Biomaterials in hand surgery

Biomaterials are used in many areas of medicine, particularly in surgery and d- tistry. In orthopedic surgery, total hip arthroplasty has been extremely successful, and has been called 'the operation of the 20th century'. Total hip arthroplasty is r- tinely performed every day in most orthopedic departments. Over the last decades, many efforts have been made to better integrate the components within the recipient bones, to decrease the friction at the prosthetic interface, and to minimize wear. Minimally invasive procedures have been developed, and various designs are inte- ed to preserve as much as possible of the bone stock of young patients. By contrast, the clinical results have been less favorable after various hand and wrist joint replacements. Many early designs have failed, the clinical data of the current pr- theses are frequently quite limited, and there is often insufficient biomechanical information available, although trapezio-metacarpal arthroplasty in particular has become quite popular in recent years. In order to promote progress in hand and wrist arthroplasty, Antonio Merolli and Thomas J. Joyce have edited this lovely book, whose chapters discuss current research and recent advances in hand and wrist arthroplasty. The problems of metacarpophalangeal joint prostheses are particularly developed.

1 Fundamentals of BiomaterialsPaolo Tranquilli Leali and Antonio Merolli
1.1 Introduction	p. 1
1.2 Metals	p. 3
1.3 Polymers	p. 4
1.3.1 Polymethyl-methacrylate	p. 5
1.3.2 Polyethylene	p. 6
1.3.3 Biodegradable Polymers	p. 6
1.4 Ceramics	p. 7
1.4.1 Hydroxyapatite	p. 8
1.4.2 Bioactive Glass	p. 9
1.5 Composites	p. 10
References	p. 10
2 Potential Applications of Tissue Engineering in Hand SurgeryMatteo Santin
2.1 Introduction	p. 13
2.1.1 Limitations of Permanent Implants	p. 14
2.1.2 Biodegradable Biomaterials: from Tissue Replacement to Tissue Regeneration	p. 14
2.2 Tissue Engineering	p. 15
2.3 Scaffold Fabrication Techniques	p. 16
2.4 Cell Types in Tissue Engineering Constructs	p. 17
2.4.1 Embryonic Stem Cells	p. 18
2.4.1.1 Technical Limitations	p. 18
2.4.1.2 Ethical Concerns	p. 18
2.4.1.3 Regulatory Issues	p. 18
2.4.2 Adult Mesenchymal Stem Cells	p. 19
2.4.3 Induced Pluripotent Stem Cells	p. 20
2.5 Biomimetic Materials, Bioligands and Bioactive Molecules for Tissue Engineering Constructs	p. 21
2.5.1 Collagen	p. 21
2.5.2 Fibrin	p. 22
2.5.3 Glycosaminoglycans (GAGs) and Proteoglycans (PGNs)	p. 22
2.5.4 Ceramics	p. 23
2.5.5	p. 24
2.5.6 Bioactive Molecules	p. 25
2.6 Conclusions	p. 26
References	p. 27
3 The Finite Element Method for the Design of Biomedical DevicesFrancesco Mollica and Luigi Ambrosio
3.1 Introduction	p. 31
3.2 What is the Finite Element Method?	p. 33
3.3 The Main Steps Involved in a FEM Analysis	p. 34
3.3.1 Preprocessing	p. 35
3.3.2 Solution	p. 41
3.3.3 Postprocessing	p. 41
3.4 Conclusions	p. 44
Further Reading	p. 44
4 Prostheses for the Joints of the HandAntonio Merolli
4.1 Introduction	p. 47
4.2 Arthrosis and Arthritis	p. 48
4.3 Metacarpophalangeal Joint Prostheses	p. 49
4.4 Trapezio-metacarpal Joint Prostheses	p. 56
4.5 Prostheses for the Interphalangeal Joints	p. 58
4.6 Prostheses for the Scaphoid	p. 60
4.7 Prostheses for the Lunate	p. 60
4.8 Mid-carpal Replacement	p. 61
References	p. 62
5 Causes of Failure in Flexible Metacarpophalangeal ProsthesesThomas J. Joyce
5.1 Introduction	p. 69
5.2 Analysis of Explanted Sutter Metacarpophalangeal Prostheses	p. 73
5.2.1 Clinical Details	p. 73
5.2.2 Macroscopic Analysis	p. 73
5.2.3 Microscopic Analysis	p. 73
5.3 Looking Ahead	p. 79
References	p. 80
6 Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients: an Open ProblemFrancesco Catalano
6.1 Introduction	p. 83
6.2 Prosthetic Surgical Treatment	p. 84
6.3 Pathological Physiology	p. 85
6.3.1 Involvement of the Wrist	p. 85
6.3.1.1 Ulnar Onset	p. 86
6.3.1.2 Central Onset	p. 86
6.3.1.3 Radial Onset	p. 87
6.3.2 Involvement of the Metacarpophalangeal Joints	p. 87
6.3.3 Involvement of the Interphalangeal Joints	p. 88
6.4 Problems Associated with Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients	p. 88
Further Reading	p. 91
7 Requirements for a Metacarpophalangeal Joint Prosthesis for Rheumatoid Patients and Suggestions for DesignAntonio Merolli
7.1 Introduction	p. 95
7.2 Four-dimensional Kinematics of the Metacarpophalangeal Joint	p. 96
7.3 Solid Modeling and Rapid Prototyping	p. 98
7.4 Clinical Requirement	p. 100
7.5 Two Surgical Constraints	p. 101
7.6 Choice of Biomaterials	p. 101
7.7 A Possible Design	p. 102
7.8 Conclusions	p. 105
References	p. 105
8 Research Trends for Flexor Tendon RepairStavros Thomopoulos
8.1 Introduction	p. 107
8.2 Animal Models for Studying Flexor Tendon Injury and Repair	p. 109
8.3 Mechanical Approaches for Enhanced Flexor Tendon Healing	p. 109
8.4 Biomaterials for Enhanced Flexor Tendon Gliding	p. 111
8.5 Biomaterials for Growth Factor-enhanced Flexor Tendon Healing	p. 114
References	p. 119
9 Peripheral Nerve Regeneration by Artificial Nerve GuidesAntonio Merolli and Lorenzo Rocchi
9.1 Introduction	p. 127
9.2 Tubular Nerve Guides	p. 128
9.3 Glue versus Stitches	p. 131
9.4 Control Macromolecules and Seeded Cells	p. 132
9.5 Clinical Limitations of the Tubular Nerve Guides	p. 133
9.6 The Role of Intraneural Vascularization in Defining the Effectiveness of Nerve Regeneration	p. 134
9.7 The NeuroBox Concept and the Search for a Nerve Regeneration Technique that is Surgically Easier, Biologically Respectful, and Technologically Affordable	p. 135
9.8 Longer Gaps as a Current Challenge and Regeneration in the Absence of the Distal Stump as the Ultimate Challenge	p. 138
References	p. 139

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