External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study.

BACKGROUND: To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. METHODS: From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. RESULTS: Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). CONCLUSION: Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

Depth-dependent ratcheting strains of young and adult articular cartilages by experiments and predictions.

BACKGROUND: Ratcheting strain is produced due to the repeated accumulation of compressive strain in cartilage and may be a precursor to osteoarthritis. The aim of this study was to investigate the ratcheting behaviors of young and adult articular cartilages under cyclic compression by experiments and theoretical predictions. METHODS: A series of uniaxial cyclic compression tests were conducted for young and adult cartilage, and the effects of different loading conditions on their ratcheting behaviors were probed. A theoretical ratcheting model was constructed and applied to predict the ratcheting strains of young and adult cartilages with different loading conditions. RESULTS: Ratcheting strains of young and adult cartilages rapidly increased at the initial stage, followed by a slower increase in subsequent stages. The strain accumulation value and its rate for young cartilage were greater than them for adult cartilage. The ratcheting strains of the two groups of cartilage samples decreased with increasing stress rate, while they increased with increasing stress amplitude. As the stress amplitude increased, the gap between the ratcheting strains of young and adult cartilages increased gradually. The ratcheting strains of young and adult cartilages decreased along the cartilage depth from the surface to the deep layer. The ratcheting strains of different layers increased with the compressive cycle, and the difference among the three layers was noticeable. Additionally, the theoretical predictions agreed with the experimental data. CONCLUSIONS: Overall, the ratcheting behavior of articular cartilage is affected by the degree of articular cartilage maturation.

Irrigating degradation properties of silk fibroin-collagen type II composite cartilage scaffold in vitro and in vivo.

Silk fibroin-collagen type II scaffolds are promising in cartilage tissue engineering due to their suitable biological functionality to promote proliferation of chondrocytes in vitro. However, their degradation properties, which are of crucial importance as scaffold degradation should consistent with the new tissue formation process, are still unknown. In this study, degradability of silk fibroin-collagen type II cartilage scaffolds was probed both in vitro and in vivo. In vitro degradation experiments show that the scaffolds decreased 32.25 % ± 0.62 %, 34.27 % ± 0.96 %, 36.27 % ± 2.39 % in weight after 8 weeks of degradation at the irrigation velocity of 0 mL/min, 7.89 mL/min and 15.79 mL/min. The degradation ratio, which increases with time and increasing irrigation velocity, is described by combining the built mathematic model and finite element modeling method. The scaffolds after 8 weeks of degradation in vitro keep their mechanical structural integrity to support new tissues. In vivo degradation experiments conducted in rabbits further show that the scaffolds degrade gradually, be absorbed with time and finally collapse in structure. The degradation process is accompanied by the growth of fibrous tissues and the scaffold is filled by fibrous tissues after 12 weeks of implantation. Immunohistology analysis shows that the inflammation caused by scaffolds is controllable and gradually alleviates with time. To sum up, silk fibroin-collagen type II cartilage scaffolds, which show suitable mechanical properties and biocompatibility during degradation in vitro and in vivo, have great potential in cartilage repair. The novelty of the study is that it not only introduces a mathematical model to predict the irrigation degradation ratio, but also provides experimental degradation data support for clinical application of silk fibroin-collagen type II cartilage scaffolds.

Mechanical property and biocompatibility of silk fibroin-collagen type II composite membrane.

Osteoarthritis is caused by injuries and cartilage degeneration. Cartilage tissue engineering provides new ideas for the treatment of osteoarthritis. Herein, the different ratios composite membranes of silk fibroin/collagen type II were constructed (SF50-50:50, SF70-70:30, SF90-90:10). The surface properties of the composite membranes and chondrocyte morphology were observed by SEM (scanning electron microscopy). Physical functionality as well as stability of composite membranes was evaluated from tensile mechanical properties, the percentage of swelling and degradation. The tensile mechanical behavior of SF70 composite membranes was also predicted based on the constitutive model established in this study, and it is found that the experimental results and predictions were in good agreement. Biocompatibility was evaluated using chondrocytes (ADTC-5) culture. Cell proliferation was analyzed and the treatment of live/dead double staining was performed to assess the viability on chondrocytes. To sum up, SF70 showed the suitable morphology, physical stability, and biological functionality to promote proliferation of chondrocytes. This indicates that the mixing ratio of SF70 shows promise in the future as a scaffold material for cartilage repair.

Quasi-static and ratcheting properties of trabecular bone under uniaxial and cyclic compression.

The quasi-static and ratcheting properties of trabecular bone were investigated by experiments and theoretical predictions. The creep tests with different stress levels were completed and it is found that both the creep strain and creep compliance increase rapidly at first and then increase slowly as the creep time goes by. With increase of compressive stress the creep strain increases and the creep compliance decreases. The uniaxial compressive tests show that the applied stress rate makes remarkable influence on the compressive behaviors of trabecular bone. The Young's modulus of trabecular bone increases with increase of stress rate. The stress-strain hysteresis loops of trabecular bone under cyclic load change from sparse to dense with increase of number of cycles, which agrees with the change trend of ratcheting strain. The ratcheting strain rate rapidly decreases at first, and then exhibits a relatively stable and small value after 50cycles. Both the ratcheting strain and ratcheting strain rate increase with increase of stress amplitude or with decrease of stress rate. The creep model and the nonlinear viscoelastic constitutive model of trabecular bone were proposed and used to predict its creep property and rate-dependent compressive property. The results show that there are good agreements between the experimental data and predictions.

Ratcheting behavior of articular cartilage under cyclic unconfined compression.

The ratcheting deformation of articular cartilage can produce due to the repeated accumulations of compressive strain in cartilage. The aim of this study was to investigate the ratcheting behavior of articular cartilage under cyclic compression. A series of uniaxial cyclic compression tests were conducted for online soaked and unsoaked cartilage samples and the effects of stress variation and stress rate on ratcheting behavior of cartilage were investigated. It is found that the ratcheting strains of online soaked and unsoaked cartilage samples increase rapidly at initial stage and then show the slower increase with cyclic compression going on. On the contrary, the ratcheting strain rate decreases quickly at first and then exhibits a relatively stable and small value. Both the ratcheting strain and ratcheting strain rate increase with stress variation increasing or with stress rate decreasing. Simultaneously, the optimized digital image correlation (DIC) technique was applied to study the ratcheting behavior and Young's modulus of different layers for cartilage under cyclic compression. It is found that the ratcheting behavior of cartilage is dependent on its depth. The ratcheting strain and its rate decrease through the depth of cartilage from surface to deep, whereas the Young's modulus increases.

Depth and rate dependent mechanical behaviors for articular cartilage: experiments and theoretical predictions.

An optimized digital image correlation (DIC) technique was applied to investigate the depth-dependent mechanical properties of articular cartilage and simultaneously the depth-dependent nonlinear viscoelastic constitutive model of cartilage was proposed and validated. The creep tests were performed with different stress levels and it is found that the initial strain and instantaneous strain increase; however the creep compliance decreases with the increase of compressive stress. The depth-dependent creep strain of cartilage was obtained by analyzing the images acquired using the optimized DIC technique. Moreover the inhomogeneous creep compliance distributions within the tissues were determined at different creep time points. It is noted that both creep strain and creep compliance with different creep times decrease from cartilage surface to deep. The depth-dependent creep compliance increases with creep time and the increasing amplitude of creep compliance decreases along cartilage depth. The depth-dependent and stress rate dependent nonlinear stress and strain curves were obtained for articular cartilage through uniaxial compression tests. It is found that the Young's modulus of cartilage increases obviously along cartilage depth from superficial layer to deep layer and the Young's modulus of different layers for cartilage increases with the increase of stress rate. The Poisson's ratio of cartilage increases along cartilage depth with given compressive strain and the Poisson's ratio of different layers decreases with the increase of compressive strain. The depth-dependent nonlinear viscoelastic constitutive model was proposed and some creep data were applied to determine the parameters of the model. The depth-dependent compressive behaviors of cartilage were predicted by the model and the results show that there are good agreements between the experimental data and predictions.

Strain distribution in the intervertebral disc under unconfined compression and tension load by the optimized digital image correlation technique.

The unconfined compression and tension experiments of the intervertebral disc were conducted by applying an optimized digital image correlation technique, and the internal strain distribution was analysed for the disc. It was found that the axial strain values of different positions increased obviously with the increase in loads, while inner annulus fibrosus and posterior annulus fibrosus experienced higher axial strains than the outer annulus fibrosus and anterior annulus fibrosus. Deep annulus fibrosus exhibited higher compressive and tensile axial strains than superficial annulus fibrosus for the anterior region, while there was an opposite result for the posterior region. It was noted that all samples demonstrated a nonlinear stress-strain profile in the process of deforming, and an elastic region was shown once the sample was deformed beyond its toe region.

Depth-dependent strain fields of articular cartilage under rolling load by the optimized digital image correlation technique.

It is significant to investigate the depth-dependent mechanical behaviors of articular cartilage under rolling load since considerable rolling occurs for cartilage joint in activities of daily living. In this study, the rolling experiments of articular cartilage were conducted by applying an optimized digital image correlation (DIC) technique for the first time and the depth-dependent normal strain and shear strain of cartilage were analyzed. It is found that the normal strain and shear strain values of different layers increase firstly and then decrease with rolling time, and they increase with increasing compressive strains. The normal strain and shear strain values decrease along cartilage depth with constant compressive strain. The normal strain values of different normalized depth decrease with increasing rolling rates. The shear strain values of superficial layer and middle layer decrease; however there are no major changes for the shear strain values of deep layer with increasing rolling rates. The normal strain values with different rolling time increase with increasing rolling numbers and the 30.6% increase in initial normal strain is observed from 1st to 99th cycle. The fitting relationship of the normal strain and normalized depth was obtained considering the effects of compressive strain and rolling rate and the fitting curves agree with the experimental results for cartilage very well.