Titanium Alloy Intramedullary Nails and Plates Affect Serum Metal Ion Levels within the Fracture Healing Period

Titanium alloy implants are the most used materials for the fixation of lower extremity fractures. Although these implants were thought to be inert materials in vitro, several studies have shown increased serum and remote tissue metal ion levels due to wear of implants and friction of the bone-implant interface in vivo. The aim of this study was to investigate the alteration of serum metal ion levels that are released from intramedullary nails and plates used for the fixation of lower extremity fractures, within the fracture healing period. The study included 20 adult patients, who were treated with intramedullary nail or plate osteosynthesis due to closed lower extremity fractures. Alterations of serum titanium, aluminum, molybdenum, and vanadium levels were evaluated at 6, 12, 18, and 24 weeks postoperatively. A statistically significant increase was determined in serum titanium, aluminum, molybdenum, and vanadium ion levels in the intramedullary nail and plate groups at the end of the follow-up period. Pairwise comparisons of metal ion levels between implant groups revealed no significant difference during a 24-week follow-up period. Compared to the control group, statistically significant increased levels of serum titanium, aluminum, vanadium, and molybdenum ions were determined in the implant groups used for the fixation of lower extremity fractures at the end of 24 weeks. In the current literature, the potential toxic effects of prolonged exposure to low levels of these metal ions are still unknown. It can be predicted that long-term metal ion exposure could result in vivo pathological processes in the future. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Levels within the Fracture Healing Period

Titanium alloy implants are the most used materials for the fixation of lower extremity fractures. Although these implants were thought to be inert materials in vitro, several studies have shown increased serum and remote tissue metal ion levels due to wear of implants and friction of the bone-implant interface in vivo. The aim of this study was to investigate the alteration of serum metal ion levels that are released from intramedullary nails and plates used for the fixation of lower extremity fractures, within the fracture healing period. The study included 20 adult patients, who were treated with intramedullary nail or plate osteosynthesis due to closed lower extremity fractures. Alterations of serum titanium, aluminum, molybdenum, and vanadium levels were evaluated at 6, 12, 18, and 24 weeks postoperatively. A statistically significant increase was determined in serum titanium, aluminum, molybdenum, and vanadium ion levels in the intramedullary nail and plate groups at the end of the follow-up period. Pairwise comparisons of metal ion levels between implant groups revealed no significant difference during a 24-week follow-up period. Compared to the control group, statistically significant increased levels of serum titanium, aluminum, vanadium, and molybdenum ions were determined in the implant groups used for the fixation of lower extremity fractures at the end of 24 weeks. In the current literature, the potential toxic effects of prolonged exposure to low levels of these metal ions are still unknown. It can be predicted that long-term metal ion exposure could result in vivo pathological processes in the future.C1 [Tanoglu, Oguzhan] Erzincan Binali Yildirim Univ, Dept Orthoped & Traumatol, Fac Med, Erzincan, Turkey.[Say, Ferhat] Ondokuz Mayis Univ, Dept Orthoped & Traumatol, Fac Med, Samsun, Turkey.[Yucens, Mehmet] Pamukkale Univ, Dept Orthoped & Traumatol, Fac Med, Denizli, Turkey.[Alemdaroglu, Kadir Bahadir; Iltar, Serkan] SBU Ankara Res & Training Hosp, Dept Orthoped & Traumatol, Ankara, Turkey.[Aydogan, Nevres Hurriyet] Mugla Sitki Kocman Univ, Dept Orthoped & Traumatol, Fac Med, Mugla, Turkey

A comparative biomechanical analysis of suprapectineal and infrapectineal fixation oacetabular anterior column fracture by finite element modeling

Background/aim: The aim of this study is to compare the stability and implant stresses of suprapectineal plate with infrapectineal plate in three subconfigurations of the screw types. Materials and methods: The stabilities of different fixation methods were compared by finite element analysis on six models. Three infrapectineal and three suprapectineal models each with locked, unlocked, or combined screws were employed. Three-dimensional finite element stress analysis was performed by using isotropic materials with a load of 2.3 kN applied at standing positions. Motion at the fracture line was measured on four different points located on the pubic and iliac sides of the fracture line. Results: Infrapectineal plate fixation with unlocked screws was found to be the most stable fixation method with 0.006 mm displacement of fragments in all axes at standing positions. The suprapectineal unlocked method was found to be the most unstable in standing positions with maximum displacement values of 0.46 mm vertical shear movement in the x-axis, –0.14 mm displacement in the y-axis, and –0.33 mm lateral shear in the z-axis. Conclusion: The infrapectineal unlocked plate supplies the most stable fixation with the least implant stress, contrary to the suprapectineal unlocked plate, which has the lowest stability and highest implant stresses. © TUBİTAK

A comparative biomechanical analysis of suprapectineal and infrapectineal fixation oacetabular anterior column fracture by finite element modeling

Background/aim: The aim of this study is to compare the stability and implant stresses of suprapectineal plate with infrapectineal plate in three subconfigurations of the screw types. Materials and methods: The stabilities of different fixation methods were compared by finite element analysis on six models. Three infrapectineal and three suprapectineal models each with locked, unlocked, or combined screws were employed. Three-dimensional finite element stress analysis was performed by using isotropic materials with a load of 2.3 kN applied at standing positions. Motion at the fracture line was measured on four different points located on the pubic and iliac sides of the fracture line. Results: Infrapectineal plate fixation with unlocked screws was found to be the most stable fixation method with 0.006 mm displacement of fragments in all axes at standing positions. The suprapectineal unlocked method was found to be the most unstable in standing positions with maximum displacement values of 0.46 mm vertical shear movement in the x-axis, –0.14 mm displacement in the y-axis, and –0.33 mm lateral shear in the z-axis. Conclusion: The infrapectineal unlocked plate supplies the most stable fixation with the least implant stress, contrary to the suprapectineal unlocked plate, which has the lowest stability and highest implant stresses. © TUBİTAK

The role of biplanar distal locking in intramedullary nailing of tibial shaft fractures

Background: To compare the union times of the uncomplicated tibial shaft fractures, which were distally locked by two coronal and one sagittal screws and by only two coronal screws. Methods: 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on PACS system was included. Fracture unions were evaluated by two authors. Results: Union time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar distal interlocking group (Group 1) (P=0.02). Mean union time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0 weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] had significantly lower union time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability for fracture union times was high with rho= 0.89 with SE of 0.51 (P0.001). Conclusion: Biplanar distal interlocking procedure had a significantly shorter union time. Biplanar distal interlocking procedure allows a faster fracture union probably because of a more stable fixation construct. © 2019 BY THE ARCHIVES OF BONE AND JOINT SURGERY

Former Arts Board

Back from L - R: Don Krause, Marge Tuckett, Leesa Lloyd; Center: Lynn Chatterton; Front: Gae Coluley, Diane Koetter (driver

The clinical effect of platelet–rich plasma prepared through different activation methods on patients with knee osteoarthritis [Farklı aktivasyon yöntemleriyle hazırlanan trombositten zengin plazma’nın diz osteoartritli hastalardaki klinik etkisi]

Aim: Intra-articular application of platelet rich plasma (PRP) can be an alternative treatment method for knee osteoarthritis. The objective of this study was to compare the activation methods of platelet rich plasma before intraarticular application. Material and Method: A total 51 patients (76 knees) was randomly selected into two groups. In group 1, activation of PRP was managed by adding calcium chloride (CaCl). In group 2, activation of PRP was managed by keeping the solution at -70° degrees for 24 hours after preparation and immersed in water at 37°C for a period of 5 minutes for complete dissolution. Then PRP was applied. The patients were assessed with VAS and WOMAC pain scores both baseline and after 2nd, 6th and 12th months of the treatment. Results: VAS and WOMAC pain scores were significantly higher at baseline compared to the results obtained at the 2nd, 6th and 12th months (p=0.06). Following 2nd, 6th and 12th months a gradual downward tendency was seen in both scores, even though no significant difference was found between the groups after 2nd, 6th and 12th months. Discussion: Patients received some clinical benefits from both activation methods. There is no significant difference between activating PRP by CaCl or -70°C which compared in terms of clinical benefits. Therefore, blood storage at -70ºC may be preferred primary due to no need for additional material such as CaCl. © 2016, Journal of Clinical and Analytical Medicine. All rights reserved