nitinol and Fractures--Bone

The use of nitinol continuous compression staples has shown clinical utility in the management of various orthopaedic injuries. While literature is most robust in the realm of foot/ankle and spine surgery, the use of nitinol staples has been documented in fixation of wrist, olecranon, patella, and pelvis fractures.. A narrative review was conducted by searching three online databases - PubMed, Web of Science, and Cochrane using the terms "Nitinol" and "Staple" published between 2003 and 2023. A total of 42 articles met inclusion/exclusion criteria and were included in this review.. Literature outside of foot/ankle and spine surgery is largely limited to biomechanical studies, case reports, and finite element analyses. The literature is summarized within this review by anatomic location including foot/ankle, lower extremity, hand, upper extremity, spine, and pelvis.. Existing literature demonstrates a diverse array of applications for nitinol continuous compression staples in both axial and appendicular orthopaedic care. Advantages of these implants include ease of application, ability to capture small bony fragments, continuous compression across a fracture or arthrodesis, and full coaptation which maximizes the surface area for healing and/or fusion.

Topics: Alloys; Arthrodesis; Fractures, Bone; Humans; Orthopedics

Shape-memory alloy (SMA) staples are a recent innovation in fracture fixation. These staples have inherent compressive properties that create a stable fracture environment that promotes primary bone healing. They have been used successfully for osteotomies, arthrodesis, and fracture fixation. Understanding where SMA staple compression can be optimized and using proper indications are important for obtaining consistent success and minimizing failures. SMA staples are not a substitute for lag screw fixation or traditional plate and screw constructs.

Topics: Acetabulum; Adult; Alloys; Biomechanical Phenomena; Clavicle; Compressive Strength; Equipment Design; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Pelvic Bones; Radius Fractures; Sutures; Ulna Fractures

In the last twenty-five years a large variety of research has been carried out in Russia using Shape Memory Alloys (SMA), particularly nearly equiatomic NiTi alloys, for medical applications. In this field of activity, Russian research centers have been quite successful in treating different kinds of diseases, from bone fractures to dental implants. This review is intended to give a panorama of SMA medical applications in Russia in order to illustrate the remarkable possibilities offered by SMA materials in the medical field.

Topics: Alloys; Biocompatible Materials; Composite Resins; Dental Implants; Equipment Design; Fractures, Bone; Humans; Materials Testing; Russia; Surgical Equipment

Reconstruction of the scaphoid with use of NITINOL shape "memory" staples.. Unstable fractures and nonunion of the middle third of the scaphoid, which need open reduction and internal fixation from palmar. The staples can only be used, if the arms of the staples can be inserted parallel to and at a distance of 3 mm to the fracture line.. Allergy to nickel. Cases in which the arms of the staple cannot be inserted parallel to and at best 3 mm apart from the fracture line.. In fractures, open reduction of the scaphoid through a palmar approach. If necessary, interposition of a bone graft and Kirschner wire transfixation. Drilling of the drill holes parallel and at a distance of 3 mm to the fracture line. Insertion of the NITINOL staple. In nonunion, excision of the fibrous nonunion, refreshening of the fracture surfaces, interposition of a bone graft and, if needed, fixation with a Kirschner wire. Drilling of the drill holes for the NITINOL staple and insertion of the staple. Within a few minutes the warming-up staple contracts and thereby compresses the scaphoid.. Immobilization in a short cast with thumb support for 6 weeks. Control for bone healing by radiographs or computed tomography. Staples, which do not cause hardware problems, are not removed. Kirschner wires are removed after bone healing.. From October 1995 to December 2006, the authors used NITINOL staples for 65 osteosyntheses of the scaphoid. Indications were 15 unstable fractures, 47 nonunions, and three partial necroses. 61 out of 65 scaphoids healed without further surgery, three of the 61 patients showed a delayed healing. Two of the four nonunions were related to the use of the NITINOL staples. Seven staples were removed, one for loosening. NITINOL shape memory staples have proven to be very helpful for osteosynthesis in fractures and nonunion of the scaphoid, if the prerequisites are given for their use.

Topics: Adult; Alloys; Equipment Failure Analysis; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Prosthesis Design; Scaphoid Bone; Sutures; Treatment Outcome

To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.. Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert's classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score.. All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation (. Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.. 评估镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围脱位的临床疗效。.. 2011 年 9 月—2018 年 10 月，采用镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围背侧脱位型患者 17 例。男 12 例，女 5 例；年龄 23～52 岁，平均 32.6 岁。病程 8 h～9 d，平均 6.5 d。致伤原因：摔伤 6 例，交通事故伤 4 例，运动致腕部应力性损伤 3 例，机器撞击致腕部暴力性损伤 2 例，军事训练致伤 1 例，其他伤 1 例。合并神经损伤 1 例。根据 Herbert 分型均为 B4 型。术前 1 周及术后 3、6 个月和末次随访时根据 Krimmer 评分表评价腕关节功能。.. 17 例患者术后均获随访，随访时间 10.5～48 个月，平均 18.6 个月。术后无内固定物松动、感染以及舟、月骨坏死发生。患者月骨周围脱位均复位良好，舟骨骨折均愈合，愈合时间为 4～18 个月，平均 11.3 个月。术前 1 周，术后 3、6 个月及末次随访时 Krimmer 腕关节评分分别为（37.5±4.4）、（61.3±7.2）、（83.3±9.3）、（87.3±8.2）分。术后各时间点 Krimmer 腕关节评分均较术前显著改善，术后 6 个月及末次随访时较术后 3 个月显著改善，差异均有统计学意义（. 镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围脱位疗效确切，手术操作简便，术后腕关节功能恢复良好。.

Topics: Adult; Alloys; Bone Wires; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Male; Middle Aged; Scaphoid Bone; Treatment Outcome; Young Adult

In the management of scaphoid fractures, nonunion is an important complication that can lead to carpal instability and early-onset arthritis. Various techniques have been described to treat scaphoid nonunions, yet a clear consensus on the superiority of one method is not yet established. The use of compression staple fixation has been described in the literature and may be a viable alternative to other fixation techniques. Volar Nitinol staple fixation avoids damage to the trapezium during retrograde fixation with a screw. It also avoids damage to the proximal dorsal cartilage, which occurs during anterograde screw fixation. Because of its shape and position on the volar aspect of the scaphoid, staple fixation provides compression, prevents graft extrusion, and avoids taking up space in the medullary canal of the scaphoid. Moreover, it may be technically easier than screw fixation. Despite these advantages, this technique has not been widely adopted. We describe the technique for utilizing Nitinol compression staples and bone grafting in the treatment of scaphoid nonunion.

Topics: Alloys; Fracture Fixation; Fractures, Bone; Fractures, Ununited; Humans; Ilium; Postoperative Care; Radius; Scaphoid Bone; Surgical Stapling

Nitinol has been shown to generate durable compression under loading via pseudoelastic shape memory. The purpose of this study was to evaluate the effectiveness of a hindfoot arthrodesis nail with an internal pseudoelastic nitinol compression element. Patients who had undergone tibiotalocalcaneal arthrodesis from 2013 to 2016 were identified at 2 tertiary referral centers (12-week follow-up minimum). Patients managed with a tibiotalocalcaneal nail with an internal nitinol compression element were identified for review. Sagittal computed tomographic scan reformats were reviewed to calculate a percentage of joint surface bony union. Intraoperative and postoperative radiographs were compared to calculate postoperative screw position change generated by the nitinol element, a surrogate for postoperative unloading of compressive forces. Thirty-three patients were included in analysis and 81% of patients had successful union of both tibiotalar and subtalar joints. Overall, 90% of all arthrodesis surfaces united. The union rate of arthrodesis surfaces among patients without Charcot osteoarthropathy was 94%. A history of Charcot was identified as a risk factor for subtalar nonunion (p = .04) and was associated with less complete computed tomography-based tibiotalar union: 94% versus 71% (p < .01). The posterior-to-anterior screw translated an average of 3.9 mm proximally relative to the rigid portion of the nail from intraoperative to initial postoperative radiographs (p < .0001). High rates of computed tomography-confirmed union were demonstrated in the face of challenging clinical scenarios. Shortening of the pseudoelastic nitinol element occurs early in the postoperative period, indicating continued unloading of the nitinol compression element through the arthrodesis sites after initial implantation.

Topics: Aged; Alloys; Ankle Joint; Arthrodesis; Bone Screws; Calcaneus; Cohort Studies; Female; Follow-Up Studies; Fracture Fixation, Intramedullary; Fracture Healing; Fractures, Bone; Humans; Injury Severity Score; Internal Fixators; Male; Middle Aged; Retrospective Studies; Risk Assessment; Subtalar Joint; Titanium; Tomography, X-Ray Computed

Operative treatment is usually recommended in displaced patella fractures. Several techniques have been advocated for internal fixation of patella fractures. Despite the relatively good clinical outcomes that have been demonstrated in many studies, postoperative morbidities such as fixation failure, nonunion, infection, and knee stiffness are not uncommon. We present a new alternative treatment technique for displaced patellar fractures. Between April 1995 and May 2005, we used the Nitinol Patella Concentrator (NTPC) to treat 156 consecutive patients with displaced patellar fractures. Injuries arose from vehicular accidents in 56 (35.9%) cases, direct falls onto the knee in 85 (54.5%) cases, and sports injuries in 15 (9.6%) cases. The mean patient age was 46.3 years (range, 25-77 years). Clinical assessments were made using the Böstman knee score and the MOS SF-36 questionnaire (Medical Outcomes Study 36-item short-form health survey), which were both recorded at the final follow-up visit. The mean follow-up was 7.3 years (range, 6-17 years). At the final follow-up, the Böstman knee scores were excellent in 88 cases (28-30), good in 55 (20-27), and unsatisfactory in 13 (<20). According to the MOS SF-36 evaluation, the average score was 84.5 (range, 62-91). Treatment of patellar fracture with the NTPC not only may serve as an effective and rigid fixation method in multifragmented displaced and inferior pole fractures, but also may provide continuous concentrative compression during the osseous healing process. Thus, use of the NTPC may help restore the functional integrity of the extensor mechanism and permit early rehabilitation with a lower incidence of postoperative complications.

Topics: Adult; Aged; Alloys; Biocompatible Materials; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Knee Joint; Male; Middle Aged; Patella

Median sternotomy can be associated with significant morbidity, including non-union, dehiscence and mediastinitis. The use of flexible thermoreactive sternal clips has been introduced recently as an alternative method of sternal closure and is advocated in patients at increased risk of sternal breakdown. It is associated with a decreased incidence of sternal complications as well as allowing faster sternal closure and easy removal on resternotomy. This report describes the case of a fractured thermoreactive clip following trauma, resulting in sternal dehiscence necessitating sternal rewiring.

Topics: Accidental Falls; Aged, 80 and over; Alloys; Bone Wires; Equipment Design; Equipment Failure; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Radiography; Reoperation; Sternotomy; Sternum; Stress, Mechanical; Surgical Instruments; Surgical Wound Dehiscence; Treatment Outcome

This report describes a case of repair of a nonunion pubic ramus fracture with intramedullary placement of a self-expanding nitinol stent across a fracture gap to provide a permeable scaffold for polymethylmethacrylate (PMMA) cement to track across the fracture gap and to restrict leakage into surrounding soft tissues. The patient presented with an 8-month history of pelvic pain and debility. His pain remains resolved after 14 months. Percutaneous repair of nonunion pubic rami fractures using a bridging metallic stent in combination with PMMA bone cement may be an effective treatment for these fractures.

Topics: Aged; Alloys; Bone Cements; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Fractures, Ununited; Humans; Male; Pain Measurement; Pelvic Pain; Polymethyl Methacrylate; Prosthesis Design; Pubic Bone; Stents; Tomography, X-Ray Computed; Treatment Outcome