Streaming potentials (SPs) measured in vivo at a specific site on intact cortical bone (canine tibia) have been compared with measurements from the same site in vitro, tested as an excised bone strip soaked in Hank's balanced salt solution. The amplitude of SPs per periosteal strain in vitro was larger in 13 tibias than in vivo (by an average x6.5 at 1 Hz), but values per transcortical strain difference were similar. In vitro, SP magnitudes rose more sharply to an asymptotic value as a function of bending frequency than did in vivo signals, possibly because of a difference in the internal state of canaliculi and/or Haversian systems. Similarly, SP response to step-loading decreased to zero more slowly with time in vitro than in vivo. Difficulties encountered in preliminary measurements due to electrical shunting through electrolyte and soft tissues suggest the need for caution in using both in vivo and in vitro SP measurements to extrapolate to electric field strengths on the cellular level.
Under development is an internal fixation plate that incorporates a piezoelectric element to generate current when excited mechanically by either weight bearing or external application of ultrasound. The intent is to deliver this current to electrodes at a fracture or osteotomy site to aid in prevention or treatment of nonunion. The present study examines quantitatively the ability of external ultrasound to generate current from small piezoelectric ceramic elements implanted in tissue. An ultrasonic transducer (2.25 MHz, 10-20 V input, less than 10 mW/cm2 output) was employed to excite small test coupons of a piezoelectric ceramic in vitro and in vivo with various materials, including water, PVC gel, cortical bone, and living soft tissues, interposed. In all instances, it was possible to generate currents of up to 20 microA after rectification; currents up to 1 mA were achieved in some cases. The work indicates that external ultrasonic energy could effectively power small internal devices designed to stimulate bone healing, without the need for implanted batteries or percutaneous leads.
Electrical potentials associated with the pulse pressure have been observed in a canine tibia model in vivo. As the medullary pressure rises during pulsing, the periosteal bone surface becomes positive with respect to the endosteal surface. This pattern is consistent with streaming potentials generated by outward flow of fluid through bone with a negatively charged matrix (negative zeta potential). Both the medullary pressure and electric potential oscillations are halted by occlusion of the femoral artery. Furthermore, systemic administration of epinephrine decreases the amplitude of the medullary pressure and the electric potential by the same fraction. Streaming potentials generated by blood flow are distinct from those generated by mechanical deformation and may have additional significance in relation to fracture healing and/or etiology of osteoporosis.
Prototype testing has been accomplished on a piezoelectric, internal fixation plate. This device combines a piezoelectric material with an internal fixation device as an integrated structure that provides mechanical stability, together with self-generated electrical stimulation, for treating fractures and nonunion. In bench and animal tests we have demonstrated that cyclical loading can cause a device of this type to generate electrical charge while attached to bone. After rectification, direct currents within the range known to stimulate osteogenesis can be produced by weight-bearing loads. Furthermore, electrical output of the implants can be increased by externally applied ultrasonic energy. These twin developments add significantly to the potential armamentarium of devices to enhance bone healing.
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