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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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Andrade JRD, Platt VB, Honicky M. Reports of Maltreatment in a Children's Hospital: Evaluation of the Epidemiological Profile and Its Relationship with the Outcome in Fractures. Rev Bras Ortop 2024; 59:e269-e277. [PMID: 38606138 PMCID: PMC11006522 DOI: 10.1055/s-0044-1785466] [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: 07/04/2023] [Accepted: 09/19/2023] [Indexed: 04/13/2024] Open
Abstract
Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved ( n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, ( n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist ( n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention ( n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.
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Isa MI, Fenton TW, Antonelli LS, Vaughan PE, Wei F. Investigating reverse butterfly fractures: An experimental approach and application of fractography. Forensic Sci Int 2021; 325:110899. [PMID: 34247140 DOI: 10.1016/j.forsciint.2021.110899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Abstract
Butterfly fractures are expected to form with the transverse portion on the tension side and the wedge portion on the compression side of a bent bone, however wedges have also been observed in the reverse orientation and are reported to be frequent in concentrated 4-point bending. To investigate how these fractures form, concentrated 4-point bending experiments were performed on nine human femora and documented using high-speed video. Videos showed the wedge portion formed as fracture initiated in tension, branched obliquely, then curved to terminate on the tension face. The transverse portion formed as a crack traveled between the curved fracture branch and the compression face. Fractography was also applied to evaluate fracture surfaces. At least one fractography feature was present in all femora and 32/35 bone fragments examined. Fracture propagation sequences interpreted using fractography matched those observed on video, demonstrating the utility of this method for evaluating complex fracture patterns.
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Affiliation(s)
- Mariyam I Isa
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, MI, United States 48824.
| | - Todd W Fenton
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, MI, United States 48824.
| | - Lillian S Antonelli
- Department of Anthropology, Michigan State University, 655 Auditorium Dr., East Lansing, MI, United States 48824.
| | - Patrick E Vaughan
- Orthopaedic Biomechanics Laboratories, Michigan State University, 965 Fee Rd., East Lansing, MI, United States 48824.
| | - Feng Wei
- Orthopaedic Biomechanics Laboratories, Michigan State University, 965 Fee Rd., East Lansing, MI, United States 48824.
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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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Vaughan PE, Wei F, Haut RC. Effects of age and rate of twist on torsional fracture patterns in infant porcine femora. J Clin Orthop Trauma 2020; 11:281-285. [PMID: 32099294 PMCID: PMC7026619 DOI: 10.1016/j.jcot.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/10/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Long bone fractures are a common injury in the pediatric population. Differentiation between abusive, or non-accidental trauma, and accidental trauma in children remains challenging for forensic practitioners. A recent clinical-based study was able to separate pediatric abusive from accidental trauma based on femoral fracture pattern using the ratio of fracture length over bone diameter (fracture ratio), as determined from radiographic analysis of this fractured bone. The forensic literature indicates more cases of abuse in younger pediatric victims than accidental cases. While this was the case in the clinical study, the effect was not shown to be statistically significant. Furthermore, while speed of trauma was not considered in the clinical study, a laboratory study with an immature bovine model indicates rotational speed influences fracture pattern, but specimen age was not varied in that study. Therefore, the objective of the current study was to use immature porcine femora to investigate the effects of age and rate of twist on a modified version of this fracture ratio parameter. METHODS Fifteen pairs of porcine femora with various ages were twisted until observable failure using a custom-built torsional fixture. The left femur of each pair was twisted to failure at a rate of 3 deg/s, while the right femur was twisted at a rate of 90 deg/s. The torque and angle of rotation were recorded at a sampling rate of 10,000 Hz. Fracture ratio was defined as total fracture length divided by bone diameter. RESULTS Fracture ratio increased with specimen age, with specimens under the low rate of twist yielding a consistently lower fracture ratio than those from specimens under the high rate of twist. The results showed that both specimen age and rate of twist were significant factors influencing fracture ratio. CONCLUSION The determination of abusive from accidental trauma in criminal cases, based on the pattern of long bone fracture alone, may need to include additional data on the specific age of the pediatric victim and the potential speed of the traumatic event.
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Affiliation(s)
- Patrick E. Vaughan
- Orthopaedic Biomechanics Laboratories, Michigan State University, East Lansing, MI, 48824, USA,Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, MI, 48824, USA
| | - Feng Wei
- Orthopaedic Biomechanics Laboratories, Michigan State University, East Lansing, MI, 48824, USA,Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, MI, 48824, USA,Department of Radiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA,Corresponding author. Michigan State University, 965 Fee Road, Room A-414B, East Lansing, MI, 48824, USA. http://www.obl.msu.edu
| | - Roger C. Haut
- Orthopaedic Biomechanics Laboratories, Michigan State University, East Lansing, MI, 48824, USA,Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, MI, 48824, USA,Department of Radiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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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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Investigating the mechanical response of paediatric bone under bending and torsion using finite element analysis. Biomech Model Mechanobiol 2018. [DOI: 10.1007/s10237-018-1008-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Femur fracture biomechanics and morphology associated with torsional and bending loading conditions in an in vitro immature porcine model. J Forensic Leg Med 2017; 52:5-11. [DOI: 10.1016/j.jflm.2017.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/23/2022]
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