Materials and Techniques Used in Cranioplasty Fixation: A Review

Cranioplasty is the surgical repair of a deficiency or deformity of the skull. The purpose of cranioplasty is to provide protection for the brain following cranial surgery, and to offer relief to psychological disadvantages while increasing social performance. There are several materials that had been used for cranioplasty, but an ideal product has yet to be developed, hence the ongoing research into biologic and non-biologic alternatives to the existing materials. This article critiques the products currently used for cranioplasty in order to facilitate the development of new materials, which can improve patient outcomes

Common Treatments and Procedures Used for Fractures of the Distal Radius and Scaphoid: A Review

The distal radius and the scaphoid are the most commonly injured carpal bones among both active adults and the osteoporotic elderly. The purpose of surgical treatment is to restore form and function to the wrist. Depending on the nature of the fracture, either topical procedures or invasive surgery can be applied. This article critiques the treatments currently used for fixation of wrist fractures in order to drive the development of new materials to improve patient outcomes

Incorporating Germanium Oxide into the Glass Phase of Novel Zinc/Magnesium-Based GPCs Designed for Bone Void Filling: Evaluating Their Physical and Mechanical Properties

The structural role of Germanium (Ge), when substituting for Zinc (Zn) up to 8 mol % in the 0.48SiO2–0.12CaO–0.36ZnO–0.04MgO glass series, was investigated with respect to both the glass chemistry and also the properties of glass polyalkenoate cements (GPCs) manufactured from them. The Network connectivity (NC) of the glass was calculated to increase from 1.83 to 2.42 with the addition of GeO2 (0–8 mol %). Differential thermal analysis (DTA) results confirmed an increase in the glass transition temperature (Tg) of the glass series with GeO2 content. X-ray photoelectron spectroscopy (XPS) showed an increase in the ratio of bridging oxygens (BO) to non-bridging oxygens (NBO) with the addition of GeO2, supporting the NC and DTA results. 29Si magic angle spinning nuclear magnetic resonance spectroscopy (29Si MAS-NMR) determined a chemical shift from −80.3 to −83.7 ppm as the GeO2 concentration increased. These ionomeric glasses were subsequently used as the basic components in a series of GPCs by mixing them with aqueous polyacrylic acid (PAA). The handling properties of the GPCs resulting were evaluated with respect to the increasing concentration of GeO2 in the glass phase. It was found that the working times of these GPCs increased from 3 to 15 min, while their setting times increased from 4 to 18 min, facilitating the injectability of the Zn/Mg-GPCs through a 16-gauge needle. These Ge-Zn/Mg-GPCs were found to be injectable up to 96% within 12 min. Zn/Mg-GPCs containing GeO2 show promise as injectable cements for use in bone void filling

The Effect of Mg²⁺ Incorporation into the Glass Phase of Zinc-Based Glass Polyalkenoate Cements

The suitability of glass polyalkenoate cements (GPCs) as injectable adhesives in orthopedics have been compromised by the presence of aluminum (Al), a component in the glass phase of all commercial GPCs. There has been considerable work on the development of Al-free GPCs which can be formulated based on calcium (Ca) zinc (Zn) silicate (Si) glasses. These materials, in terms of biocompatibility and mechanical properties, have potential for orthopedics. However, many of these experimental Al-free GPCs have setting times shorter than 60 s, restricting clinical applications. Here, the authors incorporate Magnesium (Mg) into the glass phase of Al-free GPCs in an attempt to extend their handling properties without deleteriously influencing strength. Three Mg-Ca-Zn-Si glasses with increasing amounts of Mg (up to 12 mol%) substituting for Ca were synthesized and GPCs were subsequently produced by mixing each glass with aqueous polyacrylic acid (PAA). The results show that Mg substituted for Ca in the glasses did significantly affect the chemical structure of the glasses by increasing the bridging oxygen to non-bridging oxygen (BO:NBO) ratio. The resultant GPCs exhibited extended working times, in line with Mg content in the glass, combined with significant increases in both compressive and biaxial flexural strength with both cement maturation and molecular weight of the PAA phase. Mg-based GPCs recorded working times of up to 145 s, setting times of up to 191 s, and compressive strengths in excess of 58 MPa after 30 days maturation. Thus, we have shown that Mg incorporation into Al-free ionomer glasses can result in GPCs formulated from them that have handling and mechanical properties suitable for orthopedic applications

Incorporating Germanium Oxide into the Glass Phase of Novel Zinc/Magnesium-Based GPCs Designed for Bone Void Filling: Evaluating Their Physical and Mechanical Properties

The structural role of Germanium (Ge), when substituting for Zinc (Zn) up to 8 mol % in the 0.48SiO2–0.12CaO–0.36ZnO–0.04MgO glass series, was investigated with respect to both the glass chemistry and also the properties of glass polyalkenoate cements (GPCs) manufactured from them. The Network connectivity (NC) of the glass was calculated to increase from 1.83 to 2.42 with the addition of GeO2 (0–8 mol %). Differential thermal analysis (DTA) results confirmed an increase in the glass transition temperature (Tg) of the glass series with GeO2 content. X-ray photoelectron spectroscopy (XPS) showed an increase in the ratio of bridging oxygens (BO) to non-bridging oxygens (NBO) with the addition of GeO2, supporting the NC and DTA results. 29Si magic angle spinning nuclear magnetic resonance spectroscopy (29Si MAS-NMR) determined a chemical shift from −80.3 to −83.7 ppm as the GeO2 concentration increased. These ionomeric glasses were subsequently used as the basic components in a series of GPCs by mixing them with aqueous polyacrylic acid (PAA). The handling properties of the GPCs resulting were evaluated with respect to the increasing concentration of GeO2 in the glass phase. It was found that the working times of these GPCs increased from 3 to 15 min, while their setting times increased from 4 to 18 min, facilitating the injectability of the Zn/Mg-GPCs through a 16-gauge needle. These Ge-Zn/Mg-GPCs were found to be injectable up to 96% within 12 min. Zn/Mg-GPCs containing GeO2 show promise as injectable cements for use in bone void filling

An Injectable Glass Polyalkenoate Cement Engineered for Fracture Fixation and Stabilization

Glass polyalkenoate cements (GPCs) have potential as bio-adhesives due to their ease of application, appropriate mechanical properties, radiopacity and chemical adhesion to bone. Aluminium (Al)-free GPCs have been discussed in the literature, but have proven difficult to balance injectability with mechanical integrity. For example, zinc-based, Al-free GPCs reported compressive strengths of 63 MPa, but set in under 2 min. Here, the authors design injectable GPCs (IGPCs) based on zinc-containing, Al-free silicate compositions containing GeO2, substituted for ZnO at 3% increments through the series. The setting reactions, injectability and mechanical properties of these GPCs were evaluated using both a hand-mix (h) technique, using a spatula for sample preparation and application and an injection (i) technique, using a 16-gauge needle, post mixing, for application. GPCs ability to act as a carrier for bovine serum albumin (BSA) was also evaluated. Germanium (Ge) and BSA containing IGPCs were produced and reported to have working times between 26 and 44 min and setting times between 37 and 55 min; the extended handling properties being as a result of less Ge. The incorporation of BSA into the cement had no effect on the handling and mechanical properties, but the latter were found to have increased compression strength with the addition of Ge from between 27 and 37 MPa after 30 days maturation

Glass Polyalkenoate Cements Designed for Cranioplasty Applications: An Evaluation of Their Physical and Mechanical Properties

Glass polyalkenoate cements (GPCs) have potential for skeletal cementation. Unfortunately, commercial GPCs all contain, and subsequently release, aluminum ions, which have been implicated in degenerative brain disease. The purpose of this research was to create a series of aluminum-free GPCs constructed from silicate (SiO₂), calcium (CaO), zinc (ZnO) and sodium (Na₂O)-containing glasses mixed with poly-acrylic acid (PAA) and to evaluate the potential of these cements for cranioplasty applications. Three glasses were formulated based on the SiO₂-CaO-ZnO-Na₂O parent glass (KBT01) with 0.03 mol % (KBT02) and 0.06 mol % (KBT03) germanium (GeO₂) substituted for ZnO. Each glass was then mixed with 50 wt % of a patented SiO₂-CaO-ZnO-strontium (SrO) glass composition and the resultant mixtures were subsequently reacted with aqueous PAA (50 wt % addition) to produce three GPCs. The incorporation of Ge in the glass phase was found to result in decreased working (142 s to 112 s) and setting (807 s to 448 s) times for the cements manufactured from them, likely due to the increase in crosslink formation between the Ge-containing glasses and the PAA. Compressive (σ_c) and biaxial flexural (σ_f) strengths of the cements were examined at 1, 7 and 30 days post mixing and were found to increase with both maturation and Ge content. The bonding strength of a titanium cylinder (Ti) attached to bone by the cements increased from 0.2 MPa, when placed, to 0.6 MPa, after 14 days maturation. The results of this research indicate that Germano-Silicate based GPCs have suitable handling and mechanical properties for cranioplasty fixation

A Review of Animal Models of Comorbidities in Fracture-Healing Research

There is clinical evidence that patient-specific comorbidities like osteoporosis, concomitant tissue injury and ischemia may strongly interfere with bone regeneration. However, underlying mechanisms are still unclear. To study these mechanisms in detail, appropriate animal models are needed. For decades, bone healing has been studied in large animals, including dogs, rabbits, pigs or sheep. However, large animal models display a limited ability to study molecular pathways and cellular functions. Therefore in recent years, mice and rats have become increasingly popular as a model organism for fracture healing research due to the availability of molecular analysis tools and transgenic models. Both large and small animals can be used to study comorbidities and risk factors, modelling the human clinical situation. However, attention has to be paid when choosing an appropriate model due to species differences between large animals, rodents and humans. This review focuses on large and small animal models for the common comorbidities ischemic injury/reduced vascularization, osteoporosis and polytrauma and critically discusses the translational and molecular aspects of these models. Here, we review material which was presented at the workshop "Animal Models of Comorbidities in Fracture Healing Research" at the 2019 ORS Annual Meeting in Austin Texas. This article is protected by copyright. All rights reserved

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies