Development and clinical application of an external fixator monitoring system

A monitoring system for measuring movement occurring in a dynamic external fixator used to treat fractures is described. The system measures shortening during fracture healing, micromovement at the fracture site on weight bearing and detects pin loosening. The method of calibration including cadaver experiments is presented. The clinical application is described and the reasons for measuring movement are discussed.     

Three-dimensional load measurements in an external fixator

On the basis of a six-degree-of-freedom adjustable fracture reduction hexapod external fixator, a system which can be used for measuring axial and shear forces as well as torsion and bending moments in the fixator in vivo was developed. In a pilot study on 9 patients (7 fresh fractures and 2 osteotomies of the tibia), the load in the fixator during the healing process was measured after 2, 4, 8 and 12 weeks and at fixator removal. The measured values enabled both the type of fracture to be determined as well as the monitoring of the healing process. In well-reduced type A3 fractures small axial (direction of the bone axis) forces were found in the fixator. A2, B2 and C3 fractures showed distinct axial forces, which decreased during the healing process, according to an increasing load transfer over the bone. Bending moments in the fixator showed good correspondence with the clinical healing process, except in the case of a C3 fracture. A combination of bending moment and axial force proved to be particularly suitable to assess fracture healing. In transverse fractures, the well-known resorption phenomenon of bone in the fracture gap at approximately 4 weeks was detected by the system. Compared with other external fixator load measurements in vivo, the hexapod offers the advantage of being able to measure all forces and moments in the fixator separately and with a relatively simple mechanical arrangement. In our opinion, it will be possible to control fracture healing using this system, thereby minimizing radiation exposure from radiographs. Furthermore, the measurement system is a step towards the development of external fixator systems that enable automatic adjustments of the callus mechanical situation ("automatic dynamization") and inform the patients about the optimal weight bearing of their extremity ("intelligent fixator").     

Finite-element modelling of femoral shaft fracture fixation techniques post total hip arthroplasty.

The presence of a femoral prosthesis superior to a shaft fracture severely complicates fixation and treatment. This study uses two-dimensional, multithickness, plane stress finite-element models of a femur with prosthesis to investigate the stresses developed with the application of three popular fixation techniques: revision to a long stem prosthesis, lateral plating with a cortical bone allograft strut and cerclage wires, and custom plate application with proximal Parham band fixation with distal cortical screws (Ogden plate). The plate and bone contact as well as the fracture site contact were modelled by using orthotropic elements with custom-fit moduli so that only the normal stress to the interface was significant. A thermal analogy was used to model the cerclage and Parham band preloads so that representative preloads in the proximal fixation of the two types of plate treatments could be modelled. A parametric study was performed with the long-prosthesis model to show variations in stem lengths of one, two and three femoral diameters distal to the fracture site. The Ogden plate model showed a transfer of tensile stress near the proximal-most band, with the highest tensile stress being at the fracture site with evidence of stress shielding of the proximal lateral cortex. The cortical bone strut model showed a transfer of tensile stress to the bone strut but showed less shielding of the proximal cortex. The cerclage wires at the base of the bone strut showed the highest changes in load with the distalmost wire increasing to almost four times its original preload.(ABSTRACT TRUNCATED AT 250 WORDS)     

Locally administrated perindopril improves healing in an ovariectomized rat tibial osteotomy model

Angiotensin-converting enzyme inhibitors are widely prescribed to regulate blood pressure. High doses of orally administered perindopril have previously been shown to improve fracture healing in a mouse femur fracture model. In this study, perindopril was administered directly to the fracture area with the goal of stimulating fracture repair. Three months after being ovariectomized (OVX), tibial fractures were produced in Sprague-Dawley rats and subsequently stabilized with intramedullary wires. Perindopril (0.4 mg/kg/day) was injected locally at the fractured site for a treatment period of 7 days. Vehicle reagent was used as a control. Callus quality was evaluated at 2 and 4 weeks post-fracture. Compared with the vehicle group, perindopril treatment significantly increased bone formation, increased biomechanical strength, and improved microstructural parameters of the callus. Newly woven bone was arranged more tightly and regularly at 4 weeks post-fracture. The ultimate load increased by 66.1 and 76.9% (p<0.01), and the bone volume over total volume (BV/TV) increased by 29.9% and 24.3% (p<0.01) at 2 and 4 weeks post-fracture, respectively. These findings suggest that local treatment with perindopril could promote fracture healing in ovariectomized rats.     

Reduction in wire tension caused by dynamic loading. An experimental Ilizarov frame study

Small diameter transosseous wires are main parts of the Ilizarov frame concept. Wire tensioning is essential to gain the necessary transversal stiffness, and the wire fixators are therefore important, coupling the wire to the ring. The ability of three different wire fixator designs to maintain wire tension under dynamic loading is described. The three fixator designs were combinations of two types of bolts and one washer. In a simplified frame set-up consisting of one ring and one wire, sixty wires were dynamically loaded in sequence with 200N for 450 times and wire tension was repeatedly measured. The tension loss employing the different fixator types at two wire pretension levels (883N, 1275N) was measured. Wire slippage in the fixators and the midpoint deflection angle of the wires were measured. Large differences in fixation ability were observed. Wire fixators holding a larger and rougher contact surface had significant smaller tension loss compared to fixators with a smaller and smother contact surface. Both plastic wire deformation and slippage causes tension loss with slippage as the main contributor. Wire fixators' design can be improved in order to maintain wire tension. Such improvement could be of clinical interest enhancing the mechanical stability of the fixator.     

Why Was Silcrete Heat-Treated in the Middle Stone Age? An Early Transformative Technology in the Context of Raw Material Use at Mertenhof Rock Shelter,South Africa

People heat treated silcrete during the Middle Stone Age (MSA) in southern Africa but the spatial and temporal variability of this practice remains poorly documented. This paucity of data in turn makes it difficult to interrogate the motive factors underlying the application of this technique. In this paper we present data on heat treatment of silcrete through the Howiesons Poort and post-Howiesons Poort of the rock shelter site Mertenhof, located in the Western Cape of South Africa. In contrast to other sites where heat treatment has been documented, distance to rock source at Mertenhof can be reasonably well estimated, and the site is known to contain high proportions of a diversity of fine grained rocks including silcrete, hornfels and chert at various points through the sequence. Our results suggest the prevalence of heat treatment is variable through the sequence but that it is largely unaffected by the relative abundance of silcrete prevalence. Instead there is a strong inverse correlation between frequency of heat treatment in silcrete and prevalence of chert in the assemblage, and a generally positive correlation with the proportion of locally available rock. While it is difficult to separate individual factors we suggest that, at Mertenhof at least, heat treatment may have been used to improve the fracture properties of silcrete at times when other finer grained rocks were less readily available. As such, heat treatment appears to have been a component of the MSA behavioural repertoire that was flexibly deployed in ways sensitive to other elements of technological organisation.     

A 3D computational simulation of fracture callus formation: influence of the stiffness of the external fixator

The stiffness of the external fixation highly influences the fracture healing pattern. In this work we study this aspect by means of a finite element model of a simple transverse mid-diaphyseal fracture of an ovine metatarsus fixed with a bilateral external fixator. In order to simulate the regenerative process, a previously developed mechanobiological model of bone fracture healing was implemented in three dimensions. This model is able to simulate tissue differentiation, bone regeneration, and callus growth. A physiological load of 500 N was applied and three different stiffnesses of the external fixator were simulated (2300, 1725, and 1150 N/mm). The interfragmentary strain and load sharing mechanism between bone and the external fixator were compared to those recorded in previous experimental works. The effects of the stiffness on the callus shape and tissue distributions in the fracture site were also analyzed. We predicted that a lower stiffness of the fixator delays fracture healing and causes a larger callus, in correspondence to well-documented clinical observations.     

Development and validation of a new approach for computer-aided long bone fracture reduction using unilateral external fixator

An innovative computer-aided method to plan and execute long bone fracture reduction using Dynafix unilateral external fixator (EF) is presented and validated. A matrix equation, which represents a sequential transformation from proximal to distal ends, was derived and solved for the amount of rotation and translation required at each EF joint to correct for a displaced fracture using a non-linear least square optimization method. Six polyurethane-foam models of displaced fracture tibiae were used to validate the method. The reduction accuracy was quantified by calculating the residual translations (xr, yr, zr), the residual displacement (dr), and the residual angulations (alphar, betar, gammar) based on the X-Y-Z Euler angle convention. The experiment showed that the mean+/-S.D. of alphar, betar, gammar, xr, yr, zr and dr were 1.57+/-1.14 degrees, 1.33+/-0.90 degrees, 0.71+/-0.70 degrees, 0.98+/-1.85, 0.80+/-0.67, 0.30+/-0.27, and 0.50+/-0.77 mm, respectively, which demonstrated the accuracy and reliability of the method. Instead of adjusting the fixator joints in-situ, our method allows for off-site adjustment of the fixator joints and employs the adjusted EF as a template to guide the surgeons to manipulate the fracture fragments to complete the reduction process. Success of this method would allow surgeons to perform fracture reduction more objectively, efficiently and accurately yet reduce the radiation exposure to both the involved clinicians and patients and lessen the extent of periosteum and soft tissue disruption around the fracture site.     

The effect of wire plane tilt and olive wires on proximal tibia fracture fragment stability and fracture site motion

To analyze the effect of the tilt angle relationship between the crossed wire plane and the bone axis on the stiffness of fine wire external fixation, load-deformation behavior was compared across different tilt angles (0 degree, 10 degrees, and 20 degrees) of the plane containing crossed smooth or olive wires under identical conditions of central axial compression, medial compression-bending, posterior compression-bending, posteromedial compression-bending, and torsion. Stiffness values were calculated from the load-deformation and torque-angle curves. A tilt angle of 20 degrees with olive wires provided significantly greater stiffness compared to smooth wires at any angle in any loading condition (p < 0.05). A tilt angle of 20 degrees with olive wires was also significantly more stiff than a tilt angle of 0 degree with olive wires in any loading condition. In torsion, olive wires with 10 degrees and 20 degrees tilt were not significantly different, while in posterior bending olive wires with 10 degrees tilt were significantly stiffer than olive wires with 0 degree or 20 degrees tilt. With smooth wires, tilting the wire plane caused a decrease in stiffness in posterior bending, posteromedial bending, and torsion. Overall, the use of olive wires in conjunction with tilting the wire plane enhances the fixation stiffness for proximal tibia fractures while allowing more options for wire configurations that avoid neurovascular and musculotendinous structures, and wounds.     

Experimental and clinical results of new advances in the treatment of facial trauma

Theoretical considerations and photoelastic and mechanical experiments showed us the progression from metal wires to metal plates in different systems. In the midface there is no question about stabilization by miniplate systems. For mandibular fracture treatment, there is a discussion going on at present about the use of stable maxisystems versus less stable minisystems. Our clinical experience of 15 years indicates that there is no further demand for strict stable fixation of mandibular fractures, and we were encouraged to use less stable systems with similar good results, as our follow-up and statistical evaluation showed. To continue the simplification of osteosynthesis methods we are performing experiments with resorbable materials. Early results show fracture healing comparable with that found with plate-and-screw systems. Our clinical experience has shown that there is no longer any question about the ability of stable fracture treatment by means of osteosynthesis. However, there still is the question of how functional such fracture treatment might be.     

Spawning Site Selection and Contingent Behavior in Common Snook,Centropomus undecimalis

Reproductive behavior affects spatial population structure and our ability to manage for sustainability in marine and diadromous fishes. In this study, we used fishery independent capture-based sampling to evaluate where Common Snook occurred in Tampa Bay and if it changed with spawning season, and passive acoustic telemetry to assess fine scale behavior at an inlet spawning site (2007–2009). Snook concentrated in three areas during the spawning season only one of which fell within the expected spawning habitat. Although in lower numbers, they remained in these areas throughout the winter months. Acoustically-tagged snook (n = 31) showed two seasonal patterns at the spawning site: Most fish occurred during the spawning season but several fish displayed more extended residency, supporting the capture-based findings that Common Snook exhibit facultative catadromy. Spawning site selection for iteroparous, multiple-batch spawning fishes occurs at the lifetime, annual, or intra-annual temporal scales. In this study we show colonization of a new spawning site, indicating that lifetime spawning site fidelity of Common Snook is not fixed at this fine spatial scale. However, individuals did exhibit annual and intra-seasonal spawning site fidelity to this new site over the three years studied. The number of fish at the spawning site increased in June and July (peak spawning months) and on new and full lunar phases indicating within population variability in spawning and movement patterns. Intra-seasonal patterns of detection also differed significantly with sex. Common Snook exhibited divergent migration tactics and habitat use at the annual and estuarine scales, with contingents using different overwintering habitat. Migration tactics also varied at the spawning site at the intra-seasonal scale and with sex. These results have important implications for understanding how reproductive behavior affects spatio-temporal patterns of fish abundance and their resilience to disturbance events and fishing pressure.     

Bone contact forces on the distal tibia during the stance phase of running

Although the tibia is a common site of stress fractures in runners, the loading of the tibia during running is not well understood. An integrated experimental and modeling approach was therefore used to estimate the bone contact forces acting on the distal end of the tibia during the stance phase of running, and the contributions of external and internal sources to these forces. Motion capture and force plate data were recorded for 10 male runners as they ran at 3.5-4 m/s. From these data, the joint reaction force (JRF), muscle forces, and bone contact force on the tibia were computed at the ankle using inverse dynamics and optimization methods. The distal end of the tibia was compressed and sheared posteriorly throughout most of stance, with respective peak forces of 9.00+/-1.13 and 0.57+/-0.18 body weights occurring during mid stance. Internal muscle forces were the primary source of tibial compression, whereas the JRF was the primary source of tibial shear due to the forward inclination of the leg relative to the external ground reaction force. The muscle forces and JRF both acted to compress the tibia, but induced tibial shear forces in opposing directions during stance, magnifying tibial compression and reducing tibial shear. The superposition of the peak compressive and posterior shear forces at mid stance may contribute to stress fractures in the posterior face of the tibia. The implications are that changes in running technique could potentially reduce stress fracture risk.     

Comparative Reliability Studies and Analysis of Au,Pd-Coated Cu and Pd-Doped Cu Wire in Microelectronics Packaging

This paper compares and discusses the wearout reliability and analysis of Gold (Au), Palladium (Pd) coated Cu and Pd-doped Cu wires used in fineline Ball Grid Array (BGA) package. Intermetallic compound (IMC) thickness measurement has been carried out to estimate the coefficient of diffusion (D_o) under various aging conditions of different bonding wires. Wire pull and ball bond shear strengths have been analyzed and we found smaller variation in Pd-doped Cu wire compared to Au and Pd-doped Cu wire. Au bonds were identified to have faster IMC formation, compared to slower IMC growth of Cu. The obtained weibull slope, β of three bonding wires are greater than 1.0 and belong to wearout reliability data point. Pd-doped Cu wire exhibits larger time-to-failure and cycles-to-failure in both wearout reliability tests in Highly Accelerated Temperature and Humidity (HAST) and Temperature Cycling (TC) tests. This proves Pd-doped Cu wire has a greater potential and higher reliability margin compared to Au and Pd-coated Cu wires.     

Production and turnover rates of shallow fine roots in rangelands of the Patagonian Monte, Argentina

Selective sheep grazing in arid rangelands induces a decrease in total cover and grass cover and an increase in the dominance of shrubs. Both life forms differ in aboveground and belowground traits. We hypothesized that grazing disturbance leads to the replacement of grass by shrub fine roots in the upper soil, and this is reflected in changes in the seasonal dynamics of shallow fine roots at the community level. In two sites representative of non-grazed and grazed vegetation states in the Patagonian Monte, we assessed the canopy structure, and the fine root biomass, N concentration, production, and turnover during two consecutive years. The non-grazed site exhibited higher total, grass, and shrub cover than the grazed site. The grazed site had larger or equal fine root biomass than the non-grazed site except for late spring of the second year. This could be associated with the ability of shrubs to develop dimorphic-root systems occupying the soil freed by grasses at the grazed site, and with the larger contribution of grass than shrub fine roots in relation to an extraordinary precipitation event at the non-grazed site. This was consistent with the N concentration in fine roots. Fine root production was positively correlated to temperature at the grazed site and with precipitation at the non-grazed site. Fine root turnover did not differ between sites. Our results indicate that grazing leads to a shifting in the seasonality and main climatic controls of fine root production, while fine root turnover is mostly affected by changes in soil water conditions.     

Cell-free rolling mediated by L-selectin and sialyl Lewis(x) reveals the shear threshold effect

The selectin family of adhesion molecules mediates attachment and rolling of neutrophils to stimulated endothelial cells. This step of the inflammatory response is a prerequisite to firm attachment and extravasation. We have reported that microspheres coated with sialyl Lewis(x) (sLe(x)) interact specifically and roll over E-selectin and P-selectin substrates (Brunk et al., 1996; Rodgers et al 2000). This paper extends the use of the cell-free system to the study of the interactions between L-selectin and sLe(x) under flow. We find that sLe(x) microspheres specifically interact with and roll on L-selectin substrates. Rolling velocity increases with wall shear stress and decreases with increasing L-selectin density. Rolling velocities are fast, between 25 and 225 microm/s, typical of L-selectin interactions. The variability of rolling velocity, quantified by the variance in rolling velocity, scales linearly with rolling velocity. Rolling flux varies with both wall shear stress and L-selectin site density. At a density of L-selectin of 800 sites/microm(2), the rolling flux of sLe(x) coated microspheres goes through a clear maximum with respect to shear stress at 0.7 dyne/cm(2). This behavior, in which the maintenance and promotion of rolling interactions on selectins requires shear stress above a threshold value, is known as the shear threshold effect. We found that the magnitude of the effect is greatest at an L-selectin density of 800 sites/microm(2) and gradually diminishes with increasing L-selectin site density. Our study is the first to reveal the shear threshold effect with a cell free system and the first to show the dependence of the shear threshold effect on L-selectin site density in a reconstituted system. Our ability to recreate the shear threshold effect in a cell-free system strongly suggests the origin of the effect is in the physical chemistry of L-selectin interaction with its ligand, and largely eliminates cellular features such as deformability or topography as its cause.     

Tensioning the helix: a mechanism for force generation in twining plants

Twining plants use their helical stems to clasp supports and to generate a squeezing force, providing stability against gravity. To elucidate the mechanism that allows force generation, we measured the squeezing forces exerted by the twiner Dioscorea bulbifera while following its growth using time-lapse photography. We show that the development of the squeezing force is accompanied by stiffening of the stem and the expansion of stipules at the leaf base. We use a simple thin rod model to show that despite their small size and sparse distribution, stipules impose a stem deformation sufficient to account for the measured squeezing force. We further demonstrate that tensioning of the stem helix, although counter-intuitive, is the most effective mechanism for generating large squeezing forces in twining plants. Our observations and model point to a general mechanism for the generation of the twining force: a modest radial stem expansion during primary growth, or the growth of lateral structures such as leaf bases, causes a delayed stem tensioning that creates the squeezing forces necessary for twining plants to ascend their supports. Our study thus provides the long-sought answer to the question of how twining plants ascend smooth supports without the use of adhesive or hook-like structures.     

Current shunting and formation of stationary shock waves during electric explosions of metal wires in air

Results of experiments on the generation of shock waves during electric explosions of fine copper and tungsten wires in air are analyzed. The generation mechanism of stationary shock wave by a plasma piston formed during the shunting breakdown of the electrode gap in the course of a wire explosion is investigated. The role of structural elements of such discharges, such as the core, corona, and wire environment, is analyzed.     

Kinetics of adhesion of IgE-sensitized rat basophilic leukemia cells to surface-immobilized antigen in Couette flow.

Antigen-antibody systems provide the flexibility of varying the kinetics and affinity of molecular interaction and studying the resulting effect on adhesion. In a parallel-plate flow chamber, we measured the extent and rate of adhesion of rat basophilic leukemia cells preincubated with anti-dinitrophenyl IgE clones SPE-7 or H1 26. 82 to dinitrophenyl-coated polyacrylamide gel substrates in a linear shear field. Both of these IgEs bind dinitrophenyl, but H1 26.82 has a 10-fold greater on rate and a 30-fold greater affinity. Adhesion was found to be binary; cells either arrested irreversibly or continued at their unencumbered hydrodynamic velocity. Under identical conditions, more adhesion was seen with the higher affinity (higher on rate) IgE clone. At some shear rates, adhesion was robust with H1 26.82, but negligible with SPE-7. Reduction in receptor number or ligand density reduced the maximum level of adhesion seen at any shear rate, but did not decrease the shear rate at which adhesion was first observed. The spatial pattern of adhesion for both IgE clones is well represented by the first-order kinetic rate constant kad, and we have determined how kad depends on ligand and receptor densities and shear rate. The rate constant kad found with H1 26.82 was approximately fivefold greater than with SPE-7. The dependence of kad on site density and shear rate for SPE-7 is complex: kad increases linearly with antigen site density at low to moderate shear rates, but is insensitive to site density at high shear. kad increases with shear rate at low site density but decreases with shear at high site density. With H1 26.82, the functional dependence of kad with shear rate was similar. Although these data are consistent with the hypothesis that we have sampled both transport and reaction-limited adhesion regimes, they point out deficiencies in current theories describing cell attachment under flow.     

Systems analysis of primary Sjögren's syndrome pathogenesis in salivary glands identifies shared pathways in human and a mouse model

Bone tissue has an exceptional quality to regenerate to native tissue in response to injury. However, the fracture repair process requires mechanical stability or a viable biological microenvironment or both to ensure successful healing to native tissue. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. Preclinical and clinical studies using biologic agents like recombinant bone morphogenetic proteins have demonstrated an efficacy similar or better than that of autologous bone graft in acute fracture healing. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.