A Biomechanical Comparison of a Novel Expandable Photodynamic Intramedullary System to a Metal Plate and Screw System in Humerus and Femur Osteotomy Models
DOI:
https://doi.org/10.17140/ORTOJ-1-102Keywords:
Humerus, Femur, Fracture, Intramedullary devices, BiomechanicsAbstract
The biomechanical performance of a locking compression plate system was compared to an intramedullary photodynamic bone stabilization system in a femur and humerus osteotomy model. The photodynamic bone stabilization system utilizes an angioplasty-like balloon that is introduced into the intramedullary canal of a fractured bone, filled with monomer that is then polymerized and hardened by visible blue light delivered through an optical fiber. This system has been in clinical use since 2010. Synthetic bones engineered to mimic the biomechanical properties of natural bone were cut to produce a 10 mm defect mid-shaft, and two groups of specimens were stabilized by either the compression plate or intramedullary photodynamic bone stabilization system. For each bone model, one locking compression plate system was used, and three different diameter intramedullary photodynamic bone stabilization implants were used. Experimental groups were tested for stiffness, peak load, yield load, peak displacement and yield displacement when a load was applied. Additional samples per experimental group were tested for long-term dynamic stability by cyclically loading until failure. It was found that in all biomechanical parameters measured, the 17 mm intramedullary photodynamic bone stabilization system exceeded the mechanical strength and durability of the locking compression plate system in the femur osteotomy model. It was found that in all biomechanical parameters measured, the 15 mm intramedullary photodynamic bone stabilization system performed equivalently or exceeded the mechanical strength and durability of the locking compression plate system. This testing combined with long-term clinical use, and in vivo data from a large animal model, suggest that femur fixation by an intramedullary photodynamic bone stabilization system will provide equivalent biomechanical properties to a locking compression plate once implanted.
References
Assari S, Kaufmann A, Darvish K, et al. Biomechanical com-parison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures. Injury. 2013; 44(10): 1340-1345. doi: 10.1016/j.injury.2013.04.016
Somford M, van den Bekerom MJ, Kloen P. Operative treat-ment for femoral shaft nonunions, a systematic review of the literature. Strat Traum Limb Recon. 2013; 8(2): 77-88. doi: 10.1007/s11751-013-0168-5
Hierholzer C, Glowalla C, Herrler M, et al. Reamed intramed-ullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res. 2014; 9: 88. doi: 10.1186/ s13018-014-0088-1
Eveleigh RJ. A review of biomechanical studies of intra-medullary nails. Med Eng Phys. 1995; 17(5): 323-331. doi: 10.1016/1350-4533(95)97311-C
Brinkman JM, Hurschler C, Agneskirchner JD, Freiling D, van Heerwaarden RJ. Axial and torsional stability of supracon-dylar femur osteotomies: biomechanical comparison of the sta-bility of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc. 2011; 19(4): 579-587. doi: 10.1007/s00167-010-1281-3
Xue X-H, Yan S-G, Cai X-Z, Shi M-M, Lin T. Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: A systematic review and meta-analysis. Injury. 2014; 45(4): 667-676. doi: 10.1016/j.injury.2013.10.024
Zani BG, Baird R, Stanley JRL, et al. Evaluation of an in-tramedullary bone stabilization system using a light-curable monomer in sheep. J Biomed Mater Res B Appl Biomater. 2016; 104(2): 291-299. doi: 10.1002/jbm.b.33380
Vegt P MJ, Block JE. The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures. Med Devices (Auckl). 2014; 7: 453-461. doi: 10.2147/ MDER.S71790
Heiner AD, Brown TD. Structural properties of a new design of composite replicate femurs and tibias. J Biomechanics. 2001; 34(6): 773-781. doi: 10.1016/S0021-9290(01)00015-X
Bonin GA, Baker ST, Davis CA, et al. In Vitro Biomechani-cal Comparison of 3.5 mm LC-DCP/Intramedullary Rod and 5 mm Clamp-Rod Internal Fixator (CRIF)/Intramedullary Rod Fixation in a Canine Femoral Gap Model. Vet Surg. 2014; 43(7): 860-868. doi: 10.1111/j.1532-950X.2014.12130.x
Chiodo CP, Acevedo JI, Sammarco VJ, et al. Intramedullary Rod Fixation Compared with Blade-Plate-and-Screw Fixation for Tibiotalocalcaneal Arthrodesis: A Biomechanical Investiga-tion. J Bone Joint Surg AM. 2003; 85-A(12): 2425-2428.
Cho T-J, Lee K, Oh C-W, Park MS, Yoo WJ, Choi IH. Lock-ing Plate Placement with Unicortical Screw Fixation Adjunctive to Intramedullary Rodding in Long Bones of Patients with Os-teogenesis Imperfecta. J Bone Joint Surg Am. 2015; 97(9): 733- 737. doi: 10.2106/JBJS.N.01185
Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of Locked Plates and Screws. J Orthop Trauma. 2004; 18(8): 488-493.
Gardner MJ, Silva MJ, Krieg JC. Biomechanical Testing of Fracture Fixation Constructs: Variability, Validity, and Clinical Applicability. Journal of the American Academy of Orthopaedic Surgeons. 2012; 20(2): 86-93. doi: 10.5435/JAAOS-20-02-086
Tompkins M, Paller D, Moore D, Crisco J, Terek R. Locking Buttons Increase Fatigue Life ofmLocking Plates in a Segmental Bone Defect Model. Clin Orthop Relat Res. 2013; 471(3):1039- 1044. doi: 10.1007/s11999-012-2664-1
Chapman JR, Henley MB, Agel J, Benca PJ. Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intra-medullary Nails Versus Plates. J OrthopTrauma. 2000; 14(3): 162-6.
Brinkman J-M, Hurschler C, Agneskirchner J, Lobenhoffer P, Castelein RM, van Heerwaarden RJ. Biomechanical testing of distal femur osteotomy plate fixation techniques: the role of simulated physiological loading. J Exp Orthop. 2014; 1(1): 1. doi: 10.1186/s40634-014-0001-1
Knobe M, Gradl G, Buecking B, et al. Locked minimally invasive plating versus fourth generation nailing in the treatment of AO/OTA 31A2.2 fractures: A biomechanical comparison of PCCP® and Intertan nail®. Injury. 2015; 46(8): 1475-1482. doi: 10.1016/j.injury.2015.05.011
Rand JA, An KN, Chao EY, Kelly PJ. A comparison of the effect of open intramedullary nailing and compression-plate fix-ation on fracture-site blood flow and fracture union. J Bone Joint Surg Am. 1981; 63(3): 427-442.
Wegmann K, Gick S, Heidemann C, et al. Biomechani-cal evaluation of the primary stability of pedicle screws after augmentation with an innovative bone stabilizing system. Arch Orthop Trauma Surg. 2013; 133(11): 1493-1499. doi: 10.1007/ s00402-013-1842-2
Cristofolini L, Viceconti M. Mechanical validation of whole bone composite tibia models. J Biomech. 2000; 33(3): 279-288. doi: 10.1016/S0021-9290(99)00186-4
International A. ASTM Standard F382-99 Standard Specifi-cation and Test Method for Metallic Bone Plates. 2008.
Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001; 34(7): 859-871. doi: 10.1016/S0021-9290(01)00040-9
Kadam PBS. Sample size calculation. International Journal of Ayurveda Research 2010; 1(1): 55-57. doi: 10.4103/0974- 7788.59946
Cristofolini L, Viceconti M, Cappello A, Toni A. Mechanical validation of whole bone composite femur models. J Biomechan-ics. 1996; 29(4): 525-535. doi: 10.1016/0021-9290(95)00084-4
Chong ACM, Friis EA, Ballard GP, Czuwala PJ, Cooke FW. Fatigue performance of composite analogue femur constructs under high activity loading. Ann Biomed Eng. 2007; 35(7): 1196-1205. doi: 10.1007/s10439-007-9284-z
Stumpf M, Kraus T, Plötz W, Jakobs TF. Stabilisierung einer Beckeninsuffizienzfraktur miteinem photosensiblen Kunststoff (IlluminOss™). [in German]. Unfallchirurg. 2015; 118(3): 279- 282. doi: 10.1007/s00113-015-2743-3
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