Treatment of bone and soft tissue injuries is greatly relied on orthopedic surgeon. In trauma fracture fixation, pre-operative study of the fracture is crucial for selection of appropriate fixation method. Surgeon’s knowledge about the various types of trauma implants would enhance effective selection of the implant. In this respect, design rationales and features are more considered by the surgeons to choose the best solution for stabilization of the bone fragments in anatomical position. On the other hand, orthopedic implant researchers would investigate on various biomechanical, material, and biological aspects of trauma plating fixation. Some biomechanical researchers are focusing on mechanical behavior of the cortical and trabecular bones to enhance the effective simulation of bone tissue in experimental and computational biomechanical evaluation of bone-implant fracture fixation. Other group of biomechanical researchers is conducting experimental testing (and rarely computational analysis) to investigate mechanical response of trauma fracture fixation under various loading conditions (e.g. compressive and transverse forces or bending and torsion moments). In view of material, biomaterial researchers are diligent in characterization of new biomaterials with superior biological and mechanical properties than current bioinert and hard metallic materials. Some concepts such as reduction of stress shielding, promoting of the osseointegration, implant biodegradability, etc. are considering by implant researchers to utilize in development of trauma plating systems.
In the loop of trauma plating systems development, product developers have the main role. In fact, they are responsible to have knowledge and experience about biomechanical, material, biological, and clinical aspects of the implants. The mechanical and biological characteristics of the current and new biomaterials (explored by biomaterial scientists) are utilized by product developers in design conception of orthopedic implants. Likewise, understanding the clinical requirements of bone fracture treatment is crucial to be considered during conception stage by developers. Due to essential needs to carry out clinical trials for the developed implants from new biomaterials, product developers tend to use the historical titanium alloys and upgrade the design shape and features to create new conception in development of trauma plating systems (high mechanical modulus and rarely good biocompatibility of titanium alloys allow extensive upgrading in design shape and features of trauma plates and screws in fixation of bone fractures). This would increase industrial product developers rather than scientific-industrial product developers. In fact, collaboration between engineers with design and manufacturing background and orthopedic surgeons are growing nowadays (particularly in developing countries) from which design-feature based development conception froze creating of new ideas for higher clinical benefits of trauma plating fixation.
Although, successful treatment of bone fractures is significantly relied on pre, intra, and post operative plans and enhanced by design features of the implant, however, biological reaction of the bone tissue to the implant, particularly screw-bone interaction, would be a remarkable factor in fixation stability of the fracture fixation, particularly in treatment of multi-fragmentary fracture in poor quality bones. The current metallic trauma plating systems have been found with considerable rate of malunion and nonunion in fixation of such fracture types near to the joints. It is therefore, today, total joint arthroplasty is considered as an alternative method for treatment of metaphyseal multi-fragmentary fractures in poor quality bone (e.g. in patient with osteoporosis or osteopenia). As a final solution, joint arthroplasty could be superior solution for treatment of severe fracture near to the joint, however, with development of trauma plating systems with enhanced bone healing advantages under controlled physiological loading conditions, the number of trauma plating fixation failures (e.g. plating fixation loosening, malunion, nonunion, delayed union, etc.) could be significantly reduced from which secondary arthroplasty treatment is prevented. In this respect, scientific-industrial product development strategies could be established through team-working projects with biomaterial and biomechanical researchers in collaboration with orthopedic surgeons (interested in development projects) to develop new ideas in treatment of bone fractures. Normally, such development project with essential scientific needs would be delivered to the universities or specialized institutes by top orthopedic implant manufacturers in the developed countries.
In respect to the various parties involved in development of trauma plating systems, the book “Trauma Plating Systems” was developed to provide the scientific-industrial knowledge for product developers, biomechanical & biomaterial researchers, clinician specialists, and industrial design & development engineers. With scientific and industrial efforts of the book senior author in testing, analysis, design, manufacturing, and clinical investigation for development of trauma plating systems, the new concept “Advance Healing Fixation System (AHealFS)” is introduced in this book to bring a breakthrough with superior healing advantages in future development of the trauma plating systems. Through this concept, a novel plate-screw system from new advanced biocompatible materials is conceptually presented for further in vitro and in vivo evaluation.