Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing
Abstract. Objectives:. Current surgical fracture treatment paradigms, which use rigid metallic constructs to heal bones, provide reasonable clinical outcomes; however, they do not leverage recent advances in our understanding of bone healing and mechanotransduction throughout bone healing. The objec...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-03-01
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| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000164 |
| _version_ | 1797976842346430464 |
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| author | Elaine C. Schmidt, MS Lauren M. Judkins, BS Guha Manogharan, PhD Samir Mehta, MD Michael W. Hast, PhD |
| author_facet | Elaine C. Schmidt, MS Lauren M. Judkins, BS Guha Manogharan, PhD Samir Mehta, MD Michael W. Hast, PhD |
| author_sort | Elaine C. Schmidt, MS |
| collection | DOAJ |
| description | Abstract. Objectives:. Current surgical fracture treatment paradigms, which use rigid metallic constructs to heal bones, provide reasonable clinical outcomes; however, they do not leverage recent advances in our understanding of bone healing and mechanotransduction throughout bone healing. The objective of this review was to investigate the efficacy and potential clinical applicability of surgical techniques and implants that deliberately introduce interfragmentary motion throughout the healing process.
Methods:. The authors searched PubMed and Google Scholar databases for articles reporting on fracture repair using dynamic locking plates, dynamized surgical techniques, and reverse dynamization. Data collection also included assessment of additively manufactured (AM) implants that provide dynamic mechanical behaviors.
Results:. Forty articles were included for final review. It was found that accelerated rates of fracture healing can be achieved with staged 2-part surgeries or dynamic implant designs. Temporal dynamization, where static fixation of bones is followed by the introduction of micromotion and controlled loading, has been shown to improve callus volume and accelerate the healing response. Reverse dynamization, where micromotion is encouraged during early callus formation and arrested later, may represent a significant advance for the treatment of critical defect injuries. Advances in AM techniques will likely provide the ability to create high-resolution implants capable of dynamized and reverse dynamized modalities.
Conclusions:. There is no one-size-fits-all approach to optimization of fracture healing. However, it has been clearly demonstrated that fracture treatment can be enhanced by systematically altering the construct stiffness throughout the different phases of healing, which may be achieved with AM implant designs. |
| first_indexed | 2024-04-11T04:57:25Z |
| format | Article |
| id | doaj.art-3ab49d1c2c3b4125a4f737356fcfad7f |
| institution | Directory Open Access Journal |
| issn | 2574-2167 |
| language | English |
| last_indexed | 2024-04-11T04:57:25Z |
| publishDate | 2022-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj.art-3ab49d1c2c3b4125a4f737356fcfad7f2022-12-26T06:06:07ZengWolters KluwerOTA International2574-21672022-03-0151Se16410.1097/OI9.0000000000000164OI90000000000000164Current concepts in fracture healing: temporal dynamization and applications for additive manufacturingElaine C. Schmidt, MSLauren M. Judkins, BSGuha Manogharan, PhDSamir Mehta, MDMichael W. Hast, PhDAbstract. Objectives:. Current surgical fracture treatment paradigms, which use rigid metallic constructs to heal bones, provide reasonable clinical outcomes; however, they do not leverage recent advances in our understanding of bone healing and mechanotransduction throughout bone healing. The objective of this review was to investigate the efficacy and potential clinical applicability of surgical techniques and implants that deliberately introduce interfragmentary motion throughout the healing process. Methods:. The authors searched PubMed and Google Scholar databases for articles reporting on fracture repair using dynamic locking plates, dynamized surgical techniques, and reverse dynamization. Data collection also included assessment of additively manufactured (AM) implants that provide dynamic mechanical behaviors. Results:. Forty articles were included for final review. It was found that accelerated rates of fracture healing can be achieved with staged 2-part surgeries or dynamic implant designs. Temporal dynamization, where static fixation of bones is followed by the introduction of micromotion and controlled loading, has been shown to improve callus volume and accelerate the healing response. Reverse dynamization, where micromotion is encouraged during early callus formation and arrested later, may represent a significant advance for the treatment of critical defect injuries. Advances in AM techniques will likely provide the ability to create high-resolution implants capable of dynamized and reverse dynamized modalities. Conclusions:. There is no one-size-fits-all approach to optimization of fracture healing. However, it has been clearly demonstrated that fracture treatment can be enhanced by systematically altering the construct stiffness throughout the different phases of healing, which may be achieved with AM implant designs.http://journals.lww.com/10.1097/OI9.0000000000000164 |
| spellingShingle | Elaine C. Schmidt, MS Lauren M. Judkins, BS Guha Manogharan, PhD Samir Mehta, MD Michael W. Hast, PhD Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing OTA International |
| title | Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing |
| title_full | Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing |
| title_fullStr | Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing |
| title_full_unstemmed | Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing |
| title_short | Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing |
| title_sort | current concepts in fracture healing temporal dynamization and applications for additive manufacturing |
| url | http://journals.lww.com/10.1097/OI9.0000000000000164 |
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