Treatment Of Bone Fractures Research Articles

Immunostimulatory activity and structure-activity relationship of epimedin B from Epimedium brevicornu Maxim.

Epimedii Folium (EF, Epimedium brevicornu Maxim.), a traditional botanical drug, is famous for treating bone fractures, joint diseases, and several chronic illnesses. However, some studies indicated that EF could induce idiosyncratic drug-induced liver injury (IDILI) in the clinic. The NLRP3 inflammasome plays a crucial role in the pathogenesis of various human diseases, including IDILI. In the present study, we showed that epimedin B could specifically facilitate nigericin- or ATP-induced NLRP3 inflammasome activation under synergistic induction of mitochondrial reactive oxygen species. Moreover, epimedin B resulted in activation of Caspase-1 and IL-1β secretion in a lipopolysaccharide (LPS)-mediated susceptibility mouse model. MCC950 pretreatment completely abrogated activation of the NLRP3 inflammasome and prevented liver injury. Importantly, several studies have confirmed that some active constituents of EF could enhance activation of the NLRP3 inflammasome and may be involved in the pathogenesis of EF-IDILI. No reports are available on whether the structure-activity relationship associated with the immunostimulatory activity in EF contributes to the pathogenesis of EF-IDILI. These findings have changed our conventional understanding about the more glycogen, the more immunostimulatory activity.

Kefir peptides promote osteogenic differentiation to enhance bone fracture healing in rats

AimsFractures are the result of fragile bone structures after trauma caused by direct or indirect external impact or strong muscular contraction. Most fracture patients undergo surgical fixation to accelerate the healing process and restore the function of mutilated bone. Promoting the healing process remains an important issue for the treatment of bone fractures. Our previous studies demonstrated the remarkable bone-protective effects of kefir peptides (KPs) in ovariectomized rats and mice. In this study, we further evaluate the efficacy of KPs on fracture healing using a rat model of femoral fracture. Main methodsFifteen 8-week-old male Sprague Dawley (SD) rats were divided into the sham, mock, and KPs groups, in which the mock and the KPs groups underwent femur-fracture surgery with nail fixation, while the sham group underwent a sham operation. The next day, rats were orally administered with daily 400 mg/kg of KPs (KPs group) or distilled water (sham and mock groups) for four weeks. X-ray imaging, histochemical staining and serum osteogenic markers were applied for fracture healing evaluation. In vitro, mouse bone marrow mesenchymal stem cells (BMMSCs) and MC3T3-E1 line were subjected to osteoblast differentiation in the presence of KPs and compared with no KPs treatment. Key findingsThe results demonstrated that KPs treatment improved the progression of the fracture healing process (p < 0.05) and significantly increased the expressions of Col1a1, Alp, Spp1, Vegfa and Cox2 mRNA in the femurs of the KPs-treated fractured rats compared to those of the mock-treated fracture rats. In vitro, KPs treatment promoted bone regeneration factor (Col1a1, Alp, M-csf and Phospho1) expression in MC3T3-E1-derived osteoblast cultures (on Day 3) and enhanced osteogenic differentiation and mineralization in BMMSC-derived osteoblast cultures (on Day 17 and Day 21). SignificanceThis is the first study to show that KPs can help with fracture healing by promoting osteogenic differentiation, and it also suggests that KPs can be used as a nutritional supplement to accelerate fracture healing.

Stress Riser in Orthopedics

For the adequate treatment of bone fractures, it is necessary to have knowledge about mechanical concepts as the interaction of implants and bone. The understanding of the concept of stress riser must be clear for surgeon for adequate surgical planning, thus preventing refracture due to incorrect application of implants. This article presents the concept of stress riser applied to orthopedics and briefly discussion.

Pathogenetic aspects of aseptic peri-implant and paraprosthetic complications in traumatology (review)

The use of metal implants and joint prosthetics occupy an important place in modern traumatology and orthopedics. With the increasing proportion of surgical methods for treating bone fractures and joint diseases, complications develop more frequently. Along with early and late wound infections, there are various response changes in tissues in the area of the implant of an abacterial nature. The results of clinical and experimental studies in the development of fibro-proliferative, immuno-allergic and granulomatous tissue changes around implants determine the important role of macrophages, fibroblasts, cells of the immune system, the peculiarities of the pathophysiology of which this article is devoted to.

An engineered dual function peptide to repair fractured bones.

Targeted drug delivery, often referred to as "smart" drug delivery, is a process whereby a therapeutic drug is delivered to specific parts of the body in a manner that increases its concentration at the desired sites relative to others. This approach is poised to revolutionize medicine as exemplified by the recent FDA approval of Cytalux (FDA approves pioneering drug for ovarian cancer surgery - Purdue University News) which is a folate-receptor targeted intraoperative near infrared (NIR) imaging agent that was developed in our laboratories. Fracture-associated morbidities and mortality affect a significant portion of world population. United states, Canada and Europe alone spent $48 billion in treating osteoporosis related fractures although this number doesn't count the economic burden due to loss in productivity. It is estimated that by 2050 ca 21 million hip fractures would occur globally which will be leading cause of premature death and disability. Despite the need for improvement in the treatment for fracture repair, methods for treating fractures have changed little in recent decades. Systemic delivery of fracture-homing bone anabolics holds great promise as a therapeutic strategy in this regard. Here we report the design of a fracture-targeted peptide comprised of a payload that binds and activates the parathyroid hormone receptor (PTHR1) and is linked to a targeting ligand comprised of 20 D-glutamic acids (D-Glu20) that directs accumulation of the payload specifically at fracture sites. This targeted delivery results in reduction of fracture healing times to <1/2 while creating repaired bones that are >2-fold stronger than saline-treated controls in mice. Moreover, this hydroxyapatite-targeted peptide can be administered without detectable toxicity to healthy tissues or modification of healthy bones in dogs. Additionally, since similar results are obtained upon treatment of osteoporotic and diabetic fractures in mice, and pain resolution is simultaneously accelerated by this approach, we conclude that this fracture-targeted anabolic peptide displays significant potential to revolutionize the treatment of bone fractures.

STIFFNESS PARAMETERS OF VARIOUS MODIFICATIONS OF RING FIXATOR

Relevance. To date, there is no final solution to the theoretical and practical issues of the problem of external fixation in the treatment of long bone fractures.&#x0D; Objective. To determine the rational methods of completing ring retainer (RF) in the treatment of nonunions of the shin bones after fractures of long bones on the basis of clinical and experimental substantiation of the choice, taking into account the peculiarities of the assembly of the apparatus and the implementation of the connection "apparatus-fragments of non-union".&#x0D; Materials and methods. In the experimental part, Sawbones® synthetic composite bone was used. The rigidity of fixation of bone fragments of the RF of the wire-rod type was studied. We tested and compared 5 different options for fixation of bone fragments in RF. The samples were tested in 4 modes: compression along the axis of the bone; compression on the head of the bone; twisting; bending. The strength and deformation characteristics of the materials were determined with a maximum force of up to 5 kN using the TIRATEST-2151 universal testing machine. They chose the most optimal configuration of the RF. Then, in the clinical part, the clinical effectiveness of the optimal structures was evaluated based on the analysis of their use in 12 patients with non-union of the shin bones.&#x0D; Results. Optimal structures have been determined from the point of view of integral rigidity of the structure. The greatest rigidity was the RF system No. 3, in which 3 spokes are used: 2 of them are held at an angle, 1 - in the plane of the ring. In the case of an increase in the number of spokes, the stiffness of the system increased. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5% greater than that of System No. 2 and 12.5 % greater than System No. 1, in which only 2 spokes are used. Fixing the spokes at an angle to the plane of the ring also increases the rigidity of the system. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5 % greater than that of System No. 2. The stiffening rib affects the stiffness of the entire system. But the bend became the most sensitive. Flexural stiffness decreased by 23 % and compression by 8.5 %. Debris removal during bending increased by 1.5-1.8 times.&#x0D; Conclusion. The best indicators of fixation rigidity have options for the arrangement of spokes with a cross not only in the frontal, but also in the sagittal planes. The stability of the fixation of the rod is significantly increased by mounting the "stiffness triangle". The obtained clinical data indicate the promising application of improved ring fixators.

Operative treatment of splint bone fractures in horses

In this study; it is aimed to present the operative treatment and results, which are indicated for the continue of their racing life in splint bone fractures which are frequently occurred in race horses. The 2nd and 4th metacarpal (Mc-II and Mc-IV) and metatarsal bones (Mt-II and Mt-IV) of the horse are accessory structures that support the carpus and tarsus. Fractures of these bones in horses are called “splint bone fractures”. Splint bone fractures are relatively common in horses and usually seen in forelimbs. Fractures of the proximal part are rarer and represent 2.7-5% of all splint bone fractures, but challenging to manage. In the present study, 5 cases of splint bone fractures in different horses were evaluated. The distribution of the fractures were Mc-II in three, Mc-IV and Mt-IV in one each. Localization of the fractures were distal 1/3 in 4 and diaphyseal in 1 horse. For the management of these fractures, surgical removal of the fractured fragments were performed under general anaesthesia. Functional limb usage was achieved following the 30th day postoperatively in all cases.

Effectiveness and Mechanisms of Low-Intensity Pulsed Ultrasound on Osseointegration of Dental Implants and Biological Functions of Bone Marrow Mesenchymal Stem Cells.

Dental implant restoration is the preferred choice for patients with dentition defects or edentulous patients, and obtaining stable osseointegration is the determining factor for successful implant healing. The risk of implant failure during the healing stage is still an urgent problem in clinical practice due to differences in bone quality at different implant sites and the impact of some systemic diseases on bone tissue metabolism. Low-intensity pulsed ultrasound (LIPUS) is a noninvasive physical intervention method widely recognized in the treatment of bone fracture and joint damage repair. Moreover, many studies indicated that LIPUS could effectively promote the osseointegration of dental implants and improve the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). This review is aimed at investigating the research progress on the use of LIPUS in dental implant medicine from three aspects: (1) discuss the promoting effects of LIPUS on osseointegration and peri-implant bone regeneration, (2) summarize the effects and associated mechanisms of LIPUS on the biological functions of BMSCs, and (3) introduce the application and prospects of LIPUS in the clinical work of dental implantation. Although many challenges need to be overcome in the future, LIPUS is bound to be an efficient and convenient therapeutic method to improve the dental implantation success rate and expand clinical implant indications.

Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions.

Percutaneous-reinforced osteoplasty is currently being investigated as a possible therapeutic procedure for fracture stabilization in high-risk patients, primarily in patients with bone metastases or osteoporosis. For these patients, a percutaneous approach, if structurally sound, can provide a viable method for treating bone fractures without the physiologic stress of anesthesia and open surgery. However, the low strength of fixation is a common limitation that requires further refinement in scaffold design and selection of materials, and may potentially benefit from tissue-engineering-based regenerative approaches. Scaffolds that have tissue regenerative properties and low inflammatory response promote rapid healing at the fracture site and are ideal for percutaneous applications. On the other hand, preclinical mechanical tests of fracture-repaired specimens provide key information on restoration strength and long-term stability and enable further design optimization. This review presents an overview of percutaneous-reinforced osteoplasty, emerging treatment strategies for bone repair, and basic concepts of in vitro mechanical characterization.

Topology-optimized patient-specific osteosynthesis plates

Abstract Patient-specific osteosynthesis plates can be used to reduce complications related to bone fracture treatment, such as infection, malocclusion and fatigue fractures of plates and screws. However, the implant design process is tedious. We propose a semi-automatic workflow to computationally design patient-specific titanium osteosynthesis plates for mandibular angle fractures. In this process, the plate stiffness is maximized while the mass is reduced. Two plate designs with different numbers of screw holes (implant #1 with four holes, implant #2 with eight holes) were generated with identical topology optimization settings and compared in a finite element model simulating various biomechanical masticatory loads. Differences in von Mises stresses in the implants and screws were observed. The load case of clenching the jaw on the opposite side of the fracture showed the highest stress distribution in implant #1 and higher peak stresses in implant #2. Stress concentrations were observed in sharp corners of the implant and could be reduced using local stress-based topology optimization. We conclude that the design process is an effective method to generate patientspecific implants.

Cloning and bioinformatics analysis of β-amyrin synthase in Dipsacus asper

Dipsaci Radix is one of the commonly used Chinese medicinal materials in China, with a long history. It has the medicinal activities of nourishing liver and kidney, recovering from broken sinews, and treating bone fracture. Triterpenoid saponins are the main functional ingredients of Dipsacus asper. β-Amyrin synthases(β-AS) as a superfamily of oxidosqualene cyclases(OSCs) can catalyze the construction of the skeleton structure of oleanane-type triterpenoid saponins. There are only a few studies about the β-AS in D. asper, and the catalytic mechanism of this enzyme remains to be explored. To enrich the information of β-AS, according to the transcriptome sequencing results, we cloned DaWβ-AS gene from D. asper into a specific vector for heterologous expression in Escherichia coli. In the meantime, real-time PCR was performed to analyze the relative expression of DaWβ-AS in four different tissues of D. asper. The results of RT-qPCR showed DaWβ-AS had the highest expression level in leaves. Bioinformatics results indicated that DaWβ-AS had a conserved domain of PLN03012 superfamily, belonging to the cl31551 superfamily. There was no transmembrane domain or signal peptide in DaWβ-AS. This study provides a scientific basis for revealing the biological pathways of triterpenoid saponins in D. asper, which will facilitate the biosynthesis of the associated saponins and afford reference for the cultivation and development of high-quality resources of D. asper.

Guidelines of prevention, recognition and treatment of osteoporotic bone fractures.

Population aging makes osteoporotic fractures (OP) an increasingly serious healthcare problem. It is estimated that there are approximately 2,200,000 people with an osteoporotic fracture in Poland, and according to the NFZ (National Health Found) report 126,100 new fractures were registered in 2018, including 34,700 fractures of the proximal femur (PFF). Surgical treatment of OP fractures is difficult due to local conditions and the general health condition of the patients. Reduced bone strength makes it difficult to achieve permanent bone fixation and union.The current &quot;Guidelines for the prevention, diagnosis and treatment of osteoporotic bone fractures&quot; is an update of the 2017 version (previous versions: 2007, 2012) taking into account the progress made in this area of knowledge and practice. The latest principles of conduct have been created on the basis of contemporary world standards and publications. The recommended methods of treating fractures will be discussed: of the PFF, distal end of the radius, proximal end of the humerus and the spine. Particular attention has been paid to the management of patients with PFF, because the average age - 80 years causes that an average of 29.4% of patients in Poland die within a year after the fracture (data from the National Health Fund). After sustaining a fracture, the risk of a consecutive one increases 210 times, so the surgeon is required not only to treat the fracture, but also to implement fracture prophylaxis. The study will also present the principles of diagnosis and treatment of osteoporosis.The presented guidelines were adopted in August 2022 as an official document of the National Consultant in the field of Orthopedics and Traumatology of the bone and joints system and the President of the Polish Society of Orthopedics and Traumatology. The leading author was Prof. dr hab. med. Edward Czerwiski.

A multicentric retrospective study for the treatment of humerus bone fracture following humerus plate fixation with screws

&lt;div&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The goal of this study was to investigate the performance of the humerus bone fixation with screws while treating humerus bone fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The 34 patients’ retrospective data was collected with 1 year of follow up. Humerus fractures were treated by humerus plate fixation in different hospitals and countries, including 26 males and 8 females, with the age range of 32 -74 years (mean 47.4 years). Clinical and radiological follow-ups were conducted at 1 month, 3 months, 6 months and 1 year after surgery to check the bone union and implant-related complications. Ten different plates were used for the treatment of fracture as per the fracture type. The patient's health status was evaluated by the American society of anesthesiologists grade and the visual analogue score (VAS) was also obtained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The progressive decline in the VAS score showed positive results related to pain management. All patients receive continuous physiotherapy under the supervision of physiotherapists, which aids in faster recovery and mobilization. No biomechanical issue related to implant plate and screw loosening, corrosion, bend, or other factors was detected in our 34 patients. Out of 34 patients 91% were satisfied with no pain and the remaining 9% were unsatisfied due to pain. About 85% of patients were happy with aesthetic appearance and the rest 14% of patients were unhappy related to aesthetic appearance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Humerus plate fixation is feasible for the treatment of humerus fracture. The clinical outcomes and prognosis of patients are dependent on the accuracy of intraoperative reduction and surgical expertise.&lt;/p&gt;&lt;/div&gt;

Cross-species comparisons reveal resistance of human skeletal stem cells to inhibition by non-steroidal anti-inflammatory drugs.

Fracture healing is highly dependent on an early inflammatory response in which prostaglandin production by cyclo-oxygenases (COX) plays a crucial role. Current patient analgesia regimens favor opioids over Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) since the latter have been implicated in delayed fracture healing. While animal studies broadly support a deleterious role of NSAID treatment to bone-regenerative processes, data for human fracture healing remains contradictory. In this study, we prospectively isolated mouse and human skeletal stem cells (SSCs) from fractures and compared the effect of various NSAIDs on their function. We found that osteochondrogenic differentiation of COX2-expressing mouse SSCs was impaired by NSAID treatment. In contrast, human SSCs (hSSC) downregulated COX2 expression during differentiation and showed impaired osteogenic capacity if COX2 was lentivirally overexpressed. Accordingly, short- and long-term treatment of hSSCs with non-selective and selective COX2 inhibitors did not affect colony forming ability, chondrogenic, and osteogenic differentiation potential in vitro. When hSSCs were transplanted ectopically into NSG mice treated with Indomethacin, graft mineralization was unaltered compared to vehicle injected mice. Thus, our results might contribute to understanding species-specific differences in NSAID sensitivity during fracture healing and support emerging clinical data which conflicts with other earlier observations that NSAID administration for post-operative analgesia for treatment of bone fractures are unsafe for patients.

Nervous System-Driven Osseointegration.

Implants are essential therapeutic tools for treating bone fractures and joint replacements. Despite the in-depth study of osseointegration for more than fifty years, poor osseointegration caused by aseptic loosening remains one of the leading causes of late implant failures. Osseointegration is a highly sophisticated and spatiotemporal process in vivo involving the immune response, angiogenesis, and osteogenesis. It has been unraveled that the nervous system plays a pivotal role in skeletal health via manipulating neurotrophins, neuropeptides, and nerve cells. Herein, the research related to nervous system-driven osseointegration was systematically analyzed and reviewed, aiming to demonstrate the prominent role of neuromodulation in osseointegration. Additionally, it is indicated that the implant design considering the role of neuromodulation might be a promising way to prevent aseptic loosening.

Trends in Medicare Reimbursement for the Top 20 Surgical Procedures in Craniofacial Trauma.

Research regarding financial trends in craniofacial trauma surgery is limited. Understanding these trends is important to the evolvement of suitable reimbursement models in craniofacial plastic surgery. The purpose of this study was to evaluate the trends in Medicare reimbursement rates for the top 20 most utilized surgical procedures for facial trauma. The 20 most commonly utilized Current Procedural Terminology (CPT) codes for facial trauma repairs in 2018 were queried from The National Summary Data File from the Centers for Medicare & Medicaid Services (CMS). Reimbursement data for each procedure was then extracted from The Physician Fee Schedule Lookup Tool. Changes to the United States consumer price index (CPI) were used to adjust all gathered data for inflation to 2021 US dollars (USD). The average annual and the total percent change in reimbursement were calculated for the included procedures based on the adjusted trends from the years 2000 to 2021. From 2000 to 2021, the average reimbursement for all procedures decreased by 16.6% after adjusting for inflation. Closed treatment of temporomandibular joint dislocation and closed treatment of nasal bone fractures without manipulation demonstrated the greatest decrease in mean adjusted reimbursement at -48.7% and -48.3%, respectively, while closed treatment of nasal bone fractures without stabilization demonstrated the smallest mean decrease at -1.4% during the study period. Open treatment of nasal septal fractures with or without stabilization demonstrated the greatest increase in mean adjusted reimbursement at 18.9%, while closed treatment of nasal septal fractures with or without stabilization demonstrated the smallest increase at 1.2%. The average reimbursement for all closed procedures in the top 20 decreased by 19.3%, while that for all open procedures decreased by 15.5%. The adjusted reimbursement rate for all top 20 procedures decreased by an average of 0.8% each year. To the best of our knowledge, this is the first study to comprehensively evaluate trends in Medicare reimbursement for facial trauma surgical repairs. Adjusting for inflation, Medicare reimbursement for the top 20 most commonly utilized procedures has largely decreased from 2000 to 2021. Consideration of these trends by surgeons, hospital systems, and policymakers will be important to assure continued access to meaningful surgical facial trauma care in the United States.

Traditional Uses of Medicinal Plants in Treating Bone fracture, Urine stone, Stomachache and Jaundice in Chandgad Tahsil (District Kolhapur) of Maharashtra, India

Traditional Uses of Medicinal Plants in Treating Bone fracture, Urine stone, Stomachache and Jaundice in Chandgad Tahsil (District Kolhapur) of Maharashtra, India

Bioactive antibacterial borate glass and glass-ceramics

This work aimed to study bioactive glass-ceramics obtained by controlled crystallization, as a function of the heat treatment time, in system 59.5B2O3-2P2O5-9.5CaO-19.5Na2O-9CaF2-0.5Ag2O (mol %). The samples were prepared by the melt-quench method, and thermally treated at 530 °C, with different times: 0, 4, 8, 12, 24 and 36 h. Results of DTA, XRD, FTIR, density and molar volume are shown. The results of XRD revealed the development of crystalline phases during the heat treatment (CaNaB5O9, Ca3(PO4)2, Na2B6O10 and Ag°). The percentage of crystallization and in the size of the crystallite show increases with the time of the heat treatment, as expected. In vitro bioactivity of the samples was analyzed by immersion in SBF for 7, 14, 21 and 28 days. XRD patterns and FTIR spectra after immersion proved HA precipitation. The pH results reveal a higher ion exchange rate for the crystallized samples. This can be associated with the microstructure changes that occur on the surface of the samples during the heat treatment and the solubility of the crystalline phases. In addition, glass and crystallized samples showed antibacterial action against E. coli, independently of the crystallization time. It is possible to conclude that glass-ceramics can potentially be used as biomaterials in the treatment of bone fractures.

The scientific heritage of Professor V.I. Luk’yanenko, Colonel of medical service is an important page of the national maxillofacial surgery and stomatology (To the 100th anniversary of his birth)

BACKGROUND: A great contribution to the development of the maxillofacial surgery and stomatology in the second half of XX century was made by a prominent Russian maxillofacial surgeon, participant of the Great Patriotic War 19411945, Doctor of Medicine, professor, colonel of medical service Vladimir Isidorovich Lukyanenko.&#x0D; The study aimed to present the contribution of Professor V.I. Lukyanenko to the theory and practice of maxillofacial surgery and dentistry.&#x0D; Russian literature in the field of dentistry and maxillofacial surgery that mentions the merits of Professor Lukyanenko and his monographs, textbooks, and scientific articles served as the material for the article.&#x0D; Professor Lukianenko contributed significantly to the development of many scientific problems of dentistry and maxillofacial surgery. He was an innovator in traumatology of maxillofacial region, purulent maxillofacial surgery, periodontology, and therapeutic dentistry. Many of his editions, developments, and suggestions are still used in his daily educational and pedagogical work and are the reference books for dentists and maxillofacial surgeons of military medical and medical institutions of the country.&#x0D; The scientific heritage of Prof. V.I. Lukyanenko is a valuable contribution to the development of the maxillofacial traumatology, purulent surgery, and sections of stomatology. He has done much in the field for the improvement of surgical methods of treatment of facial bone fractures, osteomyelitis of the jaws, maxillary phlegmon, and periodontitis and diagnosis and treatment of pulpitis.

Three-dimensional printable metamaterial intramedullary nails with tunable strain for the treatment of long bone fractures

Novel metamaterial unit cells with tunable strain were incorporated into titanium intramedullary (IM) nails to overcome problems of dense metallic implants. Three-dimensional (3D) models of cylindrical, pillar, and reference metamaterials were tuned and analyzed for structural authentication. Further, one solid IM nail (S0) and four different cylindrical metamaterial cell IM nails with gap sizes of 0.15 mm, 0.30 mm, 0.45 mm, and 0.60 mm were used to achieve 5% (S1), 10% (S2), 15% (S3), and 20% (S4) strain, respectively, in a 3-mm fracture, to investigate the healing outcomes. The bending stiffness (callus quality) in the S2 metamaterial IM nail increased by 22% between the 7th and 16th iterations, whereas for the S0, S1, S3, and S4 IM nails, the increases were 5.6%, 8.1%, 12.4%, and 9.0%, respectively. The S2 IM nail exhibited the best healing and bending stiffness; however, the S0 IM nail exhibited the worst results. This unique design was customized for different fracture gap sizes according to patient-specific needs.