{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:10:29Z","timestamp":1791267029047,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Low- and middle-income countries (LMICs) are disproportionately affected by trauma, resulting in &gt;5 million deaths annually. An essential treatment for musculoskeletal trauma is external fixation. However, in LMICs, current external fixator assemblies are unaffordable, costing patients upward of $5,000 (USD), leaving LMICs to rely on donations that fail to meet the needs of the patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>New, affordable external fixator (AEFIX) clamps (SONA Global), designed for use in LMIC settings, were compared with Hoffmann 3 (Stryker Medical) clamps to examine their mechanical efficacy compared with commercially available, industry-standard clamps in the U.S. market. In axial and torsional loading scenarios, mechanical testing was performed at the component level and construct level (uniplanar external fixation of a tibial diaphyseal fracture).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The AEFIX constructs showed no differences in axial or torsional stiffness compared with Stryker constructs. AEFIX constructs yielded at 434.5 N compared with Stryker constructs at 533.6 N (p = 0.04); however, the pins failed before clamp failure could occur in all AEFIX and Stryker constructs. Under cyclic loading at 100 and 300 N, no differences were observed in construct stiffness or interfragmentary gap change. At 500 N of cyclic loading, the AEFIX and Stryker constructs resulted in median gap changes of \u22124.3 and \u22121.1 mm, respectively (p &lt; 0.001), with no difference in % change in construct stiffness (p = 0.281).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>AEFIX clamps were comparable to industry-standard Stryker Hoffman 3 clamps in terms of mechanical properties and effectiveness, suggesting that the AEFIX clamps may provide safe external fracture fixation in the non-weight-bearing patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>As a safe and affordable solution, AEFIX clamps provide a foundation for enhancing essential trauma surgery capacity in resource-constrained settings around the globe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01463","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:00:09Z","timestamp":1756926009000},"page":"2289-2299","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of the Mechanical Performance of an Affordable External Fixator (AEFIX) Designed for Resource-Limited Settings"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-358X","authenticated-orcid":false,"given":"Kaveh","family":"Momenzadeh","sequence":"first","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"SONA Global, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4338-6391","authenticated-orcid":false,"given":"Mason J.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"SONA Global, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8763-293X","authenticated-orcid":false,"given":"Leon","family":"Zhao","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1925-6834","authenticated-orcid":false,"given":"Pooja","family":"Chainani","sequence":"additional","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6441-7815","authenticated-orcid":false,"given":"Samuel K.","family":"Simister","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"SONA Global, Boston, Massachusetts"},{"name":"Department of Orthopaedics, University of California Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-5364","authenticated-orcid":false,"given":"Catherine","family":"Hua","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1292-3661","authenticated-orcid":false,"given":"Thomas","family":"Miller","sequence":"additional","affiliation":[{"name":"SONA Global, Boston, Massachusetts"},{"name":"Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0566-5734","authenticated-orcid":false,"given":"Dankward","family":"H\u00f6ntzsch","sequence":"additional","affiliation":[{"name":"SONA Global, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-3489","authenticated-orcid":false,"given":"Ara","family":"Nazarian","sequence":"additional","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Mechanical Engineering, Boston University, Boston, Massachusetts"},{"name":"Department of Orthopedic Surgery, Yerevan State Medical University, Yerevan, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran J.","family":"Agarwal-Harding","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"SONA Global, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"issue":"21","key":"bib1-20260622","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.2106\/JBJS.16.00323","article-title":"Understanding and Addressing the Global Need for Orthopaedic Trauma Care","volume":"98","author":"Agarwal-Harding","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib3-20260622","doi-asserted-by":"crossref","first-page":"246","DOI":"10.2471\/BLT.08.052290","article-title":"Injuries: the neglected burden in developing countries","volume":"87","author":"Gosselin","year":"2009","journal-title":"Bull World Health Organ."},{"issue":"10","key":"bib5-20260622","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1007\/s00268-014-2607-y","article-title":"The extent of soft tissue and musculoskeletal injuries after earthquakes; describing a role for reconstructive surgeons in an emergency response","volume":"38","author":"Clover","year":"2014","journal-title":"World J Surg."},{"issue":"4","key":"bib6-20260622","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/BOT.0b013e31802f78fb","article-title":"Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom","volume":"21","author":"Owens","year":"2007","journal-title":"J Orthop Trauma."},{"issue":"7","key":"bib7-20260622","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.injury.2009.02.014","article-title":"Battlefield extremity injuries in Operation Iraqi Freedom","volume":"40","author":"Dougherty","year":"2009","journal-title":"Injury."},{"issue":"6","key":"bib8-20260622","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.2106\/JBJS.N.00314","article-title":"Estimating the global incidence of femoral fracture from road traffic collisions: a literature review","volume":"97","author":"Agarwal-Harding","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib9-20260622","doi-asserted-by":"crossref","first-page":"e442","DOI":"10.1371\/journal.pmed.0030442","article-title":"Projections of global mortality and burden of disease from 2002 to 2030","volume":"3","author":"Mathers","year":"2006","journal-title":"PLoS Med."},{"issue":"3","key":"bib10-20260622","doi-asserted-by":"crossref","first-page":"e026","DOI":"10.1097\/OI9.0000000000000026","article-title":"A multicenter observational study on the distribution of orthopaedic fracture types across 17 low- and middle-income countries","volume":"2","author":"Pouramin","year":"2019","journal-title":"OTA Int."},{"issue":"9","key":"bib11-20260622","doi-asserted-by":"crossref","first-page":"e580","DOI":"10.1016\/S2666-7568(21)00172-0","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"2","year":"2021","journal-title":"Lancet Healthy Longev."},{"issue":"1","key":"bib12-20260622","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2105\/AJPH.2004.039354","article-title":"Addressing the growing burden of trauma and injury in low- and middle-income countries","volume":"95","author":"Hofman","year":"2005","journal-title":"Am J Public Health."},{"issue":"1","key":"bib14-20260622","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0020-1383(96)00149-0","article-title":"Evaluation of a simple and low-cost external fixator","volume":"28","author":"Goh","year":"1997","journal-title":"Injury."},{"issue":"8","key":"bib15-20260622","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.injury.2015.05.003","article-title":"Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost","volume":"46","author":"Logan","year":"2015","journal-title":"Injury."},{"key":"bib16-20260622","doi-asserted-by":"crossref","first-page":"1004976","DOI":"10.3389\/fmedt.2022.1004976","article-title":"Low-cost locally manufacturable unilateral imperial external fixator for low- and middle-income countries","volume":"4","author":"Saeidi","year":"2022","journal-title":"Front Med Technol."},{"issue":"1","key":"bib17-20260622","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s13018-020-01777-5","article-title":"Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones","volume":"15","author":"Kouassi","year":"2020","journal-title":"J Orthop Surg Res."},{"key":"bib18-20260622","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.medengphy.2021.11.002","article-title":"An engineering review of external fixators","volume":"98","author":"Fernando","year":"2021","journal-title":"Med Eng Phys."},{"key":"bib19-20260622","first-page":"254","article-title":"A Review of the Biomechanical Role of a Unilateral External Fixator in the Fracture Repair Process","volume":"3","author":"Shahid","year":"2016","journal-title":"EC Orthopaedics"},{"issue":"Suppl 3","key":"bib20-20260622","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/S0020-1383(15)30007-3","article-title":"External fixation design evolution enhances biomechanical frame performance","volume":"46","author":"Sellei","year":"2015","journal-title":"Injury."},{"issue":"7","key":"bib21-20260622","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1007\/s00264-023-05807-9","article-title":"Clinical trial of a low-cost external fixator for global surgery use","volume":"47","author":"Milandri","year":"2023","journal-title":"Int Orthop."},{"issue":"2","key":"bib22-20260622","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s12593-012-0069-8","article-title":"A simple and low-cost external fixator for infected hand injuries","volume":"5","author":"Wijffels","year":"2013","journal-title":"J Hand Microsurg."},{"issue":"1","key":"bib23-20260622","article-title":"Simple low cost static external fixators for phalangeal fractures of hand","volume":"4","author":"Tank","year":"2018","journal-title":"Int J Orthop Sci."},{"issue":"1","key":"bib24-20260622","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s41205-020-00084-3","article-title":"Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study","volume":"6","author":"Landaeta","year":"2020","journal-title":"3D Print Med."},{"issue":"2","key":"bib25-20260622","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/004947558801800211","article-title":"Low-cost external fracture fixator. An attempt at more appropriate technology transfer","volume":"18","author":"Kugler","year":"1988","journal-title":"Trop Doct."},{"issue":"3","key":"bib27-20260622","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/j.1532-950X.1998.tb00121.x","article-title":"Mechanical comparison of two external fixator clamp designs","volume":"27","author":"Kraus","year":"1998","journal-title":"Vet Surg."},{"issue":"5","key":"bib28-20260622","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0020-1383(95)00037-A","article-title":"Treatment of closed tibial shaft fractures with unilateral external fixation","volume":"26","author":"Emami","year":"1995","journal-title":"Injury."},{"issue":"1","key":"bib29-20260622","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/ajhb.21227","article-title":"Birth weight, postnatal weight gain, and adult body composition in five low and middle income countries","volume":"24","author":"Kuzawa","year":"2012","journal-title":"Am J Hum Biol."},{"issue":"1","key":"bib30-20260622","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1186\/s12891-019-2679-9","article-title":"Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study","volume":"20","author":"Hao","year":"2019","journal-title":"BMC Musculoskelet Disord."},{"issue":"1","key":"bib31-20260622","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00005131-199801000-00001","article-title":"Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators","volume":"12","author":"Henley","year":"1998","journal-title":"J Orthop Trauma."},{"issue":"Suppl 2","key":"bib32-20260622","doi-asserted-by":"crossref","first-page":"B11","DOI":"10.1016\/j.injury.2003.09.021","article-title":"Biomechanical testing of the LCP\u2014how can stability in locked internal fixators be controlled?","volume":"34","author":"Stoffel","year":"2003","journal-title":"Injury."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01463","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:53:28Z","timestamp":1787752408000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":28,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.01463","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}