Show simple item record

AuthorWindolf, Markusdc.contributor.author
Date of accession2019-04-17T14:04:11Zdc.date.accessioned
Available in OPARU since2019-04-17T14:04:11Zdc.date.available
Year of creation2014dc.date.created
Date of first publication2014-09dc.date.issued
AbstractThe incidence of osteoporotic fractures will drastically increase in the future as a result of the worldwide demographic change. New challenges for the health care system include not only the rising number of elderly fracture patients requiring surgical treatment, but also the increasing complexity of the single intervention. Post-op mechanical complications occur due to diminished bone mass rendering fracture stabilization considerably difficult. New treatment strategies are needed to encounter these developments. Within the scope of this thesis, a 3-step approach for osteoporotic fracture management is evaluated from a biomechanical perspective in 20 individual experimental studies. The approach involves: 1. A novel concept for intra-operative assessment of bone strength as potentially important parameter for surgical decision making. 2. A novel design of bone fixation elements, optimized for enhanced anchorage in diminished bone mass: the helical blade. 3. Application of bone cement at the implant-bone interface for additional reinforcement of the implant purchase. Performance of a bone-strength measuring device was experimentally investigated at the hip, in spine and at the hind-foot. The device involves insertion of a probe into cancellous bone and measurement of the trabeculae's breakaway torque by turning the probe. Measured values correlated significantly with the mechanical fatigue performance of the bone-implant construct. The device output could be used e.g. for decisions on application of bone cement or on a specific implant. With regard to implant design, the performance of a helical blade for use in osteoporotic bone was experimentally evaluated. At the proximal femur, at the hind-foot and at the proximal humerus, the blade revealed a statistically significant but rather moderate biomechanical advantage over threated bone screws. It was believed that the improvement may result from cancellous bone compaction while inserting the blade. However, further studies suggested that, contrary to common thinking, compaction does not contribute to enhanced mechanical anchorage of the fixation device. From these experiences, it was hypothesized that in severely porotic bone, the potential of conventional metallic implants is exploited. The additional strategy of implant augmentation with bone cement was biomechanically investigated in several anatomical key-regions: the proximal femur, the proximal tibia, the hind-foot and the proximal humerus. The experiments revealed a significant potential to enhance fracture fixation in porotic bone, but also suggest that cement augmentation cannot be applied as a routine concept. Potential risk factors associated with cement application, such as generation of heat and pressure, were experimentally judged to draw a comprehensive picture of the concept to increase confidence for clinical use.dc.description.abstract
Languageendc.language.iso
PublisherUniversität Ulmdc.publisher
Has part(p1) Arens D, Rothstock S, Windolf M, Boger A: Bone marrow modified acrylic bone cement for augmentation of osteoporotic cancellous bone. J Mech Behav Biomed Mater 4:2081-2089 (2011). - doi:10.1016/j.jmbbm.2011.07.007dc.relation.haspart
Has part(p2) Blankstein M, Widmer D, Gotzen M, Hofmann-Fliri L, Richards RG, Gueorguiev B, Windolf M: Assessment of Intra-osseous Femoral Head Pressures During Cement Augmentation of The Perforated Proximal Femur Nail Antirotation (PFNA) blade J Orthop Trauma 28:398-402 (2014). - DOI: 10.1097/BOT.0000000000000069dc.relation.haspart
Has part(p3) Blazejak M, Hofmann-Fliri L, Buchler L, Gueorguiev B, Windolf M: In vitro temperature evaluation during cement augmentation of proximal humerus plate screw tips. Injury 44:1321-1326 (2013). - https://doi.org/10.1016/j.injury.2013.04.028dc.relation.haspart
Has part(p4) Brianza S, Plecko M, Gueorguiev B, Windolf M, Schwieger K: Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model. Clin Biomech (Bristol , Avon ) 25:886- 892 (2010). - https://doi.org/10.1016/j.clinbiomech.2010.06.015dc.relation.haspart
Has part(p5) Deckelmann S, Schwyn R, van der Pol B, Windolf M, Heini PF, Benneker LM: DensiProbe Spine: A Novel Instrument for Intraoperative Measurement of Bone Density in Transpedicular Screw Fixation. Spine (Phila Pa 1976 ) 35:607-612 (2010). - DOI: 10.1097/BRS.0b013e3181bc9470dc.relation.haspart
Has part(p6) Fliri L, Lenz M, Boger A, Windolf M: Ex vivo evaluation of the polymerization temperatures during cement augmentation of proximal femoral nail antirotation blades. J Trauma Acute Care Surg 72:1098-1101 (2012). - DOI: 10.1097/TA.0b013e318248bfa7dc.relation.haspart
Has part(p7) Goetzen M, Nicolino T, Hofmann-Fliri L, Blauth M, Windolf M: Metaphyseal screw augmentation with PMMA of the LISS-PLT plate improves angular stability in osteoporotic proximal third tibia fractures - a biomechanical study in human cadaveric tibiae. J Orthop Trauma 28:294-299 (2014). - DOI: 10.1097/BOT.0000000000000004dc.relation.haspart
Has part(p8) Klos K, Gueorguiev B, Schwieger K, Frober R, Brodt S, Hofmann GO, Windolf M, Muckley T: Comparison of calcaneal fixation of a retrograde intramedullary nail with a fixed-angle spiral blade versus a fixed-angle screw. Foot Ankle Int 30:1212-1218. - https://doi.org/10.3113/FAI.2009.1212dc.relation.haspart
Has part(p9) Klos K, Muckley T, Wahnert D, Zwipp H, Gueorguiev BG, Schwieger K, Hofmann GO, Windolf M: [The use of DensiProbe in hindfoot arthrodesis. Can fusion failure be predicted by mechanical bone strength determination?]. Z Orthop Unfall 149:206- 211. - DOI: 10.1055/s-0030-1250106. - (Nur Abdruck des Manuskripts möglich)dc.relation.haspart
Has part(p10) Klos K, Wahnert D, Gueorguiev B, Schwieger K, Hofmann GO, Windolf M, Muckley T: Development of a technique for cement augmentation of nailed tibiotalocalcaneal arthrodesis constructs. Clin Biomech (Bristol , Avon ) 25:576-581 (2010). - https://doi.org/10.1016/j.clinbiomech.2010.03.006dc.relation.haspart
Has part(p11) Roderer G, Scola A, Schmolz W, Gebhard F, Windolf M, Hofmann-Fliri L: Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures. Injury 44:1327-1332 (2013). - https://doi.org/10.1016/j.injury.2013.05.008dc.relation.haspart
Has part(p12) Sermon A, Boner V, Boger A, Schwieger K, Boonen S, Broos PL, Richards RG, Windolf M: Potential of polymethylmethacrylate cement-augmented helical proximal femoral nail antirotation blades to improve implant stability--a biomechanical investigation in human cadaveric femoral heads. J Trauma Acute Care Surg 72:E54- E59 (2012). - DOI: 10.1097/TA.0b013e31821852eddc.relation.haspart
Has part(p13) Sermon A, Boner V, Schwieger K, Boger A, Boonen S, Broos P, Richards G, Windolf M: Biomechanical evaluation of bone-cement augmented Proximal Femoral Nail Antirotation blades in a polyurethane foam model with low density. Clin Biomech (Bristol , Avon ) 27:71-76 (2012). - https://doi.org/10.1016/j.clinbiomech.2011.07.006dc.relation.haspart
Has part(p14) Sermon A, Hofmann-Fliri L, Richards RG, Flamaing J, Windolf M: Cement augmentation of hip implants in osteoporotic bone: How much cement is needed and where should it go? J Orthop Res 32:362-368 (2014). - https://doi.org/10.1002/jor.22522dc.relation.haspart
Has part(p15) Suhm N, Hengg C, Schwyn R, Windolf M, Quarz V, Hanni M: Mechanical torque measurement predicts load to implant cut-out: a biomechanical study investigating DHS anchorage in femoral heads. Arch Orthop Trauma Surg 127:469-474 (2007). - https://doi.org/10.1007/s00402-006-0265-8dc.relation.haspart
Has part(p16) Von der Linden P, Gisep A, Boner V, Windolf M, Appelt A, Suhm N: Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures. J Orthop Res 24:2230-2237 (2006). - DOI 10.1002/jor.20299dc.relation.haspart
Has part(p17) Wähnert D, Gudushauri P, Schiuma D, Richards G, Windolf M: Does cancellous bone compaction due to insertion of a blade implant influence the cut-out resistance? A biomechanical study. Clin Biomech (Bristol , Avon ) 25:1053-1057 (2010). - https://doi.org/10.1016/j.clinbiomech.2010.08.003dc.relation.haspart
Has part(p18) Wähnert D, Hofmann-Fliri L, Schwieger K, Brianza S, Raschke MJ, Windolf M: Cement augmentation of lag screws: an investigation on biomechanical advantages. Arch Orthop Trauma Surg 133:373-379 (2013). - DOI 10.1007/s00402-012-1676-3dc.relation.haspart
Has part(p19) Windolf M, Braunstein V, Dutoit C, Schwieger K: Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol , Avon ) 24:59-64 (2009). - https://doi.org/10.1016/j.clinbiomech.2008.07.004dc.relation.haspart
Has part(p20) Windolf M, Muths R, Braunstein V, Gueorguiev B, Hanni M, Schwieger K: Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance. Clin Biomech (Bristol , Avon ) 24:53-58 (2009). - https://doi.org/10.1016/j.clinbiomech.2008.09.005dc.relation.haspart
LicenseStandarddc.rights
Link to license texthttps://oparu.uni-ulm.de/xmlui/license_v3dc.rights.uri
KeywordImplantdc.subject
KeywordHelical bladedc.subject
Dewey Decimal GroupDDC 610 / Medicine & healthdc.subject.ddc
MeSHOsteoporosisdc.subject.mesh
MeSHFracture fixationdc.subject.mesh
MeSHFractures, bonedc.subject.mesh
MeSHOsteoporotic fracturesdc.subject.mesh
MeSHBone cementdc.subject.mesh
MeSHProstheses and implantsdc.subject.mesh
MeSHBlade implantationdc.subject.mesh
TitleFracture fixation in osteoporotic bonedc.title
Resource typeDissertationdc.type
Date of acceptance2014-07-17dcterms.dateAccepted
RefereeDürselen, Lutzdc.contributor.referee
RefereeRöderer, Götzdc.contributor.referee
DOIhttp://dx.doi.org/10.18725/OPARU-13726dc.identifier.doi
PPN1666410861dc.identifier.ppn
URNhttp://nbn-resolving.de/urn:nbn:de:bsz:289-oparu-13783-3dc.identifier.urn
GNDOsteoporosedc.subject.gnd
GNDKnochenbruchdc.subject.gnd
GNDImplantatdc.subject.gnd
GNDKnochenzementdc.subject.gnd
FacultyMedizinische Fakultätuulm.affiliationGeneral
InstitutionUKU. Institut für Unfallchirurgische Forschung und Biomechanikuulm.affiliationSpecific
InstitutionUKU. Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgieuulm.affiliationSpecific
Grantor of degreeMedizinische Fakultätuulm.thesisGrantor
DCMI TypeTextuulm.typeDCMI
CategoryPublikationenuulm.category
Bibliographyuulmuulm.bibliographie


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record