Finite element models and material data for analysis of infant head impacts

Defining biomechanical principles in pre-surgical infant orthopedics in a real cleft finite element model

Presurgical infant orthopedics (PSIO) is the first step in the treatment of cleft lip and palate (CLP) and is designed to approximate the cleft segments as effectively as possible before surgical reconstruction of the lip and palate. The biomechanical efficacy of different PSIO approaches in transferring molding forces to the CLP is unknown. This study aimed to define the biomechanical principles of competing PSIO techniques in a real cleft finite element (FE) model. Active intraoral (Latham), passive alveolar molding (PAM), and extraoral (DynaCleft) molding forces were virtually applied to a real cleft FE model. In the cleft region, PAM (P < 0.001) and Latham (P < 0.05) exerted significantly less stress than DynaCleft. Intraoral molding forces acted primarily at the site of the force initiation without being accompanied by high loads in the midface. PAM showed a tendency toward a better flow behavior of the molding forces than Latham. Extraoral molding transferred high stresses to the cleft, alveolar ridge, and midface. Intraoral passive molding was ultimately characterized by the highest biomechanical efficacy and showed the most favorable load distribution of all of the PSIO approaches considered in this study. Future research is needed to validate the findings against clinical data.

An Ogden hyperelastic 3D micromechanical model to depict Poynting effect in brain white matter

Shear and torsional load on soft solids such as brain white matter purportedly exhibits the Poynting Effect. It is a typical nonlinear phenomenon associated with soft materials whereby they tend to elongate (positive Poynting effect) or contract (negative Poynting effect) in a direction perpendicular to the shearing or twisting plane. In this research, a novel 3D micromechanical Finite Element Model (FEM) has been formulated to describe the Poynting effect in bi-phasic modeled brain white matter (BWM) representative volume element (RVE) with axons tracts embedded in surrounding extracellular matrix (ECM) for simulating brain matter's response to pure and simple shear. In the presented BWM 3D FEM, nonlinear Ogden hyper-elastic material model is deployed to interpret axons and ECM material phases. The modeled bi-phasic RVEs have axons tied to the surrounding ECM. In this proof-of-concept (POC) FEM, three simple shear loading configurations and a pure shear case were analyzed. Root mean square deviation (RMSD) was calculated for stress and deformation response plots to understand the effect of axon-ECM orientations and loading conditions on the degree of Poynting behavior. Variations in normal stresses (S11, S22, or S33) perpendicular to the shear plane underscored the significance of axonal fiber-matrix interactions. From the simulated ensemble of cases, a transitional dominance trend was noticed, as simple sheared axons showed pronounced Poynting behavior, but shear deformation build-up in the purely sheared brain model exhibited the highest Poynting behavior at higher strain % limits. At lower strain limits, simple shear imparted across and perpendicular to axonal tract directions emerged as the dominant Poynting effect configurations. At high strains, the stress-strain% plots manifested mild strain stiffening effects and bending stresses in purely sheared axons, substantiated the strong non-linearity in brain tissues' response.

Utilisation of 3D Printing in the Manufacturing of an Anthropomorphic Paediatric Head Phantom for the Optimisation of Scanning Parameters in CT

Computed tomography (CT) is a diagnostic imaging process that uses ionising radiation to obtain information about the interior anatomic structure of the human body. Considering that the medical use of ionising radiation implies exposing patients to radiation that may lead to unwanted stochastic effects and that those effects are less probable at lower doses, optimising imaging protocols is of great importance. In this paper, we used an assembled 3D-printed infant head phantom and matched its image quality parameters with those obtained for a commercially available adult head phantom using the imaging protocol dedicated for adult patients. In accordance with the results, an optimised scanning protocol was designed which resulted in dose reductions for paediatric patients while keeping image quality at an adequate level.

Analysis of suction-based gripping strategies in wildlife towards future evolutions of the obstetrical suction cup

The design of obstetrical suction cups used for vacuum assisted delivery has not substantially evolved through history despite of its inherent limitations. The associated challenges concern both the decrease of risk of soft tissue damage and failure of instrumental delivery due to detachment of the cup. The present study firstly details some of the suction-based strategies that have been developed in wildlife in order to create and maintain an adhesive contact with potentially rough and uneven substratum in dry or wet environments. Such strategies have permitted the emergence of bioinspired suction-based devices in the fields of robotics or biomedical patches that are briefly reviewed. The objective is then to extend the observations of such suction-based strategies toward the development of innovative medical suction cups. We firstly conclude that the overall design, shape and materials of the suction cups could be largely improved. We also highlight that the addition of a patterned surface combined with a viscous fluid at the interface between the suction cup and scalp could significantly limit the detachment rate and the differential pressure required to exert a traction force. In the future, the development of a computational model including a detailed description of scalp properties should allow to experiment various designs of bioinspired suction cups.

Cranial suture morphometry and mechanical response to loading: 2D vs. 3D assumptions and characterization

Cranial sutures are complex soft tissue structures whose mechanics are often studied due to their link with bone growth in the skull. Researchers will often use a cross-sectional two-dimensional slice to define suture geometry when studying morphometry and/or mechanical response to loading. However, using a single cross section neglects the full suture complexity and may introduce significant errors when defining their form. This study aims to determine trends in suture path variability through skull thickness in a swine model and the implications of using a 'representative' cross section on mechanical modeling. To explore these questions, a mixture of quantitative analysis of computed tomography images and finite element models was used. The linear interdigitation and width of coronal and sagittal sutures were analyzed on offset transverse planes through the skull thickness. It was found that sagittal suture width and interdigitation were largely consistent through the skull thickness, whereas the coronal suture showed significant variation in both. The finite element study found that average values of displacement and strain were similar between the two-dimensionally variable and three-dimensionally variable models. Larger ranges and more complex distributions of strain were found in the three-dimensionally variable model. Outcomes of this study indicate that the appropriateness of using a representative cross section to describe suture morphometry and predict mechanical response should depend on specific research questions and goals. Two-dimensional approximations can be sufficient for less-interdigitated sutures and when bulk site mechanics are of interest, while taking the true three-dimensional geometry into account is necessary when considering spatial variability and local mechanical response.

On the correlations of biomechanical properties of super-imposed temporal tissue layers and their age-, sex-, side- and post-mortem interval dependence

Obtaining biomechanical properties of biological tissues for simulation purposes or graft developments is time and resource consuming. The number of samples required for biomechanical tests could be reduced if the load-deformation properties of a given tissue layer could be estimated from adjacent layers or if the biomechanical parameters were unaffected by age, bodyside, sex or post-mortem interval. This study investigates for the first time potential correlations of multiple super-imposed tissue layers using the temporal region of the human head as an area of broad interest in biomechanical modelling. Spearman correlations between biomechanical properties of the scalp, muscle fascia, muscle, bone and dura mater from up to 83 chemically unfixed cadavers were investigated. The association with age, sex and post-mortem interval was assessed. The results revealed sporadic correlations between the corresponding layers, such as the maximum force (r = 0.43) and ultimate tensile strength (r = 0.33) between scalp and muscle. Side- and age-dependence of the biomechanical properties were different between the tissue types. Strain at maximum force of fascia (r = -0.37) and elastic modulus of temporal muscle (r = 0.26) weakly correlated with post-mortem interval. Only strain at maximum force of scalp differed significantly between sexes. Uniaxial biomechanical properties of individual head tissue layers can thus not be estimated solely based on adjacent layers. Therefore, correlations between the tissues' biomechanical properties, anthropometric data and post-mortem interval need to be established independently for each layer. Sex seems not to be a relevant influencing factor for the passive tissue mechanics of the here investigated temporal head tissue layers.

Sensitivity of material model parameters on finite element models of infant head impacts

Finite element (FE) models of human infant heads can be used in forensic investigations to infer whether a given pattern of head injuries could have resulted from a hypothetical scenario. This requires accurate models of the behaviour of the head tissues. Material models for human infant head tissues have been developed using experimental data from both infant and adult tissues. Experimental data for infants are scarce due to ethical considerations. To guide future experimental work, a sensitivity analysis of the material model parameters was conducted on a FE model of an infant occipital head impact. A simplified head geometry, consisting of the scalp, skull, suture and brain, was impacted onto a rigid anvil at a speed equivalent to a drop height of 0.3 m. The scalp, suture and brain were represented using hyperelastic material models, while an isotropic elastic model was used for the skull. Three hundred simulations were performed, with the material model parameters varied in each. Spearman's rank correlation was used to determine the influence of each parameter on selected outputs which predict injury level. The elastic modulus and Poisson's ratio for the skull were the most important parameters, followed by the hyperelastic constants for the brain, scalp and suture. It is recommended that future research prioritises increasing experimental datasets of skull elastic modulus, especially at higher loading rates, followed by obtaining data for the skull Poisson's ratio. The results from this sensitivity analysis can ensure that future experimental work makes the best use of scarce tissues.

Preliminary observations of the sequence of damage in excised human juvenile cranial bone at speeds equivalent to falls from 1.6 m

There is much debate within the forensic community around the indications that suggest a head injury sustained by a child resulted from abusive head trauma, rather than from accidental causes, especially when a fall from low height is the explanation given by a caregiver. To better understand this problem, finite element models of the paediatric head have been and continue to be developed. These models require material models that fit the behaviour of paediatric head tissues under dynamic loading conditions. Currently, the highest loading rate for which skull data exists is 2.81 ms^-1. This study improves on this by providing preliminary experimental data for a loading rate of 5.65 ± 0.14 ms^-1, equivalent to a fall of 1.6 m. Eleven specimens of paediatric cranial bone (frontal, occipital, parietal and temporal) from seven donors (age range 3 weeks to 18 years) were tested in three-point bending with an impactor of radius 2 mm. It was found that prompt brittle fracture with virtually no bending occurs in all specimens but those aged 3 weeks old, where bending preceded brittle fracture. The maximum impact force increased with age (or thickness) and was higher in occipital bone. Energy absorbed to failure followed a similar trend, with values 0.11 and 0.35 mJ/mm³ for age 3 weeks, agreeing with previously published static tests, increasing with age up to 9 mJ/mm³ for 18-year-old occipital bone. The preliminary data provided here can help analysts improve paediatric head finite element models that can be used to provide better predictions of the nature of head injuries from both a biomechanical and forensic point of view.

Stress and strain propagation on infant skull from impact loads during falls: a finite element analysis

Background and Objective: To simulate infant skull trauma after low height falls when variable degrees of ossification of the sutures are present. Methods: A finite elements model of a four-week-old infant skull was developed for simulating low height impact from 30 cm and 50 cm falls. Two impacts were simulated: An occipito-parietal impact on the lambdoid suture and a lateral impact on the right parietal and six cases were considered: unossified and fully ossified sutures, and sagittal, metopic, right lambdoid and right coronal craniosynostosis. Results: 26 simulations were performed. Results showed a marked increase in strain magnitudes in skulls with unossified sutures and fontanels. Higher deformations and lower Von Mises stress in the brain were found in occipital impacts. Fully ossified skulls showed less overall deformation and lower Von Mises stress in the brain. Results suggest that neonate skull impact when falling backward has a higher probability of resulting in permanent damage. Conclusion: This work shows an initial approximation to the mechanisms underlying TBI in neonates when exposed to low height falls common in household environments, and could be used as a starting point in the design and development of cranial orthoses and protective devices for preventing or mitigating TBI.