Concepts and clinical aspects of active implants for the treatment of bone fractures

Ganse, Bergita; Orth, Marcel; Roland, Michael; Diebels, Stefan; Motzki, Paul; Seelecke, Stefan; Kirsch, Susanne‐Marie; Welsch, Felix; Andres, Annchristin; Wickert, Kerstin; Braun, Benedikt J.; Pohlemann, Tim

doi:10.1016/j.actbio.2022.05.001

Cited by 18 publications

(11 citation statements)

References 121 publications

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“…It would be highly desirable if patients did not need to use separate wearables such as insoles anymore, but if orthoses and implants had sensors embedded, not only to monitor healing progress but also to identify healing problems or complications and the need for surgical revision [ 33 ]. If similar load data could be collected by sensors in artificial hip or knee joints, or potentially even by plates or nails that stabilize bone fractures, recovery regimen could be monitored continuously and advice given on time [ 34 ]. Alarms could go off if forces exceeded certain thresholds or if live pattern analyses revealed unfavorable patterns known to be associated with exceeding forces or problems.…”

Section: Discussionmentioning

confidence: 99%

Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study

Wolff,

Steinheimer,

Warmerdam

et al. 2024

J Med Internet Res

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Background Monitoring of gait patterns by insoles is popular to study behavior and activity in the daily life of people and throughout the rehabilitation process of patients. Live data analyses may improve personalized prevention and treatment regimens, as well as rehabilitation. The M-shaped plantar pressure curve during the stance phase is mainly defined by the loading and unloading slope, 2 maxima, 1 minimum, as well as the force during defined periods. When monitoring gait continuously, walking uphill or downhill could affect this curve in characteristic ways. Objective For walking on a slope, typical changes in the stance phase curve measured by insoles were hypothesized. Methods In total, 40 healthy participants of both sexes were fitted with individually calibrated insoles with 16 pressure sensors each and a recording frequency of 100 Hz. Participants walked on a treadmill at 4 km/h for 1 minute in each of the following slopes: −20%, −15%, −10%, −5%, 0%, 5%, 10%, 15%, and 20%. Raw data were exported for analyses. A custom-developed data platform was used for data processing and parameter calculation, including step detection, data transformation, and normalization for time by natural cubic spline interpolation and force (proportion of body weight). To identify the time-axis positions of the desired maxima and minimum among the available extremum candidates in each step, a Gaussian filter was applied (σ=3, kernel size 7). Inconclusive extremum candidates were further processed by screening for time plausibility, maximum or minimum pool filtering, and monotony. Several parameters that describe the curve trajectory were computed for each step. The normal distribution of data was tested by the Kolmogorov-Smirnov and Shapiro-Wilk tests. Results Data were normally distributed. An analysis of variance with the gait parameters as dependent and slope as independent variables revealed significant changes related to the slope for the following parameters of the stance phase curve: the mean force during loading and unloading, the 2 maxima and the minimum, as well as the loading and unloading slope (all P<.001). A simultaneous increase in the loading slope, the first maximum and the mean loading force combined with a decrease in the mean unloading force, the second maximum, and the unloading slope is characteristic for downhill walking. The opposite represents uphill walking. The minimum had its peak at horizontal walking and values dropped when walking uphill and downhill alike. It is therefore not a suitable parameter to distinguish between uphill and downhill walking. Conclusions While patient-related factors, such as anthropometrics, injury, or disease shape the stance phase curve on a longer-term scale, walking on slopes leads to temporary and characteristic short-term changes in the curve trajectory.

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Section: Discussionmentioning

confidence: 99%

Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study

Wolff,

Steinheimer,

Warmerdam

et al. 2024

J Med Internet Res

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“…However, adjusting the mechanical parameters of the implants can enhance bone healing and alleviate stress shielding concerns. This has spurred the development of implants with reduced stiffness, dynamic features, and functionally graded characteristics [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…However, the introduction of locking plate technology in the 1990s marked a significant shift in the approach to fracture management. This innovation provided stability that does not depend on the condition of the bone, making it especially useful for patients with osteoporosis or for treating highly fragmented fractures [3,10]. The substantial rigidity associated with locking plate reconstruction has given rise to distinct failure mechanisms, notably screw cutout, which frequently necessitates revision surgery [13].…”

Section: Introductionmentioning

confidence: 99%

A Review of the Impacts of Implant Stiffness on Fracture Healing

Mori,

Kamimura,

Ito

et al. 2024

Applied Sciences

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The bone healing process is influenced by various physiological factors. Fracture fixation traditionally relied on rigid metallic implants. However, excessively rigid constructs can lead to complications, necessitating revision surgery. This review focuses on approaches to improve bone healing by introducing adequate interfragmentary movement (IFM) at the fracture site. IFM promotes secondary fracture healing and callus formation. Studies suggest that rigid fixation may impair fracture healing by inhibiting callus formation and causing stress shielding. Titanium alloy locking plates have been shown to be biomechanically superior to stainless steel. Flexible fixation and techniques to regulate implant stiffness are crucial for managing fractures with bridge plating. Materials with a lower Young’s modulus balance biomechanical properties. A novel TiNbSn alloy with a low Young’s modulus has been developed to address stress shielding issues. It is effective in promoting osteosynthesis, bone healing, and superior mechanical properties compared with materials with higher Young’s moduli. The enhanced formation of bone and callus associated with TiNbSn alloy suggests its promise for use in fracture treatment plates. Understanding the biomechanics of fracture healing, optimizing fixation stiffness, and exploring innovative materials like TiNbSn alloys, are crucial for advancing approaches to accelerate and enhance bone healing.

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“…Electrical stimulation therapy mainly includes pulsed electromagnetic fields (PEMFs), direct current (DC), and capacitive coupling (CC) [ 15 , 16 , 17 ] ( Figure 1 ). The main working principle of a PEMF is to convert electric current into electromagnetic wave signal, and a PEMF has curative effect on nonunion and delayed fracture healing [ 18 , 19 , 20 ]. DC is an invasive technique that delivers constant direct current through an implanted electrical stimulator [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

The Possible Role of Electrical Stimulation in Osteoporosis: A Narrative Review

Zhang

Luo

et al. 2023

Medicina

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Osteoporosis is mainly a geriatric disease with a high incidence, and the resulting spinal fractures and hip fractures cause great harm to patients. Anti-osteoporosis drugs are the main treatment for osteoporosis currently, but these drugs have potential clinical limitations and side effects, so the development of new therapies is of great significance to patients with osteoporosis. Electrical stimulation therapy mainly includes pulsed electromagnetic fields (PEMF), direct current (DC), and capacitive coupling (CC). Meanwhile, electrical stimulation therapy is clinically convenient without side effects. In recent years, many researchers have explored the use of electrical stimulation therapy for osteoporosis. Based on this, the role of electrical stimulation therapy in osteoporosis was summarized. In the future, electrical stimulation might become a new treatment for osteoporosis.

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Concepts and clinical aspects of active implants for the treatment of bone fractures

Cited by 18 publications

References 121 publications

Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study

Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study

A Review of the Impacts of Implant Stiffness on Fracture Healing

The Possible Role of Electrical Stimulation in Osteoporosis: A Narrative Review

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