Image-Based Radiodensity Profilometry Measures Early Remodeling at the Bone-Callus Interface in Sheep

Bone healing has been traditionally described as a four-phase process: inflammatory response, soft callus formation, hard callus development, and remodeling. The remodeling phase has been largely neglected in most numerical mechanoregulation models of fracture repair in favor of capturing early healing using a pre-defined callus domain. However, in vivo evidence suggests that remodeling occurs concurrently with repair and causes changes in cortical bone adjacent to callus that are typically neglected in numerical models of bone healing. The objective of this study was to use image processing techniques to quantify this early-stage remodeling in ovine osteotomies. To accomplish this, we developed a numerical method for radiodensity profilometry with optimization-based curve fitting to mathematically model the bone density gradients in the radial direction across the cortical wall and callus. After assessing data from 26 sheep, we defined a dimensionless density fitting function that revealed significant remodeling occurring in the cortical wall adjacent to callus during early healing, a 23% average reduction in density compared to intact. This fitting function is robust for modeling radial density gradients in both intact bone and fracture repair scenarios and can capture a wide variety of the healing responses. The fitting function can also be scaled easily for comparison to numerical model predictions and may be useful for validating future mechanoregulatory models of coupled fracture repair and remodeling.

Selected Vancouver B2 periprosthetic femoral fractures around cemented polished femoral components can be safely treated with osteosynthesis

Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. Methods We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. Results In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296). Readmissions and major adverse events including mortality were overall high, but similar between groups (p > 0.05). The two-year patient survival rate was 87.1% (95% CI 77.49 to 95.76), 66.7% (95% CI 48.86 to 84.53), and 84.2% (95% CI 72.63 to 95.76), for the B1 group, B2 osteosynthesis group, and B2 revision group, respectively (p = 0.102). Conclusion Implant survival in Vancouver B2 PFFs treated with internal fixation was similar to that of B1 fractures treated with the same method and to B2 PFFs treated with revision arthroplasty. Low-demand, elderly patients with B2 fractures around well-cemented polished femoral components with an intact bone-cement interface can be safely treated with internal fixation. Cite this article: Bone Joint J 2021;103-B(7):1222–1230.

Connective Tissue Graft as a Predictable Curtain for Aesthetics: A Case Report

Dental implant practice has now become a major choice for replacement of missing teeth in modern dentistry. Over the years, the success rate of dental implants has increased from 80-90% to 96-98%. However, due to lack of proper availability of soft tissue and hard tissue along with improper alignment of dental implants often pose aesthetic concerns in anterior aesthetic zone though the implant is fully osseointegrated with no signs of clinical mobility. This case report presents a case of a 21 years old male with a history of tooth loss due to trauma 8 months back and rehabilitation with dental implant 6 months back. On examination, mid-labial recession of around 3mm associated with #11 with no clinical signs of overlying inflammation was noted. Intact bone support was revealed by IOPAR. The recessed area around dental implant was managed with connective tissue graft and coronally advanced flap.

Factors of radial bone strength after marginal defect formation

Purpose To determine the effect of biometrical parameters of the radial bone and due to edge defect formed on the radius strength properties using calculation methods. Materials and methods The study of bone strength affecting factors was conducted with the aid of experimental and calculation methods. Biometrical parameters were studied in 10 pairs of the human cadaveric radius as an intact bone initially and after the formation of rectangular or triangle-shaped edge cuts. To determine the stress-strain behaviour, mathematical calculations were performed based on the beam flexural theory for isotropic materials. Computation study were conducted using the finite element method with the NX Siemens software package. Based on assumed mathematical models, the actual areas of safe loads in the presence of cuts and values of destructive loads depending on the depth and shape of a cut taking into account the initial curvature of the bone as well as the criteria of a required residual strength in variation of influencing parameters were identified by means of calculations. Results It was established that an increase in bone curvature results in the reduction of longitudinal destructive loads and in increasing values of the normal strength. The 0.05 bone curvature combined with the 0.5 cut causes a decrease in the ultimate load by 20 times (up to 4.8 % for a rectangular cut and to 5.4 % for a triangular cut). A 0.5-deep cut in the bone which curvature is 0.05 enhances the normal stress by 6.9 times for a triangular cut and by 7.8 times for a rectangular one as compared to a bone without curvature. The critical values for the curvature and depth of the cut were established which permit to avoid additional bone reinforcement. Conclusion The strength of the radius with a maginal defect depends not only on the depth of a cut but on its location, shape and on the radius curvature.

Functional Evaluation of a Novel Multi-Axial Alveolar Distractor—Preliminary In Vivo Animal Study

This study evaluates the biomechanical performance of a new multi-axial alveolar distractor using an animal study. The multi-axial alveolar distractor is designed with a ball and socket joint mechanism that can rotate up to 60° toward the buccal/lingual and mesial/distal sides intra-operatively to achieve vector control. The transport segment can be moved through activating the transport screw with 0.25 pitch, allowing 13 mm in distraction height. This distractor was fixed at the right angulus mandibular of experimental rabbits and adjusted 15° toward the mesial side and 25° toward the buccal side as Group TMB (toward mesial-buccal) (n = 3), and 15° toward the mesial side as Group TM (toward mesial) (n = 3). Group TC (control) was the control group. The distractors were activated 1 mm/day for 13 days. Living bone growth was observed at various periods. The total bone growth length at the angulus region and buccal side distraction thickness after distraction were calculated. The variations in bone growth geometric shape at the mandible angulus were also recorded. Fracture testing was performed to understand the variations in the mechanical strength between the distracted and intact bone specimens. The digital radiography results showed that the osteotomy areas at the mandible angulus were healed and the bone growth completed after surgery. The average bone growth length of Group TMB was 17.68 mm. This was greater than that of Group TM at 14.79 mm. The corresponding buccal side distractor thicknesses for Group TMB and TM after distraction were 5.12 ± 0.52 mm and 3.32 ± 0.37 mm, respectively. The tensile strengths of the bone specimens after distraction of Groups TMB, TM and TC were 172.13 N, 119.27 N and 304.24 N, respectively, and the percentage of distraction bone tensile strength to normal bone was 57% and 39% for Groups TMB and TM, respectively. This study concluded that this new multi-axial alveolar bone distractor can drive bones to grow in accordance with the direction/angle of the distraction plan. The bone growth healed gradually and presented insufficient mechanical strength.

In situ measurement of the isoplanatic patch for imaging through intact bone

Wavefront-shaping (WS) enables imaging through scattering tissues like bone, which is important for neuroscience and bone-regeneration research. WS corrects for the optical aberrations at a given depth and field-of-view (FOV) within the sample; the extent of the validity of which is limited to a region known as the isoplanatic patch (IP). Knowing this parameter helps to estimate the number of corrections needed for WS imaging over a given FOV. In this paper, we first present direct transmissive measurement of murine skull IP using digital optical phase conjugation (DOPC) based focusing. Second, we extend our previously reported Phase Accumulation Ray Tracing (PART) method to provide in-situ in-silico estimation of IP, called correlative PART (cPART). Our results show an IP range of 1-3 μm for mice within an age range of 8-14 days old and 1.00±0.25 μm in a 12-week old adult skull. Consistency between the two measurement approaches indicates that cPART can be used to approximate the IP before a WS experiment, which can be used to calculate the number of corrections required within a given field of view.Abstract Figure

Design and development of a novel expanding flexible rod device (FRD) for stability in the lumbar spine: A finite-element study

The aim of this study is to design a novel expanding flexible rod device, for pedicle screw fixation to provide dynamic stability, based on strength and flexibility. Three-dimensional finite-element models of lumbar spine (L1-S) with flexible rod device on L3-L4-L5 levels are developed. The implant material is taken to be Ti-6Al-4V. The models are simulated under different boundary conditions, and the results are compared with intact model. In natural model, total range of motion under 10 Nm moment were found 66.7°, 24.3° and 13.59°, respectively during flexion–extension, lateral bending and axial rotation. The von Mises stress at intact bone was 4 ± 2 MPa and at bone, adjacent to the screw in the implanted bone, was 6 ± 3 MPa. The von Mises stress of disc of intact bone varied from 0.36 to 2.13 MPa while that of the disc between the fixed vertebra of the fixation model reduced by approximately 10% for flexion and 25% for extension compared to intact model. The von Mises stresses of pedicle screw were 120, 135, 110 and 90 MPa during flexion, extension, lateral bending, and axial rotation, respectively. All the stress values were within the safe limit of the material. Using the flexible rod device, flexibility was significantly increased in flexion/extension but not in axial rotation and lateral bending. The results suggest that dynamic stabilization system with respect to fusion is more effective for homogenizing the range of motion of the spine.