Mechanoregulation modeling of bone healing in realistic fracture geometries

Ren, Tianyi; Dailey, Hannah L.

doi:10.1007/s10237-020-01340-5

Cited by 18 publications

(22 citation statements)

References 48 publications

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“…Since callus originates in the regions surrounding the fracture gap and not within the gap, focusing on the interfragmentary gap strain (net motion between bone fragments) as a target for optimizing the healing response may be intrinsically limiting. This idea that gap strain and by association, the 2%−10% strain rule, do not entirely characterize the strain environment near the fracture site was first introduced over three decades ago by DiGioia et al, who investigated the strain fields in an ovine tibia osteotomy via finite element modeling and found that longitudinal strain alone (i.e., gap strain) cannot be used as a basis for tissue yielding or differentiation within the complex, 3D strain field 46 . At a minimum, characterization of these strains resulting from 3D movement in realistic fracture patterns requires the use of a continuum measure such as equivalent strain, instead of the traditional gap strain measurement of a transverse osteotomy model.…”

Section: Discussionmentioning

confidence: 99%

Rethinking the 10% strain rule in fracture healing: A distal femur fracture case series

Inacio

Schwarzenberg

Kantzos

et al. 2022

Journal Orthopaedic Research

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Since the 1970s, the 2%−10% rule has been used to describe the range of interfragmentary gap closure strains that are conducive for secondary bone healing.Interpreting the available evidence for the association between strain and bone healing remains challenging because interfragmentary strain is impossible to directly measure in vivo. The question of how much strain occurs within and around the fracture gap is also difficult to resolve using bench tests with osteotomy models because these do not reflect the complexity of injury patterns seen in the clinic. To account for these challenges, we used finite element modeling to assess the three-dimensional interfragmentary strain in a case series of naturally occurring distal femur fractures treated with lateral plating under load conditions representative of the early postoperative period. Preoperative computed tomography scans were used to construct patient-specific finite element models and plate fixation constructs to match the operative management of each patient. The simulations showed that gap strains were within 2%−10% only for the lowest load application level, 20% static body weight (BW).Moderate loading of 60% static BW and above caused gap strains that far exceeded 10%, but in all cases, strains in the periosteal region external to the fracture line remained low. Comparing these findings with postoperative radiographs suggests that in vivo secondary healing of distal femur fractures may be robust to early gap strains much greater than 10% because formation of new bone is initiated outside the gap where strains are lower, followed by later consolidation within the gap.

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Section: Discussionmentioning

confidence: 99%

Rethinking the 10% strain rule in fracture healing: A distal femur fracture case series

Inacio

Schwarzenberg

Kantzos

et al. 2022

Journal Orthopaedic Research

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“…is paper proposes a fuzzy control system based on expert control, which combines fuzzy control with PID to automatically modify parameters and improve production effects [16]. Fuzzy control systems can make better predictions for many complex problems and find out appropriate methods to solve them.…”

Section: Overview Of Fuzzy Controlmentioning

confidence: 99%

Biomedical Disabled Rehabilitation Analysis considering Fuzzy Parameter Adaptive PID Algorithm

Zhang

Zhao

2022

Mobile Information Systems

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Fuzzy parameter adaptation refers to an idea of adjusting parameters based on parameter deviation, deviation change rate and the relationship between the parameters. The PID control algorithm incorporates three algorithms: ratio, sigma, and lead. It is one of the most commonly used algorithms and has a wide range of applications. Embedded system is an application-centric computer system based on modern computer technology that can be flexibly dedicated according to user needs. Although it is convenient to use, it cannot perform large-scale operations and storage. This article aims to explore the role of fuzzy parameter adaptive PID algorithm in the rehabilitation of biomedical persons with disabilities. It is hoped that modern technology will be used to find a new direction for the rehabilitation of the disabled, so that the disabled can better survive in the society. This paper studies the existing classic real-time scheduling algorithms and traditional adaptive scheduling algorithms and analyzes their shortcomings when applied to embedded systems; when sorting out related concepts, clarified related concepts such as disabled persons, to provide tertiary level study for people at risk and higher education policies for persons with disabilities; it combines classic and fuzzy control to form fuzzy self-adaptation, realizes fuzzy self-adaptive control of the temperature value of high temperature sterilization, and improves the automation level of the system. The experimental results of this article show that 68 persons with disabilities need medical diagnosis, accounting for 52%; 15 persons with disabilities need physical correction, accounting for 12%; 29 persons with disabilities require acupuncture treatment, accounting for 22%; 18 persons with disabilities were in mental treatment, accounting for 14%; 57 people lost the ability to learn due to memory decline, accounting for 44%; 46 people were unable to learn due to physical disabilities, accounting for 35%; but there were still 17 people who were able to study normally, accounting for 13% of the total number of people surveyed; 10 people were unable to study due to other reasons, accounting for 8%.

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“…In fact, previous studies identified the mechanical parameters ‘interfragmentary strain’ and ‘hydrostatic pressure’, and their threshold values as reliable parameters to monitor the different types of bone healing such as, e.g., intramembranous and endochondral ossification ( Claes and Heigele, 1999 ; Shefelbine et al, 2005 ). Strain quantities beneficial or at least not harmful for bone healing have been identified in simulations and experiments, such as, e.g., octahedral shear strain and hydrostatic strain ( Shefelbine et al, 2005 ), distortional strain ( Simon et al, 2011 ; Ren and Dailey, 2020 ) or deviatoric strain ( Son et al, 2014 ). However, the translation of these mostly experimental or simulation-based parameters to real human patient clinical cases remains an absolute rarity.…”

Section: Introductionmentioning

confidence: 99%

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Orth

Ganse²,

Andres³

et al. 2023

Front. Bioeng. Biotechnol.

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Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0 km/h; 1.5 km/h; 2.0 km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.

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Mechanoregulation modeling of bone healing in realistic fracture geometries

Cited by 18 publications

References 48 publications

Rethinking the 10% strain rule in fracture healing: A distal femur fracture case series

Rethinking the 10% strain rule in fracture healing: A distal femur fracture case series

Biomedical Disabled Rehabilitation Analysis considering Fuzzy Parameter Adaptive PID Algorithm

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

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