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      Development of Digital Twins to Optimize Trauma Surgery and Postoperative Management. A Case Study Focusing on Tibial Plateau Fracture


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          Background and context: Surgical procedures are evolving toward less invasive and more tailored approaches to consider the specific pathology, morphology, and life habits of a patient. However, these new surgical methods require thorough preoperative planning and an advanced understanding of biomechanical behaviors. In this sense, patient-specific modeling is developing in the form of digital twins to help personalized clinical decision-making.

          Purpose: This study presents a patient-specific finite element model approach, focusing on tibial plateau fractures, to enhance biomechanical knowledge to optimize surgical trauma procedures and improve decision-making in postoperative management.

          Study design: This is a level 5 study.

          Methods: We used a postoperative 3D X-ray image of a patient who suffered from depression and separation of the lateral tibial plateau. The surgeon stabilized the fracture with polymethyl methacrylate cement injection and bi-cortical screw osteosynthesis. A digital twin of the patient’s fracture was created by segmentation. From the digital twin, four stabilization methods were modeled including two screw lengths, whether or not, to inject PMMA cement. The four stabilization methods were associated with three bone healing conditions resulting in twelve scenarios. Mechanical strength, stress distribution, interfragmentary strains, and fragment kinematics were assessed by applying the maximum load during gait. Repeated fracture risks were evaluated regarding to the volume of bone with stress above the local yield strength and regarding to the interfragmentary strains.

          Results: Stress distribution analysis highlighted the mechanical contribution of cement injection and the favorable mechanical response of uni-cortical screw compared to bi-cortical screw. Evaluation of repeated fracture risks for this clinical case showed fracture instability for two of the twelve simulated scenarios.

          Conclusion: This study presents a patient-specific finite element modeling workflow to assess the biomechanical behaviors associated with different stabilization methods of tibial plateau fractures. Strength and interfragmentary strains were evaluated to quantify the mechanical effects of surgical procedures. We evaluate repeated fracture risks and provide data for postoperative management.

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          Most cited references40

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          Fracture and Dislocation Classification Compendium—2018

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            Fracture healing: The diamond concept

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              3D Slicer: A Platform for Subject-Specific Image Analysis, Visualization, and Clinical Support


                Author and article information

                Front Bioeng Biotechnol
                Front Bioeng Biotechnol
                Front. Bioeng. Biotechnol.
                Frontiers in Bioengineering and Biotechnology
                Frontiers Media S.A.
                07 October 2021
                : 9
                : 722275
                [ 1 ]Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
                [ 2 ]Ansys France, Villeurbanne, France
                [ 3 ]Department of Orthopedic and Trauma Surgery at the University Hospital Center of Fort-de-France, Fort-de-France, France
                [ 4 ]PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
                [ 5 ]Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
                [ 6 ]Department of Orthopedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
                Author notes

                Edited by: Chaozong Liu, University College London, United Kingdom

                Reviewed by: Rui B. Ruben, Polytechnic Institute of Leiria, Portugal

                Philip Frank Stahel, Rocky Vista University, United States

                *Correspondence: Kévin Aubert, kevin.aubert@ 123456univ-poitiers.fr

                This article was submitted to Biomechanics, a section of the journal Frontiers in Bioengineering and Biotechnology

                Copyright © 2021 Aubert, Germaneau, Rochette, Ye, Severyns, Billot, Rigoard and Vendeuvre.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 08 June 2021
                : 06 September 2021
                Bioengineering and Biotechnology
                Original Research

                digital twin,finite element analysis,tibial fracture,personalized medicine,minimally invasive surgery


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