A Review of the Current Status of Bamboo Usage with Special Emphasis on Orthopedic Rehabilitation

It was found that bamboo has been extensively used as infrastructure material in Asia and Africa due to its exceptional properties. Its usage has ranged from simple fence construction to bridges. Bamboo, as a biodegradable and renewable material, has been used for construction purposes. Both the natural and engineered form of the Bamboo has become a center of focus for most research scientists, materials experts and most important research and development aspects of Industries. The physical and mechanical properties of Bamboo culm in its dry and green state have shown promising prospects and this has further established the need to put together a regulatory body that will help to monitor and create standards for testing and utilizing Bamboo. This paper considered the various applications of Bamboo culm both in the past and present. An area the authors considered in this paper is the use of Bamboo in orthopedics. The number of people with gait dysfunction is fast growing due to population growth, war, ageing and accidents. The cost of orthopedic devices essential to restore function and improve quality of life is not affordable for many. Earlier research in this area suggests that bamboo is a suitable material for orthopedic appliances, especially exoskeleton. Bamboo use in applications such as orthopedic rehabilitation is common in developing countries where traditional bonesetters (TBS) use splints to treat fracture. In spite of the innovative discovery made by researchers in the use of Bamboo, standardization is a major challenge especially in orthopedic application. The focus of our work revealed varieties of Bamboo application.

Orthopedic implants and devices for bone fractures and defects:Past,present and perspective

Bone is a unique tissue that is capable of repairing itself after damage.However,there are certain instances of fractures and defects that require clinical intervention for proper alignment and healing.As with any implant,careful consideration of the material used to create the implants to treat these problems is needed.If the incorrect material is chosen,the implants themselves can lead to bone fractures or defects,or bone healing may not take place at all.All three classes of biomaterials-metals,ceramics,and polymers-have been used in the treatment of both bone fractures and bone defects,and each has its own unique benefits and limitations for its applications.Furthermore,composites of these different materials have also been created to try to take advantage of all the different benefits offered by each different material.This review highlights different materials that have been used for the development of internal fixators and bone graft substitutes to treat fracture and bone defects as well as their limitations and needed future research.

Three-dimensional finite element analysis with different internal fixation methods through the anterior approach

BACKGROUND With the modernization of society and transportation in the last decades in China,the incidence of high-energy trauma increased sharply in China,including that of acetabular fractures.AIM To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.METHODS The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer.After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity,the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.RESULTS In the standing position,the maximum stress was 46.21 MPa.In the sitting position,the sacrum bore the simulated gravity load at the upper end.When comparing the five fixations,there were no significant differences in the stress mean values among groups(sitting:P=0.9794;standing:P=0.9741).In terms of displacement,the average displacement of the internal iliac plate group was smaller than that of the spring plate group(P=0.002),and no differences were observed between the other pairs of groups(all P>0.05).In the standing position,there were no significant differences in the mean value of displacement among the groups(P=0.2985).It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.CONCLUSION There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

Infection-responsive long-term antibacterial bone plates for open fracture therapy

The infections in open fracture induce high morbidity worldwide.Thus,developing efficient anti-infective orthopedic devices is of great significance.In this work,we designed a kind of infection-responsive long-term antibacterial bone plates.Through a facile and flexible volatilization method,a multi-aldehyde polysaccharide derivative,oxidized sodium alginate,was crosslinked with multi-amino compounds,gentamycin and gelatin,to fabricate a uniform coating on Ti bone plates via Schiff base reaction,which was followed by a secondary crosslinking process by glutaraldehyde.The double-crosslinked coating was stable under normal condition,and could responsively release gentamycin by the triggering of the acidic microenvironment caused by bacterial metabolism,owning to the pH-responsiveness of imine structure.The thickness of the coating was ranging from 22.0μm to 63.6μm.The coated bone plates(Ti-GOGs)showed infection-triggered antibacterial properties(>99%)and high biocompatibility.After being soaked for five months,it still possessed efficient antibacterial ability,showing its sustainable antibacterial performance.The in vivo anti-infection ability was demonstrated by an animal model of infection after fracture fixation(IAFF).At the early stage of IAFF,Ti-GOGs could inhibit the bacterial infection(>99%).Subsequently,Ti-GOGs could promote recovery of fracture of IAFF.This work provides a convenient and universal strategy for fabrication of various antibacterial orthopedic devices,which is promising to prevent and treat IAFF.

Role of locking plates in treatment of difficult ununited fractures： a clinical study

Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Mechanical tests on the reconstructed anterior cruciate ligament fixed with allogenetic cortical bone cross-pin on the femoral side

Background Anterior cruciate ligament reconstruction （ACLR） has developed dramatically in the last century.Now,ACLR has become a reliable and productive procedure.Patients feel satisfied in 〉90% cases.The aim of this study was to evaluate the feasibility of allogenetic cortical bone cross-pin （ACBCP） used as a clinical fixation method in anterior cruciate ligament reconstruction on the femoral side based on biomechanical tests in vitro.Methods The specimens were provided by the bone banks of the First Affiliated Hospital of People＇s Liberation Army of General Hospital from September 2011 to June 2012.Fresh deep frozen human allogenetic cortical bone was machined into cross-pins which is 4.0 mm in diameter and 75.0 mm in length.Biomechanical parameters compared with Rigidfix were collected while cross-pins were tested in double-shear test.The load-to-failure test and cycling test were carried out in a goat model to reconstruct anterior cruciate ligament with Achilles tendon autograft on the femoral side fixed by human 4.0 mm ACBCP and 3.3 mm Rigidfix served as control.Maximum failure load,yield load,and stiffness of fixation in single load-to-failure test were compared between the two groups.Cycle-specific stiffness and displacement at cycles 1,30,200,400,and 1 000 were also compared in between.Results In double-shear test both maximum failed load and yield load of 4.0 mm humanACBCP were （1 236.998±201.940） N.Maximum failed load and yield load of Rigidfix were （807.929±110.511） N and （592.483±58.821） N.The differences of maximum failed load and yield load were significant between ACBCP and Rigidfix,P 〈0.05.The shear strength of ACBCP and Rigidfix were （49.243±8.039） MPa and （34.637±3.439） MPa,respectively,P 〈0.05.In the load-to-failure test ex vivo,yield load and maximum failed load of ACBCP fixation complexity （（867.104±132.856）N,（1 032.243±196.281） N） were higher than those of Rigidfix （（640.935±42.836） N,（800.568±64.890） N,P 〈0.05）.However,stiffness did not differ significantly between ACBCP group （（247.116±31.897）N/mm） and Rigidfix group （（220.413±51.332） N/mm,P 〉0.05）.In the cycling test,the cycle-specific stiffness and displacement at cycles 1,30,200,400,and 1 000 did not differ significantly between the ACBCP group and Rigidfix group,P 〉0.05.Conclusions Allogenetic cortical bone cross-pin possesses satisfactory biomechanical profile which is safe for ACLR and suitable for an aggressive rehabilitation program.Animal and clinical tests should be recommended before clinical use to secure the ACBCP could successfully substituted by host new bone in vivo.