Received: 05/03/2022] [Accepted: 07/21/2022] [Indexed: 01/15/2023] Open
Abstract
Replicating the mechanical behavior of human bones, especially cancellous bone tissue, is challenging. Typically, conventional bone models primarily consist of polyurethane foam surrounded by a solid shell. Although nearly isotropic foam components have mechanical properties similar to cancellous bone, they do not represent the anisotropy and inhomogeneity of bone architecture. To consider the architecture of bone, models were developed whose core was additively manufactured based on CT data. This core was subsequently coated with glass fiber composite. Specimens consisting of a gyroid-structure were fabricated using fused filament fabrication (FFF) techniques from different materials and various filler levels. Subsequent compression tests showed good accordance between the mechanical behavior of the printed specimens and human bone. The unidirectional fiberglass composite showed higher strength and stiffness than human cortical bone in 3-point bending tests, with comparable material behaviors being observed. During biomechanical investigation of the entire assembly, femoral prosthetic stems were inserted into both artificial and human bones under controlled conditions, while recording occurring forces and strains. All of the artificial prototypes, made of different materials, showed analogous behavior to human bone. In conclusion, it was shown that low-cost FFF technique can be used to generate valid bone models and selectively modify their properties by changing the infill.
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Affiliation(s)
- F. Metzner
- grid.9647.c0000 0004 7669 9786ZESBO Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - C. Neupetsch
- grid.9647.c0000 0004 7669 9786Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany ,grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany ,grid.6810.f0000 0001 2294 5505Professorship of Adaptronics and Lightweight Design, Chemnitz Universtiy of Technology, Chemnitz, Germany
| | - A. Carabello
- grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany ,grid.6810.f0000 0001 2294 5505Professorship of Adaptronics and Lightweight Design, Chemnitz Universtiy of Technology, Chemnitz, Germany
| | - M. Pietsch
- grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - T. Wendler
- grid.9647.c0000 0004 7669 9786ZESBO Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - W.-G. Drossel
- grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany ,grid.6810.f0000 0001 2294 5505Professorship of Adaptronics and Lightweight Design, Chemnitz Universtiy of Technology, Chemnitz, Germany
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14
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Chiu YC, Hsu CE, Ho TY, Ting YN, Tsai MT, Hsu JT. Biomechanical study on fixation methods for horizontal oblique metacarpal shaft fractures. J Orthop Surg Res 2022; 17:374. [PMID: 35922799 PMCID: PMC9351190 DOI: 10.1186/s13018-022-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft fractures. MATERIALS AND METHODS Horizontal oblique metacarpal shaft fractures were created in 21 artificial metacarpal bones and fixed using one of the three methods: (1) two lag screws, (2) a regular plate, and (3) a locking plate. All the specimens were subjected to the cantilever bending test performed using a material testing machine to enable recording of the force-displacement data of the specimens before failure. The Kruskal-Wallis test was used to compare failure force and stiffness values among the three fixation methods. RESULTS The mean failure force of the two lag screw group (78.5 ± 6.6 N, mean + SD) was higher than those of the regular plate group (69.3 ± 17.6 N) and locking plate group (68.2 ± 14.2 N). However, the mean failure force did not significantly differ among the three groups. The mean stiffness value of the two lag screw group (17.8 ± 2.6 N/mm) was lower than those of the regular plate group (20.2 ± 10.5 N/mm) and locking plate group (21.8 ± 3.8 N/mm). However, the mean stiffness value did not significantly differ among the three groups. CONCLUSION The fixation strength of two lag screw fixation did not significantly differ from that of regular and locking bone plate fixation, as indicated by the measurement of the ability to sustain force and stiffness.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, College of Biomedical Engineering, China Medical University, Taichung, 404, Taiwan. .,School of Dentistry, College of Dentistry, China Medical University, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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15
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Biomechanical comparison of the femoral neck system and the dynamic hip screw in basicervical femoral neck fractures. Sci Rep 2022; 12:7915. [PMID: 35551221 PMCID: PMC9098555 DOI: 10.1038/s41598-022-11914-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/25/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to compare the fixation stability of proximal fragments and the mechanical characteristics in proximal femur models of basicervical femoral neck fracture fixed by the femoral neck system (FNS) versus the dynamic hip screw. The mean axial stiffness was 234 ± 35 N/mm in the FNS group and 253 ± 42 N/mm in the DHS group, showing no significant difference (p = 0.654). Mean values for x-axis rotation, y-axis rotation, and z-axis rotation after cycle load were 2.2 ± 0.5°, 6.5 ± 1.5°, and 2.5 ± 0.6°, respectively, in the FNS group and 2.5 ± 0.7°, 5.8 ± 2.1°, and 2.2 ± 0.9°, respectively, in the DHS group, showing no significant differences (p = 0.324, p = 0.245, and p = 0.312, respectively). The mean values of cranial and axial migration of screws within the femoral head were 1.5 ± 0.3 and 2.1 ± 0.2 mm, respectively, in the FNS group and 1.2 ± 0.3 and 2.4 ± 0.3 mm, respectively, in the DHS group, showing no significant differences (p = 0.425 and p = 0.625, respectively). The average failure load at vertical load was 1342 ± 201 N in the FNS group and 1450 ± 196 N in the DHS group, showing no significant difference (p = 0.452). FNS fixation might provide biomechanical stability comparable to that of DHS for treating displaced basicervical femoral neck fractures in young adults.
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16
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Lodde MF, Katthagen JC, Schopper CO, Zderic I, Richards RG, Gueorguiev B, Raschke MJ, Hartensuer R. Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121368. [PMID: 34946313 PMCID: PMC8706027 DOI: 10.3390/medicina57121368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). Materials and Methods: Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. Results: Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, p = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), p ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, p = 0.79. Conclusions: In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone.
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Affiliation(s)
- Moritz F. Lodde
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
- Correspondence: ; Tel.: +49-251-83-59264
| | - J. Christoph Katthagen
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - Clemens O. Schopper
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - R. Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - Michael J. Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - René Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
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17
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Layher F, Matziolis G, Kayhan LN, Bungartz M, Brinkmann O. Minimally Invasive Internal Fixation of Femoral Shaft Fractures-A Biomechanical Study with a Disruptive Technique. Life (Basel) 2021; 11:life11111254. [PMID: 34833130 PMCID: PMC8620013 DOI: 10.3390/life11111254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.
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Affiliation(s)
- Frank Layher
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Leos N. Kayhan
- Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland;
| | - Matthias Bungartz
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Olaf Brinkmann
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
- Correspondence:
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Is Anterior Plating Superior to the Bilateral Use of Retrograde Transpubic Screws for Treatment of Straddle Pelvic Ring Fractures? A Biomechanical Investigation. J Clin Med 2021; 10:jcm10215049. [PMID: 34768569 PMCID: PMC8585079 DOI: 10.3390/jcm10215049] [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] [Received: 10/02/2021] [Revised: 10/17/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Fractures of the four anterior pubic rami are described as “straddle fractures”. The aim of this study was to compare biomechanical anterior plating (group 1) versus the bilateral use of retrograde transpubic screws (group 2). Methods: A straddle fracture was simulated in 16 artificial pelvises. All specimens were tested under progressively increasing cyclic loading, with monitoring by means of motion tracking. Results: Axial stiffness did not differ significantly between the groups, p = 0.88. Fracture displacement after 1000–4000 cycles was not significantly different between the groups, p ≥ 0.38; however, after 5000 cycles it was significantly less in the retrograde transpubic screw group compared to the anterior plating group, p = 0.04. No significantly different flexural rotations were detected between the groups, p ≥ 0.32. Moreover, no significant differences were detected between the groups with respect to their cycles to failure and failure loads, p = 0.14. Conclusion: The results of this biomechanical study reveal less fracture displacement in the retrograde transpubic screw group after long-term testing with no further significant difference between anterior plating and bilateral use of retrograde transpubic screws. While the open approach using anterior plating allows for better visualization of the fracture site and open reduction, the use of bilateral retrograde transpubic screws, splinting the fracture, presents a minimally invasive and biomechanically stable technique.
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Chiu YC, Hsu CE, Ho TY, Ting YN, Wei BH, Tsai MT, Hsu JT. Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture. Medicine (Baltimore) 2021; 100:e27375. [PMID: 34596154 PMCID: PMC8483876 DOI: 10.1097/md.0000000000027375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/11/2021] [Indexed: 01/05/2023] Open
Abstract
Metacarpal shaft fractures are common hand fractures. Although bone plates possess strong fixation ability, they have several limitations. The use of headless compression screws for fracture repair has been reported, but their fixation ability has not been understood clearly.This study aimed to compare the fixation ability of locked plate with that of headless compression screw for metacarpal fracture repair.A total of 14 artificial metacarpal bones (Sawbones, Vashon, WA, USA) were subjected to transverse metacarpal shaft fractures and divided into 2 groups. The first group of bones was fixed using locked plates (LP group), whereas the second group was fixed using headless compression screws (HC group). A material testing machine was used to perform cantilever bending tests, whereby maximum fracture force and stiffness were measured. The fixation methods were compared by conducting a Mann-Whitney U test.The maximum fracture force of the HC group (285.6 ± 57.3 N, median + interquartile range) was significantly higher than that of the LP group (227.8 ± 37.5 N; P < .05). The median of the HC group was 25.4% greater. However, no significant difference in stiffness (P > .05) was observed between the HC (65.2 ± 24.6 N/mm) and LP (61.7 ± 19.7 N/mm) groups.Headless compression screws exhibited greater fixability than did locked plates, particularly in its resistance to maximum fracture force.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Bor-Han Wei
- Orthopedic Department, China Medical University Beigang Hospital, Yunlin County, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan, ROC
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Campbell A, Narvaez M, Caldwell JM, Banffy M. Stay Ipsilateral: An Analysis of Tibial Tunnel Distance Between Cruciate Ligament Reconstruction and Posterior Meniscal Root Repair. Arthrosc Sports Med Rehabil 2021; 3:e1031-e1035. [PMID: 34430882 PMCID: PMC8365198 DOI: 10.1016/j.asmr.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To establish mean distance or identify intersection between tibial tunnels for posterior meniscal root repair in the setting of anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction. Methods Twelve cadaver knees and 12 solid foam synthetic tibiae were used. ACL and PCL tunnels were drilled for single-bundle reconstruction, and both medial and lateral posterior root repair tunnels were drilled. Specimens underwent computed tomography scanning and shortest distances between tunnels in all planes were measured by 2 readers. Distances were compared between groups using a t-test. Results In ACL reconstruction, the medial meniscal root tunnel was not significantly closer to the cruciate tunnel when drilled from either medial or lateral side (P = .333). The lateral meniscal root tunnel was significantly closer when drilled from medial compared to lateral side (P < .001). In PCL reconstruction, both medial (P = .037) and lateral (P = .028) meniscal root tunnels were significantly closer to the PCL tunnel when drilled from the contralateral side of the tibia. Conclusion This study demonstrates that posterior meniscal root repair tunnels are often placed within a few millimeters and can even intersect cruciate ligament reconstruction tunnels in the proximal tibia. Clinical Relevance The information in this study may assist surgeons in planning for cruciate ligament reconstruction with concomitant posterior meniscal root repair.
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Affiliation(s)
| | - Michael Narvaez
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles California, U.S.A
| | | | - Michael Banffy
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles California, U.S.A
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21
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Jordan MC, Jäckle V, Scheidt S, Gilbert F, Hölscher-Doht S, Ergün S, Meffert RH, Heintel TM. Trans-obturator cable fixation of open book pelvic injuries. Sci Rep 2021; 11:13463. [PMID: 34188088 PMCID: PMC8241833 DOI: 10.1038/s41598-021-92755-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Veronika Jäckle
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Scheidt
- Department of Orthopaedic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Fabian Gilbert
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU München, Marchioninistr. 15, 81377, München, Germany
| | - Stefanie Hölscher-Doht
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy, Julius-Maximilians-University Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Timo M Heintel
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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22
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Lodde MF, Katthagen JC, Schopper CO, Zderic I, Richards G, Gueorguiev B, Raschke MJ, Hartensuer R. Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring. J Clin Med 2021; 10:jcm10112326. [PMID: 34073570 PMCID: PMC8199358 DOI: 10.3390/jcm10112326] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Incidence of pelvic ring fractures has increased over the past four decades, especially after low-impact trauma—classified as fragility fractures of the pelvis (FFP). To date, there is a lack of biomechanical evidence for the superiority of one existing fixation technique over another. An FFP type IIc was simulated in 50 artificial pelvises, assigned to 5 study groups: Sacroiliac (SI) screw, SI screw plus supra-acetabular external fixator, SI screw plus plate, SI screw plus retrograde transpubic screw, or S1/S2 ala–ilium screws. The specimens were tested under progressively increasing cyclic loading. Axial stiffness and cycles to failure were analysed. Displacement at the fracture sites was evaluated, having been continuously captured via motion tracking. Results: Fixation with SI screw plus plate and SI screw plus retrograde transpubic screw led to higher stability than the other tested techniques. The S1/S2 ala–ilium screws were more stable than the SI screw or the SI screw plus external fixator. Conclusions: In cases with displaced fractures, open reduction and plate fixation provides the highest stability, whereas in cases where minimally invasive techniques are applicable, a retrograde transpubic screw or S1/S2 ala–ilium screws can be considered as successful alternative treatment options.
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Affiliation(s)
- Moritz F. Lodde
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
- Correspondence: ; Tel.: +49-251-83-59264
| | - J. Christoph Katthagen
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - Clemens O. Schopper
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Michael J. Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - René Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
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23
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Chiu YC, Ho TY, Ting YN, Tsai MT, Huang HL, Hsu CE, Hsu JT. Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study. BMC Musculoskelet Disord 2021; 22:146. [PMID: 33546670 PMCID: PMC7866681 DOI: 10.1186/s12891-020-03939-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan, Republic of China, 433
| | - Heng-Li Huang
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, No. 1650, Sec. 4 Taiwan Boulevard, Situng Dist., Taichung City, 407, Taiwan (Republic of China). .,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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24
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Sherman WF, Flick TR, Dranoff CS, Weintraub MJ, Kale NN, Sommi C, Sanchez FL. Variability of Cutting and Thermal Dynamics Between New and Used Acetabular Reamers During Total Hip Arthroplasty. Arthroplast Today 2021; 7:91-97. [PMID: 33521203 PMCID: PMC7818610 DOI: 10.1016/j.artd.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Aseptic loosening of the acetabular component remains one of the leading causes of early failure of total hip arthroplasty. Poor apposition of bone onto the implant surface can be due to inaccurate reaming and osteonecrosis of the acetabular bone due to the heat generated while reaming. Methods New and used acetabular reamers were tested on an MTS system using a clinically relevant force of 87.6 N. A thermal profile and depth achieved by the reamers were analyzed and compared between the 2 cohorts. Heat generated and force required for the community used reamers to achieve the same depth as the new reamers were subsequently analyzed. Results The new reamers achieved a depth 3.4 mm deeper than the community reamers (P < .001). The new reamers generated 4.1°C less heat than the community reamers (P = .007) under the same force and time. When programmed to ream to the average depth of the new reamers, the community reamers generated 16.8°C more heat (P = .002) and required forces 95-318% greater than the 87.6 N force used by the new reamers. Conclusions Community use of reamers will cause variations in depth of penetration and increased temperatures at a clinically generated force vs new reamers. When community reamers were forced to the same depths the new reamers achieved, a significantly greater amount of heat was generated, and an increased amount of time was needed, both of which are known risk factors for osteonecrosis.
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Affiliation(s)
- William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Charles S Dranoff
- Tulane University School of Science and Engineering, New Orleans, LA, USA
| | | | - Nisha N Kale
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Corinne Sommi
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fernando L Sanchez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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25
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Comparison of five percutaneous pinning methods for unstable extra-articular distal radius fractures: A mechanical study using sawbones. Jt Dis Relat Surg 2021; 32:51-58. [PMID: 33463418 PMCID: PMC8073444 DOI: 10.5606/ehc.2021.75817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to mechanically compare five different extra-focal bi-cortical pin configurations (using two and three pins) employed for fixation of a simulated unstable extra-articular distal radius fracture with dorsal comminution using a sawbone model. Materials and methods
This in vitro mechanical study was conducted between June 2019 and July 2019. A standard fracture model (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type 23-A3.3) was created using a fourth generation composite artificial radius bone. Five groups with two- and three-pin configurations were tested under axial, volar, and dorsal loading with a universal test device. Mean stiffness values were compared statistically. Results
Comparison of stiffness values from axial and volar loading tests between groups in paired comparison showed no statistically significant difference (p=0.194 and p=0.086, respectively). Dorsal loading tests showed statistically significant difference between the groups in pairwise comparison (p=0.002). Three-pin groups (Groups 3, 4, and 5) had higher stiffness values compared to two-pin groups (Groups 1 and 2) in dorsal loading tests (p=0.001). Three-pin configuration test groups with two divergent or convergent pins from the radial styloid performed better compared to both two-pin groups (p=0.01, p=0.002) in dorsal loading tests. Conclusion
Our data demonstrated that the three-pin configuration with two divergent or convergent Kirschner wires from the styloid and a third wire from the dorsal/ulnar cortex had higher stiffness values compared to two-pin configurations in dorsal loading tests. When indicated, we suggest the use of a three-pin construct. Particularly in cases with a risk of volar angulation, we recommend a three-pin configuration with two divergent or convergent bi-cortical Kirschner wires.
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26
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Hong CK, Su WR, Kuan FC, Chen Y, Chiang CH, Hsu KL. High-Tensile Strength Tapes Show Greater Ultimate Failure Load and Less Stiffness Than High-Tensile Strength Sutures in a Subpectoral Biceps Tenodesis Porcine Model. Arthrosc Sports Med Rehabil 2020; 2:e795-e801. [PMID: 33376994 PMCID: PMC7754602 DOI: 10.1016/j.asmr.2020.07.018] [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: 01/26/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare the biomechanical properties of high-tensile strength tape and a high-tensile strength suture in subpectoral biceps tenodesis using a suture anchor in a porcine tendon model. Methods A total of 24 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons were used. Two types of suture materials, high-tensile strength sutures (group S) and high-tensile strength tapes (group T), were evaluated. After we inserted metallic suture anchors with either 2 sutures or tapes 5 cm from the superomedial corner of the greater tuberosity, a Krackow suture technique was used to secure the tendons. After a preload of 5 N for 2 minutes, a cyclic loading test from 5 to 70 N was conducted for 500 cycles. Finally, the specimen was loaded to failure at a rate of 1 mm/s. Results There were no significant between-group differences in elongation after cyclic loading and elongation at failure load for group S and group T (P = .977 and .630, respectively). The ultimate failure loads in group T (278.2 ± 54 N) were significantly greater than those in group S (249.4 ± 32 N) (P = .028). In contrast, the stiffness values in group T (28.5 ± 4.0 N/mm) were significantly lower than those in group S (32.3 ± 4.5 N) (P = .028). Ten specimens in group S and 8 specimens in group T failed, with tendons being cut through by the sutures, whereas the other 2 specimens in group S and 4 specimens in group T failed due to suture breakage. Conclusions Using high-tensile strength tapes in subpectoral biceps tenodesis using a suture anchor leads to significantly greater ultimate failure load as compared with using high-tensile strength sutures in a porcine model. Although lower levels of stiffness were found in high-tensile strength tape group, the difference in the means were not large between 2 groups. Clinical Relevance A strong suture–tendon structure may prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan
| | - Chen-Hao Chiang
- Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
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27
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Boyce GN, Philpott AJ, Ackland DC, Ek ET. Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study. J Orthop Surg Res 2020; 15:248. [PMID: 32646450 PMCID: PMC7346347 DOI: 10.1186/s13018-020-01771-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dual orthogonal plating of clavicle fractures may provide greater stiffness and strength than unilateral plate constructs and allow the use of lower-profile plates. We aim to biomechanically compare three clavicle plating constructs in a comminuted clavicle fracture model. METHOD Fifteen clavicle sawbones were osteotomised, simulating a comminuted midshaft fracture and allocated to either: group 1, single superior plate (3.5 mm superior plate); group 2, combination plating (3.5 mm superior plate, 2.8 mm anterior plate) and group 3, dual mini-plates (two 2.8-mm orthogonal mini-plates). Specimens were biomechanically tested under torsion and cantilever bending. Construct stiffness (Nm/degree) and load to failure (Nm) were measured. RESULTS Group 2 had higher torsional (0.70 vs. 0.60 Nm/deg, p = 0.017) and cantilever bending stiffness (0.61 vs. 0.51 Nm/deg, p = 0.025) than group 1. Group 3 had lower cantilever bending stiffness (0.39 vs. 0.51 Nm/deg, p < 0.004) and load to failure (40.87 vs. 54.84 Nm, p < 0.01) than group 1. All dual plate constructs that catastrophically failed did so from fracture at the lateral ends of the plates. Single plate constructs failed due to plate bending. CONCLUSION Dual orthogonal fixation with mini-plates demonstrated lower stiffness and strength than traditional superior plating. The addition of an anterior mini-plate to a traditional superior plating improved construct stiffness and may have a role in patients seeking early return to activity. LEVEL OF EVIDENCE Basic science biomechanical study.
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Affiliation(s)
- Glenn N Boyce
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
- Department of Orthopaedic Surgery, Bendigo Health, Bendigo, VIC, Australia
| | - Andrew J Philpott
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia.
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
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28
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Hong CK, Hsu KL, Kuan FC, Wang CH, Wang PH, Su WR. The effect of hole size on failure loads of the distal humerus fenestration in Outerbridge-Kashiwagi arthroplasty: A biomechanical study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:305-310. [PMID: 32544067 DOI: 10.5152/j.aott.2020.03.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to biomechanically assess the effect of humeral-fenestration size in the Outerbridge-Kashiwagi arthroplasty on the ultimate failure load of the distal humerus in a synthetic bone model. METHODS We biomechanically tested the influence of different humeral-fenestration sizes on the failure load of the distal humerus in Outerbridge-Kashiwagi arthroplasty. A total of 50 synthetic humerus models were divided into 5 groups based on the fenestration size: 10 mm, 12 mm, 15 mm, 18 mm, and 20 mm. All the samples were randomly assigned to receive either axial or anteroposterior (AP) loading and then loaded to failure at a rate of 2 mm/min on a material testing machine. The data regarding ultimate failure loads under the axial and AP loading were analyzed. RESULTS Under the AP loading, the mean ultimate failure loads of the 18 mm and 20 mm groups were lower than those of the other groups. Under the axial loading, the mean ultimate failure load of the 10 mm group was significantly greater than that of the 15 mm, 18 mm, and 20 mm groups. Additionally, the ultimate failure load of the 20 mm group was significantly lower than that of the 12 mm, 15 mm, and 18 mm groups. CONCLUSION The distal humeral fenestrations with a size greater than 18 mm may offer poor biomechanical properties in the Outerbridge-Kashiwagi ulnohumeral arthroplasty.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Hui Wang
- Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine,National Cheng Kung University, Tainan, Taiwan
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29
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Cameron MW, Schemitsch EH, Zdero R, Quenneville CE. Biomechanical impact testing of synthetic versus human cadaveric tibias for predicting injury risk during pedestrian-vehicle collisions. TRAFFIC INJURY PREVENTION 2020; 21:163-168. [PMID: 32023127 DOI: 10.1080/15389588.2020.1714603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
Objective: The tibia is the most commonly fractured long bone in a pedestrian-vehicle collision. The standard injury assessment tool is the "legform," a device that mimics the human lower limb under impact loads. These devices are designed to identify the impact load that will cause the onset of injury, rather than replicate the type and severity of fracture. Thus, this study is the first to determine if composite tibias made by Sawbones (Pacific Research Labs, Vashon, WA, USA) designed for orthopedic biomechanics research, could also potentially be used for traffic safety research by simulating both the damage tolerance of human cadaveric tibias for peak force and bending moment and the fracture patterns themselves, thereby more accurately predicting injury type during real-world pedestrian-vehicle collisions.Methods: Synthetic tibias (n = 6) and human cadaveric tibias (n = 6) were impacted at midshaft at 8.3 m/s (i.e., 30 km/h) under 3-point bending using a pneumatic impacting apparatus. Fracture force, bending moment, and fracture patterns were compared between the two groups, and Weibull survivability curves generated for force and moment results, to identify injury risk thresholds.Results: There was no difference for synthetic vs. cadaveric tibias regarding impact force (4271+/-938 N vs. 4889+/-993 N, p = 0.44) or bending moment at fracture (275+/-64 Nm vs. 302+/-107 Nm, p = 0.69). Force-time curves for all tibias were similar in shape based on the first three Principal Components (p > 0.14). Weibull survivability curves had differences in shape and in the 10% risk of fracture limits, with force thresholds of 2873 N for the synthetic vs. 3386 N for the cadaveric, and bending moment limits of 180 Nm for the synthetic compared to 157 Nm for the cadaveric. All fracture patterns were clinically realistic, but not consistent between groups. The coefficient of variation for synthetic tibias was >0.2 for both peak force and bending moment, which precludes their use as a reproducible test surrogate for injury prediction.Conclusions: Synthetic composite tibias offer the potential for developing a frangible test surrogate, and matched cadaveric response in several respects. However, the repeatability was not high enough for them to be used in their present form for injury prediction.
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Affiliation(s)
- Muir W Cameron
- Department of Mechanical Engineering, University of Glasgow, Glasgow, Scotland
| | | | - Radovan Zdero
- Department of Surgery, Western University, London, ON, Canada
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
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30
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Becker J, Winkler M, von Rüden C, Bliven E, Augat P, Resch H. Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis. Arch Orthop Trauma Surg 2020; 140:1947-1954. [PMID: 32270279 PMCID: PMC7674566 DOI: 10.1007/s00402-020-03433-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. METHODS Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch-Schneider reinforcement cage (BSRC) (n = 6). RESULTS During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). CONCLUSIONS The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.
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Affiliation(s)
- Johannes Becker
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany.
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.
| | - M Winkler
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - C von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - E Bliven
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - P Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - H Resch
- Department of Traumatology and Sports Medicine, Paracelsus Medical University, Salzburg, Austria
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Muramoto Y, Fridrici V, Kapsa P, Bouvard G, Ohta M. Effects of temperature increase during surgical drilling in acrylic resin. Technol Health Care 2019; 28:369-380. [PMID: 31796714 DOI: 10.3233/thc-191870] [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: 11/15/2022]
Abstract
BACKGROUND Acrylic resin is employed for drilling bone biomodels. Since drilling causes temperature rise, the mechanical properties of thermoplastic acrylic resin can be altered, consequently affecting drilling properties. However, it is currently unclear how this temperature increase impacts drilling. OBJECTIVE This study reports the effects of temperature rise on both mechanical and drilling properties through experiments in which acrylic resin is drilled under machining conditions employed in surgical operations. METHODS Drilling tests were performed using a surgical drill on medical acrylic resin under dry conditions to observe generated cutting chips and measure drilling properties such as torque, drilling time, and temperature rise. Dynamic mechanical analysis measurements were performed to consider temperature effects. RESULTS According to the morphological classification of the cutting chips, the drilling process is divided into three phases corresponding with the generation of cylindrical helix, waved, and rounded nubby chips respectively. During drilling, the temperature of the chips can exceed the glass transition temperature (100∘C) resulting in decreased viscoelasticity, which is associated with decreased torque. CONCLUSIONS While drilling acrylic resin under surgical machining conditions, increasing temperature can decrease torque and morphologically change cutting chips due to the decrease in mechanical properties above the glass transition temperature.
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Affiliation(s)
- Y Muramoto
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan.,Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - V Fridrici
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - Ph Kapsa
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - G Bouvard
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - M Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,ElyTMaX UMI 3757, CNRS - Université de Lyon - Tohoku University, International Joint Unit, Tohoku University, Sendai, Miyagi, Japan
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Ahrend MD, Noser H, Shanmugam R, Burr F, Kamer L, Kamarul T, Hügli H, Nagy A, Richards RG, Gueorguiev-Rüegg B. Development of generic Asian pelvic bone models using CT-based 3D statistical modelling. J Orthop Translat 2019; 20:100-106. [PMID: 31908940 PMCID: PMC6939105 DOI: 10.1016/j.jot.2019.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/18/2019] [Accepted: 10/09/2019] [Indexed: 01/23/2023] Open
Abstract
Background/Objective Artificial bone models (ABMs) are used in orthopaedics for research of biomechanics, development of implants and educational purposes. Most of the commercially available ABMs approximate the morphology of Europeans, but they may not depict the Asian anatomy. Therefore, our aim was to develop the first Asian ABM of the pelvis and compare it with the existing pelvic ABM (Synbone®; Caucasian male). Methods One hundred clinical computed tomography (CTs) of adult pelvises (male n = 50, female n = 50) of Malay, Chinese and Indian descent were acquired. CTs were segmented and defined landmarks were placed. Three 3D statistical pelvic model and mean models (overall, male, female) were generated. Anatomical variations were analysed using principal component analysis. To measure gender-related differences and differences to the existing ABM, distances between the anterior superior iliac spines (ASIS), the anterior inferior iliac spines (AIIS), the promontory and the symphysis (conjugate vera, CV) as well as the ischial spines (diameter transversa, DT) were quantified. Results Principal component analysis displayed large variability regarding the pelvic shape and size. Female and male statistical models were similar in ASIS (225 ± 20; 227 ± 13 mm; P = 0.4153) and AIIS (185 ± 11; 187 ± 10 mm; P = 0.3982) and differed in CV (116 ± 10; 105 ± 10 mm; P < 0.0001) and DT (105 ± 7; 88 ± 8 mm; P < 0.0001). Comparing the unisex mean model with the pre-existing ABM, the ASIS (226; 275 mm; P < 0.0001), the AIIS (186; 209 mm; P < 0.0001) and the CV (111; 105 mm; P < 0.0001) differed significantly. Both models were similar regarding DT (97; 95 mm; P = 0.6927). The analysis revealed notable gender- and size-dependent anatomical variations within the Asian population. Chinese, Malay and Indian descents did not differ notably. The overall Asian model was smaller than the existing ABM. The translation potential of this article Owing to the large differences between the Asian ABM and the pre-existing ABM, as well as differences between genders, the use of an Asian- and gender-specific ABM is important to consider in research, biomechanics and implant development for this population.
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Affiliation(s)
- Marc-Daniel Ahrend
- AO Research Institute Davos, Davos, Switzerland.,Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | | | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | - Tunku Kamarul
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Martetschläger F, Reifenschneider F, Fischer N, Wijdicks CA, Millett PJ, Imhoff AB, Braun S. Sternoclavicular Joint Reconstruction Fracture Risk Is Reduced With Straight Drill Tunnels and Optimized With Tendon Graft Suture Augmentation. Orthop J Sports Med 2019; 7:2325967119838265. [PMID: 31041330 PMCID: PMC6481000 DOI: 10.1177/2325967119838265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Despite the rare entity of sternoclavicular joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique drilling has been proposed to reduce intraoperative risks. Purpose: To biomechanically investigate different cerclage reconstruction techniques and the benefit of additional reinforcement using suture tape. Study Design: Controlled laboratory study. Methods: Reconstructed artificial bone specimens were mounted on a mechanical testing machine. They were subjected to anterior and posterior translation, analyzing ultimate strength, displacement, stiffness, and elongation. For stage 1, different angulations of the drill tunnels through the sternum and clavicle were compared. Straight drill tunnels from anterior to posterior were compared with 45° oblique drill tunnels. For stage 2, three different materials for cerclage reconstruction were compared: (1) suture tape alone (FT group), (2) tendon graft alone (tendon group), and (3) tendon graft with suture tape augmentation (tendon+FT group). Results: For the FT group, in the anterior and posterior directions, straight drill holes resulted in a significantly higher load to failure (936.9 ± 122.5 N) compared with oblique ones (434.5 ± 20.2 N) (P < .0001). During cyclic testing, all specimens with straight drill holes survived the 5- to 550-N step, while all specimens with oblique ones failed during the 5- to 450-N step. Analyzing the graft material choice, the mean load to failure was 556.6 ± 174.3 N for the tendon group, 936.9 ± 122.5 N for the FT group, and 767.0 ± 110.7 N for the tendon+FT group (P = .089). The stiffness of the tendon+FT group was significantly lower than that of the FT group and significantly higher than that of the tendon group. Conclusion: Oblique tunnel placement during SCJ reconstruction, while reducing the intraoperative risk, results in decreased primary stability of the construct. Tendon graft reconstruction with suture tape augmentation leads to enhanced stability and optimizes biomechanical properties of the construct. Clinical Relevance: The surgical technique with straight drill holes has superior initial biomechanical properties and may likewise produce superior clinical outcomes in the treatment of SCJ instability. Suture tape augmentation can provide additional stability to reconstruction procedures.
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Affiliation(s)
- Frank Martetschläger
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | | | - Nicole Fischer
- Department of Research & Development, Arthrex GmbH, Munich, Germany
| | - Coen A Wijdicks
- Department of Research & Development, Arthrex GmbH, Munich, Germany
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Gelenkpunkt, Sport- und Gelenkchirurgie Innsbruck, Innsbruck, Austria
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Dual Motor Drill Continuously Measures Drilling Energy to Calculate Bone Density and Screw Pull-out Force in Real Time. J Am Acad Orthop Surg Glob Res Rev 2018; 2:e053. [PMID: 30465038 PMCID: PMC6226295 DOI: 10.5435/jaaosglobal-d-18-00053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Low bone density complicates the surgical management of fractures. Screw stripping in osteoporotic bone leads to decreased fixation strength and weakening of the fixation construct. If low density could be detected during drilling, augmentation may be performed to prevent screw stripping. Furthermore, continuous monitoring of the drill bit depth and bone density can allow detection of the far cortex where density suddenly increases, providing immediate and accurate screw length measurement and reducing the risk of overpenetration or plunge in osteoporotic bone. Therefore, a dual motor drill was created to calculate bone density and pull-out force in real time. The purpose of this study was to determine whether real-time monitoring of drill bit torque and depth could be used to estimate bone density and pull-out force. We hypothesized that the calculated drilling energy could be used to determine density and would correlate with pull-out force. METHODS Drilling and screw insertion were performed using a validated composite unicortical bone model. Screws of 5-, 10-, and 20-mm length were placed into blocks of known densities (10, 20, 30, and 40 pounds per cubic foot). During creation of holes by the dual motor drill, drilling energy was recorded and used to calculate density. Calculated bone density was then compared with the known density of the block. The drill bit was exchanged for a screwdriver, and screw insertion energy was recorded in a similar fashion during screw placement. Screws were then subjected to maximal axial pull-out force testing with a material testing device. Recorded drilling energy and screw insertion energy were then correlated with the measured pull-out force. RESULTS Calculated bone density correlated very strongly with the known control density, confirming the accuracy of density calculations in real time. Drilling energy and screw insertion energy correlated very strongly with the measured pull-out force by destructive testing confirming ultimate pull-out force could be quantified during drilling or placement of a screw. DISCUSSION Our results confirmed that a dual motor drill can accurately and immediately allow determination of bone density and screw pull-out force before placing a screw. This knowledge could allow a surgeon to perform augmentation or alter surgical technique to prevent screw stripping and loss of fixation as well as detect the far cortex and prevent overpenetration in osteoporotic bone.
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Chiu YC, Tsai MT, Hsu CE, Hsu HC, Huang HL, Hsu JT. New fixation approach for transverse metacarpal neck fracture: a biomechanical study. J Orthop Surg Res 2018; 13:183. [PMID: 30045774 PMCID: PMC6060459 DOI: 10.1186/s13018-018-0890-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates. Methods We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types. Results The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm). Conclusion The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Horng-Chaung Hsu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Heng-Li Huang
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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Fletcher JWA, Williams S, Whitehouse MR, Gill HS, Preatoni E. Juvenile bovine bone is an appropriate surrogate for normal and reduced density human bone in biomechanical testing: a validation study. Sci Rep 2018; 8:10181. [PMID: 29976928 PMCID: PMC6033911 DOI: 10.1038/s41598-018-28155-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
Orthopaedic research necessitates accurate and reliable models of human bone to enable biomechanical discoveries and translation into clinical scenarios. Juvenile bovine bone is postulated to be a potential model of normal human bone given its dimensions and comparatively reduced ethical restrictions. Demineralisation techniques can reduce bone density and alter bone properties, and methods to model osteoporotic bone using demineralised juvenile bovine bone are investigated. Juvenile bovine long bones were quantitatively CT scanned to assess bone density. Demineralisation using hydrochloric acid (0.6, 1.2 and 2.4 M) was performed to create different bone density models which underwent biomechanical validation for normal and osteoporotic bone models. All long bones were found to have comparable features to normal human bone including bone density (1.96 ± 0.08 gcm-3), screw insertion torque and pullout strength. Demineralisation significantly reduced bone density and pullout strength for all types, with 0.6 M hydrochloric acid creating reductions of 25% and 71% respectively. Juvenile bovine bone is inexpensive, easy to source and not subject to extensive ethical procedures. This study establishes for the first time, the use of its long bones as surrogates for both normal and osteoporotic human specimens and offers preliminary validation for its use in biomechanical testing.
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Affiliation(s)
| | - S Williams
- Department for Health, University of Bath, Bath, UK
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - E Preatoni
- Department for Health, University of Bath, Bath, UK
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Manoharan G, Singh R, Kuiper JH, Nokes LDM. Distal fibula oblique fracture fixation using one-third tubular plate with and without lag screw - A biomechanical study of stability. J Orthop 2018; 15:549-552. [PMID: 29881191 PMCID: PMC5990239 DOI: 10.1016/j.jor.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 05/06/2018] [Indexed: 12/15/2022] Open
Abstract
This laboratory-based study compared distal fibula simple oblique fracture fixation with one-third tubular plate with and without a single lag screw to determine which was mechanically more stable. A control group fixed with a limited contact dynamic compression plate was also tested. Biomechanical testing of 30 osteotomised saw bones under lateral bending and torsional forces was performed. There was no significant difference between the mean lateral bending and mean torsional stiffness between the fixation with tubular plate and lag screw and tubular plate alone. Limited contact dynamic compression plate conferred the best stability in lateral bending and torsion, as expected.
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Affiliation(s)
- Gopikanthan Manoharan
- Cardiff School of Engineering, Trevithick Building, 14-17 The Parade, Cardiff, CF24 3AA, United Kingdom
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom
| | - Rohit Singh
- Cardiff School of Engineering, Trevithick Building, 14-17 The Parade, Cardiff, CF24 3AA, United Kingdom
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom
| | - Jan Herman Kuiper
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom
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Oak NR, Lien JR, Brunfeldt A, Lawton JN. Biomechanics of the Proximal Radius Following Drilling of the Bicipital Tuberosity to Mimic Cortical Button Distal Biceps Repair Technique. Hand (N Y) 2018; 13:331-335. [PMID: 28719995 PMCID: PMC5987976 DOI: 10.1177/1558944717701236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A fracture through the proximal radius is a theoretical concern after cortical button distal biceps fixation in an active patient. The permanent, nonossified cortical defect and medullary tunnel is at risk during a fall eliciting rotational and compressive forces. We hypothesized that during simulated torsion and compression, in comparison with unaltered specimens, the cortical button distal biceps repair model would have decreased torsional and compressive strength and would fracture in the vicinity of the bicipital tuberosity bone tunnel. METHODS Sixteen fourth-generation composite radius Sawbones models were used in this controlled laboratory study. A bone tunnel was created through the bicipital tuberosity to mimic the exact bone tunnel, 8 mm near cortex and 3.2 mm far cortex, made for the BicepsButton distal biceps tendon repair. The radius was then prepared and mounted on either a torsional or compression testing device and compared with undrilled control specimens. RESULTS Compression tests resulted in average failure loads of 9015.2 N in controls versus 8253.25 N in drilled specimens ( P = .074). Torsional testing resulted in an average failure torque of 27.3 Nm in controls and 19.3 Nm in drilled specimens ( P = .024). Average fracture angle was 35.1° in controls versus 21.1° in drilled. Gross fracture patterns were similar in compression testing; however, in torsional testing all fractures occurred through the bone tunnel in the drilled group. CONCLUSION There are weaknesses in the vicinity of the bone tunnel in the proximal radius during biomechanical stress testing which may not be clinically relevant in nature. CLINICAL RELEVANCE In cortical button fixation, distal biceps repairs creates a permanent, nonossified cortical defect with tendon interposed in the bone tunnel, which can alter the biomechanical properties of the proximal radius during compressive and torsional loading.
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Affiliation(s)
- Nikhil R. Oak
- Kaiser Permanente, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - John R. Lien
- University of Michigan Health System, Ann Arbor, USA
| | | | - Jeffrey N. Lawton
- University of Michigan Health System, Ann Arbor, USA,Jeffrey N. Lawton, Department of Orthopaedic Surgery, University of Michigan Health System, 2098 S. Main Street, Ann Arbor, MI 48103, USA.
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Losco M, Familiari F, Giron F, Papalia R. Use and Effectiveness of the Cadaver-Lab in Orthopaedic and Traumatology Education: An Italian Survey. JOINTS 2017; 5:197-201. [PMID: 29270555 PMCID: PMC5738488 DOI: 10.1055/s-0037-1608949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose
The purpose of this study is to provide basic information on the availability and current use of cadaver laboratories in the education of orthopaedic residents and trainees and to determine the interest for the implementation of this type of training.
Methods
All Orthopaedic residents and trainees who attended a cadaver laboratory organized by SIGASCOT (Italian Society of the Knee, Arthroscopy, Sports Traumatology, Cartilage and Orthopaedic Technology) between 2013 and 2016 were asked to complete a survey on the availability and current use of cadaver laboratories in the education of Orthopaedic residents and trainees. The survey was sent via e-mail to 102 Orthopaedic residents and trainees. All data were analyzed and all responses are presented as counts, percentages, or means.
Results
Thirty-eight (37.2%) Orthopaedics and traumatology residents and trainees completed the survey and were included in this analysis. Eighteen trainees (18/38; 44.3%) attended a cadaver laboratory focused on lower limb surgery, whereas 20 (20/38; 52.7%) on upper limb surgery. Twenty participants (55.7%) perceived skills laboratory sessions as extremely beneficial to the understanding and becoming familiar with the normal surgical anatomy; moreover, 16 (45.7%) participants considered the cadaver laboratory extremely beneficial to the understanding of a specific surgical technique and very beneficial (44.4%) to become confident with arthroscopic or other specific surgical instruments. Over 60% of participants perceived cadaver laboratory to be very to extremely beneficial to increase confidence and speed in the operating room (OR), and more than a half of them considered skills laboratory sessions to be extremely beneficial to increase participation and decrease the occurrence of damages in the real surgical activity.
Conclusion
Orthopaedic residents and trainees found the addition of a cadaver laboratory for teaching surgical skills a significant benefit to both their overall education and surgical skills training.
Level of Evidence
Level IV, survey study.
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Affiliation(s)
- Michele Losco
- Department of Orthopaedic and Trauma Surgery, AOUC Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Università degli Studi "Magna Graecia" di Catanzaro, Campus Universitario "Salvatore Venuta" Viale Europa, Rome, Italy
| | - Francesco Giron
- Department of Orthopaedic and Trauma Surgery, Ospedale Villa Salus, Mestre, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Policlinico Universitario Campus Bio-Medico, Rome, Italy
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McLachlin S, Lesieur M, Stephen D, Kreder H, Whyne C. Biomechanical analysis of anterior ring fixation of the ramus in type C pelvis fractures. Eur J Trauma Emerg Surg 2017; 44:185-190. [PMID: 28391395 DOI: 10.1007/s00068-017-0788-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This biomechanical study compared the stability of four different ramus fracture fixation methods for Type C pelvic ring injuries in the absence of posterior fixation. METHODS A 5-mm vertical osteotomy of the mid-superior and inferior pubic ramus was created in 12 synthetic pelvic models. Four surgical constructs were compared: (1) two-pin AIIS external fixation, (2) 3.5-mm reconstruction plating, (3) bicortical, fully threaded 3.5-mm, and (4) 6.5-mm pubic ramus screws. Specimens were tested in a simulated one-legged stance on a hemiarthroplasty implant in three stages: (1) no applied load, (2) application of the loading fixture preload to the sacrum (6N), and (3) following six cycles of a 250N load. Stability was assessed based on resultant displacement of the fracture sites at the superior ramus and the anterior sacroiliac joint. RESULTS The bicortical, fully threaded 6.5-mm pubic ramus screw provided the most stable ramus fracture fixation (0.5 ± 0.4 mm) displacement under load and was the only construct to finish testing without gross posterior pelvic disruption. Plate constructs finished the final loading stage with only a small increase (3.1 ± 2.3 mm) in ramus fracture gap size, but had significant displacement at the SI joint (>20 mm). 3.5-mm screw constructs had 1.6 ± 0.7 mm of ramus displacement in the preload stage, but had complete posterior pelvic disruption (>20 mm) that prevented further testing. External fixation was unstable at the ramus and sacroiliac sites in the initial setup. CONCLUSIONS The bicortical, fully threaded 6.5-mm pubic ramus screw was the only anterior fixation construct tested that controlled motion at both the anterior and posterior pelvic rings in the absence of posterior fixation.
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Affiliation(s)
- S McLachlin
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave., Room S611, Toronto, M4N 3M5, ON, Canada
| | - M Lesieur
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - D Stephen
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - H Kreder
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - C Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave., Room S611, Toronto, M4N 3M5, ON, Canada. .,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada. .,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
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Abstract
Sawbones are artificial bones designed to simulate the bone architecture, as well as the bone’s physical properties. The incorporation of sawbones simulation laboratories in many orthopedic training programs has provided the residents with flexibility in learning and scheduling that align with their working hour limitations. This review paper deliberates the organization of sawbones simulation in orthopedic surgical training to enhance trainee’s future learning. In addition, it explores the implications of sawbones simulation in orthopedic surgical teaching and evaluation. It scrutinizes the suitability of practicing on sawbones at the simulation laboratory to improve orthopedic trainee’s learning. This will be followed with recommendations for future enhancement of sawbones simulation-based learning in orthopedic surgical training.
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Affiliation(s)
- Bandar M Hetaimish
- Department of Orthopedics Surgery, Medical College, Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. E-mail.
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42
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Jastifer JR, Alrafeek S, Howard P, Gustafson PA, Coughlin MJ. Biomechanical Evaluation of Strength and Stiffness of Subtalar Joint Arthrodesis Screw Constructs. Foot Ankle Int 2016; 37:419-26. [PMID: 26635413 DOI: 10.1177/1071100715619680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtalar arthrodesis is a common treatment for end-stage subtalar joint arthritis as well as many other clinical problems. The best method of subtalar arthrodesis fixation is unknown. The purpose of this study was to compare the strength of subtalar arthrodesis fixation methods including a single posterior screw (SP), 2 posterior minimally divergent screws (MD) and a 2 screw highly divergent screw (HD) construct for subtalar arthrodesis. METHODS A biomechanical study was performed including the three different screw configurations (SP, MD, HD). These surrogate bone specimens were subjected to applied inversion and eversion torques about the subtalar joint axis on a servo-hydraulic load frame. Torsional stiffness of the construct and the maximum torque for each configuration were measured. Additionally, a cadaver study was performed using 5 fresh-frozen cadaver specimens. The perpendicular distance from the divergent screw guide-wire placement was measured from anatomic structures. RESULTS The HD screw configuration was found to have the highest torsional stiffness in both inversion and eversion, followed by the MD construct and then the SP construct. Similarly, the HD construct had the highest maximum torque versus the MD and SP constructs. All between-group differences were statistically significant (P < .05). The mean distance from key structures to the divergent screw included the sural nerve (13 mm), peroneus brevis tendon (18 mm), tibialis anterior tendon (8 mm), and tibialis posterior tendon (21 mm). CONCLUSION This biomechanical and cadaver study supports the use of 2 screws for fixation of subtalar arthrodesis over a single posterior screw. Additionally, we describe a biomechanically superior and potentially safe, alternative 2-screw divergent construct. CLINICAL RELEVANCE This study gives biomechanical support for 2 screw, divergent fixation of subtalar arthrodesis or a single over a single screw or two screw minimally divergent construct.
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Affiliation(s)
| | | | - Peter Howard
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Hiatt SV, Begonia MT, Thiagarajan G, Hutchison RL. Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures. J Hand Surg Am 2015; 40:1586-90. [PMID: 25980734 DOI: 10.1016/j.jhsa.2015.03.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires. METHODS Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct. RESULTS All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size. CONCLUSIONS The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires. CLINICAL RELEVANCE When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability in the plane of finger flexion-extension.
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Affiliation(s)
- Stephen V Hiatt
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO
| | - Mark T Begonia
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, Kansas City, MO
| | - Ganesh Thiagarajan
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, Kansas City, MO
| | - Richard L Hutchison
- Section of Hand Surgery, Division of Orthopaedic Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO.
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