The demand for orthopedic implants is high across the globe and this is because of the number of cases of broken bones that are reported annually. In the last 3-4 decades, this field has grown to a great extent and so does the quality of orthopedic devices. The advancements in the industry have led to improvements in trauma implants and they are now much more effective when compared to the ones used earlier.

To reduce the rejection rate of implants and deliver improved post-surgical outcomes, different types of coatings are applied. One of the most commonly used coatings is ‘Hydroxyapatite Coating.’ In this post, our sole focus will be on discussing what hydroxyapatite (HA) coating is and how it helps improve the performance of orthopedic devices.

Why Coatings Are Important on Orthopedic Implants?

Not all metals, ceramics, and polymers are compatible to manufacture trauma implants as certain considerations need to be met. After years of studies and research, only some materials have been approved to produce orthopedic devices.

It is a serious matter, as the implants are applied inside our body, and hence, the materials used must not interfere with the normal functioning of our body, and neither they should produce any adverse reactions. In simpler terms, we should say that metals or non-metals used to manufacture implants must be biocompatible as they need to stay for years inside a human body. Besides this, they must also possess excellent weight and impact resistance along with high durability.

Now, it is not possible to get all these properties in a single biomaterial thus, coatings are applied to get the required characteristics in the implants. Coatings not only improve the structural characteristics but also help in better bone integration.

The two most applied coatings on the implants are porous titanium coating and hydroxyapatite (HA) coating. These coatings are applied in layers depending upon the required thickness and porosity.

What is Hydroxyapatite?

You would be surprised to know that hydroxyapatite is a naturally occurring compound that is also present in bones and teeth, in fact, it is a primary inorganic component in them. In our bones, HA is present in its carbonated form in large amounts. Besides this, the bones of the mammals, fishes, shrimps, seashells, and eggshells of birds also comprise HA. Above all, rocks like sea corals and limestone also have hydroxyapatite.

The HA coating applied on implants is derived from the above-mentioned sources and can also be synthesized chemically. This coating plays a crucial role in enhancing the properties of orthopaedic devices.

What is the Importance of Hydroxyapatite Coating?

Studies have confirmed that HA coating on implants has shown excellent results for bone repair, bone regrowth, and successful integration. HA is not new to this use; it is something that is being used for hundreds of years for bone repair and to rebuild damaged or missing parts in the bone grafts.

Being a component of our bones, hydroxyapatite shows positive reactions with our bones when an HA-coated implant is placed inside our body. It is not only compatible with the body but is also very stable, hence, it will not break easily. Hydroxyapatite possesses excellent osteoconductive properties plus, it is bioactive as well.

HA is known to properly bind with the bones and help regenerate bone tissues to deliver excellent results. Thus, applying HA coating on the implants helps reduce implant rejection or failure chances while ensuring improved and successful implant integration. Here, it is always important to ensure that the HA coating is applied properly.

How Hydroxyapatite Functions when Applied on Implants?

Hydroxyapatite is known to have innate chemical similarities to the bone, thus, when it is coated on implants, it helps the natural bone to fix to the implant by providing an osteophilic surface. HA is also known to have good osteoinductive properties and hence, it enhances the functioning of bone-forming cells osteoblasts.

For an implant to function properly, it is necessary that the surrounding bones must accept and integrate it into the body. Here, HA coating ensures that the implant will excellently get integrated into the body in a maximum of cases.

Now, you might be thinking that when hydroxyapatite is such a great compound then why we shouldn’t make implants using it instead of coating it over other metals. So, implants made entirely from HA are not strong enough to bear the weight of the body, thus, this idea is dropped. Implants made from titanium are considered best owing to their biocompatibility and good mechanical properties. To provide good osteointegration properties, HA coating is applied to them.

What Are the Factors that Need to be Considered with HA Coating?

There are many ways by which HA coating could be applied on implants like plasma spray, electrochemical deposition, dip coating, etc. Besides this, the accuracy at which the coating is applied is the key. Below mentioned are factors to be considered while applying HA coating:

Thickness

When it comes to the thickness of the coating, then it should not be too thin and too thick. This is because a thin coating might not show the expected reaction with the bone whereas a thick coating might result in mechanical failure. So, the ideal thickness of HA coating must be there to deliver the expected results.

Uniformity

Now, we did talk about ideal thickness but, another point to be noticed here is a uniform thickness. Throughout the implant, the same thickness must be there as unevenness could hamper the performance.

Surface Texture

The quality of the growth of the bone and formation of blood vessels somehow depends upon the surface texture of the coating applied on the implant. It is measured as the roughness and porosity on the implant’s surface.

Antibacterial Properties

Scientists are creating HA with antibacterial properties as an infection is found to be one of the most common reasons for implant failure. Thus, if you would be able to provide antibacterial HA coating on orthopedic implants, the rejection rate due to infection will also reduce.

Siora Surgicals Pvt. Ltd. is a CE-certified and experienced manufacturer of an extensive range of orthopedic implants in India. It also manufactures HA coated implants like Tapered Schanz pins & Radial Head Prosthesis. With over 30 years of experience, the company specializes in producing all kinds of implants that come under different categories and sizes. Siora also exports its ISO 13485:2016 certified implants to clients based in different countries across the globe. It also offers HA-coated orthopedic implants as per the client’s request.

It doesn’t matter what type of disease or injury a person suffers from, the body’s response towards that condition is always critical. There is no doubt that effective treatment is required for healing but, if the body does not respond in the way it should, the condition could become worse.
When we talk about fractures, the similar is the case. The doctor may perform surgery to apply Orthopedic implants or apply a cast or a splint to stabilize the fractured bone fragments, but the response of the body will decide how much time it will take to bring back the normal functioning of the fractured site and the effectiveness of the treatment.
We are here to discuss in detail how our body reacts to fractures and how it helps the bone heal after the treatment.

We must say that our body is magical, as it quickly responds to any injury or disease that occurs to minimize its effects till the time right treatment is taken. Even after the treatment, it supports fixing the condition as soon as possible in a better way. In some people, the response of the body is not normal, or we should say the response is not as it should be. In such cases, significant health complications may be seen other than ongoing conditions. Let us now move to our topic starting with the basics.

Composition of the Bone

Our bone is composed of two types of tissues:

• Compact bone
• Cancellous bone

Compact Bone (Cortical Bone)

It is the outer layer of the bone, which is hard, strong, dense, & durable. Around 80% of bone mass in adults is compact bone.

Cancellous Bone

Also known as trabecular or spongy bone, it is light, flexible, and less dense when compared to compact bone.

Besides these, the type of cells found in our bones include:

• Osteoblasts
• Osteocytes
• Osteoclasts

All these cells have different functions that help in keeping bones healthy.

What Happens When a Fracture Occurs?

When a bone breaks, intense pain is obvious, and when the body starts acting against the break, swelling around the injured area is noticed. Bones also contain blood vessels, and they get damaged in case of fracture causing hematoma. The blood clots form in the gap created between the broken bone pieces.

When the inflammation occurs, the immune system of our body activates stem cells in the surrounding tissues, bone marrow, and blood. They are guided towards the fracture site to start the healing process. Now, when it comes to the healing of the bone, these cells trigger two different pathways including:

• Cartilage Formation
• Bone Formation

How Bone Repairs?

The body works according to the severity of the fracture, and the healing process is known to start within a few hours of injury. Let us see step by step how this occurs:

Step – 1

When a fracture occurs, blood clots start to form on the fracture site, and that results in swelling. Here, the immune system of our body gets activated, and it triggers stem cells to migrate to the fracture site. It also activates special types of cells that eliminate germs and small bone fragments.

Step – 2

After 2-3 weeks, a soft callus is formed around the broken bone. This is also a stage where the blood clot is replaced by collagen. One of the key reasons why a cast is applied is to maintain the stability of the bone that is being healed. This is because if the fractured bone gets displaced during the healing process, the condition could become worse.

Step – 3

Around 2 weeks after soft callus formation, the body starts producing hard callus which is more stable & stronger. Cells involved in the formation of hard callus are osteoblasts. These cells are involved in the formation of new bone. This stage generally lasts around 6-12 weeks after the fracture.

Step – 4

This is the stage where bone remodeling occurs and that is initiated by osteoclasts. These cells reshape the bone by removing any extra bone that is formed during healing and ensures that the newly formed bone takes its original shape. At this stage, the person generally starts doing physical activity, and this actually helps in strengthening the newly formed bone. Slowly, the person can also return to normal activities. You might be surprised to know that the remodeling process could continue for long even after the person returns to his/her normal life.

How Much Time Does It take for a Bone to Heal?

In most cases, the average healing time of a fracture is about 6 to 8 weeks. Although, the time required generally depends upon the severity of the fracture. If the bone break is severe or complicated, complete healing may take even months. Besides this, the age of the person also plays an important role in deciding the time required for a fracture to heal. For example, healing might require a longer time in the elderly when compared to in adults. Some other factors that could affect healing include:

• Smoking
• Lack of physical therapy or exercise as suggested by the doctor
• Diet
• Rest

What is the Role of Surgeons in Ensuring Proper Healing of a Fracture?

Now, this is a good question. When the body responds to a fracture and helps it heal then what is the role of surgeons? Let us see why surgeons are important in ensuring the correct healing of a fracture.

When a fracture occurs, broken bone fragments could move in any direction, and sometimes, they even come out of the skin. For a broken bone to heal, the fractured pieces need to be in a correct anatomical position and close to each other. This will not happen on its own, and that’s where the role of surgeons comes in.

Depending upon the diagnosis of the fracture, the surgeon decides whether the broken bones require surgery for realignment, or it could be done without that. If surgery is not required, the surgeon might perform closed reduction to realign bones if needed, and then apply a cast. Sometimes, the application of a splint is also helpful.

While on the other hand, if it is not possible to realign broken ones with closed reduction, or the fracture is complicated, surgery will be recommended. It is done either under general or local anesthesia. An incision is made during the surgery to expose the fractured bone, and pieces are then realigned in their true anatomical position using Orthopedic Trauma Implants like metal plates, screws, and pins.

Once bones are realigned, the proper healing process starts.

So, this is how a broken bone heals and helps the person get back to his/her normal life. We hope it would have been helpful to you.

Siora Surgicals Pvt. Ltd. is a CE-certified manufacturer of an extensive range of orthopedic devices including Hand Locking System, SCRUCAN Cannulated Compression System, and ILIZARC Ring Ex-Fix System. The company is operating for over 3 decades, and most of the distributors & orthopedic surgeons are connected with Siora for about 25 years. This is the kind of trust the company has built over the years. Siora also provides high-quality OEM/contract manufacturing services.

Bones provide structure to our body, anchor muscles, store calcium, and protect vital organs. There are so many roles that bones play, and all are important to ensure good health. Now, when an injury or disease occurs to the bone(s), the movements of the affected area in an individual become limited. Sometimes, the condition is severe enough to require surgical intervention for the treatment.
Bones could also get affected because of other health conditions occurring in our bodies. One such condition that occurs includes bone metastasis, and this will be our point of discussion in the post. Bone metastasis occurs in people who are suffering from certain types of cancers. Let us talk about that in detail.

Bone Metastasis – An Overview

Also known as osseous metastatic disease, bone metastasis is the condition that occurs when a primary tumor invades the bones. In other words, this condition arises when cancer cells break from their original position and starts growing on the bone. Any bone could get affected by this condition as you never know where the broken cancerous cells will fall. Epithelial tumors cause bone metastasis by creating a solid mass inside the bone.

Many problems arise when tumor cells affect bones, the most common being a pain in the bone and fractures. The cancers that have the highest chances of causing bone metastasis to include:

• Breast cancer
• Prostate cancer
• Lung cancer
• Thyroid cancer
• Kidney cancer
• Ovarian cancer

Now, when it comes to the sites where bone metastasis is most seen, then the spine is at the top. Other sites may include:

• Pelvis
• Femur
• Humerus
• Ribs
• Skull

Pain and broken bones are the common symptoms associated with the condition for which treatment is provided, but in most severe cases, the condition becomes incurable.

As per the studies, 2 types of cells maintain our bones namely:

Osteoblasts – They are responsible for the formation of new bones

Osteoclasts – They are responsible for the breakdown of old bones

Optimum functioning of both these cells is required to maintain strong and healthy bones. This is because both growth of new bone cells and the breakdown of older ones are necessary, and hence, osteoblasts and osteoclasts work in tandem.

Now, when tumor cells affect bones, the working of osteoblasts & osteoclasts gets affected as well. The rate at which they work either becomes high or low, and both situations badly affect bone health. This makes bones prone to getting fractured easily. Few other problems caused by the condition include:

If the spine is affected by bone metastasis, the spinal cord may be pressed down. If such a condition occurs, nerve damage will be on the cards. While on the other hand, if left untreated or delayed treatment is there, paralysis may be seen.

Another problem that may arise is hypercalcemia, and this occurs due to the release of excessive calcium in blood because of too much dissolving of bone.

Symptoms Associated with Bone Metastasis

Some of the common symptoms associated with the condition include:

• Pain in the bones
• Fractures
• Urinary incontinence
• Loss of bowel control
• Weakness in legs or arms
• Hypercalcemia
• Low blood cell count

Sometimes, bone metastasis is confused with bone cancer, but both conditions are different. Bone cancer is the condition where tumor cells originate in the bone itself. While on the other hand, bone metastasis is where tumor cells from a different cancerous site in our body spread to any bone and start multiplying there.

Diagnosis of Bone Metastasis

The diagnosis of the condition often starts with a complete medical history check and physical examination of the patient. During the diagnosis of bone metastasis, the doctor would also want to know any past incidences of cancer. Besides this, imaging tests also play an important role in confirming the exact location and severity of the condition. The tests ordered may include:

• X-ray
• CT scans
• Bone scans
• MRI scans
• Blood tests

Above all, a biopsy may be performed in certain cases to confirm whether the affected bone is a result of bone metastasis or a sign of primary bone cancer.

Treatment of Bone Metastasis

After proper diagnosis of the condition, the doctor decides which treatment methods will be feasible and which one will be the best. This totally depends upon the source of cancer cells, the location of the affected site, and the severity of the condition. Some of the common treatment procedures include:

Radiation Therapy

Radiation therapy is given to slow down the growth of tumor cells multiplying on the bone. Different types of radiation therapy procedures that are used include:

Local Field Radiation – During this therapy, the doctor directs radiation at the tumor and surrounding tissues. This process is known to relieve pain in most cases.

Hemi-Body Radiation – This type of therapy is preferred when the person is suffering from multiple bone metastasis. In this case, radiation is directed at a large part of the body.

Radioisotope Therapy – In this case, venous administration of radioactive medicine is done.

Medication

Medication plays an important role in the treatment of bone metastasis, and here, one or more medicines may be prescribed by the doctor depending upon the condition of the patient. The medicines prescribed may include:

• Bone-building drugs to reduce damage to bones
• Chemotherapy to kill or reduce the size of cancer cells
• Analgesics
• Hormone therapy

Surgery

When the condition is severe or other treatment methods did not deliver expected results, surgery may be performed. This is also an option in case of fractures, or the chances of fracture anytime soon are there. In certain cases, surgery is also performed to remove the tumor.

During surgical intervention, orthopedic fixation devices like metal implant plates and screws are also used to stabilize the affected bone and ensure its correct placement while it heals. The type of orthopedic implant used will depend upon the affected location.

Siora Surgicals Pvt. Ltd. is one of the oldest manufacturers of international standard quality orthopedic devices in India. The company has numerous global clients, and it exports its entire range to different parts of the world. Siora is also known to be a reliable OEM/contract manufacturing service provider.

A fibula fracture refers to a break in the fibula bone. A forceful impact, such as landing after a high jump or any impact to the outer part of the leg, can cause a fracture. Even spraining or rolling an ankle puts stress on the fibula bone, which can lead to a fracture.

Types of Fibula Fracture

Fractures in Fibula can happen at any point on the bone and can differ in type and severity. Types of fibula fracture include:

• Lateral malleolus fractures occur when the fibula is fractured at the ankle
• Fibular head fractures occur at the upper end of the fibula at the knee
• Avulsion fractures happen when a small chunk of bone that is attached to a ligament or tendon is pulled away from the main part of the bone
• Stress fractures describe a condition where the fibula is injured as the result of repetitive stress, such as hiking or running
• Fibular shaft fractures occur in the mid-portion of the fibula after an injury such as a direct blow to the area
• Fibular shaft fractures occur in the mid-portion of the fibula after an injury like a direct blow to the area
• A fibula fracture can be because of several tough injuries. It is commonly associated with a rolled ankle but can also be because of a fall, awkward landing, or a direct blow to the outer ankle or lower leg.

Fibula fractures are most common in sports, especially those that involve jumping, running, or quick changes of direction such as football, basketball,  and soccer.

Symptoms

Swelling, pain, and tenderness are some of the most common signs and symptoms of a fractured fibula. Other signs and symptoms include:

• Incapability to bear weight on the injured leg
• Bruising or bleeding in the leg
• Visible deformity
• Coldness and numbness in the foot
• Tender to the touch

Diagnosis

People who have injured their leg and are facing any of the symptoms should consult a doctor for diagnosis. The following steps occur during the process of diagnosis:

• Physical examination: A thorough examination will be conducted, and the doctor will look if there are any deformities
• X-ray: These are used to see the fracture and know if a bone has been displaced
• Magnetic resonance imaging (MRI): This type of test provides a more detailed scan and can generate detailed pictures of the soft tissues and interior bones

Computerized tomography (CT), bone scans, and other tests may be ordered to make a more precise diagnosis and judge the severity of the fibula fracture.

Treatment

Treatment for a fibula fracture can differ and depends greatly on how severe the break is. A fracture is classified as closed or open.

Open fracture (compound fracture)

In an open fracture, either a deep wound exposes the bone through the skin or the bone pokes through the skin and can be seen.

An open fracture is mostly the result of a high-energy trauma or direct blow, such as a motor vehicle collision or fall. This kind of fracture can also occur indirectly such as with a high-energy twisting type of injury.

The force needed to cause these types of fractures means that patients will often receive additional injuries. Some injuries could be potentially life-threatening.

According to the American Academy of Orthopedic Surgeons, there is 40% to 70% rate of associated trauma elsewhere within the body.

Doctors will treat open fibula fractures immediately and look for any other injuries. Antibiotics will be administered to avoid infection. A tetanus shot will also be given if it is essential.

The wound will be cleaned thoroughly, examined, stabilized, and then covered so that it can heal properly. An open reduction and internal fixation with bone screws and bone plates may be essential to stabilize the fracture. If the bones are not uniting, a bone graft may be essential to promote healing. Orthopedic implants such as Bone plates and bone screws can be accessible from orthopedic instruments suppliers.

Closed fracture (simple fracture)

In a closed fracture, the bone is broken, but the skin is left intact

The goal of treating closed fractures is to put the bone back in place, control the pain, give the fracture time to heal, prevent complications, and return to the normal function. Treatment begins with the elevation of the leg. Ice is used to relieve the pain and lessen the swelling.

If no surgery is required, crutches are used for mobility and a cast, brace, or walking boot is recommended while healing takes place. Once the area has healed, persons can stretch and strengthen weakened joints with the help of a physical therapist.

There are two main kinds of surgery if a patient requires them:

• Closed reduction involves realigning the bone back to its original position without the need to make an incision at the site of fracture
• Open reduction and internal fixation realign the fractured bone to its original position using hardware such as bone screws, orthopedic plates, and rods

The ankle will be placed into a cast or fracture boot until the process of healing is complete.