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Baleani M, Erani P, Acciaioli A, Schileo E. Tensile Yield Strain of Human Cortical Bone from the Femoral Diaphysis Is Constant among Healthy Adults and across the Anatomical Quadrants. Bioengineering (Basel) 2024; 11:395. [PMID: 38671816 PMCID: PMC11048186 DOI: 10.3390/bioengineering11040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The literature suggests that the yield strain of cortical bone is invariant to its stiffness (elastic modulus) and strength (yield stress). However, data about intra-individual variations, e.g., the influence of different collagen/mineral organisations observed in bone aspects withstanding different habitual loads, are lacking. The hypothesis that the yield strain of human cortical bone tissue, retrieved from femoral diaphyseal quadrants subjected to different habitual loads, is invariant was tested. Four flat dumbbell-shaped specimens were machined from each quadrant of the proximal femoral diaphysis of five adult donors for a total of 80 specimens. Two extensometers attached to the narrow specimen region were used to measure deformation during monotonic tensile testing. The elastic modulus (linear part of the stress-strain curve) and yield strain/stress at a 0.2% offset were obtained. Elastic modulus and yield stress values were, respectively, in the range of 12.2-20.5 GPa and 75.9-136.6 MPa and exhibited a positive linear correlation. All yield strain values were in the narrow range of 0.77-0.87%, regardless of the stiffness and strength of the tissue and the anatomical quadrant. In summary, the results corroborate the hypothesis that tensile yield strain in cortical bone is invariant, irrespective also of the anatomical quadrant. The mean yield strain value found in this study is similar to what was reported by inter-species and evolution studies but slightly higher than previous reports in humans, possibly because of the younger age of our subjects. Further investigations are needed to elucidate a possible dependence of yield strain on age.
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Affiliation(s)
- Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.E.); (A.A.)
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.E.); (A.A.)
| | - Alice Acciaioli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.E.); (A.A.)
| | - Enrico Schileo
- Laboratorio di Bioingegneria Computazionale, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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Arias-Blanco A, Marco M, Giner E, Larraínzar-Garijo R, Miguélez MH. Experimental and numerical analysis of the influence of intramedullary nail position on the cut-out phenomenon. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107734. [PMID: 37517184 DOI: 10.1016/j.cmpb.2023.107734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Proximal femur fractures, colloquially known as hip fractures, are a common pathology with increasing incidence in the last years due to the enhanced ageing population. Regarding the extracapsular fracture, the treatment for this pathology consists of a fixation of the fragments using an osteosynthesis device, mainly the intramedullary nail. This repairing method implies several complications, which may include the failure of the fixation device, frequently occurring due to the "cut-out" mechanism. The present work focuses on the study of how the position of the cephalic screw, which should be fixed during surgery, affects the cut-out risk. Through experimental tests and numerical models some variables that can be critical for the cut-out phenomenon are analysed. METHODS This study has been carried out through a numerical model based on the finite element method and experimental tests. The digital image correlation technique has been used in experimental tests to measure displacements on the femoral surface with the objective of numerical model validation. Some basic daily activities with different intramedullary nail positions have been analysed through the numerical model, considering variables that can induce the cut-out complication. RESULTS The results show how the intramedullary nail position clearly influences the cut-out risk, showing that displacements in the upper, anterior and posterior direction increase the cut-out risk, while displacement in the lower direction endangers the intramedullary nail itself. Thus, the centred position is the one which reduces the cut-out risk. CONCLUSIONS This work supposes an improvement in the knowledge of the cut-out phenomenon thanks to the combination of experimental testing and validated numerical models. The effects of different intramedullary nail positions in the femoral head are studied, including a novelty variable as torque, which is critical for the structural integrity of the fixation. The main conclusion of the work is the determination of the central intramedullary nail position as the most favourable one for decreasing the cut-out risk.
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Affiliation(s)
- A Arias-Blanco
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Spain
| | - M Marco
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Spain.
| | - E Giner
- Institute of Mechanical and Biomechanical Engineering (I2MB), Department of Mechanical and Materials Engineering, Universitat Politècnica de València, Spain
| | - R Larraínzar-Garijo
- Service of Orthopaedic Surgery and Traumatology, University Hospital Infanta Leonor, Universidad Complutense de Madrid, Spain
| | - M H Miguélez
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Spain
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Pérez-Cano FD, Jiménez-Pérez JR, Molina-Viedma AJ, López-Alba E, Luque-Luque A, Delgado-Martínez A, Díaz-Garrido FA, Jiménez-Delgado JJ. Human femur fracture by mechanical compression: Towards the repeatability of bone fracture acquisition. Comput Biol Med 2023; 164:107249. [PMID: 37473562 DOI: 10.1016/j.compbiomed.2023.107249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
The increase in life expectancy combined with greater bone fragility over the years is causing a rise in the bone fracture cases. Femur fractures are the most important due to their high mortality rate. This multidisciplinary work is carried out in this context and focuses on the experimental reproduction of human femur fractures by compression. We describe a sequence of steps supervised by orthopaedic surgeons for the correct arrangement of specimens on the system set up to perform the experiment. The device applies force by compression until the human bone is fractured. All tests performed have been monitored and evaluated from different knowledge perspectives. The results obtained have demonstrated the repeatability of the fracture type in a controlled environment as well as identifying the main features involved in this process. In addition, the fractured bones have been digitized to analyze the fracture zone to recreate and evaluate future simulations.
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Affiliation(s)
- F D Pérez-Cano
- Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain.
| | - J R Jiménez-Pérez
- Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain.
| | - A J Molina-Viedma
- Department of Mechanical and Mining Engineering, University of Jaén, Jaén, Spain.
| | - E López-Alba
- Department of Mechanical and Mining Engineering, University of Jaén, Jaén, Spain.
| | - A Luque-Luque
- Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain.
| | - A Delgado-Martínez
- Department of Orthopedic Surgery, Complejo Hospitalario de Jaén, Jaén, Spain; Department of Health Sciences, University of Jaén, Jaén, Spain.
| | - F A Díaz-Garrido
- Department of Mechanical and Mining Engineering, University of Jaén, Jaén, Spain.
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Fan ZY, Shu LY, Jin YZ, Sherrier MC, Yin BH, Liu CJ, Zhan S, Sun H, Zhang W. Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures. Injury 2022; 53:3887-3893. [PMID: 36195517 DOI: 10.1016/j.injury.2022.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the biomechanical properties of compression buttress screw (CBS) fixation with three plate fixation methods for the treatment of vertical femoral neck fractures (FNFs). METHODS A total of forty synthetic femoral models with simulated Pauwels type III fractures (angle of 70°) were equally assigned to one of four fixation groups: CBS fixation, anteromedial plate fixation (AMP), medial buttress plate fixation (MBP) and medial buttress plate fixation without proximal screw (MBPw). Within each group, half of the specimens were randomly assigned to two loading settings, an axial compression loading test and a hip-flexion torsion test. RESULTS There were no significant differences in axial load to failure, axial stiffness, torsional strength, or torsional stiffness when comparing CBS with MBP (p>0.05). In the axial compression loading test, both CBS and MBP showed higher load to failure and axial stiffness than MBPw (p<0.05). In torsional testing, AMP exhibited superior torsional strength and torsional stiffness than both MBPw and MBP (all p<0.05) and a higher torsional strength than CBS fixation (p<0.05). There were no significant differences in torsional stiffness between the CBS and AMP fixation groups (p>0.05). CONCLUSION The biomechanical parameters of CBS fixation are comparable to that of AMP and MBP, and demonstrate superior axial stiffness than MBPw fixation. Although the CBS method for surgical fixation of vertical FNF holds promise as a less invasive surgical technique than plate fixation with similar biomechanical assessments, further clinical evaluation is warranted.
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Affiliation(s)
- Zhi-Yuan Fan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Lin-Yuan Shu
- Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Ying-Zhe Jin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedic and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, United States of America
| | - Bo-Hao Yin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Chen-Jun Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Shi Zhan
- Orthopaedic Biomechanical Laboratory, Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Hui Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
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Dahan G, Safran O, Yosibash Z. Can neck fractures in proximal humeri be predicted by CT-based FEA? J Biomech 2022; 136:111039. [PMID: 35381504 DOI: 10.1016/j.jbiomech.2022.111039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Proximal humeri fractures at anatomical and surgical neck (∼5% and ∼50% incidence respectively) are frequent in elderly population. Yet, neither in-vitro experiments nor CT-based finite element analyses (CTFEA) have investigated these in depth. Herein we enhance (Dahan et al., 2019) (addressing anatomical neck fractures) by more experiments and specimens, accounting for surgical neck fractures and explore CTFEA's prediction of humeri mechanical response and yield force. METHODS Four fresh frozen human humeri were tested in a new experimental configuration inducing surgical neck fractures. Digital image correlation (DIC) provided strains and displacements on humeri surfaces and used to validate CTFEA predictions. CTFEA were enhanced herein to improve the accuracy at the proximal neck: A cortical bone mapping (CBM) algorithm was implemented to overcome insufficient scanning resolution, and a new trabecular material mapping was investigated. RESULTS The new experimental setting induced impacted surgical neck fractures in all humeri. Excellent DIC to CTFEA correlation in strains was obtained at the shaft (slope 0.984, R2=0.99) and a fair agreement (slope 0.807, R2=0.73) at the neck. CBM algorithm had worsened the correlation, whereas the new material mapping had a negligible influence. Yield loads predictions improved considerably when trabecular yielding (maximum principal strain criterion) was considered instead of surface cortical yielding. DISCUSSION CTFEA well predicts strains on the shaft and reasonably well on the neck. This enhances former conclusions by past studies conducted using SGs, now also evident by DIC. Yield load prediction for surgical neck fractures (involving crushing of trabecular bone) is predicted better by trabecular failure laws rather than cortex ones. Further FEA studies using trabecular orthotropic constitutive models and failure laws are warrant.
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Zhan S, Jiang D, Ling M, Ding J, Yang K, Duan L, Tsai TY, Feng Y, van Trigt B, Jia W, Zhang C, Hu H. Fixation effects of different types of cannulated screws on vertical femoral neck fracture: A finite element analysis and experimental study. Med Eng Phys 2021; 97:32-39. [PMID: 34756336 DOI: 10.1016/j.medengphy.2021.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Femoral neck fractures (FNFs) in young patients usually result from high-energy violence, and the vertical transcervical type is typically challenging for its instability. FNFs are commonly treated with three cannulated screws (CS), but the role of screws type on fixation effects (FE) is unclear. The purpose of this study was to evaluate the FE of ten types of CS with different diameters, lengths, depths, and pitches of thread via finite element analysis which was validated by a biomechanical test. Ten vertical FNF models were grouped, fixed by ten types of CS, respectively, all in a parallel, inverted triangular configuration. Their FE were scored comprehensively from six aspects via an entropy evaluation method, as higher scores showed better results. For partial-thread screws, thread length and thread shape factor (TSF) are determinative factors on stability of FNF only if thread depth is not too thick, and they have less cut-out risk, better compression effects and better detached resistance of fracture than full-thread screws, whereas full-thread screws appear to have better shear and shortening resistance. A combination of two superior partial-thread screws and one inferior full-thread screw for vertical FNF may get optimal biomechanical outcomes. The type of cannulated screw is important to consider when treating vertical FNF.
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Affiliation(s)
- Shi Zhan
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Dajun Jiang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Ming Ling
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Jian Ding
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Kai Yang
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Lei Duan
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, PR China
| | - Tsung-Yuan Tsai
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China
| | - Yong Feng
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Bart van Trigt
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 4, 2628 CD Delft, the Netherlands
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Changqing Zhang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Hai Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
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Barkaoui A, Ait Oumghar I, Ben Kahla R. Review on the use of medical imaging in orthopedic biomechanics: finite element studies. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.1888317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Abdelwahed Barkaoui
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
| | - Imane Ait Oumghar
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Rabeb Ben Kahla
- Laboratoire de Systémes et de Mécanique Appliquée, Ecole Polytechnique de Tunis, Université de Carthage, Tunis, Tunisia
- Ecole Nationale d’Ingénieurs de Tunis, Université de Tunis el Manar, Campus Universitaire, Tunis, Tunisia
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A novel specimen shape for measurement of linear strain fields by means of digital image correlation. Sci Rep 2021; 11:17515. [PMID: 34471200 PMCID: PMC8410939 DOI: 10.1038/s41598-021-97085-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Strains on the surface of engineering structures or biological tissues are non-homogeneous. These strain fields can be captured by means of Digital Image Correlation (DIC). However, DIC strain field measurements are prone to noise and filtering of these fields influences measured strain gradients. This study aims to design a novel tensile test specimen showing two linear gradients, to measure full-field linear strain measurements on the surface of test specimens, and to investigate the accuracy of DIC strain measurements globally (full-field) and locally (strain gauges' positions), with and without filtering of the DIC strain fields. Three materials were employed for this study: aluminium, polymer, and bovine bone. Normalized strain gradients were introduced that are load independent and evaluated at two local positions showing 3.6 and 6.9% strain change per mm. Such levels are typically found in human bones. At these two positions, two strain gauges were applied to check the experimental strain magnitudes. A third strain gauge was applied to measure the strain in a neutral position showing no gradient. The accuracy of the DIC field measurement was evaluated at two deformation stages (at [Formula: see text] 500 and 1750 μstrain) using the root mean square error (RMSE). The RMSE over the two linear strain fields was less than 500 μstrain for both deformation stages and all materials. Gaussian low-pass filter (LPF) reduced the DIC noise between 25% and 64% on average. As well, filtering improved the accuracy of the local normalized strain gradients measurements with relative difference less than 20% and 12% for the high- and low-gradient, respectively. In summary, a novel specimen shape and methodological approach are presented which are useful for evaluating and improving the accuracy of the DIC measurement where non-homogeneous strain fields are expected such as on bone tissue due to their hierarchical structure.
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Azari F, Sas A, Kutzner KP, Klockow A, Scheerlinck T, van Lenthe GH. Cemented short-stem total hip arthroplasty: Characteristics of line-to-line versus undersized cementing techniques using a validated CT-based finite element analysis. J Orthop Res 2021; 39:1681-1690. [PMID: 33095461 DOI: 10.1002/jor.24887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Short stems are becoming increasingly popular in total hip arthroplasty as they preserve the bone stock and simplify the implantation process. Short stems are advised mainly for patients with good bone stock. The clinical use of short stems could be enlarged to patients with poor bone stock if a cemented alternative would be available. Therefore, this study aimed to quantify the mechanical performance of a cemented short stem and to compare the "undersized" cementing strategy (stem one size smaller than the rasp) with the "line-to-line" technique (stem and rasp with identical size). A prototype cemented short stem was implanted in eight pairs of human cadaveric femora using the two cementing strategies. Four pairs were experimentally tested in a single-legged stance condition; stiffness, strength, and bone surface displacements were measured. Subject-specific nonlinear finite element models of all the implanted femora were developed, validated against the experimental data, and used to evaluate the behavior of cemented short stems under physiological loading conditions resembling level walking. The two cementing techniques resulted in nonsignificant differences in stiffness and strength. Strength and stiffness as calculated from finite element were 8.7 ± 16% and 9.9 ± 15.0% higher than experimentally measured. Displacements as calculated from finite element analyses corresponded strongly (R 2 ≥ .97) with those measured by digital image correlation. Stresses during level walking were far below the fatigue limit for bone and bone cement. The present study suggests that cemented short stems are a promising solution in osteoporotic bone, and that the line-to-line and undersized cementing techniques provide similar outcomes.
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Affiliation(s)
| | - Amelie Sas
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Karl P Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
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Zhang L, Jackson WJ, Bentil SA. Deformation of an airfoil-shaped brain surrogate under shock wave loading. J Mech Behav Biomed Mater 2021; 120:104513. [PMID: 34010798 DOI: 10.1016/j.jmbbm.2021.104513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Improvised explosive devices (IEDs), during military operations, has increased the incidence of blast-induced traumatic brain injuries (bTBI). The shock wave is created following detonation of the IED. This shock wave propagates through the atmosphere and may cause bTBI. As a result, bTBI research has gained increased attention since this injury's mechanism is not thoroughly understood. To develop better protection and treatment against bTBI, further studies of soft material (e.g. brain and brain surrogate) deformation due to shock wave exposure are essential. However, the dynamic mechanical behavior of soft materials, subjected to high strain rates from shock wave exposure, remains unknown. Thus, an experimental approach was applied to study the interaction between the shock wave and an unconfined brain surrogate fabricated from a biomaterial (i.e. polydimethylsiloxane (PDMS)). The 1:70 ratio of curing agent-to-base determined the stiffness of the PDMS (Sylgard 184, Dow Corning Corporation). A stretched NACA 2414 (upper airfoil surface) geometry was utilized to resemble the shape of a porcine brain. Digital image correlation (DIC) technique was applied to measure the deformation on the brain surrogate's surface following shock wave exposure. A shock tube was utilized to create the shock wave and pressure transducers measured the pressure in the vicinity of the brain surrogate. A transient structural analysis using ANSYS Workbench was performed to predict the elastic modulus of 1:70 airfoil-shaped PDMS, at a strain rate on the order of 6 × 103 s-1. Both compression and protrusion of the PDMS surface were found due to the shock wave exposure. Negative pressure was found in a semi-ring area, which was the cause of protrusion. Oscillation of the brain surrogate, due to the shock wave loading, was found. The frequency of oscillation does not depend on the geometry. This work will add to the limited data describing the dynamic behavior of soft materials due to shock wave loading.
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Affiliation(s)
- Ling Zhang
- Department of Mechanical Engineering, Iowa State University of Science and Technology, 2529 Union Drive, Ames, IA, 50011, USA
| | - William J Jackson
- Department of Mechanical Engineering, Iowa State University of Science and Technology, 2529 Union Drive, Ames, IA, 50011, USA
| | - Sarah A Bentil
- Department of Mechanical Engineering, Iowa State University of Science and Technology, 2529 Union Drive, Ames, IA, 50011, USA.
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11
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Chen P, Zhan Y, Zhan S, Li R, Luo C, Xie X. Biomechanical evaluation of different types of lateral hinge fractures in medial opening wedge high tibial osteotomy. Clin Biomech (Bristol, Avon) 2021; 83:105295. [PMID: 33662653 DOI: 10.1016/j.clinbiomech.2021.105295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral hinge fractures are common complications in the medial opening wedge high tibial osteotomy for treatment of knee osteoarthritis. The rehabilitation protocols are decided depending on the remaining stability following these fractures. This study aimed to evaluate the biomechanical properties of different types of lateral hinge fractures in medial opening wedge high tibial osteotomy. METHODS Twenty synthetic tibia models were used as test samples. A 10-mm bone wedge was removed from the medial side of the proximal tibias to create the bone defect. The samples were then divided into 4 groups: (1) intact lateral hinge; (2) Takeuchi type I fractures; (3) type II fractures; and (4) type III fractures. After fixation with a locking plate, the stability parameters including construct stiffness, wedge displacement, and construct strength were tested under compressive forces and compared among the 4 groups. FINDINGS No statistical difference was found in the construct stiffness among the 4 groups (P = 0.78). The type III fractures had the largest wedge displacement compared with the other 3 groups. The failure loads on average were significantly reduced in the type III fractures compared with those with intact hinge (P < 0.01) and in type I fractures (P = 0.04). No statistical difference was observed between the type I fractures and the intact hinge in terms of wedge displacement or failure loads. INTERPRETATION The type III fractures were the most unstable and patients with these fractures should be managed cautiously. Delayed weightbearing and/or additional fixation should be considered.
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Affiliation(s)
- Peng Chen
- Department of Orthopaedic Surgery, Zhejiang Sian International Hospital, 2369 Hongxing Road, Jiaxing, Zhejiang Province, 314000, China
| | - Yu Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Shi Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Ruiyang Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Congfeng Luo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
| | - Xuetao Xie
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
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12
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Subject-specific FE models of the human femur predict fracture path and bone strength under single-leg-stance loading. J Mech Behav Biomed Mater 2020; 113:104118. [PMID: 33125949 DOI: 10.1016/j.jmbbm.2020.104118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
Hip fractures are a major health problem with high socio-economic costs. Subject-specific finite element (FE) models have been suggested to improve the fracture risk assessment, as compared to clinical tools based on areal bone mineral density, by adding an estimate of bone strength. Typically, such FE models are limited to estimate bone strength and possibly the fracture onset, but do not model the fracture process itself. The aim of this study was to use a discrete damage approach to simulate the full fracture process in subject-specific femur models under stance loading conditions. A framework based on the partition of unity finite element method (PUFEM), also known as XFEM, was used. An existing PUFEM framework previously used on a homogeneous generic femur model was extended to include a heterogeneous material description together with a strain-based criterion for crack initiation. The model was tested on two femurs, previously mechanically tested in vitro. Our results illustrate the importance of implementing a subject-specific material distribution to capture the experimental fracture pattern under stance loading. Our models accurately predicted the fracture pattern and bone strength (1% and 5% error) in both investigated femurs. This is the first study to simulate complete fracture paths in subject-specific FE femur models and it demonstrated how discrete damage models can provide a more complete picture of fracture risk by considering both bone strength and fracture toughness in a subject-specific fashion.
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Turunen MJ, Le Cann S, Tudisco E, Lovric G, Patera A, Hall SA, Isaksson H. Sub-trabecular strain evolution in human trabecular bone. Sci Rep 2020; 10:13788. [PMID: 32796859 PMCID: PMC7429852 DOI: 10.1038/s41598-020-69850-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
To comprehend the most detrimental characteristics behind bone fractures, it is key to understand the material and tissue level strain limits and their relation to failure sites. The aim of this study was to investigate the three-dimensional strain distribution and its evolution during loading at the sub-trabecular level in trabecular bone tissue. Human cadaver trabecular bone samples were compressed in situ until failure, while imaging with high-resolution synchrotron radiation X-ray tomography. Digital volume correlation was used to determine the strains inside the trabeculae. Regions without emerging damage were compared to those about to crack. Local strains in close vicinity of developing cracks were higher than previously reported for a whole trabecular structure and similar to those reported for single isolated trabeculae. Early literature on bone fracture strain thresholds at the tissue level seem to underestimate the maximum strain magnitudes in trabecular bone. Furthermore, we found lower strain levels and a reduced ability to capture detailed crack-paths with increased image voxel size. This highlights the dependence between the observed strain levels and the voxel size and that high-resolution is needed to investigate behavior of individual trabeculae. Furthermore, low trabecular thickness appears to be one predictor of developing cracks. In summary, this study investigated the local strains in whole trabecular structure at sub-trabecular resolution in human bone and confirmed the high strain magnitudes reported for single trabeculae under loading and, importantly extends its translation to the whole trabecular structure.
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Affiliation(s)
- Mikael J Turunen
- Department of Applied Physics, University of Eastern Finland, Box 1627, 70211, Kuopio, Finland. .,Department of Biomedical Engineering, Lund University, Lund, Sweden.
| | - Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Goran Lovric
- Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland.,Centre D'Imagerie BioMédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden.,Lund Institute of advanced Neutron and X-ray Science (LINXS), Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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14
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Grassi L, Kok J, Gustafsson A, Zheng Y, Väänänen SP, Jurvelin JS, Isaksson H. Elucidating failure mechanisms in human femurs during a fall to the side using bilateral digital image correlation. J Biomech 2020; 106:109826. [DOI: 10.1016/j.jbiomech.2020.109826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
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15
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Iori G, Peralta L, Reisinger A, Heyer F, Wyers C, van den Bergh J, Pahr D, Raum K. Femur strength predictions by nonlinear homogenized voxel finite element models reflect the microarchitecture of the femoral neck. Med Eng Phys 2020; 79:60-66. [PMID: 32291201 DOI: 10.1016/j.medengphy.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022]
Abstract
In the human femoral neck, the contribution of the cortical and trabecular architecture to mechanical strength is known to depend on the load direction. In this work, we investigate if QCT-derived homogenized voxel finite element (hvFE) simulations of varying hip loading conditions can be used to study the architecture of the femoral neck. The strength of 19 pairs of human femora was measured ex vivo using nonlinear hvFE models derived from high-resolution peripheral QCT scans (voxel size: 30.3 µm). Standing and side-backwards falling loads were modeled. Quasi-static mechanical tests were performed on 20 bones for comparison. Associations of femur strength with volumetric bone mineral density (vBMD) or microstructural parameters of the femoral neck obtained from high-resolution QCT were compared between mechanical tests and simulations and between standing and falling loads. Proximal femur strength predictions by hvFE models were positively associated with the vBMD of the femoral neck (R² > 0.61, p < 0.001), as well as with its cortical thickness (R² > 0.27, p < 0.001), trabecular bone volume fraction (R² = 0.42, p < 0.001) and with the first two principal components of the femoral neck architecture (R² > 0.38, p < 0.001). Associations between femur strength and femoral neck microarchitecture were stronger for one-legged standing than for side-backwards falling. For both loading directions, associations between structural parameters and femur strength from hvFE models were in good agreement with those from mechanical tests. This suggests that hvFE models can reflect the load-direction-specific contribution of the femoral neck microarchitecture to femur strength.
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Affiliation(s)
- Gianluca Iori
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laura Peralta
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, INSERM UMR S 1146, CNRS UMR, 7371, Paris, France; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andreas Reisinger
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Frans Heyer
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Caroline Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Joop van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Dieter Pahr
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria; Institute for Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Kay Raum
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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16
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Sas A, Van Camp D, Lauwers B, Sermon A, van Lenthe GH. Cement augmentation of metastatic lesions in the proximal femur can improve bone strength. J Mech Behav Biomed Mater 2020; 104:103648. [DOI: 10.1016/j.jmbbm.2020.103648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
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17
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Ristow J, Mead M, Cordeiro M, Ostrander J, Atkinson T, Atkinson P. Pre-bending a dynamic compression plate significantly alters strain distribution near the fracture plane in the mid-shaft femur. Proc Inst Mech Eng H 2020; 234:478-485. [PMID: 32022642 DOI: 10.1177/0954411920903875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the effect of pre-bending dynamic compression plates on fracture site compression. Recommendations of 1 to 2 mm of pre-bend have been proposed, but there does not appear to be experimental data to confirm the optimal pre-bend magnitude. Dynamic compression plating was performed on the lateral convex surface of 18 femoral analogs to fixate a simulated mid-shaft fracture. Plates with 0 mm (flat plate), 1 mm, and 2 mm of pre-bend were evaluated for their production of compression by determining the strain magnitudes for 10 equal-sized zones across the anterior cortex at the osteotomy site using digital imaging correlation. The 0 and 1 mm plates produced significantly more compression at the near cortex (p = 0.001 and p = 0.003, respectively) than the 2 mm plate. However, the 0 and 1 mm plates also created visible diastasis at the far cortex, while the 2 mm plate exhibited compression across all zones. The strain magnitudes for the 0 mm (R2 = 0.62) and 1 mm (R2 = 0.86) plates linearly and significantly decreased from the region adjacent to the plate until a region 50%-60% across the analog diameter. In contrast, the 2 mm plate exhibited uniform strains across the osteotomy site. This study demonstrates that pre-bending a dynamic compression plate 2 mm prior to fixation on a convex lateral femur provides the most compression at the far cortex. It also produces more uniform compression across the fracture when compared to 0 and 1 mm of pre-bend.
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Affiliation(s)
- Jacob Ristow
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA
| | - Matthew Mead
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA
| | - Minal Cordeiro
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA
| | - James Ostrander
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA
| | - Theresa Atkinson
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA.,Mechanical Engineering Department, Kettering University, Flint, MI, USA
| | - Patrick Atkinson
- Department of Orthopaedic Surgery, McLaren Regional Medical Center, Flint, MI, USA.,Mechanical Engineering Department, Kettering University, Flint, MI, USA
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Väänänen SP, Grassi L, Venäläinen MS, Matikka H, Zheng Y, Jurvelin JS, Isaksson H. Automated segmentation of cortical and trabecular bone to generate finite element models for femoral bone mechanics. Med Eng Phys 2019; 70:19-28. [PMID: 31280927 DOI: 10.1016/j.medengphy.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/16/2019] [Accepted: 06/23/2019] [Indexed: 02/02/2023]
Abstract
Finite element (FE) models based on quantitative computed tomography (CT) images are better predictors of bone strength than conventional areal bone mineral density measurements. However, FE models require manual segmentation of the femur, which is not clinically applicable. This study developed a method for automated FE analyses from clinical CT images. Clinical in-vivo CT images of 13 elderly female subjects were collected to evaluate the method. Secondly, proximal cadaver femurs were harvested and imaged with clinical CT (N = 17). Of these femurs, 14 were imaged with µCT and three had earlier been tested experimentally in stance-loading, while collecting surface deformations with digital image correlation. Femurs were segmented from clinical CT images using an automated method, based on the segmentation tool Stradwin. The method automatically distinguishes trabecular and cortical bone, corrects partial volume effect and generates input for FE analysis. The manual and automatic segmentations agreed within about one voxel for in-vivo subjects (0.99 ± 0.23 mm) and cadaver femurs (0.21 ± 0.07 mm). The strains from the FE predictions closely matched with the experimentally measured strains (R2 = 0.89). The method can automatically generate meshes suitable for FE analysis. The method may bring us one step closer to enable clinical usage of patient-specific FE analyses.
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Affiliation(s)
- Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB 100, FIN-70029 Kuopio, Finland; Department of Medical Physics, Central Finland Central Hospital, Keskussairaalantie 19, FIN-40620 Jyväskylä, Finland.
| | - Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
| | - Mikko S Venäläinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Tykistökatu 6, FIN-20520 Turku, Finland.
| | - Hanna Matikka
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland.
| | - Yi Zheng
- Department of Physics, Technical University of Denmark, Fysikvej, building 311, 2800 Kgs. Lyngby, Denmark.
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
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19
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Correction to: Prediction of femoral strength using 3D finite element models reconstructed from DXA images: validation against experiments. Biomech Model Mechanobiol 2019; 18:1263-1267. [PMID: 31134388 DOI: 10.1007/s10237-019-01173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the original publication of the article, Fig. 3 and Tables 2, 4 and 5 were published with errors. The issue was caused by an error in the code used to predict femoral strength in the finite element (FE) models.
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20
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Marco M, Giner E, Caeiro-Rey JR, Miguélez MH, Larraínzar-Garijo R. Numerical modelling of hip fracture patterns in human femur. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 173:67-75. [PMID: 31046997 DOI: 10.1016/j.cmpb.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Hip fracture morphology is an important factor determining the ulterior surgical repair and treatment, because of the dependence of the treatment on fracture morphology. Although numerical modelling can be a valuable tool for fracture prediction, the simulation of femur fracture is not simple due to the complexity of bone architecture and the numerical techniques required for simulation of crack propagation. Numerical models assuming homogeneous fracture mechanical properties commonly fail in the prediction of fracture patterns. This paper focuses on the prediction of femur fracture based on the development of a finite element model able to simulate the generation of long crack paths. METHODS The finite element model developed in this work demonstrates the capability of predicting fracture patterns under stance loading configuration, allowing the distinction between the main fracture paths: intracapsular and extracapsular fractures. It is worth noting the prediction of different fracture patterns for the same loading conditions, as observed during experimental tests. RESULTS AND CONCLUSIONS The internal distribution of bone mineral density and femur geometry strongly influences the femur fracture morphology and fracture load. Experimental fracture paths have been analysed by means of micro-computed tomography allowing the comparison of predicted and experimental crack surfaces, confirming the good accuracy of the numerical model.
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Affiliation(s)
- Miguel Marco
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avda. de la Universidad 30, 28911 Leganés, Madrid, Spain.
| | - Eugenio Giner
- CIIM-Department of Mechanical and Materials Engineering, Universitat Politècnica de València Camino de Vera, 46022 Valencia, Spain
| | - José Ramón Caeiro-Rey
- Orthopedic Surgery and Traumatology Service, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa de Ramón Baltar, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - M Henar Miguélez
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avda. de la Universidad 30, 28911 Leganés, Madrid, Spain
| | - Ricardo Larraínzar-Garijo
- Orthopaedics and Trauma Department, Surgery Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain
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21
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Grassi L, Väänänen SP, Ristinmaa M, Jurvelin JS, Isaksson H. Corrigendum to “How accurately can subject-specific finite element models predict strains and strength of human femora? Investigation using full-field measurements” [J. Biomech. 49 (2016) 802–806]. J Biomech 2019; 84:290-292. [DOI: 10.1016/j.jbiomech.2018.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Zhao S, Arnold M, Ma S, Abel RL, Cobb JP, Hansen U, Boughton O. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018; 7:524-538. [PMID: 30258572 PMCID: PMC6138811 DOI: 10.1302/2046-3758.78.bjr-2018-0025.r1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing, an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed, and Scopus databases. Studies using bulk tissue, animal tissue, whole bone, or testing techniques other than compression testing were excluded. Results A total of 4712 abstracts were retrieved, with 177 papers included in the analysis; 20 studies directly analyzed the compression testing technique to improve the accuracy of testing. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration, and loading protocol. Conclusion Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, although further studies are needed to establish standardized bone testing techniques in order to increase the comparability and reliability of bone stiffness studies. Cite this article: S. Zhao, M. Arnold, S. Ma, R. L. Abel, J. P. Cobb, U. Hansen, O. Boughton. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018;7:524–538. DOI: 10.1302/2046-3758.78.BJR-2018-0025.R1.
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Affiliation(s)
- S Zhao
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - M Arnold
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - S Ma
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - R L Abel
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - J P Cobb
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - U Hansen
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - O Boughton
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, London, UK
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Gustafsson A, Mathavan N, Turunen MJ, Engqvist J, Khayyeri H, Hall SA, Isaksson H. Linking multiscale deformation to microstructure in cortical bone using in situ loading, digital image correlation and synchrotron X-ray scattering. Acta Biomater 2018; 69:323-331. [PMID: 29410089 DOI: 10.1016/j.actbio.2018.01.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/20/2017] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
The incidence of fragility fractures is expected to increase in the near future due to an aging population. Therefore, improved tools for fracture prediction are required to treat and prevent these injuries efficiently. For such tools to succeed, a better understanding of the deformation mechanisms in bone over different length scales is needed. In this study, an experimental setup including mechanical tensile testing in combination with digital image correlation (DIC) and small/wide angle X-ray scattering (SAXS/WAXS) was used to study deformation at multiple length scales in bovine cortical bone. Furthermore, micro-CT imaging provided detailed information about tissue microstructure. The combination of these techniques enabled measurements of local deformations at the tissue- and nanoscales. The orientation of the microstructure relative to the tensile loading was found to influence the strain magnitude on all length scales. Strains in the collagen fibers were 2-3 times as high as the strains found in the mineral crystals for samples with microstructure oriented parallel to the loading. The local tissue strain at fracture was found to be around 0.5%, independent of tissue orientation. However, the maximum force and the irregularity of the crack path were higher when the load was applied parallel to the tissue orientation. This study clearly shows the potential of combining these different experimental techniques concurrently with mechanical testing to gain a better understanding of bone damage and fracture over multiple length scales in cortical bone. STATEMENT OF SIGNIFICANCE To understand the pathophysiology of bone, it is important to improve our knowledge about the deformation and fracture mechanisms in bone. In this study, we combine several recently available experimental techniques with mechanical loading to investigate the deformation mechanisms in compact bone tissue on several length scales simultaneously. The experimental setup included mechanical tensile testing in combination with digital image correlation, microCT imaging, and small/wide angle X-ray scattering. The combination of techniques enabled measurements of local deformations at the tissue- and nanoscales. The study clearly shows the potential of combining different experimental techniques concurrently with mechanical testing to gain a better understanding of structure-property-function relationships in bone tissue.
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Affiliation(s)
- Anna Gustafsson
- Department of Biomedical Engineering, Lund University, Box 118, SE-221 00 Lund, Sweden.
| | - Neashan Mathavan
- Department of Biomedical Engineering, Lund University, Box 118, SE-221 00 Lund, Sweden.
| | - Mikael J Turunen
- Department of Biomedical Engineering, Lund University, Box 118, SE-221 00 Lund, Sweden; Department of Applied Physics, University of Eastern Finland, POB 1627, FI-702 11 Kuopio, Finland.
| | - Jonas Engqvist
- Division of Solid Mechanics, Lund University, Box 118, SE-221 00 Lund, Sweden.
| | - Hanifeh Khayyeri
- Department of Biomedical Engineering, Lund University, Box 118, SE-221 00 Lund, Sweden.
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Box 118, SE-221 00 Lund, Sweden.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, SE-221 00 Lund, Sweden.
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Damage Identification on Vertebral Bodies During Compressive Loading Using Digital Image Correlation. Spine (Phila Pa 1976) 2017; 42:E1289-E1296. [PMID: 28306642 DOI: 10.1097/brs.0000000000002156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED MINI: Identifying fracture is important for understanding vertebral mechanics. Isolated cadaveric thoracolumbar vertebrae were compressed, and surface strains were measured using digital image correlation. Fracture locations from video analysis were qualitatively similar to the locations of high compressive strains and local damage occurred before the maximum force was reached. STUDY DESIGN Ex vivo compression experiments on isolated cadaveric vertebrae. OBJECTIVE To qualitatively compare the fracture locations identified in video analysis with the locations of high compressive strain measured with digital image correlation (DIC) on vertebral bodies and to evaluate the timing of local damage to the cortical shell relative to the global yield force. SUMMARY OF BACKGROUND DATA In previous ex vivo experiments, cortical bone fracture has been identified using various methods including acoustic emission sensors, strain gages, video analysis, or force signals. These methods are, however, limited in their ability to detect the location and timing of fracture. We propose use of DIC, a noncontact optical technique that measures surface displacement, to quantify variables related to damage. METHODS Isolated thoracolumbar human cadaveric vertebral bodies (n = 6) were tested in compression to failure at a quasi-static rate, and the force applied was measured using a load cell. The surface displacement and strain were measured using DIC. Video analysis was performed to identify fractures. RESULTS The location of fractures identified in the video corresponded well with the locations of high compressive strain on the bone. Before reaching the global yield force, more than 10% of the DIC measurements reached a minimum principal strain of 1.0%, a previously reported threshold for cortical bone damage. CONCLUSION DIC measurements provide an objective measure that can be used to identify the location and timing of fractures during ex vivo vertebral experiments. This is important for understanding fracture mechanics and for validating vertebral computational models that incorporate failure. LEVEL OF EVIDENCE N /A.
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Bettamer A, Allaoui S, Hambli R. Using 3D digital image correlation to visualise the progress of failure of human proximal femur. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2015.1067152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Grassi L, Väänänen SP, Ristinmaa M, Jurvelin JS, Isaksson H. Prediction of femoral strength using 3D finite element models reconstructed from DXA images: validation against experiments. Biomech Model Mechanobiol 2016; 16:989-1000. [PMID: 28004226 PMCID: PMC5422489 DOI: 10.1007/s10237-016-0866-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/10/2016] [Indexed: 12/01/2022]
Abstract
Computed tomography (CT)-based finite element (FE) models may improve the current osteoporosis diagnostics and prediction of fracture risk by providing an estimate for femoral strength. However, the need for a CT scan, as opposed to the conventional use of dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnostics, is considered a major obstacle. The 3D shape and bone mineral density (BMD) distribution of a femur can be reconstructed using a statistical shape and appearance model (SSAM) and the DXA image of the femur. Then, the reconstructed shape and BMD could be used to build FE models to predict bone strength. Since high accuracy is needed in all steps of the analysis, this study aimed at evaluating the ability of a 3D FE model built from one 2D DXA image to predict the strains and fracture load of human femora. Three cadaver femora were retrieved, for which experimental measurements from ex vivo mechanical tests were available. FE models were built using the SSAM-based reconstructions: using only the SSAM-reconstructed shape, only the SSAM-reconstructed BMD distribution, and the full SSAM-based reconstruction (including both shape and BMD distribution). When compared with experimental data, the SSAM-based models predicted accurately principal strains (coefficient of determination >0.83, normalized root-mean-square error <16%) and femoral strength (standard error of the estimate 1215 N). These results were only slightly inferior to those obtained with CT-based FE models, but with the considerable advantage of the models being built from DXA images. In summary, the results support the feasibility of SSAM-based models as a practical tool to introduce FE-based bone strength estimation in the current fracture risk diagnostics.
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Affiliation(s)
- Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84, Lund, Sweden.
| | - Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84, Lund, Sweden
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Gustafson H, Siegmund G, Cripton P. Comparison of Strain Rosettes and Digital Image Correlation for Measuring Vertebral Body Strain. J Biomech Eng 2016; 138:054501. [DOI: 10.1115/1.4032799] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Indexed: 11/08/2022]
Abstract
Strain gages are commonly used to measure bone strain, but only provide strain at a single location. Digital image correlation (DIC) is an optical technique that provides the displacement, and therefore strain, over an entire region of interest on the bone surface. This study compares vertebral body strains measured using strain gages and DIC. The anterior surfaces of 15 cadaveric porcine vertebrae were prepared with a strain rosette and a speckled paint pattern for DIC. The vertebrae were loaded in compression with a materials testing machine, and two high-resolution cameras were used to image the anterior surface of the bones. The mean noise levels for the strain rosette and DIC were 1 με and 24 με, respectively. Bland–Altman analysis was used to compare strain from the DIC and rosette (excluding 44% of trials with some evidence of strain rosette failure or debonding); the mean difference ± 2 standard deviations (SDs) was −108 με ± 702 με for the minimum (compressive) principal strain and −53 με ± 332 με for the maximum (tensile) principal strain. Although the DIC has higher noise, it avoids the relatively high risk we observed of strain gage debonding. These results can be used to develop guidelines for selecting a method to measure strain on bone.
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Affiliation(s)
- Hannah Gustafson
- Department of Mechanical Engineering, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada e-mail:
| | - Gunter Siegmund
- MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC V7A 4S5, Canada
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada e-mail:
| | - Peter Cripton
- Department of Mechanical Engineering, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada e-mail:
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28
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Palanca M, Tozzi G, Cristofolini L. The use of digital image correlation in the biomechanical area: a review. Int Biomech 2015. [DOI: 10.1080/23335432.2015.1117395] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Marco Palanca
- School of Engineering and Architecture, University of Bologna, Bologna, Italy
| | - Gianluca Tozzi
- School of Engineering, University of Portsmouth, Portsmouth, UK
| | - Luca Cristofolini
- School of Engineering and Architecture, Department of Industrial Engineering, University of Bologna, Bologna, Italy
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29
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Extracting accurate strain measurements in bone mechanics: A critical review of current methods. J Mech Behav Biomed Mater 2015; 50:43-54. [DOI: 10.1016/j.jmbbm.2015.06.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 11/19/2022]
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30
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Chanda S, Dickinson A, Gupta S, Browne M. Full-field in vitro measurements and in silico predictions of strain shielding in the implanted femur after total hip arthroplasty. Proc Inst Mech Eng H 2015; 229:549-59. [DOI: 10.1177/0954411915591617] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
Alterations in bone strain as a result of implantation may contribute towards periprosthetic bone density changes after total hip arthroplasty. Computational models provide full-field strain predictions in implant–bone constructs; however, these predictions should be verified using experimental models wherever it is possible. In this work, finite element predictions of surface strains in intact and implanted composite femurs were verified using digital image correlation. Relationships were sought between post-implantation strain states across seven defined Gruen zones and clinically observed longer-term bone density changes. Computational predictions of strain distributions in intact and implanted femurs were compared to digital image correlation measurements in two regions of interest. Regression analyses indicated a strong linear correlation between measurements and predictions (R = 0.927 intact, 0.926 implanted) with low standard error (standard error = 38 µε intact, 26 µε implanted). Pre- to post-operative changes in measured and predicted surface strains were found to relate qualitatively to clinically observed volumetric bone density changes across seven Gruen zones: marked proximal bone density loss corresponded with a 50%−64% drop in surface strain, and slight distal density changes corresponded with 4%−14% strain increase. These results support the use of digital image correlation as a pre-clinical tool for predicting post-implantation strain shielding, indicative of long-term bone adaptations.
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Affiliation(s)
- Souptick Chanda
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Alexander Dickinson
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Martin Browne
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
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