Cast selection and non-union rates for acute scaphoid fractures treated conservatively: a systematic review and meta-analysis.

Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively.

Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants.

Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.

Nanomechanical tribological characterisation of nanostructured titanium alloy surfaces using AFM: A friction vs velocity study.

Medical-grade titanium alloys used for orthopaedic implants are at risk from infections and complications such as wear and tear. We have recently shown that hydrothermally etched (HTE) nanostructures (NS) formed on the Ti6AlV4 alloy surfaces impart enhanced anti-bacterial activity which results in inhibited formation of bacterial biofilm. Although these titanium alloy nanostructures may resist bacterial colonisation, their frictional properties are yet to be understood. Orthopaedic devices are encapsulated by bone and muscle tissue. Contact friction between orthopaedic implant surfaces and these host tissues may trigger inflammation, osteolysis and wear. To address these challenges, we performed simulation of the contact behaviour between a smooth control Ti6Al4V alloy and HTE surfaces against a hardwearing SiO2 sphere using Atomic Force Microscopy (AFM) in Lateral Force Microscopy mode. The friction study was evaluated in both air and liquid environments at high (5 Hz) and low (0.5 Hz) scan velocities. Lower scan velocities demonstrated opposing friction force changes between the two mediums, with friction stabilising at higher velocities. The friction measured on the NS alloy surfaces was reduced by ~20% in air and ~80% in phosphate buffered saline, in comparison to the smooth control surface, displaying a non-linear behaviour of the force applied by the AFM tip. Changes in friction values and cantilever scan velocities on different substrates are discussed with respect to the Stribeck curve. Reduced friction on nanostructured surfaces may improve wear resistance and aid osseointegration.

Traumatic Complex Scaphoid Dislocation With Radial Carpal Disruption: A Case Report.

Background. Scaphoid dislocation with radial carpal disruption constitutes an extremely rare injury, and there are no clear guidelines for treatment. This article reviews a delayed presentation of this injury and its surgical management.

Surgical Management of Bronchobiliary Fistula After Thoracoabdominal Trauma.

Bronchobiliary fistulas are exceedingly rare pathological connections between the biliary and the bronchial systems, which result from hepatobiliary neoplasms, abscesses, or thoracoabdominal trauma. Prompt recognition, diagnosis, and intervention is essential in order to prevent the high morbidity and mortality associated with this disease process. Multiple management strategies have been described in the literature; however, the optimal course has not been well defined. We present a case of a 31-year-old male who developed a bronchobiliary fistula 1 month after thoracoabdominal trauma. After conservative management with biliary stenting failed, he successfully underwent latissimus sparing right posterolateral thoracotomy, complete fistulectomy, right lower lobe wedge resection, and diaphragmatic reconstruction with subsequent resolution of his symptoms.

Acute Ulnar Neurapraxia and Carpal Tunnel Syndrome in the Context of a Distal Radius Fracture.

Distal radius fractures, carpal tunnel syndrome, and ulnar nerve compression are common causes of symptoms that result in patients presenting for hand evaluation. This is a unique case of a distal radius fracture leading to both carpal tunnel syndrome and ulnar nerve compression requiring urgent operative management.

Mechanics of Bacterial Interaction and Death on Nanopatterned Surfaces.

Nanopatterned surfaces are believed to kill bacteria through physical deformation, a mechanism that has immense potential against biochemical resistance. Because of its elusive nature, this mechanism is mostly understood through biophysical modeling. Problematically, accurate descriptions of the contact mechanics and various boundary conditions involved in the bacteria-nanopattern interaction remain to be seen. This may underpin conflicting predictions, found throughout the literature, regarding two important aspects of the mechanism-that is, its critical action site and relationship with geometry. Herein, a robust computational analysis of bacteria-nanopattern interaction is performed using a three-dimensional finite element modeling that incorporates relevant continuum mechanical properties, multilayered envelope structure, and adhesion interaction conditions. The model is applied to more accurately study the elusory mechanism and its enhancement via nanopattern geometry. Additionally, micrographs of bacteria adhered on a nanopatterned cicada wing are examined to further inform and verify the major modeling predictions. Together, the results indicate that nanopatterned surfaces do not kill bacteria predominantly by rupture in between protruding pillars as previously thought. Instead, nondevelopable deformation about pillar tips is more likely to create a critical site at the pillar apex, which delivers significant in-plane strains and may locally rupture and penetrate the cell. The computational analysis also demonstrates that envelope deformation is increased by adhesion to nanopatterns with smaller pillar radii and spacing. These results further progress understanding of the mechanism of nanopatterned surfaces and help guide their design for enhanced bactericidal efficiency.

Trends in Bactericidal Nanostructured Surfaces: An Analytical Perspective.

Since the discovery of the bactericidal properties of cicada wing surfaces, there has been a surge in the number of studies involving antibacterial nanostructured surfaces (NSS). Studies show that there are many parameters (and thus, thousands of parameter combinations) that influence the bactericidal efficiency (BE) of these surfaces. Researchers attempted to correlate these parameters to BE but have so far been unsuccessful. This paper presents a meta-analysis and perspective on bactericidal NSS, aiming to identify trends and gaps in the literature and to provide insights for future research. We have attempted to synthesize data from a wide range of published studies and establish trends in the literature on bactericidal NSS. Numerous research gaps and findings based on correlations of various parameters are presented here, which will assist in the design of efficient bactericidal NSS and shape future research. Traditionally, it is accepted that BE of NSS depends on the bacterial Gram-stain type. However, this review found that factors beyond Gram-stain type are also influential. Furthermore, it is found that despite their higher BE, hydrophobic NSS are less commonly studied for their bactericidal effect. Interestingly, the impacts of surface hydrophobicity and roughness on the bactericidal effect were found to be influenced by a Gram-stain type of the tested bacteria. In addition, cell motility and shape influence BE, but research attention into these factors is lacking. It was found that hydrophobic NSS demonstrate more promising results than their hydrophilic counterparts; however, these surfaces have been overlooked. Confirming the common belief of the influence of nanofeature diameter on bactericidal property, this analysis shows the feature aspect ratio is also decisive. NSS fabricated on silicon substrates perform better than their titanium counterparts, and the success of these silicon structures maybe attributed to the fabrication processes. These insights benefit engineers and scientists alike in developing next-generation NSS.

A systematic approach towards biomimicry of nanopatterned cicada wings on titanium using electron beam lithography.

The interaction of bacteria on nanopatterned surfaces has caught attention since the discovery of the bactericidal property of cicada wing surfaces. While many studies focused on the inspiration of such surfaces, nanolithography-based techniques are seldom used due to the difficulties in fabricating highly dense (number of pillars per unit area), geometrical nanostructured surfaces. Here we present a systematic modelling approach for optimising the electron beam lithography parameters in order to fabricate biomimicked nanopillars of varying patterned geometries. Monte Carlo simulation was applied to optimize the beam energy and pattern design prior to the experimental study. We optimized the processing parameters such as exposure factor, write field size, pitch, the different types and thicknesses of the PMMA resist used, and the shape of the feature (circle or a dot) for the fabrication of nanopillars to achieve the best lift-off with repeatable result. Our simulation and experimental results showed that a circle design with a voltage of 30 kV and 602 nm thickness of PMMA 495 A4 as base layers and 65 nm of PMMA 950 A2 as top layer achieves the best results. The antibacterial activity was also validated on the representative fabricated titanium nanopillar surface. The surface with a base diameter of 94.4 nm, spike diameter of 12.6 nm, height of 115.6 nm, density of 43/µm2, aspect ratio of 2.16 and centre to centre distance of 165.8 nm was the optimum surface for antibacterial activity. Such a systematic design approach for fabrication of insect wing-mimicked closely packed nanopillars have not been investigated before which provides an excellent platform for biomedical Ti implants.

Antiviral and Antibacterial Nanostructured Surfaces with Excellent Mechanical Properties for Hospital Applications.

With the rise of bacterial and viral infections including the recent outbreak of coronavirus, the requirement for novel antimicrobial strategies is also rising with urgency. To solve this problem, we have used a wet etching technique to fabricate 23 nm wide nanostructures randomly aligned as ridges on aluminum (Al) 6063 alloy surfaces. The surfaces were etched for 0.5, 1, and 3 h. The surfaces were characterized using scanning electron microscopy, energy-dispersive X-ray spectroscopy, contact angle goniometry, nanoindentation and atomic force microscopy. Strains of the Gram negative bacteria Pseudomonas aeruginosa and the Gram positive bacteria Staphylococcus aureus were used to evaluate the bacterial attachment behavior. For the first time, common respiratory viruses, respiratory syncytial virus (RSV) and rhinovirus (RV), were investigated for antiviral activity on nanostructured surfaces. It was found that the etched Al surfaces were hydrophilic and the nanoscale roughness enhanced with the etching time with Rrms ranging from 69.9 to 995 nm. Both bacterial cells of P. aeruginosa and S. aureus were physically deformed and were nonviable upon attachment after 3 h on the etched Al 6063 surface. This nanoscale surface topography inactivated 92 and 87% of the attached P. aeruginosa and S. aureus cells, respectively. The recovery of infectious RSV was also reduced significantly within 2 h of exposure to the nanostructured surfaces compared to the smooth Al control surfaces. There was a 3-4 log10 reduction in the viability counts of rhinovirus after 24 h on the nanostructured surfaces. The nanostructured surfaces exhibited excellent durability as the surfaces sustained 1000 cycles of 2000 µN load without any damage. This is the first report that has shown the combined antibacterial and antiviral property of the nanostructured surface with excellent nanomechanical properties that could be potentially significant for use in hospital environments to stop the spread of infections arising from physical surfaces.

Antiviral Nanostructured Surfaces Reduce the Viability of SARS-CoV-2.

In this letter, we report the ability of the nanostructured aluminum Al 6063 alloy surfaces to inactivate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There was no recoverable viable virus after 6 h of exposure to the nanostructured surface, elucidating a 5-log reduction compared to a flat Al 6063 surface. The nanostructured surfaces were fabricated using wet-etching techniques which generated nanotextured, randomly aligned ridges approximately 23 nm wide on the Al 6063 alloy surfaces. In addition to the excellent mechanical resilience properties previously shown, the etched surfaces have also demonstrated superior corrosion resistance compared to the control surfaces. Such nanostructured surfaces have the potential to be used in healthcare environment such as hospitals and public spaces to reduce the surface transmission of SARS-CoV-2 and combat COVID-19.

A nanopillar array on black titanium prepared by reactive ion etching augments cardiomyogenic commitment of stem cells.

A major impediment in the clinical translation of stem cell therapy has been the inability to efficiently and reproducibly direct differentiation of a large population of stem cells. Thus, we aimed to engineer a substrate for culturing stem cells to efficiently induce cardiomyogenic lineage commitment. In this work, we present a nanopillar array on the surface of titanium that was prepared by mask-less reactive ion etching. Scanning electron and atomic force microscopy revealed that the surface was covered by vertically aligned nanopillars each of ≈1 µm with a diameter of ≈80 nm. The nanopillars supported the attachment and proliferation of human mesenchymal stem cells (hMSCs). Cardiomyogenic lineage commitment of the stem cells was more enhanced on the nanopillars than on the smooth surface. When co-cultured with neonatal rat cardiomyocytes, the cyclic pattern of calcium transport observed distinctly in cells differentiated on the arrays compared to the cells cultured on the smooth surface was the functional validation of differentiation. The use of small molecule inhibitors revealed that integrins namely, α2ß1 and αvß3, are essential for cardiomyogenesis on the nanostructured surface, which is further mediated by FAK, Erk and Akt cell signaling pathways. This study demonstrates that the nanopillar array efficiently promotes the cardiomyogenic lineage commitment of stem cells via integrin-mediated signaling and can potentially serve as a platform for the ex vivo differentiation of stem cells toward cell therapy in cardiac tissue repair and regeneration.

Mimicking Insect Wings: The Roadmap to Bioinspiration.

Insect wings possess unique, multifaceted properties that have drawn increasing attention in recent times. They serve as an inspiration for engineering of materials with exquisite properties. The structure-function relationships of insect wings are yet to be documented in detail. In this review, we present a detailed understanding of the multifunctional properties of insect wings, including micro- and nanoscale architecture, material properties, aerodynamics, sensory perception, wettability, optics, and antibacterial activity, as investigated by biologists, physicists, and engineers. Several established modeling strategies and fabrication methods are reviewed to engender novel ideas for biomimetics in diverse areas.

Multi-biofunctional properties of three species of cicada wings and biomimetic fabrication of nanopatterned titanium pillars.

Recently, multi-biofunctional properties of cicada wings have drawn keen interest for biomedical device applications due to their superhydrophobic, self-cleaning and bactericidal effects. We present a systematic evaluation of bactericidal and cytocompatible properties of cicada wings. We also present biomimetic nanofabrication of a patterned array of titanium nanopillars using electron beam lithography. We have characterized the nanoscale architecture of the wings of three different Australian species of cicadas (Psaltoda claripennis, Aleeta curvicosta and Palapsalta eyrei) using helium ion microscopy (HIM), scanning electron microscopy, atomic force measurement (AFM) and transmission electron microscopy (TEM). The chemical nature of the nanopatterned substrates was investigated using Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS). Pseudomonas aeruginosa and Staphylococcus aureus cells were attached to determine the bactericidal activity of the insect wings. Human osteoblast cells were attached to examine the biocompatibility of the insect wings. It was found that all the three cicada species have unique surface topography on their wing membranes and veins. The height, spacing, diameter, density and aspect ratio of the three species varied between the species and between the membrane and the veins. The density and aspect ratio of the nanopillars on the membranes were significantly higher than on the veins. Bacterial attachment investigation confirmed that P. aeruginosa cells and S. aureus cells were damaged by the nanopatterned array of pillars. A significant reduction in colonies of P. aeruginosa cells was found on the wings of the three species compared to the control after 18 hours. A significant reduction of S. aureus cells on the wings was observed at 2 and 4 hours but not at 18 hours compared to the control. The cell morphology of the human osteoblast cells appeared intact after 24 hours of attachment, indicating the biocompatibility of the insect wings. As a proof of concept, patterned nanopillars of titanium have been fabricated using the electron beam lithography technique directly inspired by the cicada wing architecture. The titanium nanopillars were observed to damage the bacterial cells of P. aeruginosa in a manner similar to the cicada wing species and remain compatible to osteoblast cells. The outcomes of this research can help to engineer an optimum nano-patterned surface to enhance the bioactivity and bactericidal effect on biomedical devices.

Engineering an in vitro organotypic model for studying cardiac hypertrophy.

Neonatal cardiomyocytes cultured on flat surfaces are commonly used as a model to study cardiac failure of diverse origin. A major drawback of such a system is that the cardiomyocytes do not exhibit alignment, organization and calcium transients, similar to the native heart. Therefore, there is a need to develop in vitro platforms that recapitulate the cellular microenvironment of the murine heart as organotypic models to study cardiovascular diseases. In this study, we report an engineered platform that mimics cardiac cell organization and function of the heart. For this purpose, microscale ridges were fabricated on silicon using ultraviolet lithography and reactive ion etching techniques. Physical characterization of the microstructures was done using scanning electron microscopy and atomic force microscopy. Cardiomyocytes grown on these micro-ridges showed global parallel alignment and elliptical nuclear morphology as observed in the heart. Interestingly, calcium currents traversed the engineered cardiomyocytes in a coordinated and directional manner. Moreover, the cardiomyocytes on the engineered substrates were found to be responsive to hypertrophic stimuli, as observed by the expression of a fetal gene, atrial natriuretic peptide and increase in calcium transients upon agonist treatment. Taken together, our work demonstrates that micro-ridges can be used to obtain cardiomyocyte response in vitro, which closely resembles mammalian heart.

Multi-scale surface topography to minimize adherence and viability of nosocomial drug-resistant bacteria.

Toward minimizing bacterial colonization of surfaces, we present a one-step etching technique that renders aluminum alloys with micro- and nano-scale roughness. Such a multi-scale surface topography exhibited enhanced antibacterial effect against a wide range of pathogens. Multi-scale topography of commercially grade pure aluminum killed 97% of Escherichia coli and 28% of Staphylococcus aureus cells in comparison to 7% and 3%, respectively, on the smooth surfaces. Multi-scale topography on Al 5052 surface was shown to kill 94% of adhered E. coli cells. The microscale features on the etched Al 1200 alloy were not found to be significantly bactericidal, but shown to decrease the adherence of S. aureus cells by one-third. The fabrication method is easily scalable for industrial applications. Analysis of roughness parameters determined by atomic force microscopy revealed a set of significant parameters that can yield a highly bactericidal surface; thereby providing the design to make any surface bactericidal irrespective of the method of fabrication. The multi-scale roughness of Al 5052 alloy was also highly bactericidal to nosocomial isolates of E. coli, K. pneumoniae and P. aeruginosa. We envisage the potential application of engineered surfaces with multi-scale topography to minimize the spread of nosocomial infections.

Nanoscale Topography on Black Titanium Imparts Multi-biofunctional Properties for Orthopedic Applications.

We have developed a chlorine based reactive ion etching process to yield randomly oriented anisotropic nanostructures that render the titanium metal surface 'black' similar to that of black silicon. The surface appears black due to the nanostructures in contrast to the conventional shiny surface of titanium. The nanostructures were found to kill bacteria on contact by mechanically rupturing the cells as has been observed previously on wings of certain insects. The etching was optimized to yield nanostructures of ≈1 µm height for maximal bactericidal efficiency without compromising cytocompatibility. Within 4 hours of contact with the black titanium surface, 95% ± 5% of E. coli, 98% ± 2% of P. aeruginosa, 92% ± 5% of M. smegmatis and 22% ± 8% of S. aureus cells that had attached were killed. The killing efficiency for the S. aureus increased to 76% ± 4% when the cells were allowed to adhere up to 24 hours. The black titanium supported the attachment and proliferation of human mesenchymal stem cells and augmented osteogenic lineage commitment in vitro. Thus, the bioinspired nanostructures on black titanium impart multi-biofunctional properties toward engineering the next-generation biomaterials for orthopedic implants.

Recent advances in engineering topography mediated antibacterial surfaces.

The tendency of bacterial cells to adhere and colonize a material surface leading to biofilm formation is a fundamental challenge underlying many different applications including microbial infections associated with biomedical devices and products. Although, bacterial attachment to surfaces has been extensively studied in the past, the effect of surface topography on bacteria-material interactions has received little attention until more recently. We review the recent progress in surface topography based approaches for engineering antibacterial surfaces. Biomimicry of antibacterial surfaces in nature is a popular strategy. Whereas earlier endeavors in the field aimed at minimizing cell attachment, more recent efforts have focused on developing bactericidal surfaces. However, not all such topography mediated bactericidal surfaces are necessarily cytocompatible thus underscoring the need for continued efforts for research in this area for developing antibacterial and yet cytocompatible surfaces for use in implantable biomedical applications. This mini-review provides a brief overview of the current strategies and challenges in the emerging field of topography mediated antibacterial surfaces.

Engineering a nanostructured "super surface" with superhydrophobic and superkilling properties.

We present a nanostructured "super surface" fabricated using a simple recipe based on deep reactive ion etching of a silicon wafer. The topography of the surface is inspired by the surface topographical features of dragonfly wings. The super surface is comprised of nanopillars 4 µm in height and 220 nm in diameter with random inter-pillar spacing. The surface exhibited superhydrophobicity with a static water contact angle of 154.0° and contact angle hysteresis of 8.3°. Bacterial studies revealed the bactericidal property of the surface against both gram negative (Escherichia coli) and gram positive (Staphylococcus aureus) strains through mechanical rupture of the cells by the sharp nanopillars. The cell viability on these nanostructured surfaces was nearly six-fold lower than on the unmodified silicon wafer. The nanostructured surface also killed mammalian cells (mouse osteoblasts) through mechanical rupture of the cell membrane. Thus, such nanostructured super surfaces could find applications for designing self-cleaning and anti-bacterial surfaces in diverse applications such as microfluidics, surgical instruments, pipelines and food packaging.