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Turkish Journal of Medical Sciences Nov 2020The success of treatment of bone fracture and defects are based on a proper contact and compression between the bone fracture fragments. Intraoperative manipulations... (Review)
Review
BACKGROUND/AIM
The success of treatment of bone fracture and defects are based on a proper contact and compression between the bone fracture fragments. Intraoperative manipulations such as bone compression or distractions are generally done in order to achieve this. However, none of the bone plates currently in routine use allow these manipulations after fixation to the bone, requiring refixation and repeated drilling, and screwing operations. Based on this shortcoming, we designed a novel adjustable bone plate (ABP) system which allows bone shortening and lengthening even after fixation to the bone surface. The aim of the paper is to clarify the unique properties of the novel bone plate.
MATERIALS AND METHODS
In this paper, the new generation adjustable bone plate applicability, design, indication, and new characteristics in addition to conventional bone plates with review of the literature were discussed and surgical technique was demonstrated in a saw bone model.
RESULTS
This novel design allows for compression and distraction at the fracture ends post fixation as well as bone segment transfers.
CONCLUSIONS
The potential of the new generation ABP plate for use in bone compression, distraction, and the segmental bone transfer is a promising invention for clinical applications in the future.
Topics: Bone Plates; Fracture Fixation, Internal; Fractures, Bone; Humans
PubMed: 32222126
DOI: 10.3906/sag-2002-69 -
Scientific Reports Aug 2021Fractures are difficult to treat because of individual differences in bone morphology and fracture types. Compared to serialized bone plates, the use of customized...
Fractures are difficult to treat because of individual differences in bone morphology and fracture types. Compared to serialized bone plates, the use of customized plates significantly improves the fracture healing process. However, designing custom plates often requires the extraction of skeletal morphology, which is a complex and time-consuming procedure. This study proposes a method for extracting bone morphological features to facilitate customized plate designs. The customized plate design involves three major steps: extracting the morphological features of the bone, representing the undersurface features of the plate, and constructing the customized plate. Among these steps, constructing the undersurface feature involves integrating a group of bone features with different anatomical morphologies into a semantic feature parameter set of the plate feature. The undersurface feature encapsulates the plate and bone features into a highly cohesive generic feature and then establishes an internal correlation between the plate and bone features. Using the femoral plate as an example, we further examined the validity and feasibility of the proposed method. The experimental results demonstrate that the proposed method improves the convenience of redesign through the intuitive editing of semantic parameters. In addition, the proposed method significantly improves the design efficiency and reduces the required design time.
Topics: Bone Plates; Femoral Fractures; Fracture Fixation, Internal; Stress, Mechanical
PubMed: 34341376
DOI: 10.1038/s41598-021-94924-9 -
Journal of the Mechanical Behavior of... May 2022The influence of joint degeneration on the biomechanical properties of calcified cartilage and subchondral bone plate at the osteochondral junction is relatively...
Subchondral bone plate thickness is associated with micromechanical and microstructural changes in the bovine patella osteochondral junction with different levels of cartilage degeneration.
The influence of joint degeneration on the biomechanical properties of calcified cartilage and subchondral bone plate at the osteochondral junction is relatively unknown. Common experimental difficulties include accessibility to and visualization of the osteochondral junction, application of mechanical testing at the appropriate length scale, and availability of tissue that provides a consistent range of degenerative changes. This study addresses these challenges. A well-established bovine patella model of early joint degeneration was employed, in which micromechanical testing of fully hydrated osteochondral sections was carried out in conjunction with high-resolution imaging using differential interference contrast (DIC) optical light microscopy. A total of forty-two bovine patellae with different grades of tissue health ranging from healthy to mild, moderate, and severe cartilage degeneration, were selected. From the distal-lateral region of each patella, two adjacent osteochondral sections were obtained for the mechanical testing and the DIC imaging, respectively. Mechanical testing was carried out using a robotic micro-force acquisition system, applying compression tests over an array (area: 200 μm × 1000 μm, step size: 50 μm) across the osteochondral junction to obtain a stiffness map. Morphometric analysis was performed for the DIC images of fully hydrated cryo-sections. The levels of cartilage degeneration, DIC images, and the stiffness maps were used to associate the mechanical properties onto the specific tissue regions of cartilage, calcified cartilage, and subchondral bone plate. The results showed that there were up to 20% and 24% decreases (p < 0.05) in the stiffness of calcified cartilage and subchondral bone plate, respectively, in the severely degenerated group compared to the healthy group. Furthermore, there were increases (p < 0.05) in the number of tidemarks, bone spicules at the cement line, and the mean thickness of the subchondral bone plate with increasing levels of degeneration. The decreasing stiffness in the subchondral bone plate coupled with the presence of bone spicules may be indicative of a subchondral remodeling process involving new bone formation. Moreover, the mean thickness of the subchondral bone plate was found to be the strongest indicator of mechanical and associated structural changes in the osteochondral joint tissues.
Topics: Animals; Bone Plates; Cartilage, Articular; Cattle; Osteoarthritis; Patella
PubMed: 35279448
DOI: 10.1016/j.jmbbm.2022.105158 -
Der Unfallchirurg Nov 2018Distraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the... (Review)
Review
BACKGROUND
Distraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the past the available procedures were practically exclusively external.
PRINCIPLES
In the plate-assisted segmental bone transport (PABST) procedure a commercially available motorized intramedullary lengthening nail is used for segment transport. The transport segment is transported along a bone plate, which is responsible for maintaining the position of the proximal and distal main fragments.
SURGICAL TECHNIQUE
In staged sequences, a plate spanning the defect is placed. A lengthening nail is inserted in an antegrade or retrograde direction and a vascularized transport segment is created with an osteotomy. Bone transport is initiated at 1.0 mm a day. The transport segment is pulled or pushed into place, depending on the location of the bone void. In due time, a docking procedure is performed and full weight bearing is allowed. Supplementary lengthening can be initiated at docking or in a separate procedure. In smaller defects the gap is closed immediately over the plate and the bone is lengthened by the nail in the opposite end of the defect.
CONCLUSION
The presented method is a valuable addition to the armamentarium for treatment of bone defects. The main advantages are the avoidance of external fixation (fixation wires, Schanz screws) and the creation of physiological bone substitute. Vital soft tissues are essential for a good outcome. With appropriate management (systematic debridement, local and systemic administration of antibiotics and free soft tissue flaps), this method can be a solution to even complex reconstructive problems.
Topics: Bone Lengthening; Bone Plates; External Fixators; Radiography; Tibia; Treatment Outcome
PubMed: 30242443
DOI: 10.1007/s00113-018-0546-z -
Cartilage Sep 2023This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse.
BACKGROUND
This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse.
METHODS
This retrospective study included 76 ONFH patients (89 consecutive hips) with Association for Research on Osseous Circulation stage II who received conservative treatment without surgical intervention. The mean follow-up time was 15.60 ± 12.29 months. ONFH was divided into 2 types (I and II): Type I with a necrotic lesion involving subchondral bone plate and Type II with a necrotic lesion not involving subchondral bone plate. The radiological evaluations were based on plain x-rays. The data were analyzed using SPSS 26.0 statistical software.
RESULTS
The collapse rate in Type I ONFH was significantly higher than that in Type II ONFH (P < 0.001). The survival time of hips with Type I ONFH was significantly shorter than those with Type II ONFH and with the endpoint of the femoral head collapse (P < 0.001). The collapse rate of Type I in the new classification (80.95%) was higher compared with that of the China-Japan Friendship Hospital (CJFH) classification (63.64%), and the difference was statistically significant (χ = 1.776, P = 0.024).
CONCLUSION
Subchondral bone plate necrosis is an important factor that affects ONFH collapse and prognosis. Current classification using subchondral bone plate necrosis is more sensitive for predicting collapse compared with the CJFH classification. Effective treatments should be taken to prevent collapse if ONFH necrotic lesions involve the subchondral bone plate.
Topics: Humans; Retrospective Studies; Femur Head; Bone Plates; Prognosis; Femur Head Necrosis
PubMed: 37211723
DOI: 10.1177/19476035231173096 -
The Veterinary Clinics of North... Jan 2020Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous... (Review)
Review
Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.
Topics: Animals; Arthrodesis; Bone Plates; Fracture Fixation, Internal
PubMed: 31653536
DOI: 10.1016/j.cvsm.2019.08.014 -
Cartilage 2022To investigate the effect of bone-marrow stimulation (BMS) on subchondral bone plate morphology and remodeling compared to untreated subchondral bone in a validated...
PURPOSE
To investigate the effect of bone-marrow stimulation (BMS) on subchondral bone plate morphology and remodeling compared to untreated subchondral bone in a validated minipig model.
METHODS
Three Göttingen minipigs received BMS with drilling as treatment for two chondral defects in each knee. The animals were euthanized after six months. Follow-up consisted of a histological semiquantitative evaluation using a novel subchondral bone scoring system and micro computed tomography (µCT) of the BMS subchondral bone. The histological and microstructural properties of the BMS-treated subchondral bone were compared to that of the adjacent healthy subchondral bone.
RESULTS
The µCT analysis showed that subchondral bone treated with BMS had significantly higher connectivity density compared to adjacent untreated subchondral bone (26 1/mm vs. 21 1/mm, = 0.048). This was the only microstructural parameter showing a significant difference. The histological semiquantitative score differed significantly between the subchondral bone treated with BMS and the adjacent untreated subchondral (8.0 vs. 10 = < 0.001). Surface irregularities were seen in 43% and bone overgrowth in 27% of the histological sections. Only sparse formation of bone cysts was detected (1%).
CONCLUSIONS
BMS with drilling does not cause extensive changes to the subchondral bone microarchitecture. Furthermore, the morphology of BMS subchondral bone resembled that of untreated subchondral bone with almost no formation of bone cyst, but some surface irregularities and bone overgrowth.
Topics: Animals; Bone Marrow; Bone Plates; Cartilage, Articular; Swine; Swine, Miniature; X-Ray Microtomography
PubMed: 35098739
DOI: 10.1177/19476035221074011 -
Journal of Investigative Surgery : the... Jan 2022In this research, low modulus carbon fiber (CF)-reinforced polyetheretherketone composite plates (CF-PEEK plates) were compared with traditional metal plates using...
PURPOSE
In this research, low modulus carbon fiber (CF)-reinforced polyetheretherketone composite plates (CF-PEEK plates) were compared with traditional metal plates using finite element analysis to establish a reference for clinical application.
MATERIAL AND METHODS
Plates of stainless steel, titanium alloy (Ti6Al4V), or CF-PEEK with different carbon fiber reinforcement ratios (CF30, CF50, and CF60) were used to fix the tibial shaft comminuted fracture. The maximum stress, the maximum displacement of fracture and the stress shielding of cortex bone were analyzed.
RESULTS
Under 200 N axial compression, the maximum displacement was measured in the CF30 plate (4.62 mm) and the minimum in the stainless steel plate (0.23 mm). The stress shielding rates of stainless steel, titanium, CF30, CF50, and CF60 plates were 59.4%, 54.4%, 23.75%, 48.75% and 66.25%. Under 700 N axial compression, the internal fixation by the CF30 plate failed. Among the other 4 plates, the maximum displacement was measured in the CF50 plate (2.52 mm) and the minimum in the stainless steel plate (0.78 mm). The stress shielding rate of plates made of stainless steel, titanium, CF50, and CF60 were 57.1%, 52.0%, 48.1%, and 67.8%.
CONCLUSIONS
CF50 plates can be safely used in the tibial shaft comminuted fracture. The micromotion in the CF50 and CF60 plate was more beneficial to callus formation and fracture healing. The stress shielding of the cortex bone under the CF50 plate was the lowest. The finite element analysis indicated that the CF-PEEK material is worthy of further study because of its biomechanical advantages.
Topics: Biomechanical Phenomena; Bone Plates; Finite Element Analysis; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Materials Testing; Tibial Fractures
PubMed: 33089722
DOI: 10.1080/08941939.2020.1836290 -
The International Journal of Esthetic... Feb 2023Implants in the esthetic area are challenging for many reasons, all the more so when the hard and soft tissue are deficient at the beginning of the procedure. Numerous...
Implants in the esthetic area are challenging for many reasons, all the more so when the hard and soft tissue are deficient at the beginning of the procedure. Numerous grafting techniques are available for the clinician, each one with its own strengths and weaknesses. It is important to understand these differences and to carry out a thorough diagnosis and case selection in order to make the right choice for each patient. The present article describes the treatment of a deficient maxillary central incisor site after extracting an ankylosed tooth. A palatal bone plate was utilized to reconstruct the missing buccal wall in the first place. Three months later, an implant was inserted and at the same time the soft tissue was augmented with a connective tissue graft. The case was successfully restored and finalized with a satisfactory esthetic outcome. The morbidity related to autogenous bone and soft tissue harvesting is discussed, but the shorter healing periods and optimal tissue quality obtained are highlighted.
Topics: Humans; Bone Plates; Esthetics, Dental; Connective Tissue; Maxilla; Dental Implants, Single-Tooth; Dental Implantation, Endosseous
PubMed: 36734422
DOI: No ID Found -
Injury Oct 2019A novel Ti6Al4V adjustable locking plate (ALP) is designed to provide enhanced bone stability for segmental bone fractures and to allow precise positioning of...
A novel Ti6Al4V adjustable locking plate (ALP) is designed to provide enhanced bone stability for segmental bone fractures and to allow precise positioning of disconnected segments. The design incorporates an adjustable rack and pinion mechanism to perform compression, distraction and segment transfer during plate fixation surgery. The aim of this study is to introduce the advantages of the added feature and computationally characterize the biomechanical performance of the proposed design. Structural strength of the novel plate is analyzed using numerical methods for 4-point bending and fatigue properties, following ASTM standards. An additional mechanical failure finite element test is also conducted on the rack and pinion to reveal how much torque can be safely applied to the mechanism by the surgeon. Simulation results predict that the new design is sufficiently strong to not fail under regular anatomical loading scenarios with close bending strength and fatigue life properties to clinically used locking compression plates. The novel ALP design is expected to be a good candidate for addressing problems regarding fixation of multi-fragmentary bone fractures.
Topics: Alloys; Biomechanical Phenomena; Bone Plates; Bone Screws; Compressive Strength; Computer Simulation; Equipment Design; Finite Element Analysis; Fracture Fixation, Intramedullary; Humans; Humeral Fractures; Materials Testing; Titanium; Torque
PubMed: 31455505
DOI: 10.1016/j.injury.2019.08.034