Orbital stress analysis, Part IV: Use of a "stiffness-graded" biodegradable implants to repair orbital blow-out fracture

The purpose of this study was to develop a finite element model (FEM) of a human orbit, of 1 patient, who had an orbital blow-out fracture, to study the effect of using a "stiffness-graded" (SG) biodegradable implant on the biomechanics of bone-fracture repair. An FEM of the orbit and the globe, of 1 patient who had an orbital blow-out fracture and was treated with biodegradable poly-L/DL-lactide [P(L/DL)LA 70/30], was generated based on computed tomography scan images. Simulations were performed with a computer using a commercially available finite element software. The FEM was then used to study the effect of using an SG biodegradable implant on the stress distribution in the fractured bone. This was compared with the stress distribution at the fracture interface and at the bone-implant interface, when using P(L/DL)LA implant with a uniform stiffness. The use of SG implants caused less stress shielding to the fractured bone. At 50% of the bone healing stage, stress at the fracture interface was compressive in nature, that is, 0.2 MPa for the uniform implant, whereas SG implants resulted in tensile stress of 0.2 MPa. The result was that SG implants allowed the 50% healed bone to participate in loadings. Stiffness-graded implants are more flexible and hence permit more bending of the fractured bone. This results in higher compressive stresses, induced at the fractured faces, to accelerate bone healing. However, away from the fracture interface, the reduced stiffness and elastic modulus of the implant cause the neutral axis of the composite structure to be lowered into the bone, resulting in the higher tensile stress in the bone layer underneath the implant. The use of SG implants induced significant changes in the stress patterns at the fracture interface and at the bone-implant interface. Stiffness-graded biodegradable implants offered less stress shielding to the bone, providing higher compressive stress at the fractured surface, to induce accelerated bone healing, as well as higher tensile stress in the intact portion of the bone. It seems that this is the first reported study, in the literature, on the use of SG biodegradable implants to repair and promote bone healing at the fracture site of the inferior orbital wall bone defect.