Biomaterials in Hand Surgery (eBook)

Foreword 5
Preface 7
Contents 8
List of Contributors 12
Abbreviations 13
1 Fundamentals of Biomaterials 15
1.2 Metals 17
1.3 Polymers 18
1.3.1 Polymethyl- methacrylate 19
1.3.2 Polyethylene 20
1.3.3 Biodegradable Polymers 20
1.4 Ceramics 21
1.4.1 Hydroxyapatite 22
1.4.2 Bioactive Glass 23
1.5 Composites 24
References 24
2 Potential Applications of Tissue Engineering in Hand Surgery 26
2.1 Introduction 26
2.1.1 Limitations of Permanent Implants 27
2.1.2 Biodegradable Biomaterials: from Tissue Replacement to Tissue Regeneration 27
2.2 Tissue Engineering 28
2.3 Scaffold Fabrication Techniques 29
2.4 Cell Types in Tissue Engineering Constructs 30
2.4.1 Embryonic Stem Cells 31
2.4.2 Adult Mesenchymal Stem Cells 32
2.4.3 Induced Pluripotent Stem Cells 33
2.5 Biomimetic Materials, Bioligands and Bioactive Molecules for Tissue Engineering Constructs 34
2.5.1 Collagen 34
2.5.2 Fibrin 35
2.5.3 Glycosaminoglycans ( GAGs) and Proteoglycans ( PGNs) 35
2.5.4 Ceramics 36
2.5.5 Synthetic Bioligands 37
2.5.6 Bioactive Molecules 38
2.6 Conclusions 39
References 40
3 The Finite Element Method for the Design of Biomedical Devices 43
3.1 Introduction 43
3.2 What is the Finite Element Method? 45
3.3 The Main Steps Involved in a FEM Analysis 46
3.3.1 Preprocessing 47
3.3.2 Solution 53
3.3.3 Postprocessing 53
3.4 Conclusions 56
Further Reading 56
4 Prostheses for the Joints of the Hand 58
4.1 Introduction 58
4.2 Arthrosis and Arthritis 59
4.3 Metacarpophalangeal Joint Prostheses 60
4.4 Trapezio- metacarpal Joint Prostheses 67
4.5 Prostheses for the Interphalangeal Joints 69
4.6 Prostheses for the Scaphoid 71
4.7 Prostheses for the Lunate 71
4.8 Mid-carpal Replacement 72
References 73
5 Causes of Failure in Flexible Metacarpophalangeal Prostheses 80
5.1 Introduction 80
5.2 Analysis of Explanted Sutter Metacarpophalangeal Prostheses 84
5.2.1 Clinical Details 84
5.2.2 Macroscopic Analysis 84
5.2.3 Microscopic Analysis 84
5.3 Looking Ahead 90
References 91
Summary 91
6 Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients: an Open Problem 94
6.1 Introduction 94
6.2 Prosthetic Surgical Treatment 95
6.3 Pathological Physiology 96
6.3.1 Involvement of the Wrist 96
6.3.2 Involvement of the Metacarpophalangeal Joints 98
6.3.3 Involvement of the Interphalangeal Joints 99
6.4 Problems Associated with Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients 99
Further Reading 102
7 Requirements for a Metacarpophalangeal Joint Prosthesis for Rheumatoid Patients and Suggestions for Design 106
7.1 Introduction 106
7.2 Four- dimensional Kinematics of the Metacarpophalangeal Joint 107
7.3 Solid Modeling and Rapid Prototyping 109
7.4 Clinical Requirement 111
7.5 Two Surgical Constraints 112
7.6 Choice of Biomaterials 112
7.7 A Possible Design 113
7.8 Conclusions 116
References 116
8 Research Trends for Flexor Tendon Repair 118
8.1 Introduction 118
8.2 Animal Models for Studying Flexor Tendon Injury and Repair 120
8.3 Mechanical Approaches for Enhanced Flexor Tendon Healing 120
8.4 Biomaterials for Enhanced Flexor Tendon Gliding 122
8.5 Biomaterials for Growth Factor- enhanced Flexor Tendon Healing 125
Summary 129
References 130
9 Peripheral Nerve Regeneration by Artificial Nerve Guides 137
9.1 Introduction 137
9.2 Tubular Nerve Guides 138
9.3 Glue versus Stitches 141
9.4 Control Macromolecules and Seeded Cells 142
9.5 Clinical Limitations of the Tubular Nerve Guides 143
9.6 The Role of Intraneural Vascularization in Defining the Effectiveness of Nerve Regeneration 144
9.7 The NeuroBox Concept and the Search for a Nerve Regeneration Technique that is Surgically Easier, Biologically Respectful, and Technologically Affordable 145
9.8 Longer Gaps as a Current Challenge and Regeneration in the Absence of the Distal Stump as the Ultimate Challenge 148
References 149