Effectiveness of Selected Fitness Exercises on Stress of Femoral Neck using Musculoskeletal Dynamics Simulations and Finite Element Model

Exploration of the synergistic role of cortical thickness asymmetry ("Trabecular Eccentricity" concept) in reducing fracture risk in the human femoral neck and a control bone (Artiodactyl Calcaneus)

The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded in rather simple bending, which causes net tension stress in the upper (superior) femoral neck and net compression stress in its inferior aspect ("T/C paradigm"). This T/C loading regime lacks in vivo proof. The "C/C paradigm" is a plausible alternative simplified load history that is characterized by a gradient of net compression across the entire femoral neck; action of the gluteus medius and external rotators of the hip are important in this context. It is unclear which paradigm is at play in natural loading due to lack of in vivo bone strain data and deficiencies in understanding mechanisms and manifestations of bone adaptation in tension vs. compression. For these reasons, studies of the femoral neck would benefit from being compared to a 'control bone' that has been proven, by strain data, to be habitually loaded in bending. The artiodactyl (sheep and deer) calcaneus model has been shown to be a very suitable control in this context. However, the application of this control in understanding the load history of the femoral neck has only been attempted in two prior studies, which did not examine the interplay between cortical and trabecular bone, or potential load-sharing influences of tendons and ligaments. Our first goal is to compare fracture risk factors of the femoral neck in both paradigms. Our second goal is to compare and contrast the deer calcaneus to the human femoral neck in terms of fracture risk factors in the T/C paradigm (the C/C paradigm is not applicable in the artiodactyl calcaneus due to its highly constrained loading). Our third goal explores interplay between dorsal/compression and plantar/tension regions of the deer calcaneus and the load-sharing roles of a nearby ligament and tendon, with insights for translation to the femoral neck. These goals were achieved by employing the analytical model of Fox and Keaveny (J. Theoretical Biology 2001, 2003) that estimates fracture risk factors of the femoral neck. This model focuses on biomechanical advantages of the asymmetric distribution of cortical bone in the direction of habitual loading. The cortical thickness asymmetry of the femoral neck (thin superior cortex, thick inferior cortex) reflects the superior-inferior placement of trabecular bone (i.e., "trabecular eccentricity," TE). TE helps the femoral neck adapt to typical stresses and strains through load-sharing between superior and inferior cortices. Our goals were evaluated in the context of TE. Results showed the C/C paradigm has lower risk factors for the superior cortex and for the overall femoral neck, which is clinically relevant. TE analyses of the deer calcaneus revealed important synergism in load-sharing between the plantar/tension cortex and adjacent ligament/tendon, which challenges conventional understanding of how this control bone achieves functional adaptation. Comparisons with the control bone also exposed important deficiencies in current understanding of human femoral neck loading and its potential histocompositional adaptations.

Physical Functions and Comorbidity Affecting Collapse at 4 or More Weeks after Admission in Patients with Osteoporotic Vertebral Fractures: A Prospective Cohort Study

Study Design

A prospective cohort study.

Purpose

This study aimed to reveal physical functions and comorbidity affecting collapse at ≥4 weeks after hospital admission of patients with osteoporotic vertebral fracture.

Overview of Literature

Only a few studies have investigated the influence of physical function and activity on collapse in patients with osteoporotic vertebral fractures.

Methods

This prospective cohort study analyzed patients with osteoporotic vertebral fractures admitted to the hospital between March 2018 and October 2019. Logistic regression analysis was performed to explore the predictors of vertebral collapse at >4 weeks after admission. Model 1 used basic medical information and physical functions at admission; model 2 used basic medical information and physical function and activity at >4 weeks after admission.

Results

In the model 1 results of logistic regression analysis, cardiovascular disease (odds ratio [OR], 12.27; 95% confidence interval [CI], 1.28–117.91) was extracted as a factor affecting vertebral collapse at ≥4 weeks after admission. In the model 2 results of logistic regression analysis, cardiovascular disease (OR, 34.57; 95% CI, 2.53–471.74), movement control during one leg standing at 4 weeks (OR, 7.25; 95% CI, 1.36–38.71), and Pain Catastrophizing Scale score at 4 weeks (OR, 1.11; 95% CI, 1.01–1.21) were extracted as factors affecting vertebral collapse at ≥4 weeks after admission.

Conclusions

Our results indicate that physical functions and comorbidity affect collapse at ≥4 weeks after admission in patients with osteoporotic vertebral fractures.

Dynamic finite element analysis of implants for femoral neck fractures simulating walking

BACKGROUND

To examine postoperative complications for osteosynthesizing femoral neck fractures (Pauwels III), biomechanical analysis should be conducted under dynamic conditions simulating for walking, not static conditions. Among the two main aims of this study, one is to pioneer the technique of dynamic finite element (FE) analysis, and the other is to compare stress distribution between two implants during walking.

MATERIALS AND METHODS

First, we performed an inverse dynamic analysis with optimization method using a musculoskeletal model to calculate the inter-segmental and muscular forces during walking. Second, three FE models were prepared: (I) intact hip joint, (II) fractures treated with two Hansson pins (HP), and (III) fractures with Dual SC Screws (DSCS) maintaining an angular stability. The direction and magnitude of the loadings varied continuously. Stress distribution during the walking was evaluated by using a dynamic explicit method. We examined the time-dependent von Mises stresses at two representative spots: medial cortex at the femoral neck fracture site and lateral pin (presumed) insertion holes.

RESULTS

In general, stress values are always changing during walking cycle. Regarding medial femoral neck cortex at the fracture line, intact model showed almost consistent value. Both HP model and DSCS model amounted the highest around 30 MPa. At lateral holes, highest values were 18.8, 104.0, and 63.1 MPa of intact, HP, and DSCS models, respectively.

CONCLUSION

Thus, our analysis simulating the real walking will be useful in evaluating time-varying stress distribution to assess postoperative complication.

CLINICAL RELEVANCE

DSCS is expected to be paramount for treatment of unstable femoral neck fractures.

The effects of unilateral and bilateral eccentric overload training on hypertrophy, muscle power and COD performance, and its determinants, in team sport players

The study aimed to compare the chronic eccentric-overload training effects of unilateral (lateral lunge) vs bilateral (half-squat) using an inertial device, on hypertrophy and physical performance. Twenty-seven young team sports male players performed a 4 sets of 7 repetitions of inertial eccentric overload training, biweekly for 6 weeks, distributed in unilateral lunge group (UG: age: 22.8 ± 2.9 years; body mass: 75.3 ± 8.8 kg; height: 177.3 ± 3.7 cm) and bilateral squat group (BG: age: 22.6 ± 2.7 years; body mass: 79.5 ± 12.8 kg; height: 164.2 ± 7 cm). Lower limb muscle volume, counter movement jump (CMJ), power with both (POWER), dominant (POWERd) and no-dominant leg (POWERnd), change of direction turn of 90° with dominant (COD90d) and no-dominant leg (COD90nd) and 180° (COD180d and COD180nd), and 10m sprint time (T-10m) were measured pre and post-intervention. The UG obtained an increase of adductor major (+11.1%) and vastus medialis (+12.6%) higher than BG. The BG obtained an increase of vastus lateralis (+9.9%) and lateral gastrocnemius (+9.1%) higher than UG. Both groups improved CMJ, POWER, POWERd, POWERnd, COD90 and DEC-COD90, without changes in T-10m. The UG decrease DEC-COD90nd (-21.1%) and BG increase POWER (+38.6%) substantially more than the other group. Six-weeks of unilateral / bilateral EO training induce substantial improvements in lower limbs muscle volume and functional performance, although unilateral training seems to be more effective in improving COD90 performance.

Effects of a multichannel dynamic functional electrical stimulation system on hemiplegic gait and muscle forces

[Purpose] The purpose of the study was to design and implement a multichannel dynamic functional electrical stimulation system and investigate acute effects of functional electrical stimulation of the tibialis anterior and rectus femoris on ankle and knee sagittal-plane kinematics and related muscle forces of hemiplegic gait. [Subjects and Methods] A multichannel dynamic electrical stimulation system was developed with 8-channel low frequency current generators. Eight male hemiplegic patients were trained for 4 weeks with electric stimulation of the tibia anterior and rectus femoris muscles during walking, which was coupled with active contraction. Kinematic data were collected, and muscle forces of the tibialis anterior and rectus femoris of the affected limbs were analyzed using a musculoskelatal modeling approach before and after training. A paired sample t-test was used to detect the differences between before and after training. [Results] The step length of the affected limb significantly increased after the stimulation was applied. The maximum dorsiflexion angle and maximum knee flexion angle of the affected limb were both increased significantly during stimulation. The maximum muscle forces of both the tibia anterior and rectus femoris increased significantly during stimulation compared with before functional electrical stimulation was applied. [Conclusion] This study established a functional electrical stimulation strategy based on hemiplegic gait analysis and musculoskeletal modeling. The multichannel functional electrical stimulation system successfully corrected foot drop and altered circumduction hemiplegic gait pattern.