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Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study

Non-union rate after tibial fractures remains high. Apart from largely uncontrollable biologic, injury, and patient-specific factors, the mechanical fracture environment is a key determinant of healing. Our aim was to establish a patient-specific simulation workflow to determine the mechanical fract...

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Autores principales: Braun, Benedikt J., Orth, Marcel, Diebels, Stefan, Wickert, Kerstin, Andres, Annchristin, Gawlitza, Joshua, Bücker, Arno, Pohlemann, Tim, Roland, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511819/
https://www.ncbi.nlm.nih.gov/pubmed/34660686
http://dx.doi.org/10.3389/fsurg.2021.749209
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author Braun, Benedikt J.
Orth, Marcel
Diebels, Stefan
Wickert, Kerstin
Andres, Annchristin
Gawlitza, Joshua
Bücker, Arno
Pohlemann, Tim
Roland, Michael
author_facet Braun, Benedikt J.
Orth, Marcel
Diebels, Stefan
Wickert, Kerstin
Andres, Annchristin
Gawlitza, Joshua
Bücker, Arno
Pohlemann, Tim
Roland, Michael
author_sort Braun, Benedikt J.
collection PubMed
description Non-union rate after tibial fractures remains high. Apart from largely uncontrollable biologic, injury, and patient-specific factors, the mechanical fracture environment is a key determinant of healing. Our aim was to establish a patient-specific simulation workflow to determine the mechanical fracture environment and allow for an estimation of its healing potential. In a referred patient with failed nail-osteosynthesis after tibial-shaft fracture exchange nailing was performed. Post-operative CT-scans were used to construct a three-dimensional model of the treatment situation in an image processing and computer-aided design system. Resulting forces, computed in a simulation-driven workflow based on patient monitoring and motion capturing were used to simulate the mechanical fracture environment before and after exchange nailing. Implant stresses for the initial and revision situation, as well as interfragmentary movement, resulting hydrostatic, and octahedral shear strain were calculated and compared to the clinical course. The simulation model was able to adequately predict hardware stresses in the initial situation where mechanical implant failure occurred. Furthermore, hydrostatic and octahedral shear strain of the revision situation were calculated to be within published healing boundaries—accordingly the fracture healed uneventfully. Our workflow is able to determine the mechanical environment of a fracture fixation, calculate implant stresses, interfragmentary movement, and the resulting strain. Critical mechanical boundary conditions for fracture healing can be determined in relation to individual loading parameters. Based on this individualized treatment recommendations during the early post-operative phase in lower leg fractures are possible in order to prevent implant failure and non-union development.
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spelling pubmed-85118192021-10-14 Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study Braun, Benedikt J. Orth, Marcel Diebels, Stefan Wickert, Kerstin Andres, Annchristin Gawlitza, Joshua Bücker, Arno Pohlemann, Tim Roland, Michael Front Surg Surgery Non-union rate after tibial fractures remains high. Apart from largely uncontrollable biologic, injury, and patient-specific factors, the mechanical fracture environment is a key determinant of healing. Our aim was to establish a patient-specific simulation workflow to determine the mechanical fracture environment and allow for an estimation of its healing potential. In a referred patient with failed nail-osteosynthesis after tibial-shaft fracture exchange nailing was performed. Post-operative CT-scans were used to construct a three-dimensional model of the treatment situation in an image processing and computer-aided design system. Resulting forces, computed in a simulation-driven workflow based on patient monitoring and motion capturing were used to simulate the mechanical fracture environment before and after exchange nailing. Implant stresses for the initial and revision situation, as well as interfragmentary movement, resulting hydrostatic, and octahedral shear strain were calculated and compared to the clinical course. The simulation model was able to adequately predict hardware stresses in the initial situation where mechanical implant failure occurred. Furthermore, hydrostatic and octahedral shear strain of the revision situation were calculated to be within published healing boundaries—accordingly the fracture healed uneventfully. Our workflow is able to determine the mechanical environment of a fracture fixation, calculate implant stresses, interfragmentary movement, and the resulting strain. Critical mechanical boundary conditions for fracture healing can be determined in relation to individual loading parameters. Based on this individualized treatment recommendations during the early post-operative phase in lower leg fractures are possible in order to prevent implant failure and non-union development. Frontiers Media S.A. 2021-09-29 /pmc/articles/PMC8511819/ /pubmed/34660686 http://dx.doi.org/10.3389/fsurg.2021.749209 Text en Copyright © 2021 Braun, Orth, Diebels, Wickert, Andres, Gawlitza, Bücker, Pohlemann and Roland. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Braun, Benedikt J.
Orth, Marcel
Diebels, Stefan
Wickert, Kerstin
Andres, Annchristin
Gawlitza, Joshua
Bücker, Arno
Pohlemann, Tim
Roland, Michael
Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title_full Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title_fullStr Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title_full_unstemmed Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title_short Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing—A Simulation-Based Feasibility Study
title_sort individualized determination of the mechanical fracture environment after tibial exchange nailing—a simulation-based feasibility study
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511819/
https://www.ncbi.nlm.nih.gov/pubmed/34660686
http://dx.doi.org/10.3389/fsurg.2021.749209
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