Optimal internal fixation of anatomically shaped synthetic bone grafts for massive segmental defects of long bones.

Autor: Vorys GC; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Bai H; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Chandhanayingyong C; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Lee CH; Center for Craniofacial Regeneration, School of Dental Medicine, Columbia University, New York, NY, USA., Compton JT; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Caldwell JM; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Gardner TR; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA., Mao JJ; Center for Craniofacial Regeneration, School of Dental Medicine, Columbia University, New York, NY, USA., Lee FY; Robert E. Carroll, MD and Jane Chace Carroll Laboratories for Orthopedic Surgery, Department of Orthopedic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Electronic address: fl127@columbia.edu.
Jazyk: angličtina
Zdroj: Clinical biomechanics (Bristol, Avon) [Clin Biomech (Bristol, Avon)] 2015 Dec; Vol. 30 (10), pp. 1114-8. Date of Electronic Publication: 2015 Sep 02.
DOI: 10.1016/j.clinbiomech.2015.08.016
Abstrakt: Background: Large segmental bone defects following tumor resection, high-energy civilian trauma, and military blast injuries present significant clinical challenges. Tissue engineering strategies using scaffolds are being considered as a treatment, but there is little research into optimal fixation of such scaffolds.
Methods: Twelve fresh-frozen paired cadaveric legs were utilized to simulate a critical sized intercalary defect in the tibia. Poly-ε-caprolactone and hydroxyapatite composite scaffolds 5 cm in length with a geometry representative of the mid-diaphysis of an adult human tibia were fabricated, inserted into a tibial mid-diaphyseal intercalary defect, and fixed with a 14-hole large fragment plate. Optimal screw fixation comparing non-locking and locking screws was tested in axial compression, bending, and torsion in a non-destructive manner. A cyclic torsional test to failure under torque control was then performed.
Findings: Biomechanical testing showed no significant difference for bending or axial stiffness with non-locking vs. locking fixation. Torsional stiffness was significantly higher (P=0.002) with the scaffold present for both non-locking and locking compared to the scaffold absent. In testing to failure, angular rotation was greater for the non-locking compared to locking constructs at each torque level up to 40 N-m (P<0.05). The locking constructs survived a significantly higher number of loading cycles before reaching clinical failure at 30 degrees of angular rotation (P<0.02).
Interpretation: The presence of the scaffold increased the torsional stiffness of the construct. Locking fixation resulted in a stronger construct with increased cycles to failure compared to non-locking fixation.
(Copyright © 2015 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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