New concept of 3D printed bone clip (polylactic acid/hydroxyapatite/silk composite) for internal fixation of bone fractures

Abstract Open reduction with internal fixation is commonly used for the treatment of bone fractures. However, postoperative infection associated with internal fixation devices (intramedullary nails, plates, and screws) remains a significant complication, and it is technically difficult to fix multiple fragmented bony fractures using internal fixation devices. In addition, drilling in the bone to install devices can lead to secondary fracture, bone necrosis associated with postoperative infection. In this study, we developed bone clip type internal fixation device using three- dimensional (3D) printing technology. Standard 3D model of the bone clip was generated based on computed tomography (CT) scan of the femur in the rat. Polylacticacid (PLA), hydroxyapatite (HA), and silk were used for bone clip material. The purpose of this study was to characterize 3D printed PLA, PLA/HA, and PLA/HA/Silk composite bone clip and evaluate the feasibility of these bone clips as an internal fixation device. Based on the results, PLA/HA/Silk composite bone clip showed similar mechanical property, and superior biocompatibility compared to other types of the bone clip. PLA/HA/Silk composite bone clip demonstrated excellent alignment of the bony segments across the femur fracture site with well-positioned bone clip in an animal study. Our 3D printed bone clips have several advantages: (1) relatively noninvasive (drilling in the bone is not necessary), (2) patient-specific design (3) mechanically stable device, and (4) it provides high biocompatibility. Therefore, we suggest that our 3D printed PLA/HA/Silk composite bone clip is a possible internal fixation device.

[1]  Dong Wook Kim,et al.  Fabrication and characterization of hydrocolloid dressing with silk fibroin nanoparticles for wound healing , 2016, Tissue Engineering and Regenerative Medicine.

[2]  Zhongmin Jin,et al.  A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures , 2016, International Orthopaedics.

[3]  Wei Zheng,et al.  An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures , 2015, Biomedical materials.

[4]  Adam E M Eltorai,et al.  Three-Dimensional Printing in Orthopedic Surgery. , 2015, Orthopedics.

[5]  C. Kao,et al.  Poly(dopamine) coating of 3D printed poly(lactic acid) scaffolds for bone tissue engineering. , 2015, Materials science & engineering. C, Materials for biological applications.

[6]  Zhanglin Wu,et al.  Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report. , 2015, International journal of clinical and experimental medicine.

[7]  Anthony Atala,et al.  Essentials of 3D Biofabrication and Translation , 2015 .

[8]  J. Parvizi,et al.  Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors. , 2015, The archives of bone and joint surgery.

[9]  Zhongmin Jin,et al.  Application of 3D printed customized external fixator in fracture reduction. , 2015, Injury.

[10]  J. Demol,et al.  One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection , 2015, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[11]  D. Meaney,et al.  The mechanics of traumatic brain injury: a review of what we know and what we need to know for reducing its societal burden. , 2014, Journal of biomechanical engineering.

[12]  P. Tak,et al.  Relationship between inflammation, bone destruction, and osteoproliferation in the HLA-B27/human β2 -microglobulin-transgenic rat model of spondylarthritis. , 2012, Arthritis and rheumatism.

[13]  Jung Min Lee,et al.  Biodegradation behavior of silk fibroin membranes in repairing tympanic membrane perforations. , 2012, Journal of biomedical materials research. Part A.

[14]  P. Törmälä,et al.  Fixation of distal femoral osteotomies with self-reinforced polymer/bioactive glass rods: an experimental study on rabbits. , 2004, Biomaterials.

[15]  Stephan M Perren,et al.  Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. , 2002, The Journal of bone and joint surgery. British volume.

[16]  P. Törmälä,et al.  Fixation of distal femoral osteotomies with self-reinforced poly(desamino tyrosyl–tyrosine ethyl ester carbonate) rods: an experimental study on rats , 2002, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[17]  P. Nordström.  Self-reinforced polyglycolide and poly-levo-lactide pins in implantation and fixation of osteotomies in cancellous bone : An experimental study on rats , 2001 .

[18]  O. Böstman,et al.  Bioabsorbable fixation in orthopaedic surgery and traumatology. , 2000, Biomaterials.

[19]  O. Böstman,et al.  Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: a review. , 2000, Biomaterials.

[20]  James H Henderson,et al.  Self-deploying shape memory polymer scaffolds for grafting and stabilizing complex bone defects: A mouse femoral segmental defect study. , 2016, Biomaterials.

[21]  K. Moharamzadeh,et al.  HPLC analysis of components released from dental composites with different resin compositions using different extraction media , 2007, Journal of materials science. Materials in medicine.

[22]  R. Ganz,et al.  Biological internal fixation of fractures , 2004, Archives of Orthopaedic and Trauma Surgery.