caa a22 4500 606214968 CHVBK 20210128101056.0 cr unu---uuuuu 210128e20150301xx s 000 0 eng 10.1007/s00701-014-2319-y doi (NATIONALLICENCE)springer-10.1007/s00701-014-2319-y Spontaneous fractures in custom-made porous hydroxyapatite cranioplasty implants: is fragility the only culprit? [Elektronische Daten] [Bruno Zanotti, Angela Verlicchi, Stefano Indiani, Stefano Scarparo, Nicola Zingaretti, Pier Parodi] Background: Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material appreciated for its biomimetic properties, before osteointegration it is initially very fragile. Nevertheless, we wondered whether this primary fragility is entirely due to brittleness or whether the surgeon's actions may influence the behavior of the material. Methods: To study the influence of the surgeon's behavior, we made a virtual model of a custom-made PHA cranioplasty implant and submitted it to three implant procedural variables using finite element methods. In the first test, a scenario in which the surgeon's design, validation, and positioning techniques are impeccable, the edges of the implant adhered well to the craniectomy margins. In the second test, a discrepancy between a portion of the perimeter of the craniectomy and the profile of the prosthesis was modeled, and in the third test, several gaps were simulated between the implant and the craniectomy margins. Results: Our mathematical model showed that when local and general discontinuities were included in the test scenarios, there was an increase in the load coming to bear on the cranioplasty implant, which amounted to 80 and 50%, respectively. Conclusions: The fragility of custom-made PHA cranioplasty implants increases if the surgeon fails to achieve a precise design and validation, and/or an accurate surgical procedure. Nevertheless, careful attention during these phases helps to maintain the strength of the implant, given the more favorable mechanical conditions, without interfering with its biomimetic capacity. Springer-Verlag Wien, 2015 Cranioplasty nationallicence Material strength nationallicence Porous hydroxyapatite nationallicence Spontaneous fracture nationallicence Zanotti Bruno Unit of Neurosurgery, "S.M. della Misericordia” University Hospital, Udine, Italy aut Verlicchi Angela Free University of Neuroscience "Anemos”, Reggio Emilia, Italy aut Indiani Stefano Biomedical Eng. D, Padova, Italy aut Scarparo Stefano Biomedical Eng. D, Padova, Italy aut Zingaretti Nicola Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Michele”, Piazza Rodolone, 33013, Gemona del Friuli, UD, Italy aut Parodi Pier Clinic of Plastic Reconstructive Surgery, University of Udine, Udine, Italy aut Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 517-523 0001-6268 157:3<517 2015 157 701 https://doi.org/10.1007/s00701-014-2319-y text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2319-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Zanotti Bruno Unit of Neurosurgery, "S.M. della Misericordia” University Hospital, Udine, Italy aut NATIONALLICENCE 700 1- Verlicchi Angela Free University of Neuroscience "Anemos”, Reggio Emilia, Italy aut NATIONALLICENCE 700 1- Indiani Stefano Biomedical Eng. D, Padova, Italy aut NATIONALLICENCE 700 1- Scarparo Stefano Biomedical Eng. D, Padova, Italy aut NATIONALLICENCE 700 1- Zingaretti Nicola Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Michele”, Piazza Rodolone, 33013, Gemona del Friuli, UD, Italy aut NATIONALLICENCE 700 1- Parodi Pier Clinic of Plastic Reconstructive Surgery, University of Udine, Udine, Italy aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 517-523 0001-6268 157:3<517 2015 157 701