scholarly journals Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

2021 ◽  
Author(s):  
Saeid Samiezadeh ◽  
Pouria Tavakkoli Avval ◽  
Zouheir Fawaz ◽  
Habiba Bougherara
Keyword(s):  
Mechanical Performance ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Femoral Shaft ◽  
Delayed Union ◽  
Fracture Site ◽  
Long Bone ◽  
Fe Model ◽  
Non Union ◽  
Shaft Fractures

Background: Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the above mentioned complications. Methods: In this study, a new hybrid concept for nails made of carbon fibers/ fl ax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Results: Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23 N ( P b 0.05), and the mean stress in the vicinity of fracture by 2.11 MPa ( P b 0.05) at 45% gait cycle, while only 0.33 mm and 0.39 mm ( P b 0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Interpretation: Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.

scholarly journals Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

2021 ◽  
Author(s):  
Saeid Samiezadeh ◽  
Pouria Tavakkoli Avval ◽  
Zouheir Fawaz ◽  
Habiba Bougherara
Keyword(s):  
Mechanical Performance ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Femoral Shaft ◽  
Delayed Union ◽  
Fracture Site ◽  
Long Bone ◽  
Fe Model ◽  
Non Union ◽  
Shaft Fractures

Background: Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the above mentioned complications. Methods: In this study, a new hybrid concept for nails made of carbon fibers/ fl ax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Results: Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23 N ( P b 0.05), and the mean stress in the vicinity of fracture by 2.11 MPa ( P b 0.05) at 45% gait cycle, while only 0.33 mm and 0.39 mm ( P b 0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Interpretation: Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.

scholarly journals Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

2018 ◽  
Vol 15 (12) ◽  
pp. 2845 ◽  
Author(s):  
Christina Ekegren ◽  
Elton Edwards ◽  
Richard de Steiger ◽  
Belinda Gabbe
Keyword(s):  
Fracture Healing ◽  
Hospital Admissions ◽  
Femoral Shaft ◽  
Hospital Length Of Stay ◽  
Long Bone ◽  
Future Research ◽  
Related Factors ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

scholarly journals Delayed healing of lower limb fractures with bisphosphonate therapy

2015 ◽  
Vol 97 (5) ◽  
pp. 333-338 ◽  
Author(s):  
B Yue ◽  
A Ng ◽  
H Tang ◽  
S Joseph ◽  
M Richardson
Keyword(s):  
Lower Limb ◽  
Bone Fractures ◽  
Operative Management ◽  
Delayed Union ◽  
Bisphosphonate Therapy ◽  
Long Bone ◽  
Non Union ◽  
Lower Limb Fractures ◽  
The Mean ◽  
Limb Fractures

Introduction Bisphosphonate therapy (BT) is used commonly in the management of osteoporosis. A systematic review was conducted investigating delayed union of lower limb, long bone fractures in patients on BT. We specifically assessed whether BT increases the risk of delayed union or non-union in lower limb, long bone fractures. Methods A literature search was conducted in the PubMed and Embase™ on 4 November 2014. Articles that investigated lower limb fractures, history of BT and fracture union were included in the review. Results A total of 9,809 papers were retrieved and 14 were deemed suitable for this review. The mean time to union in patients on BT was 8.5 months. A longer time to union was reported in a study investigating BT users versus controls (6.5 vs 4.8 months respectively). The mean rate of delayed or non-union for BT associated atypical fractures was 20% per fracture. Specifically in one study, delayed union was more common in the cohort with more than three years of BT (67%) than in the group with less than three years of BT (26%). Surgical fixation was associated with improved outcomes compared with non-operative management. Conclusions BT has been described to be associated with multiple adverse outcomes related to atypical fractures. Current evidence recommends operative management for this patient group. Further investigation is required to evaluate the exact effects of BT on lower limb fractures, in particular typical femoral fractures.

scholarly journals Biomechanical Evaluation Method to Optimize External Fixator Configuration in Long Bone Fractures—Conceptual Model and Experimental Validation Using Pilot Study

2021 ◽  
Vol 11 (18) ◽  
pp. 8481
Author(s):  
Thiran Sellahewa ◽  
Charitha Weerasinghe ◽  
Pujitha Silva
Keyword(s):  
Mechanical Properties ◽  
Pilot Study ◽  
Evaluation Method ◽  
Bone Fractures ◽  
Element Model ◽  
Fracture Site ◽  
System Stability ◽  
Long Bone ◽  
Use Case ◽  
Non Union

External fixation is a commonly used method in stabilizing fracture sites. The performance of the fixator depends on how it affects the mechanical properties of the fracture site and is governed by parameters like the fixator type and fixator configuration. Identifying ideal configurations prior to surgery will help surgeons in planning the procedure, limiting the possibility of complications such as non-union. In this study, a framework has been proposed as a surgical pre-planning tool, to assist surgeons compare mechanical properties of a fracture site under different fixator configurations, and thereby identify the optimum solution. A computational tool was identified as the best method for this purpose. Cost and time of computation were given special consideration to reduce complexity in clinical settings. A pilot study was conducted on a section of the proposed framework, where the aim was to understand the feasibility of implementation. In the pilot study, a unilateral uni-planar fixator on a simple diaphyseal transverse fracture was analyzed. During the pilot study the selected fixator was tested and a few models were developed to assess system stability. The models were then compared to identify the optimum model that could be used with the proposed framework. The proposed framework provided a suitable solution for the use case and out of the models developed the simplified finite element model was identified as the best option for the use case.

scholarly journals Role of PRP injection in delayed union and non union of long bone fractures

2020 ◽  
Vol 6 (1) ◽  
pp. 35-40
Author(s):  
Apser Khan ◽  
◽  
Suresh Kumar Kaushik ◽  
Mrigank Mathur ◽  
Milan Jaiswal ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Long Bone Fractures

scholarly journals Local Platelet-rich plasma (PRP) injection for the treatment of Delayed Union after Internal Fixation in Fractures of Long Bones

2020 ◽  
Vol 23 (1) ◽  
pp. 30-36
Author(s):  
Tanup Prasai ◽  
Sashmit Sharma ◽  
Kiran Prasad Rijal ◽  
Krishna Raj Khanal
Keyword(s):  
Internal Fixation ◽  
Bone Fractures ◽  
Platelet Rich Plasma ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Medical College ◽  
Long Bone Fractures ◽  
Usual Solution ◽  
Without Bone Graft

Introduction: Long bone fractures are among the most common orthopaedic injuries encountered. A fracture that fails to progress to union despite appropriate fixation and absence of complications presents a treatment dilemma to the surgeon. The usual solution of re-fixation with or without bone graft constitutes repeat exposure to surgery and its risks, as well as added morbidity and cost. Recent advances in molecular biology suggest Platelet rich plasma (PRP) may have bone forming potential. This study was done to determine whether PRP has any beneficial role in patients with delayed healing of long bone fractures. Methods: A prospective interventional study was done on patients arriving at the department of orthopaedic surgery of Kathmandu Medical College with delayed union of long bone fractures after internal fixation between January 2014 and January 2017. Patients were treated with local injection of group-matched PRP directly into the fracture gap and were followed-up for six months to check for radiological signs of fracture union. Results: A total of 10 fractures were included in 10 patients that involved four humeri, three tibiae, and three femora. Eight out of the 10 fractures united at a median time of three months after the injection. Two had non-union that required revision surgery. Conclusion: Local Platelet rich plasma injection may constitute a ‘nothing to lose, everything to gain’ intermediate option before a decision for major reoperation on such patients is made.

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