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Lehigh Researcher Develops Revolutionary Orthopedic Device

Healing Bone Faster

To heal small bone fractures—like those in a wrist, finger or ankle—a cast or splint is usually all that is needed to promote regrowth. Once stable, the bone tissue—a living material—regenerates and heals.

Healing a break in a long bone—like the femur (thigh bone) or tibia (shin bone)—is a more complicated and much lengthier process. It can take four to six months—sometimes even longer—for a patient to return to full use of their legs after a traumatic incident.

Since the 1940s, surgeons have used a process called intramedullary nailing to heal long bone breaks. During this procedure, a specially designed metal rod is inserted into the marrow canal of the bone. The rod passes across the fracture to keep it in position and is screwed to the bone at both ends. As the bone tissue regrows, the rod holds the bone in place, directing where and how new bone tissue forms.

Device design improvements have focused on the mechanical environment at the fracture site to accelerate bone remodeling.

"When it comes to bone healing, extremes of both stability and instability can have a detrimental effect," explains Hannah Dailey, assistant professor of mechanical engineering and mechanics. "My focus is on improving patient outcomes by designing a rod that optimizes healing through micro-motion—a device that creates the ideal conditions at the fracture site to promote maximum healing."

Research has shown that axial movement—the movement of the rod up and down inside the bone—speeds healing. Unfortunately, an increase in such movement has also been associated with increased twisting motion, which has been found to slow healing.

Dailey and her colleagues have developed a technology that achieves the ideal combination: increased axial motion that speeds healing with minimal torsional, or twisting, movement. The device is called a Flexible Axial Stimulation (FAST) intramedullary nail. Known commercially as the Apex Tibial Nail System from OrthoXel, FAST has the potential to revolutionize bone fracture recovery.

A revolution in orthopedic medicine is on the agenda at OrthoXel, the medical device start-up that Dailey co-founded and where she serves as Chief Scientific Officer. The company seeks to develop and commercialize orthopedic devices that improve patient outcomes, increase surgeon accuracy and efficiency, and reduce costs to patients and the health care system. The Apex Tibial Nail System is the first OrthoXel device to hit the market.

The device is the result of a five-year research and development process led by Dailey and colleagues at the Cork Institute of Technology in Ireland, who oversaw all aspects from conceptual ideation through a large-animal preclinical study.

She and her team undertook a proof of concept study that demonstrated support for the development of a micro-motion-enabled intramedullary nail. Notably, the study suggested that when compared to rigid-fixation nails—which require significant weight-bearing to induce the interfragmentary motion that promotes healing—the micromotion-enabled nail was likely to allow movement in non-weight bearing patients during the early healing period. The early recovery stage is when the benefits of mechanical stimulation at the fracture site are most critical.

Later, the team published the results of a comprehensive biomedical study showing that the device provided controlled axial motion at the fracture site while retaining high torsional stability—the ideal combination to enhance healing.

Finally, preclinical trials on the micro-motion-enabled tibial nails produced successful healing, and provided strong safety evidence in vivo—paving the way to the development of the commercial product now marketed to surgeons. The team is also working on an Apex Femoral Nail System to provide solutions for additional fracture types.

This story appears as "Healing Bone Faster" in the 2017 Lehigh Research Review.


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3-D Printing to Regenerate Tissue

Lesley Chow, assistant professor of materials science and engineering and bioengineering, and Dailey are collaborating to create biodegradable 3D-printed biomaterials for musculoskeletal tissue regeneration. The duo are working on fabricating scaffolds—highly-porous structures that provide a template for the body to regrow tissue.

Recent advancements in 3D printing have made it possible to print scaffolds made of multiple materials as inks. The Chow lab creates libraries of bioactive inks, or “bio-inks” that can be 3D printed together into a scaffold that mimics the biochemical organization of native tissues. By changing the scaffold’s physical structure and porosity, the Dailey lab aims to recapitulate the mechanical properties of native tissues. Together, the collaborative team explores how the combination of biochemical and mechanical information “coaxes” stem cells to become a variety of cell types with different functions.

Most researchers are focused on printing one type of tissue or cell. Chow’s work focuses on organizing multiple bio-inks in a specific way to guide multiple cells all in one construct. Ultimately, this will regenerate more functional tissues that integrate well with its environment inside the body.

“Biological tissues are not homogenous—they are organized in ways that give rise to function,” says Chow. “Our goal is to create scaffolds that mimic the physical architectures and biochemical organization found in native tissues.”

While many companies are focused on growing tissues in a lab from a patient’s cells, Chow and Dailey are pursuing a novel path. The scaffolds they are creating can be implanted to guide tissue regeneration inside the body.

“With this strategy, there is no need to harvest cells—which could broaden access to regenerative medicine by significantly lowering the cost of re-growing damaged tissue,” says Dailey.

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