A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis

doi:10.1186/s12891-020-03465-1

. 2020 Jul 1;21(1):421.

doi: 10.1186/s12891-020-03465-1.

A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis

Jian Lu^{1

2

3}, Qi-Yang Wang¹, Jia-Gen Sheng¹, Shang-Chun Guo^{4

5}, Shi-Cong Tao⁶

Affiliations

¹ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
² Department of Orthopedic Surgery, Shanghai Fengxian Central Hospital, Branch of The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 201400, China.
³ Department of Medicine, Soochou University, Suzhou, 215123, Jiangsu, China.
⁴ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. achuni@126.com.
⁵ Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. achuni@126.com.
⁶ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. jerrytao1990@outlook.com.

PMID: 32611412
PMCID: PMC7331224
DOI: 10.1186/s12891-020-03465-1

A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis

Jian Lu et al. BMC Musculoskelet Disord. 2020.

. 2020 Jul 1;21(1):421.

doi: 10.1186/s12891-020-03465-1.

Authors

Jian Lu^{1

2

3}, Qi-Yang Wang¹, Jia-Gen Sheng¹, Shang-Chun Guo^{4

5}, Shi-Cong Tao⁶

Affiliations

¹ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
² Department of Orthopedic Surgery, Shanghai Fengxian Central Hospital, Branch of The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 201400, China.
³ Department of Medicine, Soochou University, Suzhou, 215123, Jiangsu, China.
⁴ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. achuni@126.com.
⁵ Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. achuni@126.com.
⁶ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. jerrytao1990@outlook.com.

PMID: 32611412
PMCID: PMC7331224
DOI: 10.1186/s12891-020-03465-1

Abstract

Background: Although double-plate fixation (DP), i.e., fixation with a combination of a main lateral plate (LP) and a support medial plate (MP), is a relatively mature method for treating femoral shaft non-union with bone defect causes complications. The purpose of this study was to evaluate LP fixation with a 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system (LP + 3DpbsBRS) as an alternative with less collateral damage.

Methods: Structure-specific finite element modelling was used to simulate femoral shaft non-union with bone defects and treatment with an LP only as the blank control. Then, the peak von Mises stress (VMS), the VMS distribution, and the plate displacement were determined to compare the effectiveness of LP + CBG (cancellous bone grafting), DP + CBG, and LP + 3DpbsBRS under 850 N of axial force.

Results: Our results indicated that the peak VMS was 260.2 MPa (LP + 3DpbsBRS), 249.6 MPa (MP in DP + CBG), 249.3 MPa (LP in DP + CBG), and 502.4 MPa (LP + CBG). The bending angle of the plate was 1.2° versus 1.0° versus 1.1° versus 2.3° (LP + 3DpbsBRS versus MP in DP + CBG versus LP in DP + CBG versus LP + CBG).

Conclusion: The 3DpbsBRS in the LP + 3DpbsBRS group could replace the MP in the DP + CBG group by providing similar medial mechanical support. Furthermore, avoiding the use of an MP provides better protection of the soft tissue and vasculature.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Femoral model development. a 3D geometric models established in Mimics. b Sampling and surface building for geometry in Geomagic. c Compiling and meshing the fundamental 3D models in HyperMesh. (D) A 15-mm transverse osteotomy plane was made at the mid-end of the femur (168 mm from the lateral femoral condyle) to simulate femoral shaft non-union with bone defects

**Fig. 2**
Establishment of four models (cases) for subsequent finite element analysis. a LP only group. b LP + CBG group. c DP + CBG group. d LP + 3DpbsBRS group. 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system; LP, lateral plate; CBG, cancellous bone grafting; DP, double-plate

**Fig. 3**
Establishment of the 3DpbsBRS. a Schematic of the loading force from the focal point of the femoral head to the midpoint of the femoral condyle. b The case 2 model was used for the finite element analysis. c von Mises stress distribution of cancellous bone. d Customized 3DpbsBRS according to the stress distribution of cancellous bone. 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system

**Fig. 4**
General observation of the stress distribution and deformation. a LP only group. b LP + CBG group. c DP + CBG group. d LP + 3DpbsBRS group. 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system; LP, lateral plate; CBG, cancellous bone grafting; DP, double-plate

**Fig. 5**
VMS distribution in the plate. a Unified scale for the VMS distribution. b LP + CBG group. c DP + CBG group. d LP + 3DpbsBRS group. VMS, von Mises stress; 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system; LP, lateral plate; CBG, cancellous bone grafting; DP, double-plate

**Fig. 6**
Deformation conditions in the four models (cases). a Unified scale for plate deformation. b Plate deformation in the LP + CBG group. c Plate deformation in the DP + CBG group. d Plate deformation in the LP + 3DpbsBRS group. e Visualized general model of displacement in the LP only group. f Visualized general model of displacement in the LP + CBG group. g Visualized general model of displacement in the DP + CBG group. h Visualized general model of displacement in the LP + 3DpbsBRS group. VMS, von Mises stress; 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system; LP, lateral plate; CBG, cancellous bone grafting; DP, double-plate

**Fig. 7**
Graphical demonstration of the peak VMS (a) and displacement (b) in three fixation constructs under 850 N of axial force. VMS, von Mises stress; 3DpbsBRS, 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system; LP, lateral plate; MP, medial plate; CBG, cancellous bone grafting; DP, double-plate

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References

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1. Tzioupis C, Giannoudis PV. Prevalence of long-bone non-unions. Injury. 2007;38(Suppl 2):S3–S9. doi: 10.1016/S0020-1383(07)80003-9. - DOI - PubMed
1. van Griensven M. Preclinical testing of drug delivery systems to bone. Adv Drug Deliv Rev. 2015;94:151–164. doi: 10.1016/j.addr.2015.07.006. - DOI - PubMed
1. Zhang H, Li J, Zhou J, Li L, Hao M, Wang K, Xu G, Li C, Zhang W, Tang P. Finite element analysis of different double-plate angles in the treatment of the femoral shaft nonunion with no cortical support opposite the primary lateral plate. Biomed Res Int. 2018;2018:3267107. - PMC - PubMed
1. Bozic KJ, Rosenberg AG, Huckman RS, Herndon JH. Economic evaluation in orthopaedics. J Bone Joint Surg-Am Vol. 2003;85A(1):129–142. doi: 10.2106/00004623-200301000-00021. - DOI - PubMed

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[1] Agarwal-Harding KJ, Meara JG, Greenberg SL, Hagander LE, Zurakowski D, Dyer GS. Estimating the global incidence of femoral fracture from road traffic collisions: a literature review. J Bone Joint Surg Am. 2015;97(6):e31. doi: 10.2106/JBJS.N.00314. - DOI - PubMed

[2] Agarwal-Harding KJ, Meara JG, Greenberg SL, Hagander LE, Zurakowski D, Dyer GS. Estimating the global incidence of femoral fracture from road traffic collisions: a literature review. J Bone Joint Surg Am. 2015;97(6):e31. doi: 10.2106/JBJS.N.00314. - DOI - PubMed

[3] Tzioupis C, Giannoudis PV. Prevalence of long-bone non-unions. Injury. 2007;38(Suppl 2):S3–S9. doi: 10.1016/S0020-1383(07)80003-9. - DOI - PubMed

[4] Tzioupis C, Giannoudis PV. Prevalence of long-bone non-unions. Injury. 2007;38(Suppl 2):S3–S9. doi: 10.1016/S0020-1383(07)80003-9. - DOI - PubMed

[5] van Griensven M. Preclinical testing of drug delivery systems to bone. Adv Drug Deliv Rev. 2015;94:151–164. doi: 10.1016/j.addr.2015.07.006. - DOI - PubMed

[6] van Griensven M. Preclinical testing of drug delivery systems to bone. Adv Drug Deliv Rev. 2015;94:151–164. doi: 10.1016/j.addr.2015.07.006. - DOI - PubMed

[7] Zhang H, Li J, Zhou J, Li L, Hao M, Wang K, Xu G, Li C, Zhang W, Tang P. Finite element analysis of different double-plate angles in the treatment of the femoral shaft nonunion with no cortical support opposite the primary lateral plate. Biomed Res Int. 2018;2018:3267107. - PMC - PubMed

[8] Zhang H, Li J, Zhou J, Li L, Hao M, Wang K, Xu G, Li C, Zhang W, Tang P. Finite element analysis of different double-plate angles in the treatment of the femoral shaft nonunion with no cortical support opposite the primary lateral plate. Biomed Res Int. 2018;2018:3267107. - PMC - PubMed

[9] Bozic KJ, Rosenberg AG, Huckman RS, Herndon JH. Economic evaluation in orthopaedics. J Bone Joint Surg-Am Vol. 2003;85A(1):129–142. doi: 10.2106/00004623-200301000-00021. - DOI - PubMed

[10] Bozic KJ, Rosenberg AG, Huckman RS, Herndon JH. Economic evaluation in orthopaedics. J Bone Joint Surg-Am Vol. 2003;85A(1):129–142. doi: 10.2106/00004623-200301000-00021. - DOI - PubMed

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A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis

Affiliations

A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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