Fixation of distal tibia fracture through plating, nailing, and nailing with Poller screws: A comparative biomechanical-based experimental and numerical investigation

2020 ◽  
Vol 234 (10) ◽  
pp. 1129-1138
Author(s):  
Amin Baseri ◽  
Mohammad Ali Bagheri ◽  
Gholamreza Rouhi ◽  
Mohammad Reza Aghighi ◽  
Nima Bagheri
Keyword(s):  
Distal Tibia ◽  
Axial Loading ◽  
Axial Stiffness ◽  
Element Analysis ◽  
Bone Implant ◽  
Interfragmentary Movement ◽  
Tibia Fractures ◽  
Poller Screw ◽  
Bone Nail

The goal of this study was to investigate two commonly used methods of fixation of distal metaphyseal tibia fractures, plating and nailing as well as the less frequently employed nailing with Poller screws, from a biomechanical perspective. Despite numerous studies, the best method to repair fractures of tibia the remains up for of debate. This study includes an in vitro experimental phase on human cadaveric tibias followed by a finite element analysis. In the experimental phase, under partial weight-bearing axial loading, the axial stiffness of the bone-implant construct and interfragmentary movements for each of the fixation methods, bone-plate, bone-nail, and bone-nail-Poller screw, were measured and compared with each other. Shear interfragmentary movement and stress distribution in the bone-implant construct for the three mentioned fixation methods were also determined from FE models and compared with each other. Results of in vitro experiments, i.e., the exertion of axial loading on the tibia-plate, tibia-nail, and tibia-nail-Poller screw, showed that utilization of tibia-nail and tibia-nail-Poller screw led to a stiffer bone-implant construct, and consequently, lower interfragmentary movement, compared to the tibia-plate construct ( p values for tibia-nail and tibia-nail-Poller screw, and for both axial stiffness and interfragmentary movement, compared to those of tibia-plate construct, were less than 0.05). Numerical analyses showed that nailing produced less undesirable shear interfragmentary movement, compared to the plating, and application of a Poller screw decreased the shear movements, compared to tibia-nail. Furthermore, using the finite element analysis, maximum von Mises stress of adding a screw in tibia-nail, tibia-plate, and tibia-nail-Poller screw, was found to be: 51.5, 78.6, and 60.5 MPa, respectively. The results of this study suggested that from a biomechanical standpoint, nailing both with and without a Poller screw is superior to plating for the treatment of distal tibia fractures.

scholarly journals A comparative biomechanical study of the Distal Tibia Nail against compression plating for the osteosynthesis of supramalleolar corrective osteotomies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julia Greenfield ◽  
Philipp Appelmann ◽  
Yoann Lafon ◽  
Karine Bruyère-Garnier ◽  
Pol Maria Rommens ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Biomechanical Study ◽  
Worst Case ◽  
Lateral Cortex ◽  
Torsional Testing ◽  
Interfragmentary Movement ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Von Mises ◽  
Force Displacement

AbstractThe Distal Tibia Nail (DTN; Mizuho, Japan) has demonstrated higher biomechanical stiffness to locking plates in previous research for A3 distal tibia fractures. It is here investigated as a fixation option for supramalleolar corrective osteotomies (SMOT). Sixteen Sawbones tibiae were implanted with either a DTN (n = 8) or Medial Distal Tibia Plate (MDTP; n = 8) and a SMOT simulated. Two surgical outcome scenarios were envisaged: “best-case” representing an intact lateral cortex, and “worst-case” representing a fractured lateral cortex. All samples were subjected to compressive (350 N, 700 N) and torsional (± 4 Nm, ± 8 Nm) testing. Samples were evaluated using calculated construct stiffness from force–displacement data, interfragmentary movement and Von Mises’ strain distribution. The DTN demonstrated a greater compressive stiffness for the best-case surgical scenario, whereas the MDTP showed higher stiffness (p < 0.05) for the worst-case surgical scenario. In torsional testing, the DTN proved more resistant to torsion in the worst-case surgical setup (p < 0.05) for both ± 4 Nm and ± 8 Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as a treatment option particularly in patients presenting vascularisation problems where the MDTP is an inappropriate choice.

Peri-Implant Biomechanical Responses to Standard, Short-Wide, and Mini Implants Supporting Single Crowns Under Axial and Off-Axial Loading (an In Vitro Study)

2014 ◽  
Vol 40 (1) ◽  
pp. 42-52 ◽  
Author(s):  
Lamia Sayed Kheiralla ◽  
Jihan Farouk Younis
Keyword(s):  
Considerable Increase ◽  
Axial Loading ◽  
In Vitro Study ◽  
Element Analysis ◽  
Mini Implants ◽  
Biomechanical Responses ◽  
Fea Simulation ◽  
Standard Implant ◽  
Single Crowns

This study compared the biomechanical responses of 3 single crowns supported by 3 different implants under axial and off-axial loading. A standard implant (3.75 mm diameter, 13 mm length), a mini implant (3 mm diameter, 13 mm length), and a short-wide implant (5.7 mm diameter, 8 mm length) were embedded in epoxy resin by the aid of a surveyor to ensure their parallelism. Each implant supported a full metal crown made of Ni-Cr alloy with standardized dimensions. Strain gauges and finite element analysis (FEA) were used to measure the strain induced under axial and off-axial functional loads of 300 N. Results showed that mini implants recorded the highest microstrains, under both axial and off-axial loading. All implants showed a considerable increase in strain values under off-axial loading. Standard and short-wide implants proved to be preferable in supporting crowns, as the standard implant showed the lowest strains under axial and off-axial loading using FEA simulation, while the short-wide implant showed the lowest strains under nonaxial loading using strain gauge analysis.

scholarly journals Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

2021 ◽  
Author(s):  
Julia Greenfield ◽  
Philipp Appelmann ◽  
Felix Wunderlich ◽  
Dorothea Mehler ◽  
Pol Maria Rommens ◽  
...  
Keyword(s):  
Tibial Fracture ◽  
Distal Tibia ◽  
Torsional Stiffness ◽  
Distal Interlocking ◽  
Distal Screw ◽  
Interfragmentary Movement ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Surgical Options ◽  
Biomechanical Evaluation

Abstract Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.

scholarly journals Osseointegrating and phase-oriented micro-arc-oxidized titanium dioxide bone implants

2021 ◽  
Vol 19 ◽  
pp. 228080002110068
Author(s):  
Hsien-Te Chen ◽  
Hsin-I Lin ◽  
Chi-Jen Chung ◽  
Chih-Hsin Tang ◽  
Ju-Liang He
Keyword(s):  
Titanium Dioxide ◽  
High Surface ◽  
Cell Activity ◽  
Active Surface ◽  
Rutile Phase ◽  
Hydroxyl Groups ◽  
Bone Implant ◽  
Implant System

Here, we present a bone implant system of phase-oriented titanium dioxide (TiO2) fabricated by the micro-arc oxidation method (MAO) on β-Ti to facilitate improved osseointegration. This (101) rutile-phase-dominant MAO TiO2 (R-TiO2) is biocompatible due to its high surface roughness, bone-mimetic structure, and preferential crystalline orientation. Furthermore, (101) R-TiO2 possesses active and abundant hydroxyl groups that play a significant role in enhancing hydroxyapatite formation and cell adhesion and promote cell activity leading to osseointegration. The implants had been elicited their favorable cellular behavior in vitro in the previous publications; in addition, they exhibit excellent shear strength and promote bone–implant contact, osteogenesis, and tissue formation in vivo. Hence, it can be concluded that this MAO R-TiO2 bone implant system provides a favorable active surface for efficient osseointegration and is suitable for clinical applications.

scholarly journals Macrophagic Inflammatory Response Next to Dental Implants with Different Macro- and Micro-Structure: An In Vitro Study

2021 ◽  
Vol 11 (12) ◽  
pp. 5324
Author(s):  
Maria Menini ◽  
Francesca Delucchi ◽  
Domenico Baldi ◽  
Francesco Pera ◽  
Francesco Bagnasco ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Dental Implants ◽  
In Vitro Study ◽  
Titanium Implants ◽  
Implant Surface ◽  
Bone Implant ◽  
Optimal Outcomes ◽  
Negative Controls ◽  
Inflammatory Effect

(1) Background: Intrinsic characteristics of the implant surface and the possible presence of endotoxins may affect the bone–implant interface and cause an inflammatory response. This study aims to evaluate the possible inflammatory response induced in vitro in macrophages in contact with five different commercially available dental implants. (2) Methods: one zirconia implant NobelPearl® (Nobel Biocare) and four titanium implants, Syra® (Sweden & Martina), Prama® (Sweden & Martina), 3iT3® (Biomet 3i) and Shard® (Mech & Human), were evaluated. After 4 h of contact of murine macrophage cells J774a.1 with the implants, the total RNA was extracted, transcribed to cDNA and the gene expression of the macrophages was evaluated by quantitative PCR (qPCR) in relation to the following genes: GAPDH, YWHAZ, IL1β, IL6, TNFα, NOS2, MMP-9, MMP-8 and TIMP3. The results were statistically analyzed and compared with negative controls. (3) Results: No implant triggered a significant inflammatory response in macrophages, although 3iT3 exhibited a slight pro-inflammatory effect compared to other samples. (4) Conclusions: All the samples showed optimal outcomes without any inflammatory stimulus on the examined macrophagic cells.

scholarly journals Are Suprapectineal Quadrilateral Surface Buttressing Plates Performances Superior to Traditional Fixation? A Finite Element Analysis

2021 ◽  
Vol 11 (2) ◽  
pp. 858
Author(s):  
Mara Terzini ◽  
Andrea Di Pietro ◽  
Alessandro Aprato ◽  
Stefano Artiaco ◽  
Alessandro Massè ◽  
...  
Keyword(s):  
Finite Element ◽  
Movement Analysis ◽  
High Energy ◽  
Clinical Analysis ◽  
Acetabular Fractures ◽  
Element Analysis ◽  
Bone Stress ◽  
Interfragmentary Movement ◽  
Element Approach ◽  
Transverse Fractures

Acetabular fractures have a high impact on patient’s quality of life, and because acetabular fractures are high energy injuries, they often co-occur with other pathologies such as damage to cartilage that could increase related morbidity; thus, it appears of primary importance developing reliable treatments for this disease. This work aims at the evaluation of the biomechanical performances of non-conservative treatments of acetabular fractures through a finite element approach. Two pelvic plates models (the standard suprapectineal plate—SPP, and a suprapectineal quadrilateral surface buttressing plate—SQBP) were analyzed when implanted on transverse or T-shaped fractures. The plates geometries were adapted to the specific hemipelvis, mimicking the bending action that the surgeon performs on the plate intraoperatively. Implemented models were tested in a single leg stance condition. The obtained results show that using the SQBP plate in transverse and T-shaped acetabular fractures generates lower bone stress if compared to the SPP plate. Interfragmentary movement analysis shows that the SQBP plate guarantees greater stability in transverse fractures. In conclusion, the SQBP plate seems worthy of further clinical analysis, having resulted as a promising option in the treatment of transverse and T-shaped acetabular fractures, able to reduce bone stress values and to get performances comparable, and in some cases superior, to traditional fixation.

Osteoclast and osteoblast response to strontium-doped struvite coatings on titanium for improved bone integration

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Claus Moseke ◽  
Katharina Wimmer ◽  
Markus Meininger ◽  
Julia Zerweck ◽  
Cornelia Wolf-Brandstetter ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Osteoclast Differentiation ◽  
Inhibitory Effect ◽  
Osteoclast Formation ◽  
Strontium Nitrate ◽  
Bone Implant ◽  
Electrochemically Deposited ◽  
Bone Integration ◽  
Titanium Substrates

AbstractTo develop implants with improved bone ingrowth, titanium substrates were coated with homogeneous and dense struvite (MgNH4PO4·6H2O) layers by means of electrochemically assisted deposition. Strontium nitrate was added to the coating electrolyte in various concentrations, in order to fabricate Sr-doped struvite coatings with Sr loading ranging from 10.6 to 115 μg/cm2. It was expected and observed that osteoclast activity surrounding the implant was inhibited. The cytocompatibility of the coatings and the effect of Sr-ions in different concentrations on osteoclast formation were analyzed in vitro. Osteoclast differentiation was elucidated on morphological, biochemical as well as on gene expression level. It could be shown that moderate concentrations of Sr2+ had an inhibitory effect on osteoclast formation, while the growth of osteoblastic cells was not negatively influenced compared to pure struvite surfaces. In summary, the electrochemically deposited Sr-doped struvite coatings are a promising approach to improve bone implant ingrowth.

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