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Boosting the Clinical Benefits of Bone Plating Fracture Fixation

By: , Posted on: March 13, 2017

“Boundaries between Clinical benefits and Biomechanical-Material-Biological parameters of trauma plating system/fixation”

Today, surgeons desire to enhance the clinical benefits of the trauma fracture fixation which encouraged manufacturers and researchers to improve the clinical advantages of trauma plating systems (as the main solution for bone fracture fixation). Implant developers modify the plating systems by enhancing the plate design and features to be more adopted with the fracture pattern or indication of use. However, feature based development strategies would be temporary attracting the surgeons and after a while the interest to the developed plating system with the upgraded features is reduced and could not eliminate the risk of malunion and nonunion in fixation of multi-fragmentary fractures in poor quality bones. In order to promote and reduce such complications, insight studies are nowadays carrying out to investigate the various effective biomechanical, material, and biological parameters on clinical outcomes of trauma plating fixation. However, combination of these all parameters in one new plating system has not been explored as a possible solution to enhance fixation stability of the fracture fixation and ultimately eliminate or significantly reduce the rate of malunion or nonunion in treatment of multi-fragmentary fractures in poor quality bones. In this respect, the book Trauma Plating Systems has been developed as a compiled reference book to review, discuss, and challenge the effective biomechanical, material, and biological parameters on clinical outcomes of trauma plating fixation.

In view of Biomechanical parameters; Trauma Plating Systems reviewed basic biomechanical concepts and fundamentals of cancellous and cortical bones (section I – chapter 1 to 3). The principles and specific concepts and challenges of trauma plating systems, biomechanical evaluation methods, and biomechanics of plating fixation are then comprehensively expressed (section II – chapter 4 to 6). Review of these principles would allow insight expression the effect of biomechanical parameters on clinical benefits and outcome of trauma plating fixation. In section IV (chapter 10 to 15), more common bone fracture fixations (fractures in humerus, radius, ulna, femur, tibia, hand & foot, pelvic, and clavicle bones) are individually described. The main biomechanical concepts of plating fixation are reviewed for each plating fixation. Then the most challenging and controversy clinical and biomechanical concerns of each plating fixation are discussed with exploration of new justifications which have not been discussed in relevant publications.

From that, based on the mechanical fundamentals and technology of each fixation system, possible reasons are also highlighted for further improvements of plating fixation. For instance, in literature it was stated that, in fixation of distal femoral fractures, plating fixation has higher strength under torsion stress compared to the intramedullary nailing fixation while the strength under compressive stress is higher in nailing fixation. Possible reasons along with clinical privileges have been discussed for this biomechanical finding in chapter 12. As other example, for fixation of distal tibial fractures, various types of plates have been introduced based on the fracture pattern at the distal metaphyseal and diaphyseal tibia bone. The biomechanical and clinical benefits of each plating fixation method have been discussed in chapter 13.

Due to existence of various biomechanical-clinical interactions (in some cases might be conflict), biomechanical evaluation methods are also reviewed in this book (section II – chapter 5 in general and section IV – chapters 10 to 15 individually for each bone fracture fixation). The suitability of these methods to address the strength of plating system under physiological conditions is discussed and relevant clinical advantages and disadvantages of the fixation methods are highlighted.

With the sight of Biological parameters; effective healing of the bone fractures is the key of successful clinical outcomes in treatment of bone fractures. Generally, the current systems made of titanium alloy or stainless steel has shown good clinical outcomes, fixing the fractured bones with good or normal mineral density. Clinical studies have revealed that the stability of the plating fixation could not be guaranteed in treatment of poor quality fractured bones. In such bones, the rate of comminuted or multi-fragmentary fractures is significant and therefore small bone fragments are created in trauma bone injuries.

Buttressing advantage of plating fixation with plate and screw could enhance the stability of the bone fragments close to the plate and not far fragments. Thus, long screws are used to capture the far bone fragment which has been found not effective to fix the fragment under dynamic physiological loading conditions and prevent its dislocation during healing period. On the other hand, capturing of the bone fragments with screws might be affected by the poor integration of the bone tissue through the screw threads. It could be highlighted that, the biological interaction between the screw and bone, particularly cancellous bone, greatly influences on the stability of plating fixation under dynamic physiological loading conditions. This would necessitate development of the screw-bone integration strength in future development of the trauma plating systems. Trauma Plating Systems discusses this important issue with respected malunion and nonunion complications in section IV (chapter 10 to 15) for each bone fracture plating fixation.

By looking at the Material parameters; material inherent characteristics such as; biocompatibility and corrosion resistance, mechanical properties, biodegradability or inertness, and bioactivity (osseointegration, osseoinductivity, osseoconductivity) are all affecting the biomechanical and biological interaction of the trauma plating systems with bone tissues. This would enhance or reduce the quality of fracture plating fixation which ultimately result in good or unsatisfactory clinical outcomes. Trauma Plating Systems  provides a rigorous review of the current (stainless steel, titanium alloy, and cobalt chromium alloy) and promising (PEEK composites and magnesium alloys) materials in section III (chapter 7 to 9). For each material, all mentioned characteristics are reviewed and its advantages/disadvantages of their use in trauma plating system are discussed.

Trauma Plating Systems is an effective, amazing, and smooth platform of review, discussion, and evaluation of the trauma plating fixation on the basis of literature findings, scientific fundamentals, and authors’ discussion and judgments. In addition of various interesting biomechanical, material, biological, and clinical topics related to the “Trauma Plating Systems”, the concept of Advance Healing Fixation System (AHealFS) is thoroughly introduced in chapter 16. AHealFS enhances the integration of bone-screw and reduces the effect of stress shielding in early and final stages of fracture healing. Likewise, this system deducts the need for implant removal and if removal is desired would reduce the integration of bone-screw after union of the fracture to facilitate easier removal of the implant.

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