☆ 4.8 Review

Concepts and clinical aspects of active implants for the treatment of bone fractures

ACTA BIOMATERIALIA (2022)

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Assessment of fracture healing in orthopaedic trauma

Davide Bizzoca et al.

Summary: Fracture healing is a complex physiological process that relies on the interplay between biological and mechanical factors. Traditional imaging techniques are routinely used in orthopedic clinical practice but do not provide information on the biomechanical status of the fracture site. Recent advancements in non-invasive techniques and smart orthopedic implants have the potential to improve the assessment of fracture healing process and reduce patients' exposure to X-rays.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2023)

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Article Critical Care Medicine

The influence of biomechanical stability on bone healing and fracture-related infection: the legacy of Stephan Perren

Andrew L. Foster et al.

Summary: Bone healing is a complex process influenced by various biological and biomechanical factors. Construct stability is crucial for preventing and treating fracture-related infections. Stephan Perren's theories have had a profound impact on surgical techniques and implant development for the past 50 years.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2021)

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Review Engineering, Biomedical

Smart materials in cardiovascular implants: Shape memory alloys and shape memory polymers

Heather Holman et al.

Summary: This article reviews the characteristics, advantages, and disadvantages of shape memory alloys and shape memory polymers for clinical cardiovascular applications, highlighting their potential in coronary stents and transcatheter valves. The development of smart materials in cardiovascular implant design offers new possibilities for improving patient outcomes and could have significant clinical impact in the future.

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A comparative finite element simulation of locking compression plate materials for tibial fracture treatment

Sami Beirami et al.

Summary: This study aimed to investigate the biomechanical performance of internal tibial locked plates at different material properties in treating medial tibial fracture using patient-specific finite element model. The results showed that carbon/PEEK composite materials can tolerate higher strains at lower stresses, making them suitable for designing an internal LCP system.

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Improvement of clinical fracture healing-What can be learned from mechano-biological research?

Lutz Claes

Summary: Experimental and numerical mechano-biological studies on fracture healing suggest that isolated muscle crush may temporarily impair fracture healing, while severe muscle trauma can significantly reduce callus formation and biomechanical properties. Intraoperative trauma and surgical removal of haematoma or periosteum can impede vascularization and disturb fracture healing process. Reaming for intramedullary nailing may reduce blood flow in the bone during early healing phases but not affect the stiffness or strength of final bone healing. Optimal conditions for rapid vascularization and bone healing involve fracture fixation that minimizes shearing movements while allowing moderate compressive movements. The stiffness of fracture fixation systems applied in clinical treatments can impact bone healing, with nails and external fixators often displaying insufficient stiffness and plate systems potentially causing overly stiff fixation.

JOURNAL OF BIOMECHANICS (2021)

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Article Biophysics

Biphasic plating improves the mechanical performance of locked plating for distal femur fractures

Devakara R. Epari et al.

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Programable Active Fixator System for Systematic In Vivo Investigation of Bone Healing Processes

Jan Barcik et al.

Summary: The programmable active bone fixator system introduced in this manuscript enables systematic investigation of bone healing processes in a sheep animal model by precisely controlling mechanical conditions and continuously monitoring healing progression. The system was validated in vivo, demonstrating feasibility for further preclinical studies on the influence of mechanical conditions on fracture healing.

SENSORS (2021)

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Article Biophysics

Clinical feasibility of fracture healing assessment through continuous monitoring of implant load

Manuela Ernst et al.

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Raasti Naseem et al.

Summary: Researchers have developed approaches such as polymer blending, copolymerisation, and the use of particulates and fiber bioceramic materials to improve the mechanical and biological performances of polyester-based materials used in bone fixation devices. Commercially adopted methods focus on influencing the in vivo degradation rate. Future opportunities lie in novel polymer blends and nanoscale particulate systems to further optimize clinical performances.

MOLECULES (2021)

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Article Biochemistry & Molecular Biology

A Polymer for Application as a Matrix Phase in a Concept of In Situ Curable Bioresorbable Bioactive Load-Bearing Continuous Fiber Reinforced Composite Fracture Fixation Plates

Artem Plyusnin et al.

Summary: The study demonstrated that PLAMA-500 has excellent curing efficiency and mechanical properties, slower bioresorption rate, and no impact on cell proliferation and morphological development, thus showing potential as the ideal matrix material for bioresorbable load-bearing composite fracture fixation plates.

MOLECULES (2021)

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Article Biology

Biomechanical evaluation of glass fiber/polypropylene composite bone fracture fixation plates: Experimental and numerical analysis

Ali Kabiri et al.

Summary: This study evaluated the impact behavior of polypropylene composite fixation plates with different glass fibers in the fracture healing of long bone diaphysis, measuring their biomechanical responses through experimental and numerical methods. The research found that the fixation plate structures could serve as an initial shock absorber and dampen the transmission of axial impact load by distributing the impact energy over time, increasing stress shielding and promoting bone ossification as a proper alternative in orthopedics.

COMPUTERS IN BIOLOGY AND MEDICINE (2021)

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Review Critical Care Medicine

Low-intensity pulsed ultrasound (LIPUS) for stimulation of bone healing-A narrative review

Andrew Harrison et al.

Summary: LIPUS has been shown to accelerate fracture repair, but its effectiveness is controversial in some cases. Studies indicate that LIPUS may have greater benefits for patients at risk of fracture healing.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2021)

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Article Critical Care Medicine

Base Deficit ≥ 6 within 24 h of Injury is a risk factor for fracture nonunion in the polytraumatized patient

Neil R. Sardesai et al.

Summary: In polytrauma patients, a base deficit (BD) greater than or equal to 6 within 24 hours of admission was significantly associated with an increased risk of lower extremity fracture nonunion, even after adjusting for other risk factors. The study also found associations between nonunion and smoking, alcohol use, open fractures, and treatment for deep infection at the fracture site.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2021)

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Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing-A Simulation-Based Feasibility Study

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Summary: The study aimed to establish a patient-specific simulation workflow to determine the mechanical fracture environment and estimate its healing potential. Results showed that the workflow was able to predict mechanical implant failure accurately and play a crucial role in fracture repair.

FRONTIERS IN SURGERY (2021)

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Article Orthopedics

Clinical and Radiographic Predictors of Nonunion in Open Tibial Shaft Fractures

Amy N. Ford et al.

Summary: This study investigated predictors of nonunion in open tibial shaft fractures, finding that high-energy mechanism of injury, Gustilo-Anderson IIIA injury, and early postoperative complications were significant predictors. Furthermore, lack of cortical continuity was identified as a radiographic predictor of nonunion that should be carefully assessed in this high-risk population.

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Auto Strut: a novel smart robotic system for external fixation device for bone deformity correction, a preliminary experience

Roy Gigi et al.

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Low intensity pulsed ultrasound (LIPUS) use for the management of instrumented, infected, and fragility non-unions: a systematic review and meta-analysis of healing proportions

Ross Leighton et al.

Summary: This study offers a comprehensive overview of the current literature on the potential of LIPUS treatment for instrumented, infected, and fragility fracture non-unions. The healing rates for non-unions in these subgroups were found to be comparable to those seen in general non-union literature, suggesting that LIPUS treatment could be a conservative non-surgical option to potentially reduce socioeconomic impact and improve quality of life for these patients.

BMC MUSCULOSKELETAL DISORDERS (2021)

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Fracture nonunion in long bones: A literature review of risk factors and surgical management *

J. A. Nicholson et al.

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2021)

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Article Critical Care Medicine

The role of low-grade infection in the pathogenesis of apparently aseptic tibial shaft nonunion

Simon Hackl et al.

Summary: This study revealed that low-grade infection may play a role in tibial shaft nonunion even in the absence of clinical signs of infection. Nonunion with positive bacterial cultures required more time and surgical revisions to achieve healing.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2021)

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Laura Caliogna et al.

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INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

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Article Engineering, Biomedical

Optimal time-dependent levels of weight-bearing for bone fracture healing under Ilizarov circular fixators

Ganesharajah Ganadhiepan et al.

Summary: A computational model is presented in this study to predict optimal levels of weight-bearing during fracture healing under ICF, enhancing mechano-regulation mediated healing without hindering angiogenesis. The results demonstrate that allowable level of weightbearing and timings depend on fracture gap size.

JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS (2021)

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Article Orthopedics

Assessing hip fracture risk in type-2 diabetic patients using CT-based autonomous finite element methods A FEASIBILITY STUDY

D. Rotman et al.

Summary: This study demonstrated the feasibility of using CTFEA to assess hip fracture risk in T2DM patients. The Hip Strength Score (HSS) was significantly lower in patients who had sustained a hip fracture, indicating its potential as a novel measure of bone strength for risk assessment.

BONE & JOINT JOURNAL (2021)

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Review Biochemistry & Molecular Biology

Strategies to Improve Bone Healing: Innovative Surgical Implants Meet Nano-/Micro-Topography of Bone Scaffolds

Dirk Waehnert et al.

Summary: Successful fracture healing relies on optimal mechanical and biological environment, and new surgical implant concepts and advances in nano- and micro-topography of bone scaffolds are promising to optimize mechanical conditions and guide bone regeneration.

BIOMEDICINES (2021)

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Conservative treatment options for non-unions

T. Grossner et al.

UNFALLCHIRURG (2020)

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Review Orthopedics

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

Ruifeng Tian et al.

JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH (2020)

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Extracorporeal shock wave therapy: an update

Vinzenz Auersperg et al.

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Patient-specific computed tomography-based finite element analysis: a new tool to assess fracture risk in benign bone lesions of the femur

Haggai Schermann et al.

CLINICAL BIOMECHANICS (2020)

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VEGF-loaded mineral-coated microparticles improve bone repair and are associated with increased expression of epo and RUNX-2 in murine non-unions

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Enrique Guerado et al.

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The role of external fixation in paediatric limb lengthening and deformity correction

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2019)

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Neuromuscular Electrical Stimulation as a Potential Countermeasure for Skeletal Muscle Atrophy and Weakness During Human Spaceflight

Nicola A. Maffiuletti et al.

FRONTIERS IN PHYSIOLOGY (2019)

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Tibiotalocalcaneal Arthrodesis Utilizing a Titanium Intramedullary Nail With an Internal Pseudoelastic Nitinol Compression Element: A Retrospective Case Series of 33 Patients

Samuel E. Ford et al.

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Radiographic Results of Nitinol Compression Staples for Hindfoot and Midfoot Arthrodeses

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FOOT & ANKLE INTERNATIONAL (2018)

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Markus Rupp et al.

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Early mechanical stimulation only permits timely bone healing in sheep

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Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions

Lukas Grassner et al.

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Pulsed electromagnetic fields (PEMF) attenuate changes in vertebral bone mass, architecture and strength in ovariectomized mice

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Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome

Joon-Woo Kim et al.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED (2017)

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Benedikt J. Braun et al.

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Anna Katharina Kosters et al.

INTERNATIONAL ORTHOPAEDICS (2017)

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Ditte Beck Jepsen et al.

BMJ OPEN (2017)

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A Concert between Biology and Biomechanics: The Influence of the Mechanical Environment on Bone Healing

Vaida Glatt et al.

FRONTIERS IN PHYSIOLOGY (2017)

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Ning Zhang et al.

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Influence of fracture geometry on bone healing under locking plate fixations: A comparison between oblique and transverse tibial fractures

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An automated workflow for the biomechanical simulation of a tibia with implant using computed tomography and the finite element method

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Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence

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Early application of pulsed electromagnetic field in the treatment of postoperative delayed union of long-bone fractures: a prospective randomized controlled study

Hong-fei Shi et al.

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A novel intramedullary nail for micromotion stimulation of tibial fractures

Hannah L. Dailey et al.

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The influence of compression on the healing of experimental tibial fractures

Ulf Sigurdsen et al.

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Patient-specific finite element analysis of the human femur-A double-blinded biomechanical validation

Nir Trabelsi et al.

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Influence of the fixation stability on the healing time - A numerical study of a patient-specific fracture healing process

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CLINICAL BIOMECHANICS (2010)

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Experimental characterization of the hysteretic and rate-dependent electromechanical behavior of dielectric electro-active polymer actuators

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PROLONGED ENDOCHONDRAL BONE HEALING IN SENESCENCE IS SHORTENED BY LOW-INTENSITY PULSED ULTRASOUND IN A MANNER DEPENDENT ON COX-2

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The effects of LIPUS on soft-tissue healing: a review of literature

Anil Khanna et al.

BRITISH MEDICAL BULLETIN (2009)

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Osteogenic activity of human fracture haematoma-derived progenitor cells is stimulated by low-intensity pulsed ultrasound in vitro

T. Hasegawa et al.

JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME (2009)

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Low-Magnitude High-Frequency Mechanical Signals Accelerate and Augment Endochondral Bone Repair: Preliminary Evidence of Efficacy

Allen E. Goodship et al.

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Experimental validation of a finite element model of a human cadaveric tibia

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JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME (2008)

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Computational mechanics of Nitinol stent grafts

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A new method for evaluation of fracture healing by echo tracking

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Fracture heating: The diamond concept

Peter V. Giannoudis et al.

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Pulsed low intensity ultrasound enhances mineralisation in preosteoblast cells

Jenny Unsworth et al.

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Prevalence of long-bone non-unions

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Shear does not necessarifly inhibit bone healing

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