Composite Bone Models in Orthopaedic Surgery Research and Education

The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.53). 02/2014; 22(2):111-20. DOI: 10.5435/JAAOS-22-02-111
Source: PubMed


Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens.

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    • "The advantageous of synthetic bones over cadaver warrant its current application, such as low cost, easier storage, no biohazard, lower interspecimen variability in physical properties, and commercial availability [42]. Since cadaveric bones are often acquired from elderly patients, they do not necessarily represent the younger orthopedic patient population [43]. Moreover, several biomechanical validation studies have shown that the current " fourth generation " composite bone is reasonably comparable to cadaveric human bone for a number of mechanical properties [40,44–48]. "
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    ABSTRACT: Femur fracture at the tip of a total hip replacement (THR), commonly known as Vancouver B1 fracture, is mainly treated using rigid metallic bone plates which may result in "stress shielding" leading to bone resorption and implant loosening. To minimize "stress shielding", a new carbon fiber (CF)/Flax/Epoxy composite plate has been developed and biomechanically compared to a standard clinical metal plate. For dynamic cyclic conditions, experiments were done using 6 artificial femurs cyclically loaded through the femoral head in axial compression for 4 stages: Stage 1 (intact), Stage 2 (after THR insertion), Stage 3 (after plate fixation of a simulated Vancouver B1 femoral midshaft fracture gap), and Stage 4 (after fracture gap healing). For fracture fixation, one group was fitted with the new CF/Flax/Epoxy plate (n=3), whereas another group was repaired with a traditional metal plate (Zimmer, Warsaw, IN, USA) (n=3). In addition to axial stiffness measurements, infrared thermography technique was used to capture the femur and plate surface stresses during the testing. Moreover, finite element analysis (FEA) was performed to evaluate the composite plate's axial stiffness and surface stress field. Experimental results showed that the CF/Flax/Epoxy plated femur had comparable axial stiffness (fractured = 645 ± 67 N/mm; healed = 1731 ± 109 N/mm) to the metal plated femur (fractured = 658 ± 69 N/mm; healed = 1751 ± 39 N/mm) (p=1.00). However, the bone beneath the CF/Flax/Epoxy plate was the only area that had a significantly higher average surface stress (fractured = 2.10 ± 0.66 MPa; healed = 1.89±0.39 MPa) compared to bone beneath the metal plate (fractured = 1.18 ± 0.93 MPa; healed = 0.71 ± 0.24 MPa) (p<0.05). FEA bone surface stresses yielded peak of 13 MPa at distal epiphysis (Stage 1), 16 MPa at distal epiphysis (Stage 2), 85 MPa for composite and 129 MPa for metal plated femurs at the vicinity of nearest screw just proximal to fracture (Stage 3), 21 MPa for composite and 24 MPa for metal plated femurs at the vicinity of screw farthest away distally from fracture (Stage 4). These results confirm that the new CF/Flax/Epoxy material could be a potential candidate for bone fracture plate applications as it can simultaneously provide similar mechanical stiffness and lower "stress shielding" (i.e. higher bone stress) compared to commercially-used metal bone plates.
    Full-text · Article · May 2014 · Journal of Biomechanical Engineering
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    ABSTRACT: To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires. Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct. All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size. The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires. When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability in the plane of finger flexion-extension. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · May 2015 · The Journal of hand surgery
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    ABSTRACT: The aim of this cadaver study was to identify the change in position of the sciatic nerve during arthroplasty using the posterior surgical approach to the hip. We investigated the position of the nerve during this procedure by dissecting 11 formalin-treated cadavers (22 hips: 12 male, ten female). The distance between the sciatic nerve and the femoral neck was measured before and after dislocation of the hip, and in positions used during the preparation of the femur. The nerve moves closer to the femoral neck when the hip is flexed to > 30° and internally rotated to 90° (90° IR). The mean distance between the nerve and femoral neck was 43.1 mm (standard deviation (sd) 8.7) with the hip at 0° of flexion and 90° IR; this significantly decreased to a mean of 36.1 mm (sd 9.5), 28.8 mm (sd 9.8) and 19.1 mm (sd 9.7) at 30°, 60° and 90° of hip flexion respectively (p < 0.001). In two hips the nerve was in contact with the femoral neck when the hip was flexed to 90°. This study demonstrates that the sciatic nerve becomes closer to the operative field during hip arthroplasty using the posterior approach with progressive flexion of the hip. Cite this article: Bone Joint J 2015;97-B:1056-62. ©2015 The British Editorial Society of Bone & Joint Surgery.
    No preview · Article · Aug 2015 · Bone and Joint Journal
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