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Abstract

BACKGROUND: The optimum fixation device for the critical size bone defect is not established yet.

OBJECTIVE: A reliable, feasible and low-cost fixation device for the long-term maintenance of a critical bone defect.

METHODS: A custom-made plate made of poly-methyl-methacrylate was used for the fixation of a critical defect of rats’ femurs. The screws were securely fixing both on the plate and the bone. A three point bending test, aimed to resemble the in vivo loading pattern, a Finite Element Analysis and a 24-week in vivo monitoring of the integrity of the plate fixation were utilized.

RESULTS: The plate has linear and reproducible behavior. It presents no discontinuities in the stress field of the fixation. Its properties are attributed to the material and the locking principle. It fails beyond the level of magnitude of the normal ambulatory loads. In vivo, 100% of the plates maintained the bone defect intact up to 12 weeks and 85% of them at 24 weeks.

CONCLUSION: This novel locking plate shows optimal biomechanical performance and reliability with high long-term in vivo survival rate. It is fully implantable, inexpensive and easily manufactured. It can be qualified for long term critical defect fixation in bone regeneration studies.

Keywords

Bone tissue engineering segmental bone defects animal models plate critical size defect fixation device

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References

[1] Reichert

J.C.

Saifzadeh

Wullschleger

M.E.

Epari

D.R.

Schütz

M.A.

Duda

G.N.

et al., The challenge of establishing preclinical models for segmental bone defect research, Biomaterials 30(12) (2009), 2149–2163.

[2] Puelacher

W.C.

Vacanti

J.P.

Ferraro

N.E.

Schloo

and Vacanti

C.A.

, Femoral shaft reconstruction using tissue-engineered growth of bone, Int. J. Oral Maxillofac. Surg. 25(3) (1996), 223–228.

[3] Muschler

G.F.

Lane

J.M.

and Wernz

, Segmental femoral defect model in the rat, in: Bone Transplantation Aebi

and Regazzoni

, eds, Springer, Berlin, 1989, pp. 167–169.

[4] Yasko

A.W.

Lane

J.M.

Fellinger

Rosen

Wozney

J.M.

and Wang

E.A.

, The healing of segmental bone defects, induced by recombinant human bone morphogenetic protein (rhBMP-2), J. Bone Joint Surg. Am. 74(5) (1992), 659–671.

[5] Jäger

Sager

Lensing-Höhn

and Krauspe

, The critical size bony defect in a small animal for bone healing studies (II): Implant evolution and surgical technique on a rat’s femur, Biomed. Tech. (Berl.) 50(5) (2005), 137–142.

[6] Johnson

K.D.

August

Sciadini

M.F.

and Smith

, Evaluation of ground cortical autograft as a bone graft material in a new canine bilateral segmental long bone defect model, J. Orthop. Trauma 10(1) (1996), 28–36.

[7] Srouji

Blumenfeld

Rachmiel

and Livne

, Bone defect repair in rat tibia by TGF-β1 and IGF-1 released from hydrogel scaffold, Cell Tissue Bank. 5(4) (2004), 223–230.

[8] Einhorn

T.A.

Lane

J.M.

Burstein

A.H.

Kopman

C.R.

and Vigorita

V.J.

, The healing of segmental bone defects induced by demineralized bone matrix. A radiographic and biomechanical study, J. Bone Joint Surg. Am. 66(2) (1984), 274–279.

[9] Jäger

Sager

Lensing-Höhn

and Krauspe

, The critical size bony defect in a small animal for bone healing studies (I): Comparative anatomical study on rats femur, Biomed. Tech. (Berl.) 50(4) (2005), 107–110.

10.

[10] Drosse

Volkmer

Seitz

Penzkofer

Zahn

et al., Validation of a femoral critical size defect model for orthotopic evaluation of bone healing: A biomechanical, veterinary and trauma surgical perspective, Tissue Eng. Part C Methods 14(1) (2008), 79–88.

11.

[11] Oest

M.E.

Dupont

K.M.

Kong

H.J.

Mooney

D.J.

and Guldberg

R.E.

, Quantitative assessment of scaffold and growth factor-mediated repair of critically sized bone defects, J. Orthop. Res. 25(7) (2007), 941–950.

12.

[12] Zhao

Yang

Zhao

Nie

and Successful

S.Z.

, Repair of a critical-sized bone defect in the rat femur with a newly developed external fixator, Tohoku J. Exp. Med. 219(2) (2009), 115–120.

13.

[13] Wildemann

Bamdad

Holmer

Haas

N.P.

Raschke

and Schmidmaier

, Local delivery of growth factors from coated titanium plates increases osteotomy healing in rats, Bone 34(5) (2004), 862–868.

14.

[14] Wingerter

Calvert

Tucci

Tsao

Russell

and Benghuzzi

, Comparison of two different fixation techniques for a segmental defect in a rat femur model, J. Invest. Surg. 20(3) (2007), 149–155.

15.

[15] Russell

Tucci

Conflitti

Graves

Wingerter

Woodall

Jr. et al., Characterization of a femoral segmental nonunion model in laboratory rats: Report of a novel surgical technique, J. Invest. Surg. 20(4) (2007), 249–255.

16.

[16] Kaspar

Matziolis

Strube

Sentürk

Dormann

Bail

H.J.

et al., A new animal model for bone atrophic nonunion: Fixation by external fixator, J. Orthop. Res. 26(12) (2008), 1649–1655.

17.

[17] Glatt

Evans

C.H.

and Matthys

, Design, characterisation and in vivo testing of a new, adjustable stiffness, external fixator for the rat femur, Eur. Cell Mater. 21 (2012), 289–298.

18.

[18] Sha

Guo

Yuan

C.F.

Shi

et al., The effects of nail rigidity on fracture healing in rats with osteoporosis, Acta Orthop. 80(1) (2009), 135–138.

19.

[19] Sciadini

M.F.

Dawson

J.M.

and Johnson

K.D.

, Bovine-derived bone protein as a bone graft substitute in a canine segmental defect model, J. Orthop. Trauma 11(7) (1997), 496–508.

20.

[20] Tiedeman

J.J.

Connolly

J.F.

Strates

B.S.

and Lippiello

, Treatment of nonunion by percutaneous injection of bone marrow and demineralised bone matrix. An experimental study in dogs, Clin. Orthop. Relat. Res. 268 (1991), 294–302.

21.

[21] Wehner

Wolfram

Henzler

Niemeyer

Claes

and Simon

, Internal forces and moments in the femur of the rat during gait, J. Biomech. 43(13) (2010), 2473–2479.

22.

[22] Boerckel

J.D.

Dupont

K.M.

Kolambkar

Y.M.

Lin

A.S.

and Guldberg

R.E.

, In vivo model for evaluating the effects of mechanical stimulation on tissue-engineered bone repair, J. Biomech. Eng. 131(8) (2009), 084502.

23.

[23] Leppänen

Sievänen

Jokihaara

Pajamäki

and Järvinen

T.L.N.

, Three-point bending of rat femur in the mediolateral direction: Introduction and validation of a novel biomechanical testing protocol, J. Bone Miner. Res. 21(8) (2006), 1231–1237.

24.

[24] Brzoska

N.M.

Majewska

and Moniuszko-Jakoniuk

, Mechanical properties of femoral diaphysis and femoral neck of female rats chronically exposed to various levels of cadmium, Calcif. Tissue Int. 76(4) (2005), 287–298.

25.

[25] Brown

K.M.

Saunders

M.M.

Kirsch

Donahue

H.J.

and Reid

J.S.

, Effect of COX-2-specific inhibition on fracture-healing in the rat femur, J. Bone Joint Surg. Am. A 86(1) (2004), 116–123.

26.

[26] Utvag

S.E.

and Reikeras

, Effects of nail rigidity on fracture healing: Strength and mineralisation in rat femoral bone, Arch. Orthop. Trauma Surg. 118(1,2) (1998), 7–13.

27.

[27] Wheeler

D.L.

Eschbach

E.J.

Montfort

M.J.

Maheshwari

and McLoughlin

S.W.

, Mechanical strength of fracture callus in osteopenic bone at different phases of healing, J. Orthop. Trauma 14(2) (2000), 86–92.

28.

[28] Shefelbine

S.J.

Simon

Claes

Gold

Gabet

Bab

Müller

and Augat

, Prediction of fracture callus mechanical properties using micro-CT images and voxel-based finite element analysis, Bone 36(3) (2005), 480–488.

29.

[29] Michailidis

Karabinas

Tsouknidas

Maliaris

Tsipas

and Koidis

, A FEM based endosteal implant simulation to determine the effect of peri-implant bone resorption on stress induced implant failure, Bio-Med. Mater. Eng. 23(5) (2013), 317–327.

30.

[30] Viceconti

Olsen

Nolte

L.P.

and Burton

, Extracting clinically relevant data from finite element simulations, Clin. Biomech. 20(5) (2005), 451–454.

31.

[31] Tsouknidas

Savvakis

Asaniotis

Anagnostidis

Lontos

and Michailidis

, The effect of kyphoplasty parameters on the dynamic load transfer within the lumbar spine considering the response of a bio-realistic spine segment, Clin. Biomech. 28(9,10) (2013), 949–955.

32.

[32] Keller

T.S.

and Spengler

D.M.

, Regulation of bone stress and strain in the immature and mature rat femur, J. Biomech. 22(11,12) (1989), 1115–1127.

33.

[33] Stürmer

E.K.

Seidlová-Wuttke

Sehmisch

Rack

Wille

Frosch

K.H.

et al., Standardized bending and breaking test for the normal and osteoporotic metaphyseal tibias of the rat: Effect of estradiol, testosterone, and raloxifene, J. Bone Miner. Res. 21(1) (2006), 89–96.

34.

[34] Hogan

H.A.

Ruhmann

S.P.

and Sampson

H.W.

, The mechanical properties of cancellous bone in the proximal tibia of ovariectomized rats, J. Bone Miner. Res. 15(2) (2000), 284–292.

35.

[35] Brzóska

M.M.

Majewska

and Moniuszko-Jakoniuk

, Bone mineral density, chemical composition and biomechanical properties of the tibia of female rats exposed to cadmium since weaning up to skeletal maturity, Food Chem. Toxicol. 43(10) (2005), 1507–1519.

36.

[36] Huang

T.H.

Lin

S.C.

Chang

F.L.

Hsieh

S.S.

Liu

S.H.

and Yang

R.S.

, Effects of different exercise modes on mineralization, structure, and biomechanical properties of growing bone, J. Appl. Physiol. 95(1) (2003), 300–307.

37.

[37] Engineering ToolBox, Elastic properties and Young modulus for some materials, 2010, available at: http://www.engineeringtoolbox.com/young-modulus-d_417.html (10/05/2014).

38.

[38] Egol

K.A.

Kubiak

E.N.

Fulkerson

Kummer

F.J.

and Koval

K.J.

, Biomechanics of locked plates and screws, J. Orthop. Trauma 18(8) (2004), 488–493.

39.

[39] Wagner

, General principles for the clinical use of the LCP, Injury 34(Suppl. 2) (2003), B31–B42.

40.

[40] Gautier

and Sommer

, Guidelines for the clinical application of the LCP, Injury 34(Suppl. 2) (2003), B63–B76.

41.

[41] Sammarco

G.J.

Burstein

A.H.

Davis

W.L.

and Frankel

V.H.

, The biomechanics of torsional fractures: The effect of loading on ultimate properties, J. Biomech. 4(2) (1971), 113–117.

42.

[42] Buray

Bourgois

and Donkerwolkcke

, Elastic external fixation: Concepts in external fixation. A biomechanical study of the half-frame, in: Concepts in External Fixation Seligson

and Pope

M.H.

, eds, Grune & Stratton, New York, 1982, p. 67.

43.

[43] Burstein

A.H.

Currey

Frankel

V.H.

Heiple

K.G.

Lunseth

and Vessely

J.C.

, Bone strength: The effect of screw holes, J. Bone Joint Surg. 54(6) (1972), 1143–1156.

44.

[44] Chao

E.Y.S.

and Pope

M.H.

, The mechanical basis of external fixation, in: Concepts in External Fixation Seligson

and Pope

M.H.

, eds, Grune & Stratton, New York, 1982, p. 13.

A new,low cost,locking plate for the long-term fixation of a critical size bone defect in the ratfemur: In vivo performance,biomechanical and finite element analysis

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