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Wu C, Wang X, Zhang H, Xie S, He J. Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis. Injury 2023:110917. [PMID: 37400327 DOI: 10.1016/j.injury.2023.110917] [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: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. METHODS Finite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. RESULTS Group A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. CONCLUSION Combining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).
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Affiliation(s)
- Chaomeng Wu
- Jiangxi university of Traditional Chinese Medicine, Nanchang 33004, China
| | - Xingyu Wang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Hao Zhang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Shuihua Xie
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Jianhua He
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China.
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Nichols JA, Baratta C, Reb CW. Biomechanical Sequelae of Syndesmosis Injury and Repair. Foot Ankle Clin 2023; 28:77-98. [PMID: 36822690 DOI: 10.1016/j.fcl.2022.10.004] [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: 01/04/2023]
Abstract
This review characterizes fibula mechanics in the context of syndesmosis injury and repair. Through detailed understanding of fibula kinematics (the study of motion) and kinetics (the study of forces that cause motion), the full complexity of fibula motion can be appreciated. Although the magnitudes of fibula rotation and translation are inherently small, even slight alterations of fibula position or movement can substantially impact force propagation through the ankle and hindfoot joints. Accordingly, implications for clinical care are discussed.
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Affiliation(s)
- Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA.
| | - Chloe Baratta
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA
| | - Christopher W Reb
- Orthopaedics, Veterans Health Administration North Florida / South Georgia Health System, Malcolm Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA
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Szczęsny G, Kopec M, Szolc T, Kowalewski ZL, Małdyk P. Deformation of the Titanium Plate Stabilizing the Lateral Ankle Fracture Due to Its Overloading in Case of the Young, Obese Patient: Case Report Including the Biomechanical Analysis. Diagnostics (Basel) 2022; 12:diagnostics12061479. [PMID: 35741288 PMCID: PMC9221673 DOI: 10.3390/diagnostics12061479] [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: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
The number of overweight and obese patients in developed countries is gradually increasing. It was reported that 1287 (64%) out of 2007 adults operated on in 2017 had a body mass index (BMI) greater than 25 kg/m2, and 26.4% even greater than 30, while the BMI of the most obese patient was as high as 57.6 kg/m2. Such distressing statistics raised an issue related to the inadequate durability of implants used for the fixation of bone fractures. Implants for the lower-extremity fractures may not be durable enough to fit the requirements of overweight and obese patients. This case report presents the history of a 23-year-old obese male with a BMI of 38.7, who bent the angularly stabile titanium plate stabilizing his broken lateral ankle and torn distal tibiofibular syndesmosis. Biomechanical analysis showed that the maximal static bending moment registered during one-leg standing was equal to 1.55 Nm. This value was circa one-third of the maximally admissible bending moment for this particular plate (5.34 Nm) that could be transmitted without its plastic deformation. Since dynamic forces exceed static ones several (3–12) times during typical activities, such as walking, climbing the stairs, running, and jumping, unpredictable forces may occur and increase the risk of loosening, bending, and even breaking implants. None of these situations should have occurred for the typical patient’s body mass of 75 kg, or even for the analyzed mass of the young patient (120 kg) who tried to avoid excessive loading during his daily routine. Subsequent implant bending and destabilization of the fracture shows that for the significantly high and still growing number of obese patients, a very strict physical regime should be recommended to prevent overabundant dynamic loads. On the other hand, the geometry of implants dedicated to these patients should be reconsidered.
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Affiliation(s)
- Grzegorz Szczęsny
- Department of Orthopaedic Surgery and Traumatology, Medical University, 4 Lindleya Street, 02-005 Warsaw, Poland; (G.S.); (P.M.)
| | - Mateusz Kopec
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Street, 02-106 Warsaw, Poland; (T.S.); (Z.L.K.)
- Correspondence:
| | - Tomasz Szolc
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Street, 02-106 Warsaw, Poland; (T.S.); (Z.L.K.)
| | - Zbigniew L. Kowalewski
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Street, 02-106 Warsaw, Poland; (T.S.); (Z.L.K.)
| | - Paweł Małdyk
- Department of Orthopaedic Surgery and Traumatology, Medical University, 4 Lindleya Street, 02-005 Warsaw, Poland; (G.S.); (P.M.)
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Hariri AE, Mirzabozorg H, Esmaeili R, Soltani A, Aghajanzadeh M. Predicting ankle joint syndesmotic screw lifetime using finite element and fatigue analysis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221077274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
After recovery and loading on the patient’s leg, syndesmotic screws mounted on an injured ankle may fail. The main subject of this study is to estimate the lifetime of screws considering the patient’s weight and physical activity. Method: A 3D finite element model of the bone and implemented screws were provided assigning the mechanical properties of ligaments, bones, and screws. Considering axial and tangential physiological loads during the walking phase, the stress and fatigue analyses were performed. Results: The stress distribution had an identical pattern in the screws and all of them experienced the maximum stress during 60–70% of the walking phase. Conclusion: The results of analyses show that body weight has a significant effect on the mounted screw lifetime. Patients with a weight of more than [Formula: see text] kg should prevent applying body load on the operated leg. Conversely, no worry about a patient having less than [Formula: see text] kg body weight.
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Affiliation(s)
- A. E. Hariri
- Civil Engineering Department, K. N. Toosi University of Technology, Tehran, Iran
| | - H. Mirzabozorg
- Civil Engineering Department, K. N. Toosi University of Technology, Tehran, Iran
| | - R. Esmaeili
- Emergency Medicine, Faculty of Medical Science, Iran University of Medical Science, Tehran, Iran
| | - A.R. Soltani
- Civil Engineering Department, K. N. Toosi University of Technology, Tehran, Iran
| | - M. Aghajanzadeh
- Civil Engineering Department, K. N. Toosi University of Technology, Tehran, Iran
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Alastuey-López D, Seral B, Pérez MÁ. Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: Screw vs. suture button. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106272. [PMID: 34293494 DOI: 10.1016/j.cmpb.2021.106272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Tibiofibular syndesmotic injuries may cause degenerative changes, reduction in ankle function and compromising ankle stability. Different fixation techniques try to restore its functionality. Screw-fixation is the gold-standard. Recently, suture-button fixation has aroused the attention because it allows for physiologic micromotion while maintaining an accurate reduction. The aim of this study is to compare the biomechanical behaviour of both fixation techniques using the finite element method. METHODS A three-dimensional finite element model of the tibiofibular joint was reconstructed simulating the intact ankle and the injured syndesmosis. Then, different methods of syndesmosis fixation were analysed: screws (number of cortices, number of screws and distance between screws) and suture buttons (single, double parallel and double divergent with a sensitivity analysis on the pretension forces) configuration. Ligaments and cartilages were included and simulated as spring elements. Physiological loads during stance phase were simulated. RESULTS Syndesmosis widening and von Mises stresses were computed. Syndesmosis widening in the injured configuration compromised joint stability (2.06 mm), whereas using a single quadricortical screw (0.18 mm) stiffened the joint. Syndesmosis widening using suture-buttons were closer to syndesmosis widening of the intact ankle configuration (0.97 mm). Von Mises stresses were higher for the titanium screws than for the suture buttons. CONCLUSIONS A detailed biomechanical comparison among different syndesmotic fixation was performed. Suture buttons have advantages with regard to syndesmosis widening in comparison to screw fixation. This fact supports the good long-term clinical results obtained with suture buttons fixation. The proposed methodology could be an efficient tool for preoperative planning.
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Affiliation(s)
- Diego Alastuey-López
- M2BE-Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Aragón Institute of Health Science (IACS), Universidad de Zaragoza, Campus Río Ebro, c/María de Luna s/n, 50018-Zaragoza, España, Spain.
| | - Belén Seral
- Hospital Universitario "Lozano Blesa", Aragón Institute of Health Science (IACS), University of Zaragoza,, Zaragoza, Spain.
| | - Mª Ángeles Pérez
- M2BE-Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Aragón Institute of Health Science (IACS), Universidad de Zaragoza, Campus Río Ebro, c/María de Luna s/n, 50018-Zaragoza, España, Spain.
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Jabran A, Peach C, Zou Z, Ren L. Parametric Design Optimisation of Proximal Humerus Plates Based on Finite Element Method. Ann Biomed Eng 2018; 47:601-614. [PMID: 30386950 PMCID: PMC6342901 DOI: 10.1007/s10439-018-02160-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/22/2018] [Indexed: 10/30/2022]
Abstract
Optimal treatment of proximal humerus fractures remains controversial. Locking plates offer theoretical advantages but are associated with complications in the clinic. This study aimed to perform parametric design optimisation of proximal humerus plates to enhance their mechanical performance. A finite element (FE) model was developed that simulated a two-part proximal humerus fracture that had been treated with a Spatial Subchondral Support (S3) plate and subjected to varus bending. The FE model was validated against in vitro biomechanical test results. The predicted load required to apply 5 mm cantilever varus bending was only 0.728% lower. The FE model was then used to conduct a parametric optimisation study to determine the orientations of inferomedial plate screws that would yield minimum fracture gap change (i.e. optimal stability). The feasible design space was automatically identified by imposing clinically relevant constraints, and the creation process of each FE model for the design optimisation was automated. Consequently, 538 FE models were generated, from which the obtained optimal model had 4.686% lower fracture gap change (0.156 mm) than that of the manufacturer's standard plate. Whereas its screws were oriented towards the inferomedial region and within the range of neck-shaft angle of a healthy subject. The methodology presented in this study promises future applications in patient-specific design optimisation of implants for other regions of the human body.
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Affiliation(s)
- Ali Jabran
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Sackville Street, Manchester, M13 9PL, UK
| | - Chris Peach
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Sackville Street, Manchester, M13 9PL, UK.,Department of Shoulder and Elbow Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Zhenmin Zou
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Sackville Street, Manchester, M13 9PL, UK
| | - Lei Ren
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Sackville Street, Manchester, M13 9PL, UK.
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Yang K, Zhou C, Fan H, Fan Y, Jiang Q, Song P, Fan H, Chen Y, Zhang X. Bio-Functional Design, Application and Trends in Metallic Biomaterials. Int J Mol Sci 2017; 19:E24. [PMID: 29271916 PMCID: PMC5795975 DOI: 10.3390/ijms19010024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction of metals as biomaterials has been known for a long time. In the early development, sufficient strength and suitable mechanical properties were the main considerations for metal implants. With the development of new generations of biomaterials, the concepts of bioactive and biodegradable materials were proposed. Biological function design is very import for metal implants in biomedical applications. Three crucial design criteria are summarized for developing metal implants: (1) mechanical properties that mimic the host tissues; (2) sufficient bioactivities to form bio-bonding between implants and surrounding tissues; and (3) a degradation rate that matches tissue regeneration and biodegradability. This article reviews the development of metal implants and their applications in biomedical engineering. Development trends and future perspectives of metallic biomaterials are also discussed.
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Affiliation(s)
- Ke Yang
- School of Mechanical Engineering and Automation, Xihua University, Chengdu 610039, China.
| | - Changchun Zhou
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Hongsong Fan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Yujiang Fan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Qing Jiang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Ping Song
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu 610065, China.
| | - Hongyuan Fan
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu 610065, China.
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China.
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
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Optimizing left anterior oblique (LAO) caudal imaging in coronary angiography using the Taguchi method: A phantom study with clinical verification. Int J Cardiovasc Imaging 2017; 33:1287-1295. [PMID: 28364178 DOI: 10.1007/s10554-017-1129-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
The aim of this work tried to optimize the spider view of the coronary angiograph for the clinical diagnosis of cardiac artery disease by cardiologists. A qualified spider view in coronary angiography must be exactly a "quasi-spider" image, which can help to diagnose a lesion in left main coronary artery and related regions. Coronary artery phantom was placed in a 75 mm-thick acrylic box to model a 70 kg human thorax. Eighteen groups of various combinations of operating factors of the X-ray facility were organized based on a Taguchi analysis. The six factors that govern the imaging quality of X-ray were (A) whether the X-rays emitted through a filter, (B, C) the Left Anterior Oblique (LAO) and Caudal Angulation (CAU) projection angles, (D) X-ray peak voltage (kVp), (E) X-ray pulse duration and current (mAs) and (F) distance between X-ray source and intensifying plate (SID). The obtained X-ray spider view images of each group were graded to determine the optimal settings; X-ray emitted without filter, 70° LAO, 30° CAU, 110 kVp, 1.5 mAs and 108 cm of SID. X-ray imaging quality optimal result was confirmed based on a clinical diagnosis of 43 patients, to prove the effectiveness of this study.
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