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Novel intramedullary-fixation technique for long bone fragility fractures using bioresorbable materials.

Nishizuka T, Kurahashi T, Hara T, Hirata H, Kasuga T - PLoS ONE (2014)

Bottom Line: In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week.The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body.IM-BM can be one treatment option for those with severe osteoporosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Almost all of the currently available fracture fixation devices for metaphyseal fragility fractures are made of hard metals, which carry a high risk of implant-related complications such as implant cutout in severely osteoporotic patients. We developed a novel fracture fixation technique (intramedullary-fixation with biodegradable materials; IM-BM) for severely weakened long bones using three different non-metallic biomaterials, a poly(l-lactide) (PLLA) woven tube, a nonwoven polyhydroxyalkanoates (PHA) fiber mat, and an injectable calcium phosphate cement (CPC). The purpose of this work was to evaluate the feasibility of IM-BM with mechanical testing as well as with an animal experiment. To perform mechanical testing, we fixed two longitudinal acrylic pipes with four different methods, and used them for a three-point bending test (Nā€Š=ā€Š5). The three-point bending test revealed that the average fracture energy for the IM-BM group (PLLA + CPC + PHA) was 3 times greater than that of PLLA + CPC group, and 60 to 200 times greater than that of CPC + PHA group and CPC group. Using an osteoporotic rabbit distal femur incomplete fracture model, sixteen rabbits were randomly allocated into four experimental groups (IM-BM group, PLLA + CPC group, CPC group, Kirschner wire (K-wire) group). No rabbit in the IM-BM group suffered fracture displacement even under full weight bearing. In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week. The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body. IM-BM can be one treatment option for those with severe osteoporosis.

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IM-BM procedures.View of the distal femur (B1) and bone cross section schema (B2) after CPC injection. PLLA: PLLA woven tube; PHA: PHA fiber mat; CPC: calcium phosphate cement.
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pone-0104603-g003: IM-BM procedures.View of the distal femur (B1) and bone cross section schema (B2) after CPC injection. PLLA: PLLA woven tube; PHA: PHA fiber mat; CPC: calcium phosphate cement.

Mentions: The procedure for IM-BM begins with reaming the intramedullary cavity and inserting a PLLA woven tube into the cavity, followed by injection of CPC paste both inside and outside the tube using a syringe. However, massive CPC paste leakage occurs from the fracture site, and it appears likely to inhibit bone union. Therefore, we use a nonwoven PHA fiber mat to prevent CPC leakage. The 3-hydroxybutyrate (3HB) and 4-hydroxybutyrate (4HB) copolymers (poly [P](3HB-co-4HB)) used in the PHA fiber mat in this work demonstrate both strength and flexibility (Figure 1). The nonwoven PHA fiber mat can prevent CPC leakage. Therefore, when we injected the CPC paste inside and outside the PLLA woven tube, the nonwoven PHA fiber mat was expanded until it fit the cavity (Figures 2 and 3).


Novel intramedullary-fixation technique for long bone fragility fractures using bioresorbable materials.

Nishizuka T, Kurahashi T, Hara T, Hirata H, Kasuga T - PLoS ONE (2014)

IM-BM procedures.View of the distal femur (B1) and bone cross section schema (B2) after CPC injection. PLLA: PLLA woven tube; PHA: PHA fiber mat; CPC: calcium phosphate cement.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128718&req=5

pone-0104603-g003: IM-BM procedures.View of the distal femur (B1) and bone cross section schema (B2) after CPC injection. PLLA: PLLA woven tube; PHA: PHA fiber mat; CPC: calcium phosphate cement.
Mentions: The procedure for IM-BM begins with reaming the intramedullary cavity and inserting a PLLA woven tube into the cavity, followed by injection of CPC paste both inside and outside the tube using a syringe. However, massive CPC paste leakage occurs from the fracture site, and it appears likely to inhibit bone union. Therefore, we use a nonwoven PHA fiber mat to prevent CPC leakage. The 3-hydroxybutyrate (3HB) and 4-hydroxybutyrate (4HB) copolymers (poly [P](3HB-co-4HB)) used in the PHA fiber mat in this work demonstrate both strength and flexibility (Figure 1). The nonwoven PHA fiber mat can prevent CPC leakage. Therefore, when we injected the CPC paste inside and outside the PLLA woven tube, the nonwoven PHA fiber mat was expanded until it fit the cavity (Figures 2 and 3).

Bottom Line: In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week.The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body.IM-BM can be one treatment option for those with severe osteoporosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Almost all of the currently available fracture fixation devices for metaphyseal fragility fractures are made of hard metals, which carry a high risk of implant-related complications such as implant cutout in severely osteoporotic patients. We developed a novel fracture fixation technique (intramedullary-fixation with biodegradable materials; IM-BM) for severely weakened long bones using three different non-metallic biomaterials, a poly(l-lactide) (PLLA) woven tube, a nonwoven polyhydroxyalkanoates (PHA) fiber mat, and an injectable calcium phosphate cement (CPC). The purpose of this work was to evaluate the feasibility of IM-BM with mechanical testing as well as with an animal experiment. To perform mechanical testing, we fixed two longitudinal acrylic pipes with four different methods, and used them for a three-point bending test (Nā€Š=ā€Š5). The three-point bending test revealed that the average fracture energy for the IM-BM group (PLLA + CPC + PHA) was 3 times greater than that of PLLA + CPC group, and 60 to 200 times greater than that of CPC + PHA group and CPC group. Using an osteoporotic rabbit distal femur incomplete fracture model, sixteen rabbits were randomly allocated into four experimental groups (IM-BM group, PLLA + CPC group, CPC group, Kirschner wire (K-wire) group). No rabbit in the IM-BM group suffered fracture displacement even under full weight bearing. In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week. The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body. IM-BM can be one treatment option for those with severe osteoporosis.

Show MeSH
Related in: MedlinePlus