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Evaluating and Improving and Emergent Technology for Fixation of Bone Fractures

骨折固定的评估、改进和新兴技术

基本信息

批准号：
7268144
负责人：
MICHAEL BOTTLANG
金额：
$ 16.77万
依托单位：
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-07-01 至 2009-05-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Each year, 6.2 million extremity fractures are treated in the US at a cost in excess of $13 billion. Even today, 5-8% of these fractures experience complications in fixation and healing, which presents a significant secondary, but preventable, public health issue. Locked plating is thought to be one of the most important, present-day advancements in fracture fixation. It preserves periosteal blood supply and may improve fixation in osteoporotic bone. As such, it provides a tremendous opportunity to improve the healing rate in problematic high-energy fractures and osteoporotic fractures alike. By providing a potential solution to a pressing clinical challenge, locked plating technology has gained rapid and widespread acceptance despite the virtual absence of supportive data. This enthusiasm is in stark contrast to the 13-21% failure rates found in recent clinical reports on locked plates. The majority of these clinical complications manifest as delayed unions or non-unions. The likely reason for these complications is the high stiffness of locked plate constructs, which can suppress the interfragmentary motion required for secondary bone healing. Unlike conventional plates, locked plates rely on secondary bone healing by callus formation. As a solution to this problem inherent to locked plating, we have explored a novel strategy, termed Far Cortical Locking (FCL), capable of reducing the stiffness of locked plate constructs while retaining sufficient fixation strength. The proposed in vivo study will investigate for the first time, how locked plating affects fracture healing in an ovine fracture model. In addition, we will test if stiffness-reduced FCL fixation can enhance fracture healing. Specific Aim 1 will compare periosteum-sparing locked plating and conventional plating to determine if biology-preserving locked plates can improve fracture healing. Specific Aim 2 will compare locked plating and FCL plating to determine if stiffness-reduced FCL constructs can improve fracture healing. Specific Aim 3 will compare FCL plating to standard conventional plating to evaluate the combined benefit of biology-preservation and reduced stiffness provided by FCL plating. This proposed exploratory and developmental research constitutes an urgent first step toward evaluation and optimization of locked plating technology on a scientific basis. Results will have direct clinical implications by providing a long-overdue evaluation of readily adopted locked plating technology. Furthermore, results may direct the future evolution of locked plate technology by providing a working solution to an inherent problem associated with contemporary locked plates.

描述（由申请人提供）：美国每年治疗 620 万例四肢骨折，费用超过 130 亿美元。即使在今天，仍有 5-8% 的骨折在固定和愈合过程中出现并发症，这是一个重要的次要但可预防的公共卫生问题。锁定钢板被认为是当今骨折固定领域最重要的进步之一。它可以保留骨膜血液供应，并可以改善骨质疏松骨的固定。因此，它为提高有问题的高能量骨折和骨质疏松性骨折的愈合率提供了巨大的机会。尽管实际上缺乏支持数据，但通过为紧迫的临床挑战提供潜在的解决方案，锁定电镀技术已获得快速和广泛的接受。这种热情与最近的锁定板临床报告中发现的 13-21% 的失败率形成鲜明对比。大多数这些临床并发症表现为延迟愈合或不愈合。这些并发症的可能原因是锁定钢板结构的高刚度，这会抑制二次骨愈合所需的碎片间运动。与传统钢板不同，锁定钢板依靠愈伤组织形成的二次骨愈合。作为锁定钢板固有问题的解决方案，我们探索了一种称为远皮层锁定（FCL）的新策略，能够降低锁定钢板结构的刚度，同时保持足够的固定强度。拟议的体内研究将首次研究锁定钢板如何影响绵羊骨折模型中的骨折愈合。此外，我们将测试降低刚度的 FCL 固定是否可以促进骨折愈合。具体目标 1 将比较保留骨膜的锁定钢板和传统钢板，以确定生物保护锁定钢板是否可以改善骨折愈合。具体目标 2 将比较锁定钢板和 FCL 钢板，以确定降低刚度的 FCL 结构是否可以改善骨折愈合。具体目标 3 将比较 FCL 电镀与标准传统电镀，以评估 FCL 电镀提供的生物保存和降低刚度的综合效益。这项探索性和发展性的研究是在科学基础上评估和优化锁定电镀技术的紧迫的第一步。通过对易于采用的锁定电镀技术提供早就该进行的评估，结果将具有直接的临床意义。此外，通过为与当代锁定板相关的固有问题提供可行的解决方案，结果可能会指导锁定板技术的未来发展。