RESUMEN
Clinical epidemiology studies suggest the majority of lower limb amputations were preceded by a minor traumatic event, often footwear-related, and lower limb ulcers. To reduce foot trauma and ulcers, the diabetic patient with foot insensitivity has unique footwear needs. To address these needs for patients not requiring custom shoes, the DVA/Seattle Footwear System was developed. The six components of this system include: 1) a specially designed shoe last based on the geometry of the diabetic foot and research findings on foot regions at highest risk of ulceration, 2) a depth-inlay shoe, "Custom Stride by PRS," designed to be paired with either a custom-fabricated cork insole or a preformed polyurethane insole, 3) a laser digitizing system that captures 3-D plantar foot contours, 4) DVA/Seattle ShapeMaker software adaptation for modifying plantar surface contours and applying free-form and template modifications to increase or relieve loading, 5) software that translates files into code used by a milling machine to define the cutting path and carve cork blockers into custom insoles, and 6) a preformed polyurethane insole thicker than a typical insole to accommodate the extra volume and the interior dimensions of the shoe. A 6-month pilot cross-over trial of 24 diabetic male veterans without prior foot ulcers was conducted to determine the feasibility of producing, and the safety of wearing, these depthinlay shoes and both types of insoles. During the first 4 weeks, patients were assigned to the study shoes and one type of insole. During the next 4 weeks, they wore the other type of insole, and during the final 4 months, they chose which pair of insoles to wear with the study shoes. Over 150 person-months of footwear observation revealed no breaks in the cutaneous barrier with use of either cork or polyurethane insoles and the study shoes. Patient compliance with the footwear was 88%. Patients were highly satisfied with the appearance, stability, and comfort of the shoes and the comfort of both types of insole. However, 75% of the patients noted that the study shoes felt heavier than their customary shoes. Further research is needed to determine the long-term effectiveness of footwear in prevention of foot ulcers in the population at highest risk for diabetic reulceration and amputation.
Asunto(s)
Pie Diabético/rehabilitación , Úlcera del Pie/prevención & control , Zapatos , Veteranos , Anciano , Estudios Cruzados , Diseño de Equipo , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Satisfacción del Paciente , Proyectos Piloto , Estudios ProspectivosRESUMEN
Osteoarticular allografts are commonly used in the treatment of segmental bone loss due to a wide resection of tumour. While the use of such grafts has met with considerable clinical success, fractures are a recognized complication of allograft use. Although trabecular bone can play an important structural role in the function of segmental allografts, few data exist on the effects of common storage and sterilization procedures on the mechanical properties of trabecular bone. To this end, we investigated with these experiments the effects of freezing at -20 degrees C, freezing at -70 degrees C, eight freeze-thaw cycles at -20 degrees C, freeze-drying, boiling and autoclaving on the compressive modulus and strength of bovine trabecular bone. Of these treatments, boiling and autoclaving were the only treatments to alter the properties of bovine trabecular bone, resulting in 26 and 58% reductions in strength, respectively. Autoclaving also significantly reduced the compressive modulus by 59%. From these data, freezing at temperatures between -20 and -70 degrees C does not appear to compromise the structural integrity of trabecular bone.
Asunto(s)
Densidad Ósea/fisiología , Criopreservación , Húmero/fisiología , Esterilización/normas , Animales , Fenómenos Biomecánicos , Trasplante Óseo , Bovinos , Fracturas Óseas/etiología , Liofilización , Distribución Aleatoria , Temperatura , Trasplante HomólogoRESUMEN
We performed a series of uniaxial compression tests on wet bovine trabecular bone to compare both modulus and strength when measured using 2:1 aspect ratio (10 mm long, 5 mm diameter) cylinders (n = 30) and 5 mm cubes (n = 29). We also compared the correlation coefficients in the resulting modulus-density and strength-density regressions and the standard errors of the estimate. When comparing the mean values of modulus and strength for each group, the confounding variations in apparent density were accounted for with an analysis of covariance. The Fisher's Z transformation was used to compare the correlation coefficients statistically. Results from the analysis of covariance indicated that the modulus and strength of the cubes were higher by 36% (p < 0.01) and 18% (p < 0.05), respectively, with respect to the 2:1 cylinder values. The correlation coefficients in the modulus-density and strength-density regressions were not sensitive to the regression model (linear versus power law). However, correlation coefficients for both modulus-density and strength-density regressions were higher (p < 0.05) for the 2:1 cylinders (r = 0.90, modulus; r = 0.94, strength) than for the cubes (r = 0.57, modulus; r = 0.82, strength). In addition, the standard errors of the estimate in both modulus and strength were substantially lower for the 2:1 cylinders. These data indicate that both modulus and strength can depend on the specimen geometry when using conventional compression testing techniques. We conclude, therefore, that inter-study comparisons of modulus and strength may be invalid if these confounding effects of different specimen geometries are not addressed. Our data also indicate that density can better explain the observed variance in modulus and strength when 2:1 cylinders are used as opposed to cubes. Using this phenomenon as a rationale for choosing a standard specimen gometry, we recommend that the 2:1 cylinder be used as a standard specimen in studies designed to determine the effects of various treatments on the uniaxial compressive modulus and strength of trabecular bone.
Asunto(s)
Huesos/anatomía & histología , Huesos/fisiología , Animales , Densidad Ósea , Bovinos , Elasticidad , Húmero , Análisis de Regresión , Manejo de Especímenes , Estrés MecánicoRESUMEN
A theoretical analysis was performed to characterize potential experimental artifacts in conventional compression testing of trabecular bone, where strains are based on the relative displacements of the two loading platens. We assumed that the total experimental artifact for modulus was the sum of a damage and friction artifact and derived equations to describe these artifacts. The two unknown constants in these equations were found using a combination of data derived from linear finite element analyses and in vitro uniaxial compression tests. Subsequent finite element analyses allowed estimation of the artifacts for a wide range of specimens (cube, 1:4-3:1 aspect ratio cylinders). If friction is completely eliminated at the specimen-platen interface, the Young's modulus of a 5 mm sized (1:1 aspect ratio dimension) specimen which has a damage artifact due to machining may be underestimated by at least 45% regardless of specimen geometry; otherwise, the platens modulus may vary from less than 30 to over 175% of the Young's modulus, depending upon the specimen geometry and Poisson's ratio of the bone. Increasing the specimen size reduces the artifact only slightly. Since Poisson's ratio can be large for trabecular bone and is rarely known a priori, the precision of the conventional compression test will, therefore, be poor unless friction is completely eliminated at the specimen-platen interface. However, without friction at the interface, the platens modulus will always underestimate Young's modulus, thereby reducing the accuracy of this test. There was also evidence that the strength may be affected by these artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Artefactos , Huesos/fisiología , Modelos Biológicos , Fenómenos Biomecánicos , Huesos/anatomía & histología , Elasticidad , Predicción , Fracturas por Estrés/fisiopatología , Humanos , Análisis de Regresión , Manejo de Especímenes , Estrés MecánicoRESUMEN
Bisphosphonates inhibit osteoclast-mediated bone resorption, but their effects on the mechanical behavior of bone remain uncertain. This study investigated the effects of 4-amino-1-hydroxybutylidene bisphosphonate (AHBuBP) on the biomechanical and morphologic properties of bone in ovariectomized rats. Sprague-Dawley rats (four groups, n = 6) were ovariectomized at 3 months of age. From 7 to 13 months, the groups received vehicle or 0.28, 2.8, or 28 micrograms/kg of AHBuBP twice weekly through subcutaneous injection. An additional group of control animals (n = 6) received neither surgery nor drug. We determined the stiffness, yield, and ultimate loads of the femoral midshaft, the sixth lumbar (L6) vertebra, and the femoral neck. Geometric properties of the cortical bone were measured from digitized images of the tibial diaphysis at the level of the synostosis. The area fraction of trabecular bone was determined through the midsagittal plane of the fifth lumbar (L5) vertebra. There were no significant differences in the structural properties of the femoral neck and midshaft, with the exception that the medium-dose group had a greater ultimate load than the vehicle group for the femoral midshaft in bending. Cross-sectional analysis of the tibia did not show significant differences in the inertial properties or area. Ovariectomy caused a significant reduction in the stiffness and ultimate load of L6 and in the area fraction of trabecular bone of L5.(ABSTRACT TRUNCATED AT 250 WORDS)