Astronauts, Spectacles, Racing Cars & Broken Bones | Peter Ogrodnik | TEDxStoke
The speaker argues for improving bone healing through engineering by demonstrating the limitations of current methods and proposing a shift toward remote monitoring, citing his work at Stoke-on-Trent with Prof. Pete Thomas. The speaker's philosophy is that an engineer must know "absolutely everything about the area in which [they're] designing to produce a design that works." The strongest evidence is the development of the Internet of Things (IoT) system to monitor healing remotely, which could eliminate up to 60% of necessary clinic visits.
## Speakers & Context
- **Speaker:** Unidentified expert in medical engineering, initially used computational methods for designing power stations.
- **Context:** Presented work done in Stoke-on-Trent with Prof. Pete Thomas, an orthopedic surgeon based at Stoke.
- **Speaker's Anecdote:** Was bullied for having a foreign-sounding name; previously designed power stations using computational methods.
- **Initial Contact:** Answered a phone call on summer duties; the caller was speaking a language the speaker didn't understand, leading him to learn orthopedics.
## Theses & Positions
- Engineering design requires knowing "absolutely everything about the area in which i'm designing to produce a design that works."
- The goal of orthopedic intervention is not just to fix a break, but to design something that helps the bone heal and does not "gets in the way."
- The most significant opportunity for improvement is moving from periodic, inaccurate assessments (like X-rays) to continuous, remote monitoring.
- The concept of "Internet of Things technology" can monitor fracture healing at home, potentially eliminating up to 60% of required clinic visits.
## Concepts & Definitions
- **Tibia:** The long bone referred to, commonly known as the shin.
- **Callus:** Nature's glue, which builds up around a break to facilitate healing.
- **Osteoclasts:** Cells described as "nature's diggers" that break down unnecessary bone material.
- **Osteoblasts:** Cells described as a "builder" that lay down bone where needed.
- **Moore's Law (Biological Application):** Principles guiding bone remodeling where excess bone is removed by osteoclasts, and new bone is laid down by osteoblasts, leading to an optimum structural solution.
- **Stable fracture:** A break where the ends come together when loaded, causing little issue.
- **Unstable fracture:** A more complex shape that requires external support, such as metalwork.
- **Reduction:** The process of bringing the bones back into correct alignment.
- **External Fixator:** Support metalwork placed outside the body to aid in mending.
- **IoT Technology:** Implementation of monitoring devices placed on the leg to send data wirelessly to a computer, allowing remote assessment.
## Mechanisms & Processes
- **Bone Healing Process:** A process involving the creation of callus, which builds up until the bone is stiff enough; this requires movement to facilitate the release of callus.
- **Callus Formation:** A process described as building up until it halts, indicating sufficient stiffness.
- **Bone Remodeling:** A continuous life process managed by the balance between osteoclasts removing old bone and osteoblasts building new bone.
- **Mechanical Assessment (Old Way):** Surgeons assessed stability using X-rays and physical manipulation, which the speaker deems "pretty inaccurate."
- **Mechanical Assistance (New Way):** Using devices like the "Storm" orthopedic reduction machine for controlled reduction, followed by the implantation of a fixator providing an "optimum environment for callus formation."
- **Remote Monitoring:** Monitoring fracture healing at home via attached sensors that collect data, which is then transmitted to a central computer for analysis, comparing the patient's data to expected healing curves.
## Timeline & Sequence
- **Initial Interest:** Developed in the speaker's professional life by answering a phone call concerning orthopedics, despite having no initial knowledge of broken bones.
- **Historical Assessment (Pre-Work):** Reliance on X-rays and physical manipulation of the fracture.
- **Speaker's Intervention:** Developing tools like the "Storm" machine and the fixed external fixator.
- **Modern Monitoring Phase:** Shifting from clinic visits to at-home IoT data collection, which allows for continuous tracking and prediction of healing progress.
## Named Entities
- **Stoke-on-Trent:** Location where the speaker's work was conducted.
- **Prof. Pete Thomas:** Orthopedic surgeon based at Stoke-on-Trent; collaborator.
- **Tibia:** The specific long bone discussed for fracture treatment.
- **Oasis/Stafford Shear Notice:** Name associated with the reduction machine (partial name mentioned).
## Numbers & Data
- **430:** Estimated number of people per million head of population who will need an operation to mend a broken tibia annually worldwide.
- **18 weeks:** Average time for activity to heal a broken tibia.
- **24 weeks:** Maximum time for healing.
- **8.5 weeks:** Minimum time for healing.
- **Four weeks:** Delaying the healing time by this period (e.g., due to smoking).
- **60%:** Percentage of clinics visits that could potentially be eliminated through remote monitoring.
- **400 patients:** Number of patients in Stoke assessed with the new method.
## Examples & Cases
- **The tibia demonstration:** Use of a prepared, broken tibia (the shin) to illustrate the subject matter.
- **Astronaut exercise:** The need for astronauts to exercise in space because lack of gravity removes the load on bones, leading to bone density issues upon return.
- **Load proportionality:** Analogy that a small load results in a small bone, and a big load requires a big bone.
- **Structural Analogy:** Comparing material strength to spider webs (efficiently structured) vs. inefficient excess material.
- **Modern Monitoring Test:** Successful assessment of 400 patients in Stoke using the non-invasive method.
## Tools, Tech & Products
- **External Fixator:** Metal supportwork used on unstable fractures.
- **"Storm" orthopedic reduction machine:** A mechanical assistance device designed for controlled reduction of fractures.
- **IoT technology:** Wearable sensors applied to the leg that transmit data wirelessly to a computer for remote healing monitoring.
## References Cited
- *None explicitly cited, though the speaker references the need for expertise gleaned from an unknown source:* "I can help this girl out."
## Trade-offs & Alternatives
- **Old Methods:** Reliance on X-rays and physical manipulation, described as "pretty inaccurate."
- **New Method (Ideal):** Continuous, remote monitoring via IoT, allowing for early intervention and predicting required recovery time.
- **Cost/Efficiency Trade-off:** The older model required days off work for hospital visits; the new IoT model saves labor, reduces traffic, and cuts $\text{CO}_2$ emissions.
## Methodology
- **Diagnosis:** Classifying fractures as stable or unstable.
- **Reduction:** Achieving proper bone alignment, possibly using mechanical assistance like the "Storm" machine.
- **Immobilization/Support:** Applying fixators to create an optimum environment for callus formation.
- **Assessment:** Utilizing advanced, non-invasive methods (like the final monitoring system) to measure stiffness and track healing progress, rather than relying solely on visual inspection or radiation.
## Conclusions & Recommendations
- The shift from physical clinic attendance to IoT-enabled remote monitoring is strongly recommended to improve patient outcomes and reduce systemic burden.
- The speaker advocates for leveraging complex mathematical modeling (originally used for power stations) to manage biological systems like bone healing.
- The final proposal is to utilize data modeling across global infrastructure (connecting power stations via the ether) to predict complex outcomes.
## Implications & Consequences
- **Clinical:** Greatly improved accuracy in assessing fracture healing, leading to timely removal of fixation hardware.
- **Societal/Economic:** Elimination of 60% of necessary clinical visits reduces lost work time, decreases traffic, and lowers $\text{CO}_2$ emissions.
- **Engineering Legacy:** The speaker connects his disparate professional history—from modeling power stations to medicine—showing a unifying application of complex quantitative principles.
## Verbatim Moments
- *"if we could just do this much for a material that was like bone it would be absolutely amazing"*
- *"my philosophy for engineering and particularly engineering design is very simple I have to know absolutely everything about the area in which i'm designing to produce a design that works"*
- *"if you're young and you're female doesn't mean you're immune you can still break a leg"*
- *"it's called callous... another wonderful think it's nature's glue"*
- *"what's done with storm you can't even see the fracture site"*
- *"this is like saying I'll turn on that nuclear power station it hasn't blown up by next week it's okay it's going to work"*
- *"the Internet of Things technology there it is on someone's what it would look like on someone's leg"*
- *"sixty percent of clinics gone means is less traffic less traffic means is more parking less traffic means there's less co2 emission and the number is enormous for a clinic that's the estimate for one clinic for one year"*
- *"I was laughed out of the room they'll went Sydney data over the ether are you mad"*