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Szabo E, Bensusan J, Akkus O, Rimnac C. Immature porcine cortical bone mechanical properties and composition change with maturation and displacement rate. J Mech Behav Biomed Mater 2024; 153:106487. [PMID: 38490048 DOI: 10.1016/j.jmbbm.2024.106487] [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: 11/22/2023] [Revised: 02/11/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Computational models of mature bone have been used to predict fracture; however, analogous study of immature diaphyseal fracture has not been conducted due to sparse experimental mechanical data. A model of immature bone fracture may be used to aid in the differentiation of accidental and non-accidental trauma fractures in young, newly ambulatory children (0-3 years). The objective of this study was to characterize the evolution of tissue-level mechanical behavior, composition, and microstructure of maturing cortical porcine bone with uniaxial tension, Raman spectroscopy, and light microscopy as a function of maturation. We asked: 1) How do the monotonic uniaxial tensile properties change with maturation and displacement rate; 2) How does the composition and microstructure change with maturation; and 3) Is there a correlation between composition and tensile properties with maturation? Elastic modulus (p < 0.001), fracture stress (p < 0.001), and energy absorption (p < 0.014) increased as a function of maturation at the quasistatic rate by 110%, 86%, and 96%, respectively. Fracture stress also increased by 90% with maturation at the faster rate (p = 0.001). Fracture stress increased as a function of increasing displacement rate by 28% (newborn p = 0.048; 1-month p = 0.004; 3-month p= < 0.001), and fracture strain decreased by 68% with increasing displacement rate (newborn p = 0.002; 1-month p = 0.036; 3-month p < 0.001). Carbonate-to-phosphate ratio was positively linearly related to elastic modulus, and fracture stress was positively related to carbonate-to-phosphate ratio and matrix maturation ratio. The results of this study support that immature bone is strain-rate dependent and becomes more brittle at faster rates, contributing to the foundation upon which a computational model can be built to evaluate immature bone fracture.
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Affiliation(s)
- Emily Szabo
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA.
| | - Jay Bensusan
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
| | - Ozan Akkus
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
| | - Clare Rimnac
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
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Cruz MAF, Santana JVL, Battaglion LR, Volpon JB. Stability of Proximal Femoral Osteotomies in Pediatric Bone Models Fixed with Flexible Intramedullary Nails and Evaluated by the Finite Element Method. Rev Bras Ortop 2024; 59:e278-e283. [PMID: 38606142 PMCID: PMC11006526 DOI: 10.1055/s-0044-1785467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/06/2023] [Indexed: 04/13/2024] Open
Abstract
Objective To evaluate the stability of osteotomies created in the subtrochanteric and trochanteric regions in a pediatric femur model fixed by flexible intramedullary rods. Method Tomographic sections were obtained from a pediatric femur model with two elastic titanium rods and converted to a three-dimensional model. This model created a mesh with tetrahedral elements according to the finite element method. Three virtual models were obtained, and osteotomies were performed in different regions: mediodiaphyseal, subtrochanteric, and trochanteric. A vertical load of 85N was applied to the top of the femoral head, obtaining the displacements, the maximum and minimum main stress, and the equivalent Von Mises stress on the implant. Results With the applied load, displacements were observed at the osteotomy site of 0.04 mm in the diaphyseal group, 0.5 mm in the subtrochanteric group, and 0.06 mm in the trochanteric group. The maximum stress in the diaphyseal, subtrochanteric, and trochanteric groups was 10.4 Pa, 7.52 Pa, and 26.4 Pa, respectively. That is around 40% higher in the trochanteric group in regards to the diaphyseal (control). The minimum stress of the bone was located in the inner cortical of the femur. The equivalent Von Mises stress on the implants occurred at osteotomy, with a maximum value of 27.6 Pa in the trochanteric group. Conclusion In both trochanteric and subtrochanteric osteotomies, fixation stability was often lower than in the diaphyseal model, suggesting that flexible intramedullary nails are not suitable implants for proximal femoral fixations.
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Affiliation(s)
| | | | - Leonardo Rigobello Battaglion
- Laboratório de Bioengenharia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brasil
| | - José Batista Volpon
- Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brasil
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3
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Sun X, Wu W, Zhang R, Qu H, Wang J, Xu K, Fang L, Xu L, Jiang R. Mechanical response and in-situ deformation mechanism of cortical bone materials under combined compression and torsion loads. PLoS One 2022; 17:e0271301. [PMID: 35895673 PMCID: PMC9328520 DOI: 10.1371/journal.pone.0271301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Bone fracture is an extremely dangerous health risk to human. Actually, cortical bone is often subjected to the complicated loading patterns. The mechanical properties and deformation mechanism under the complicated loading pattern could provide a more precise understanding for the bone fracture. For this purpose, the mechanical response and multi-scale deformation mechanism of cortical bone material were investigated by in-situ experimental research using the compression-torsion coupling loads as an example. It was found that the torsion strength and shear modulus all decreased under the compression-torsion coupling loads than single torsion load. This indicated bone would suffer greater risk of fracture under the compression-torsion coupling loads. Based on in-situ observation, it was found that the rapid reduction of the anisotropy of bone material under the compression load was the potential influencing factor. Because of the redistribution of the principal strain and the variations of cracks propagation, the comprehensive fracture pattern containing both transverse and longitudinal fracture was shown under the coupling loads, and finally resulted in the reduction of the torsion properties. This research could provide new references for researches on mechanical properties of cortical bone material under complicated loading patterns.
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Affiliation(s)
- Xingdong Sun
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
- * E-mail:
| | - Wandi Wu
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Renbo Zhang
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Hongru Qu
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Jie Wang
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Ke Xu
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Liangfei Fang
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Liangyuan Xu
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
| | - Rui Jiang
- School of Engineering, Anhui Agricultural University, Hefei, People’s Republic of China
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Meng W, Chen M, Song Y, Zhang H, Xie R, Zhang F. Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study. J Acquir Immune Defic Syndr 2022; 90:360-368. [PMID: 35315797 DOI: 10.1097/qai.0000000000002958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our study aimed to investigate the prevalence and risk factors of low bone mineral density (BMD) among HIV/AIDS patients in China. METHODS We performed a cross-sectional analysis of HIV-infected patients from October 2017 to August 2020. Demographic information, clinical data, and serum parameters were obtained. Univariable and multiple logistic regression analyses were performed. RESULTS A total of 1143 patients were included. In the ART-naive group, low BMD was diagnosed in 19.2% (117/608), including osteoporosis in 1.0% (6/608) and osteopenia in 18.3% (111/608). In the ART group, low BMD was diagnosed in 32.2% (231/717), including osteoporosis in 2.4% (17/717) and osteopenia in 29.8% (214/717). Using multivariate analysis, we identified age older than 50 years, body mass index < 18.5 kg/m2, and treatment based on tenofovir disoproxil fumarate as independent risk factors for low BMD. Low high-density lipoprotein cholesterol was a protective factor for low BMD. Among low BMD participants, the most common number of low BMD sites for a patient to have was 4 (33.6%, 117/348). CONCLUSION We confirmed a high prevalence of low BMD and osteoporosis in HIV/AIDS patients, and we identified age older than 50 years, low body mass index, and a treatment based on tenofovir disoproxil fumarate as risk factors for low BMD. Low high-density lipoprotein cholesterol had a protective effect against low BMD. Among low BMD patients, patients most commonly had 4 sites with low BMD, which has been associated with fracture risk. In addition, bone changes to L1 can present before low BMD diagnosis and may be a potentially useful indicator that low BMD is developing.
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Affiliation(s)
- Weiqing Meng
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Meiling Chen
- The Medical Record Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China; and
| | - Yangzi Song
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huan Zhang
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fujie Zhang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Sekhar Miraj S, Vyas N, Kurian SJ, Baral T, Thomas L, Reddy BS, Munisamy M, Banerjee M, Rao M. Vitamin D receptor gene polymorphism and vitamin D supplementation on clinical/ treatment outcome in tuberculosis: current and future perspectives. Expert Rev Anti Infect Ther 2022; 20:1179-1186. [PMID: 35608034 DOI: 10.1080/14787210.2022.2081546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is a transnational public health concern, which requires more precise treatment strategies than the existing approaches. Vitamin D modulates the inflammatory and immune response to the disease. Robust evidence shows that vitamin D deficiency and its receptor gene polymorphism influence the susceptibility to TB and the outcome of the anti-tubercular treatment (ATT). However, in the different populations, these findings were inconsistent and even contradictory. AREAS COVERED The current review focuses on the association between vitamin D receptor (VDR) gene polymorphism with the risk of development of TB disease and response to the ATT. Additionally, it reviews various systematic reviews and meta-analyses on the impact of vitamin D supplements on both clinical and treatment outcomes in TB patients. EXPERT OPINION Although the majority of the findings rule out the benefits of the supplementation, sufficient evidence is available to warrant larger epidemiological research that should be aimed to generate possible interaction among the VDR polymorphism, vitamin D status, and the outcome in TB. We conclude that establishing such an association in different ethnic populations will help design nutrigenomics- or pharmacogenomics-based vitamin D supplementation to develop a personalized medicine approach to flatten the curve of TB disease.
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Affiliation(s)
- Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Navya Vyas
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.,Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Shilia Jacob Kurian
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Tejaswini Baral
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Levin Thomas
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - B Shrikar Reddy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Murali Munisamy
- Department of Translational Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
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Ramírez-Vela V, Aguilar-Pérez LA, Paredes-Rojas JC, Flores-Campos JA, Ortiz-Hernández FEL, Torres-SanMiguel CR. Bone Fractures Numerical Analysis in a Femur Affected by Osteogenesis Imperfecta. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121177. [PMID: 34943373 PMCID: PMC8700594 DOI: 10.3390/children8121177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
This work presents a non-invasive methodology to obtain a three-dimensional femur model of three-year-old infants affected with Osteogenesis Imperfecta (OI) type III. DICOM® Files of a femur were processed to obtain a finite element model to assess the transverse, the oblique, and the comminuted fractures. The model is evaluated under a normal walking cycle. The loads applied were considered the most critical force generated on the normal walking cycle, and the analyses considered anisotropic bone conditions. The outcome shows stress concentration areas in the central zone of the diaphysis of the femur, and the highest levels of stress occur in the case of the comminuted fracture, while the transverse fracture presents the lowest values. Thus, the method can be helpful for determining the bone fracture behavior of certain pathologies, such as osteogenesis imperfecta, osteopenia, and osteoporosis.
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Affiliation(s)
- Viridiana Ramírez-Vela
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (V.R.-V.); (L.A.A.-P.)
| | - Luis Antonio Aguilar-Pérez
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (V.R.-V.); (L.A.A.-P.)
| | - Juan Carlos Paredes-Rojas
- Instituto Politécnico Nacional, Centro Mexicano para la Producción más Limpia, Ciudad de Mexico 07340, Mexico;
| | - Juan Alejandro Flores-Campos
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria en Ingeniería y Tecnologías Avanzadas, Ciudad de Mexico 07340, Mexico;
| | - Fernando ELi Ortiz-Hernández
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Culhuacán, Ciudad de Mexico 04260, Mexico;
| | - Christopher René Torres-SanMiguel
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (V.R.-V.); (L.A.A.-P.)
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7
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Szabo E, Rimnac C. Biomechanics of immature human cortical bone: A systematic review. J Mech Behav Biomed Mater 2021; 125:104889. [PMID: 34736022 DOI: 10.1016/j.jmbbm.2021.104889] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022]
Abstract
The whole bone geometry, microstructure, and mechanical properties of mature human bone are widely reported; however, immature bone (0-18 years) has not been similarly robustly characterized. There is an interest in analyzing and predicting the mechanical loading conditions associated with long bone diaphyseal fractures attributed to trauma in children. Thus, understanding the mechanical properties of immature bone in a temporal reference frame is an essential first step to understand diaphyseal fractures of pediatric long bones. The purpose of this systematic review was to ask, what is the state of knowledge regarding the 1) evolution of whole bone geometry and microstructure of immature pediatric bone as a function of maturation and 2) cortical bone density and experimental quasi-static mechanical properties at the tissue level in the diaphyseal region of immature pediatric long bones? The systematic search yielded 36 studies of the whole bone geometry, microstructure, and mechanical properties of immature pediatric long bones. The elastic modulus, yield stress, and ultimate stress were shown to generally increase with maturation, whereas the yield strain was approximately invariant; however, the specific year-to-year progression of these properties could not be characterized from the limited studies available. The results of this systematic search indicate there is a dearth of knowledge associated with the biomechanics of cortical bone from immature pediatric long bones; it also provides a basis for computational studies of immature human long bones. Additional biomechanical studies of immature human bone are necessary to develop a robust catalogue, which can be used in broad applications to understand fracture mechanics, bone pathologies, and athletic injury in the pediatric setting.
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Affiliation(s)
- Emily Szabo
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH, 44106, USA.
| | - Clare Rimnac
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH, 44106, USA.
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8
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The relationship between orthopedic clinical imaging and bone strength prediction. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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9
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McKinsey K, Thompson A, Bertocci G. Investigation of femur fracture potential in common pediatric falls using finite element analysis. Comput Methods Biomech Biomed Engin 2020; 24:517-526. [PMID: 33115286 DOI: 10.1080/10255842.2020.1837119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A finite element (FE) model of an 11-month-old child's femur was developed to evaluate fracture risk in short-distance feet-first falls and bed falls. Pediatric material properties were applied to the FE model. Femur loading was derived from previously conducted fall experiments using a child surrogate where fall conditions (e.g., fall height, impact surface) were varied. Fracture thresholds based on principal stress and strain were used to examine potential for fracture. Peak stress/strain were significantly greater for feet-first falls from greater heights and onto harder impact surfaces. Feet-first falls exceeded some, but not all fracture thresholds. Bed falls did not exceed any fracture thresholds.
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Affiliation(s)
- Keyonna McKinsey
- Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - Angela Thompson
- Department of Engineering Fundamentals, University of Louisville, Louisville, KY, USA
| | - Gina Bertocci
- Department of Bioengineering, University of Louisville, Louisville, KY, USA
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Viceconti M. Predicting bone strength from CT data: Clinical applications. Morphologie 2019; 103:180-186. [PMID: 31630964 DOI: 10.1016/j.morpho.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
In this review we summarise over 15 years of research and development around the prediction of whole bones strength from Computed Tomography data, with particular reference to the prediction of the risk of hip fracture in osteoporotic patients. We briefly discuss the theoretical background, and then provide a summary of the laboratory and clinical validation of these modelling technologies. We then discuss the three current clinical applications: in clinical research, in clinical trials, and in clinical practice. On average the strength predicted with finite element models (QCT-FE) based on computed tomography is 7% more accurate that that predicted with areal bone mineral density from Dual X-ray Absorptiometry (DXA-aBMD), the current standard of care, both in term of laboratory validation on cadaver bones and in terms of stratification accuracy on clinical cohorts of fractured and non-fractured women. This improved accuracy makes QCT-FE superior to DXA-aBMD in clinical research and in clinical trials, where the its use can cut in half the number of patients to be enrolled to get the same statistical power. For routine clinical use to decide who to treat with antiresorptive drugs, QCT-FE is more accurate but less cost-effective than DXA-aBMD, at least when the decision is on first line treatment like bisphosphonates. But the ability to predict skeletal strength from medical imaging is now opening a number of other applications, for example in paediatrics and oncology.
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Affiliation(s)
- M Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy; Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Altai Z, Viceconti M, Li X, Offiah AC. Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study. Clin Radiol 2019; 75:78.e9-78.e16. [PMID: 31590914 DOI: 10.1016/j.crad.2019.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Abstract
AIM To use personalised computed tomography (CT)-based finite element models to quantitatively investigate the likelihood of self-inflicted humeral fracture in non-ambulant infants secondary to rolling. MATERIALS AND METHODS Three whole-body post-mortem CT examinations of children at the age of rolling (two 4-month-old and one 6-month-old) were used. The mechanical moment needed by each infant to perform a rolling manoeuvre was calculated and applied to the finite element model in order to simulate spontaneous rolling from the prone to the supine position. RESULTS The maximum predicted strains were found to be substantially lower (with a difference of >80%) than the elastic limit of the bone. CONCLUSION Results of this study challenge the plausibility of self-inflicted humeral fracture caused by rolling in non-ambulant infants and indicate that it is unlikely for a humeral fracture to result from this mechanism without the assistance of an external force.
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Affiliation(s)
- Z Altai
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK
| | - M Viceconti
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK
| | - X Li
- Department of Mechanical Engineering, University of Sheffield, UK; Insigneo Institute for in silico Medicine, University of Sheffield, UK.
| | - A C Offiah
- Insigneo Institute for in silico Medicine, University of Sheffield, UK; Department of Oncology and Metabolism, University of Sheffield, UK
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Castro APG, Altai Z, Offiah AC, Shelmerdine SC, Arthurs OJ, Li X, Lacroix D. Finite element modelling of the developing infant femur using paired CT and MRI scans. PLoS One 2019; 14:e0218268. [PMID: 31211799 PMCID: PMC6581244 DOI: 10.1371/journal.pone.0218268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Bone finite element (FE) studies based on infant post-mortem computed tomography (CT) examinations are being developed to provide quantitative information to assist the differentiation between accidental and inflicted injury, and unsuspected underlying disease. As the growing skeleton contains non-ossified cartilaginous regions at the epiphyses, which are not well characterised on CT examinations, it is difficult to evaluate the mechanical behaviour of the developing whole bone. This study made use of paired paediatric post mortem femoral CT and magnetic resonance imaging (MRI) examinations at two different stages of development (4 and 7 months) to provide anatomical and constitutive information for both hard and soft tissues. The work aimed to evaluate the effect of epiphyseal ossification on the propensity to shaft fractures in infants. The outcomes suggest that the failure load of the femoral diaphysis in the models incorporating the non-ossified epiphysis is within the range of bone-only FE models. There may however be an effect on the metaphysis. Confirmation of these findings is required in a larger cohort of children.
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Affiliation(s)
- A. P. G. Castro
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Z. Altai
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - A. C. Offiah
- Dept. of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - S. C. Shelmerdine
- Dept. of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
- UCL Great Ormond Street Institute for Child Health, University College London, London, United Kingdom
| | - O. J. Arthurs
- Dept. of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
- UCL Great Ormond Street Institute for Child Health, University College London, London, United Kingdom
| | - X. Li
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - D. Lacroix
- INSIGNEO Institute, Dept. of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
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Delbreil A, Bouriat M, Pin A, Rigoard P, Vendeuvre T, Germaneau A. Humerus fractures in an infant: which causal mechanisms? Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1715000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. Delbreil
- CHU Poitiers, Département de médecine légale, IML/UMJ, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - M. Bouriat
- CHU Poitiers, Département de médecine légale, IML/UMJ, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - A. Pin
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - P. Rigoard
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - A. Germaneau
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
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