3-D finite element analysis of the influence of synovial condition in sacroiliac joint on the load transmission in human pelvic system

3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

BACKGROUND

Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress.

METHODS

We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes.

RESULTS

Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening.

CONCLUSION

The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.

Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study

BACKGROUND

Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively.

METHODS

From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution.

PRIMARY OUTCOME

limb function.

SECONDARY OUTCOMES

implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models.

RESULTS

In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher.

CONCLUSIONS

The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions.

LEVEL OF EVIDENCE

Level III, therapeutic study (Retrospective comparative study).

Design of 3D-printed prostheses for reconstruction of periacetabular bone tumors using topology optimization

Background: Prostheses for the reconstruction of periacetabular bone tumors are prone to instigate stress shielding. The purpose of this study is to design 3D-printed prostheses with topology optimization (TO) for the reconstruction of periacetabular bone tumors and to add porous structures to reduce stress shielding and facilitate integration between prostheses and host bone. Methods: Utilizing patient CT data, we constructed a finite element analysis (FEA) model. Subsequent phases encompassed carrying out TO on the designated area, utilizing the solid isotropic material penalization model (SIMP), and this optimized removal area was replaced with a porous structure. Further analyses included preoperative FEA simulations to comparatively evaluate parameters, including maximum stress, stress distribution, strain energy density (SED), and the relative micromotion of prostheses before and after TO. Furthermore, FEA based on patients' postoperative CT data was conducted again to assess the potential risk of stress shielding subsequent to implantation. Ultimately, preliminary follow-up findings from two patients were documented. Results: In both prostheses, the SED before and after TO increased by 143.61% (from 0.10322 to 0.25145 mJ/mm3) and 35.050% (from 0.30964 to 0.41817 mJ/mm3) respectively, showing significant differences (p < 0.001). The peak stress in the Type II prosthesis decreased by 10.494% (from 77.227 to 69.123 MPa), while there was no significant change in peak stress for the Type I prosthesis. There were no significant changes in stress distribution or the proportion of regions with micromotion less than 28 μm before and after TO for either prosthesis. Postoperative FEA verified results showed that the stress in the pelvis and prostheses remained at relatively low levels. The results of follow-up showed that the patients had successful osseointegration and their MSTS scores at the 12th month after surgery were both 100%. Conclusion: These two types of 3D-printed porous prostheses using TO for periacetabular bone tumor reconstruction offer advantages over traditional prostheses by reducing stress shielding and promoting osseointegration, while maintaining the original stiffness of the prosthesis. Furthermore, in vivo experiments show that these prostheses meet the requirements for daily activities of patients. This study provides a valuable reference for the design of future periacetabular bone tumor reconstruction prostheses.

Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress: A Finite Element Analysis

STUDY DESIGN

This study compared hip stress among different types of lumbopelvic fusion based on finite element (FE) analysis.

OBJECTIVE

We believe that the number and placement of S2 alar iliac (AI) screws and whether the screws loosen likely influence hip joint stress in the FE model.

SUMMARY OF BACKGROUND DATA

Spinopelvic fixation has been shown to increase the risk of progression for hip joint osteoarthritis. The biomechanical mechanism is not well understood. We hypothesize that the rigid pelvic fixation may induce stress at adjacent joints.

MATERIALS AND METHODS

A three-dimensional nonlinear FE model was constructed from the L4 vertebra to the femoral bone. From the intact model, we made four fusion models, each with different lower vertebrae instrumentation: (1) intact, (2) L4-S1 fusion, (3) L4-S2 AI screw fixation, (4) L4-S2 AI screw fixation with S2 AI screw loosening, and (5) L4-S1 and dual sacral AI screw fixation. A compressive load of 400 N was applied vertically to the L4 vertebra, followed by an additional 10 Nm bending moment about different axes to simulate either flexion, extension, left lateral bending, or right axial rotation. The distal femoral bone was completely restrained. The von Mises stress and angular motion were analyzed across the hip joints within each fusion construct model.

RESULTS

Hip joint cartilage stress and range of motion increased for all postures as pelvic fixation became more rigid. The dual sacral AI screw fixation model increased stress and angular motion at the hip joint more than intact model. Our results suggest that more rigid fixation of the pelvis induces additional stress on the hip joint, which may precipitate or accelerate adjacent joint disease.

CONCLUSIONS

Dual sacral AI fixation led to the highest stress while loosening of S2 AI decreased stress on the hip joint. This study illustrates that more rigid fixation among lumbosacral fusion constructs increases biomechanical stress on the hip joints.

Acetabular fracture pattern is altered by pre-injury sacroiliac joint autofusion

PURPOSE

Acetabular fracture shape is determined by the direction of force applied. We perceive an anecdotally observed connection between pre-existing autofused sacroiliac joints (aSIJ) and high anterior column (HAC) injuries. The purpose of this study was to compare variations in acetabular fracture patterns sustained in patients with and without pre-injury sacroiliac (SI) joint autofusion.

METHODS

All adult patients receiving unilateral acetabular fixation (level 1 academic trauma; 2008-2018) were reviewed. Injury radiographs and CT scans were reviewed for fracture patterns and pre-existing aSIJ. Fracture types were subgrouped presence of HAC injury (includes anterior column (AC), anterior column posterior hemitransverse (ACPHT), or associated both column (ABC)).

ANALYSIS

Logistic regression determined the association between aSIJ and HAC.

RESULTS

A total of 371 patients received unilateral acetabular fixation (2008-2018); 61 (16%) demonstrated CT evidence of idiopathic aSIJ. These patients were older (64.1 vs. 47.4, p < 0.01), more likely to be male (95% vs. 71%, p < 0.01), less likely to be smokers (19.0% vs. 44.8%, p < 0.01), and were injured from lower energy mechanisms (21.3% vs. 8.4%, p = 0.01). The most common patterns with autofusion were ACPHT (n = 13, 21%) and ABC (n = 25, 41%). Autofusion was associated with greater odds of patterns involving a high anterior column injury (ABC, ACPHT, or isolated anterior column; OR = 4.97, p < 0.01). After adjusting for age, mechanism, and body mass index, the connection between autofusion and high anterior column injuries remained significant (OR = 2.60, p = 0.01).

CONCLUSIONS

SI joint autofusion appears to change mode of failure in acetabular injuries; a more rigid posterior ring may precipitate a high anterior column injury.

LEVEL OF EVIDENCE

Prognostic level III.

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Background: Posterior long spinal fusion was the common procedure for adult spinal deformity (ASD). Although the application of sacropelvic fixation (SPF), the incidence of pseudoarthrosis and implant failure is still high in long spinal fusion extending to lumbosacral junction (LSJ). To address these mechanical complications, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended. This was the first study to compare the biomechanical performance of combining multiple pelvic screws and multirod construct to other advanced SPF constructs for the augmentation of LSJ in long spinal fusion surgery through finite element (FE) analysis.

Methods: An intact lumbopelvic FE model based on computed tomography images of a healthy adult male volunteer was constructed and validated. The intact model was modified to develop five instrumented models, all of which had bilateral pedicle screw (PS) fixation from L1 to S1 with posterior lumbar interbody fusion and different SPF constructs, including No-SPF, bilateral single S2-alar-iliac (S2AI) screw and single rod (SS-SR), bilateral multiple S2AI screws and single rod (MS-SR), bilateral single S2AI screw and multiple rods (SS-MR), and bilateral multiple S2AI screws and multiple rods (MS-MR). The range of motion (ROM) and stress on instrumentation, cages, sacrum, and S1 superior endplate (SEP) in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were compared among models.

Results: Compared with intact model and No-SPF, the ROM of global lumbopelvis, LSJ, and sacroiliac joint (SIJ) was decreased in SS-SR, MS-SR, SS-MR, and MS-MR in all directions. Compared with SS-SR, the ROM of global lumbopelvis and LSJ of MS-SR, SS-MR, and MS-MR further decreased, while the ROM of SIJ was only decreased in MS-SR and MS-MR. The stress on instrumentation, cages, S1-SEP, and sacrum decreased in SS-SR, compared with no-SPF. Compared with SS-SR, the stress in EX and AR further decreased in SS-MR and MS-SR. The most significantly decreased ROM and stress were observed in MS-MR.

Conclusion: Both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ and reduce stress on instrumentation, cages, S1-SEP, and sacrum. The MS-MR construct was the most adequate to reduce the risk of lumbosacral pseudarthrosis, implant failure, and sacrum fracture. This study may provide surgeons with important evidence for the application of MS-MR construct in the clinical settings.

Effects of manipulations of oblique pulling on the biomechanics of the sacroiliac joint: a cadaveric study

BACKGROUND

There are many reports on the treatment of sacroiliac joint dysfunction by manipulation of oblique pulling (MOP). However, the specific mechanism of MOP on the sacroiliac joint remains unclear. This study aimed to investigate the effect of MOP on the biomechanics of the sacroiliac joint and the effect of the anterior sacroiliac ligament on the stability of the sacroiliac joint.

METHODS

First, MOP-F1 (F: force) and MOP-F2 were applied to nine cadaveric pelvises. Then, segmental resection of the anterior sacroiliac ligament was performed. The range of motion of the sacroiliac joint was observed in all procedures.

RESULTS

Under MOP-F1 and F2, the average total angles were 0.84° ± 0.59° and 1.52° ± 0.83°, and the displacements were 0.61 ± 0.21 mm and 0.98 ± 0.39 mm, respectively. Compared with MOP-F1, MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint (p = 0.00 and p = 0.01, respectively). In addition, the rotation angles and displacements of the sacroiliac joint significantly increased after complete resection of the anterior sacroiliac ligament (p = 0.01 and p = 0.02, respectively). The increase was mainly due to the transection of the upper part of the anterior sacroiliac ligament.

CONCLUSIONS

MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint and was a more effective manipulation. The anterior sacroiliac ligament played an important role in maintaining the stability of the sacroiliac joint; the upper part of the anterior sacroiliac ligament contributed more to the stability of the joint than the lower part.

Manipulations of Oblique Pulling Affect Sacroiliac Joint Displacements and Ligament Strains: A Finite Element Analysis

Objective

Clinical studies have found that manipulation of oblique pulling has a good clinical effect on sacroiliac joint pain. However, there is no uniform standard for manipulation of oblique pulling at present. The purpose of this study was to investigate the effects of four manipulations of oblique pulling on sacroiliac joint and surrounding ligaments.

Methods

A three-dimensional finite element model of the pelvis was established. Four manipulations of oblique pulling were simulated. The stresses and displacements of sacroiliac joint and the strains of surrounding ligaments were analyzed under four manipulations of oblique pulling.

Results

Manipulation of oblique pulling F2 and F3 caused the highest and lowest stress on the pelvis, at 85.0 and 52.6 MPa, respectively. Manipulation of oblique pulling F3 and F1 produced the highest and lowest stress on the left sacroiliac joint, at 6.6 and 5.6 MPa, respectively. The four manipulations of oblique pulling mainly produced anterior-posterior displacement. The maximum value was 1.21 mm, produced by manipulation of oblique pulling F2, while the minimal value was 0.96 mm, produced by manipulation of oblique pulling F3. The four manipulations of oblique pulling could all cause different degrees of ligament strain, and manipulation of oblique pulling F2 produced the greatest ligament strain.

Conclusions

The four manipulations of oblique pulling all produced small displacements of sacroiliac joint. However, they produced different degrees of ligament strain. Manipulation of oblique pulling F2 produced the largest displacement of sacroiliac joint and the greatest ligament strain, which could provide a certain reference for physiotherapists.

Creation of the biomechanical finite element model of female pelvic floor supporting structure based on thin-sectional high-resolution anatomical images

PURPOSE

The main purpose of this study is to obtain a finite element biomechanical model that accurately mimics pelvic organ prolapse in women, to study pelvic floor supporting structures' biomechanical properties and function. We used thin-sectional high-resolution anatomical images (Chinese Visible Human, CVH) to reconstruct a detailed three-dimensional (3D) biomechanical finite element model of the female pelvic floor supporting structure including cardinal ligament, uterosacral ligament, levator ani muscle (LAM) and perianal body. The Valsalva maneuver was simulated by loading the uterus and bladder with a pressure increasing from 0 to 10 kPa. The stress, strain and displacement of supporting structures were calculated. The cardinal ligament, the uterosacral ligament and the LAM were stressed greatly when the uterus moved downward, and the maximum stress could reach 0.267 MPa, 1.51 MPa and 0.065 MPa respectively, and the maximum strain could reach 0.154, 0.16, 0.265, and the maximum displacement could reach 1.786 cm, 1.946 cm and 0.567 cm. Displacement of the perineal body also occurred, and its stress, strain and displacement were 0.092 MPa, 0.381, 0.73 cm. The stress, strain and displacement of the supporting structure around the urethra were 0.339 MPa, 0.169, 1.491 cm. Our model based on CVH has more detailed anatomical structures, which is superior to that based on MRI. Our simulation results were consistent with previous findings, which verified the unbalance of abdominal pressure and pelvic floor supporting structures will lead to POP, which provide a theoretical basis for pelvic floor anatomy and function as well as obstetrical surgery.

Numerical Analyses of Fracture Mechanism of the Pelvic Ring during Side-Impact Load

The aim of this study is the analysis of the multiple pelvis fracture mechanism in side-impact dynamic load cases. The elaborated numerical model of a pelvis complex includes pelvic and sacral bones as well as soft tissues such as ligaments and cartilages. The bone has been modelled as a viscoelasticity material based on the Johnson-Cook model. The model parameters have been chosen based on the experimental data. The uniqueness of a presented approach refers to the selection of crack criteria for the bone. Thus, it was allowed to analyse the process of multiple fractures inside the pelvic bones. The analysis was evaluated for the model in which the deformation rate influences the bone material properties. As a result, the stress distributions inside particular bones were changed. It has been estimated that the results can vary by 50% or even more depending on the type of boundary conditions adopted. The second step of work was a numerical analysis of military vehicle subjected to an IED. An analysis of the impactor's impact on the pelvis of the Hybrid ES-2RE mannequin was conducted. It was shown that the force in the pelvis exceeds the critical value by a factor of 10. The results of the numerical analysis were then used to validate the model of a military vehicle with a soldier. It was shown that for the adopted loading conditions, the critical value of the force in the pelvis was not exceeded.

Medial meniscus extrusion and varus tilt of joint line convergence angle increase stress in the medial compartment of the knee joint in the knee extension position -finite element analysis

PURPOSE

Although it has been recognized that the medial meniscus extrusion (MME) leads to progressive cartilage loss and osteoarthritis (OA), about 20% of cases with MME had minor symptoms and poor progression of knee OA. However, it is still unclear which patients will have minimal symptoms or will not progress to degeneration. The purpose of this study is to compare the effect of the relationship between the MME and Joint line convergence angle (JLCA) on knee stress with the finite element (FE) analysis method.

METHODS

The 65 year-old female was taken computer tomography (CT) from thigh to ankle. A 3-dimentional nonlinear FE model was constructed from the patient's DICOM data. We made the six models, which was different from JLCA and MME. Contact stresses on the surfaces between femoral and tibial cartilages and both side of meniscus are analyzed.

RESULTS

As the JLCA or MME increased, the stress load on the medial compartment increased. The effect of MME was stronger on the femoral side, while the effect of JLCA was stronger for the tibia and meniscus. If the JLCA was tilted valgus, the stress in the medial compartment did not increase even in the presence of MME.

CONCLUSIONS

This study revealed that the MME is associated with increased a stress loading on medial compartment structures. Furthermore, this change was enhanced by the varus tilt of the JLCA. In the case of valgus alignment, the contact pressure of the medial compartment did not increase so much even if with the MME.

LEVEL OF EVIDENCE

Level V.

Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study

Introduction

Adult spinal fusion surgery improves lumbar alignment and patient satisfaction. Adult spinal deformity surgery improves saggital balance not only lumbar lesion, but also at hip joint coverage. It was expected that hip joint coverage rate was improved and joint stress decreased. However, it was reported that adjacent joint disease at hip joint was induced by adult spinal fusion surgery including sacroiliac joint fixation on an X-ray study. The mechanism is still unclear. We aimed to investigate the association between lumbosacral fusion including sacroiliac joint fixation and contact stress of the hip joint.

Methods

A 40-year-old woman with intact lumbar vertebrae underwent computed tomography. A three-dimensional nonlinear finite element model was constructed from the L4 vertebra to the femoral bone with triangular shell elements (thickness, 2 mm; size, 3 mm) for the cortical bone's outer surface and 2-mm (lumbar spine) or 3-mm (femoral bone) tetrahedral solid elements for the remaining bone. We constructed the following four models: a non-fusion model (NF), a L4-5 fusion model (L5F), a L4-S1 fusion model (S1F), and a L4-S2 alar iliac screw fixation model (S2F). A compressive load of 400 N was applied vertically to the L4 vertebra and a 10-Nm bending moment was additionally applied to the L4 vertebra to stimulate flexion, extension, left lateral bending, and axial rotation. Each model's hip joint's von Mises stress and angular motion were analyzed.

Results

The hip joint's angular motion in NF, L5F, S1F, and S2F gradually increased; the S2F model presented the greatest angular motion.

Conclusions

The average and maximum contact stress of the hip joint was the highest in the S2F model. Thus, lumbosacral fusion surgery with sacroiliac joint fixation placed added stress on the hip joint. We propose that this was a consequence of adjacent joint spinopelvic fixation. Lumbar-to-pelvic fixation increases the angular motion and stress at the hip joint.

A Tribological Comparison of Facet Joint, Sacroiliac Joint, and Knee Cartilage in the Yucatan Minipig

OBJECTIVE

Pathology of the facet and sacroiliac (SI) joints contributes to 15% to 45% and 10% to 27% of lower back pain cases, respectively. Although tissue engineering may offer novel treatment options to patients suffering from cartilage degeneration in these joints, the tribological characteristics of the facet and SI joints have not been studied in either the human or relevant large animal models, which hinders the development of joint-specific cartilage implants.

DESIGN

Cartilage was isolated from the knee, cervical facet, thoracic facet, lumbar facet, and SI joints of 6 skeletally mature Yucatan minipigs (Sus scrofa). Tribological characteristics were assessed via coefficient of friction testing, interferometry, and immunohistochemistry for lubricin organization.

RESULTS

Compared with the knee, the coefficient of friction was higher by 43% in the cervical facet, 77% in the thoracic facet, 37% in the lumbar facet, and 28% in the SI joint. Likewise, topographical features of the facet and SI joints varied significantly, ranging from a 114% to 384% increase and a 48% to 107% increase in global and local surface roughness measures, respectively, compared with the knee. Additionally, the amount of lubricin in the SI joint was substantially greater than in the knee. Statistical correlations among the various tribological parameters revealed that there was a significant correlation between local roughness and coefficient of friction, but not global roughness or the presence of lubricin.

CONCLUSION

These location-specific tribological characteristics of the articular cartilages of the spine will need to be taken into consideration during the development of physiologically relevant, functional, and durable tissue-engineered replacements for these joints.

Prediction of fracture initiation and propagation in pelvic bones

The objective is developing an XFEM model that is capable of predicting different types of fracture in the pelvic bone under various loading conditions. Previously published mechanical and failure characteristics of cortical and cancellous tissues were implemented and assigned to an intact pelvic bone with specified cortical and cancellous tissues. Various loading conditions, including combined load directions, were applied to the acetabulum to model different types of fracture (e.g., anterior/posterior wall fracture and transverse fracture) in the pelvic bone. The predicated types of fracture and the maximum force at fracture were compared to those acquired from previously published experimental tests. Anterior/posterior wall fracture and transverse fracture were the most common types of fractures determined in the simulations. The XFEM simulations were able to predict similar fractures to those reported in the experimental tests. The maximum fracture force in the XFEM model was found to be 18.6 kN compared to 8.85 kN reported in the previous experimental tests. The results revealed that different types of fracture in the pelvic bones can be caused by the various loading conditions in unstable high-rate impact loads. Using proper mechanical and failure behaviors of cortical and cancellous tissues, XFEM modeling of pelvic bone is capable of predicting bone fracture. In future work, the XFEM models of cancellous and cortical tissues can be assigned to other bones in human body skeleton so that the failure mechanism in such bones can be investigated.

Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads

OBJECTIVE

To explore the biomechanical changes of the lumbar spine segment of idiopathic scoliosis under different loads by simulating six kinds of lumbar spine motions based on a three-dimensional finite element (FE) model. Methods According to the plain CT scan data of L1-L5 segment of an AIS patient, a three-dimensional FE model was established to simulate the biomechanics of lumbar scoliosis under different loads. The lumbar model was reconstructed using Mimics20.0, smoothed in Geomagic2013, assembled in Solidworks 2020, with FE analysis performed using Workbench19.0. Results The completed model had a total of 119029 C3D4 solid elements, 223805 nodes, including finely reconstructed tissue structures. In patients with AIS, the range of motion (ROM) is reduced under all loads. Under flexion loads, the vertebral concave stress distribution is greater; under extension lateral bending, and rotation load at the posterior side of the vertebral body, the stress is concentrated in the L3 vertebral arch. The buffering effect of intervertebral disc on the rotational load is the weakest. Different loads of AIS cause corresponding changes in the force and displacement of different positions of the vertebral body or intervertebral discs. Conclusions The change in physiological shape of the lumbar vertebrae limits the ROM of the lumbar vertebrae. The stress showed a trend of local concentration which located in the concave side of the scoliosis. The stress on the lumbar vertebrae comprising the greatest curvature is the most excessive. The stress in the intervertebral disc under the rotating load is greater than that under other kinds of loads, and the intervertebral disc is more likely to be injured because of the rotating load.

Asymmetry of the pelvic ring evaluated by CT-based 3D statistical modeling

The human pelvis is a complex anatomical structure that consists of the innominate bones, sacrum and coccyx to form the pelvic ring. Even though considered to be a symmetric entity, asymmetry of the pelvic ring (APR) might occur to alter its anatomy, function, or biomechanics or to impact assessment and treatment of clinical cases. APR and its assessment is complicated by the intricate anatomy of the pelvic ring. There is only limited information and understanding about APR with no established evaluation methods existing. The objective of the present study was to adopt CT-based 3D statistical modeling and analysis to assess APR within the complex anatomy of the pelvic ring. We were interested to establish a better understanding of APR with knowledge and applications transferred to human anatomy, related research, and development subjects and to clinical settings. A series of 150 routine, clinical, pelvic CT protocols of European and Asian males and females (64 ± 15 (20-90) years old) were post-processed to compute gender- and ancestry-specific 3D statistical models of the pelvic ring. Evaluations comprised principal component analysis (PCA) that included size, shape, and asymmetry patterns and their variations to be assessed. Four different CT-based 3D statistical models of the entire pelvic ring were computed according to the gender and ancestry specific groups. PCA mainly displayed size and shape variations. Examination of additional PCA modes permitted six distinct asymmetry patterns to be identified. They were located at the sacrum, iliac crest, pelvic brim, pubic symphysis, inferior pubic ramus, and near to the acetabulum. Accordingly, the pelvic ring demonstrated not to be entirely symmetric. Assessment of its asymmetry proved to be a challenging task. Using CT-based 3D statistical modeling and PCA, we identified six distinct APRs that were located at different anatomical regions. These regions are more prone to APRs than other sites. Minor asymmetry patterns have to be distinguished from the distinct APRs. Side differences with regard to size, shape, and/or position require to be taken into account. APRs may be due different load mechanisms applied via spine or lower extremity or locally. There is a need for simpler and efficient, yet reliable methods to be routinely transferred to human anatomy, related research, and development subjects and to clinical settings.

A finite element analysis of sacroiliac joint displacements and ligament strains in response to three manipulations

BACKGROUND

Clinical studies have found that manipulations have a good clinical effect on sacroiliac joint (SIJ) pain without specific causes. However, the specific mechanisms underlying the effect of manipulations are still unclear. The purpose of this study was to investigate the effects of three common manipulations on the stresses and displacements of the normal SIJ and the strains of the surrounding ligaments.

METHODS

A three-dimensional finite element model of the pelvis-femur was developed. The manipulations of hip and knee flexion (MHKF), oblique pulling (MOP), and lower limb hyperextension (MLLH) were simulated. The stresses and displacements of the SIJ and the strains of the surrounding ligaments were analyzed during the three manipulations.

RESULTS

MOP produced the highest stress on the left SIJ, at 6.6 MPa, while MHKF produced the lowest stress on the right SIJ, at 1.5 MPa. The displacements of the SIJ were all less than 1 mm during the three manipulations. The three manipulations caused different degrees of ligament strain around the SIJ, and MOP produced the greatest straining of the ligaments.

CONCLUSION

The three manipulations all produced small displacements of the SIJ and different degrees of ligament strains, which might be the mechanism through which they relieve SIJ pain. MOP produced the largest displacement and the greatest ligament strains.

Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model

The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary.

Computed Tomographic Evaluation of the Sacroiliac Joints of Young Working Labrador Retrievers of Various Work Status Groups: Detected Lesions Vary Among the Different Groups and Finite Element Analyses of the Static Pelvis Yields Repeatable Measures of Sacroiliac Ligament Joint Strain

Musculoskeletal injuries can lead to a working dog being withdrawn from service prior to retirement. During training exercises, young working dogs are often required to perform repetitive tasks, including adoption of an upright posture (or “hupp” task). Non-invasive, quantitative methods would be helpful for supporting research on effects of these repetitive tasks on sacroiliac joints (SIJ). Furthering our understanding of lesions in and biomechanical stresses on the SIJ could provide insight into possible training modifications for minimizing risks of SIJ injury. Aims of this retrospective, secondary analysis, exploratory study were to test hypotheses that (1) mean numbers of SIJ computed tomographic (CT) lesions/dog would differ among work status groups in young working Labrador Retrievers; (2) a methodology for using CT data and finite element analysis (FEA) to quantify SIJ ligament strain in the static canine pelvis would be feasible; and (3) this FEA methodology would yield repeatable measures of SIJ ligament strain. Clinical and CT data for 22 Labrador retriever working dogs, aged 11–48 months, were retrospectively reviewed. Dogs were categorized into three work status groups (Breeder, Detection, Other). A veterinary radiologist who was unaware of dog group status recorded numbers of CT lesions for each SIJ, based on previously published criteria. Mean numbers of SIJ CT lesions/dog were compared among dog work status groups. An a priori FEA model was created from the CT images of one of the dogs using image analysis software packages. Using tissue properties previously published for the human pelvis, various directional loads (n = 8) and forces (48 ligament strain values) were placed on the canine model in five trials. Repeatability was tested using regression analysis. There was a significantly greater mean number of subchondral sclerosis lesions in left SIJ of Breeder vs. Detection dogs, a significantly greater mean number of subchondral cysts in right SIJ for Detection vs. Breeder dogs, and a significantly greater mean number of subchondral cysts in right SIJ of Other vs. Breeder dogs (p < 0.05). Finite element modeling and analysis using CT data was feasible and yielded repeatable results in 47/48 (98%) of tests at each combination of strain, ligament, and side.

Three-Dimensional Finite Element Analysis of the Effects of Ligaments on Human Sacroiliac Joint and Pelvis in Two Different Positions

To present the ligament effects on sacroiliac joint (SIJ) stability and human pelvis biomechanical characteristics in two different positions by using three-dimensional (3D) finite element (FE) models of pelvis. Based on the computed tomography (CT) data of human pelvis, three-dimensional FE models of human pelvis in sitting and standing positions were established, which include the bone (sacrum, ilium, and coccyx) and six ligaments (sacroiliac, sacrospinous, sacrotuberous, inguinal, superior pubic, and arcuate pubic ligaments). 600 N vertical load was applied at the upper surface of sacrum to analyze the stress and displacement distribution of pelvis and SIJ. The simulation results demonstrated that the maximum stresses of sacrum and ilium on SIJ contact surface were 5.63 MPa and 7.40 MPa in standing position and 7.44 MPa and 7.95 MPa in sitting position. The stresses of ligament dysfunction group were higher than that of health group, which increased by 22.6% and 35.7% in standing position and 25.2% and 43.6% in sitting position in sacrum and ilium. The maximum displacements located on the upper surface of sacrum, which were 0.13 mm and 1.04 mm in standing and sitting positions. Ligaments dysfunction group increased 30.7% and 9.6% than health group in standing and sitting positions. The integral displacement of pelvis was greater in sitting position. The location of stress concentration and displacement distribution of pelvic bone are closely resembled previous research results in two different positions. The simulation results may provide beneficial information and theoretical models for clinical research of pelvic fracture, joint movement, and ligament functional injuries, and so on.

Biomechanical comparison of the angle of inserted screws and the length of anterior cervical plate systems with allograft spacers

BACKGROUND

Comparative studies of the biomechanical effects of plates of varying lengths and different screw insertion angles on allograft spacers are lacking.

METHODS

Finite element model analysis of a previously validated, three-dimensional, intact cervical spinal segment model of C3-6 was conducted in the present study. On the C5-6 segment, anterior discectomy and fusion were performed using allograft spacers and different combinations of anterior plates and screws. The biomechanical characteristics of combinations of short, medium, and maximal length plates with screw insertion angles of 0°, 8°, 16°, and 32° were analyzed.

FINDINGS

In flexion and extension, the risk of allograft spacer subsidence decreased as screw angles increased. Short plates with a screw insertion angle of 32° posed the lowest subsidence risk, similar to medium length plates with a screw insertion angle of 16°, in all motion conditions. The risk of bone yielding increased as plate length increased, but decreased as the screw insertion angle increased.

INTERPRETATION

Short plates with a large screw insertion angle (32°) showed the highest mechanical stability and load sharing of allograft spacers and the lowest risk of screw loosening. Accordingly, we recommend the use of a short plate and large screw insertion angle for anterior cervical discectomy and fusion.

Effect of anthropometry scaling on the response of the piper child scalable human body model subject to pelvic impact

The Open Source PIPER child scalable human body model was publicly released in April 2017 (www.piper-project.org) along with frontal and side impact validation conditions. The objective of this paper is to investigate the effect of anthropometry scaling on the response of the model in side pelvic impact. Three setups from two published studies were used: (1) a lateral drop test (2) a greater trochanter impact with a rigid pendulum (3) a pelvis side impact with a flat surface. The first study used scaling assumption developed for crash test dummy design (setups 1 and 2) and the second performed tests on post mortem human surrogates. The baseline 6 years old child model was scaled using a model morphing methodology to match the stature and weight of the surrogates used in the two published studies. Overall, the main trends observed in the three setups can be approached using the baseline model. Although the model morphing did not account for specific skeletal dimensions, it reduced some of the discrepancies between model response and reference for the drop test and flat plate impact. However, it had little effect on the pendulum test. In that case, the model response was in the corridor at low speed but above at higher speeds. Possible reasons for this difference should be further investigated.

Influence of pubic symphysis stiffness on pelvic load distribution during single leg stance

This study focuses on the influence of the softening and stiffening of pubic symphysis on the load distribution within the bones of the pelvic ring under the physiological loadings of the single leg stance. Muscle forces and joint reaction forces were first determined by inverse dynamics and applied to a linear finite element model of the pelvis. With normal pubic symphysis stiffness, high Von Mises stresses are located on the anterior surface to the sacrum around the sacroiliac joint and on the superior ramus, both on the side of the weight-bearing leg. Softening of the pubic symphysis redirects the load backward, decreases the stresses at the anterior pelvis, and increases them at the posterior pelvis. A stiffening of the pubic symphysis redirects the load forward, increases the load on the posterior pelvis, and decreases them at the anterior pelvis. This investigation highlights the significance of the pubic symphysis on the load distribution of the pelvis and in maintaining the integrity of the structures. Its role should not be neglected when analyzing the pelvis.

Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures

Background

Despite the development of minimally invasive techniques for pelvic fractures, performing minimally invasive surgery for Tile C3 pelvic fractures remains challenging. Thus, we propose use of anterior ring internal fixation combined with sacroiliac screw fixation for Tile C3 pelvic fractures.

Material/Methods

A normal pelvic finite element model (model 1) was established. Two-screw, three-screw, and four-screw anterior ring internal fixators and plate combined with sacroiliac screw Tile C3 pelvic fracture models (models 2, 3, 4, and 5, respectively) were also established. A vertical load of 600 N was applied on S1. The distribution of displacement and stress in the standing and sitting positions was compared.

Results

Models 2, 3, 4, and 5 can provide effective fixation. Compared with model 1, in the erect position, the maximum displacement of models 2, 3, 4, and 5 increased by 66.51%, 65.36%, 35.16%, and 35.47% and the maximum stress increased by 201.78%, 130.65%, 100.82%, and 99.03%, respectively. Compared with model 1, in sitting position, the maximum displacement of models 2, 3, 4, and 5 increased by 9.1%, 11.04%, 5.57%, and 8.59% and the maximum stress increased by 157.73%, 118.02%, 98.32%, and 93.16%, respectively.

Conclusions

Anterior ring internal fixators combined with sacroiliac screws can effectively fix Tile C3 pelvic fractures.

Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw)

BACKGROUND

The purpose of this study is to investigate effects of different fixation methods on the physical stress on allospacers, endplate-vertebral body, and implants using finite element model analyses.

METHODS

Stress distribution and subsidence risk according to the fixation methods under the condition of hybrid motion control were analyzed. The detailed finite element model of a previously validated, three-dimensional, intact cervical spinal segment model, with C5-C6 segmental fusion using allospacer, was used to evaluate the biomechanical characteristics of different fixation combinations, such as anterior plate/screws, lateral mass screw, and posterior pedicle screw.

FINDINGS

The load sharing on allospacers increased in extension in order of posterior pedicle screws (21.4%), lateral mass screws (31.5%), and anterior plate/screws (56.6%). lateral mass screw demonstrated the highest load sharing (68.1%) on the allospacer in flexion. The Peak von Mises stress of the allospacer was the lowest in flexion and axial rotation but the highest in extension with anterior plate/screws. Allospacer subsidence risk was the lowest in extension, lateral bending, and axial rotation with posterior pedicle screws but the lowest in flexion with anterior plate/screws. The bone-screw loosening risk was the lowest in all modes with posterior pedicle screws but the highest with anterior plate/screws.

INTERPRETATION

Posterior pedicle screws demonstrated the best mechanical stability of allospacer failure-subsidence and the lowest risk of screw loosening. Different motion restrictions depending on the fixation method should be considered for implant and allospacer safety.

What do we know about the biomechanics of the sacroiliac joint and of sacropelvic fixation? A literature review

The purpose of this review is to summarize the general knowledge about the biomechanics of the sacroiliac joint and sacropelvic fixation techniques. Additionally, this study aims to support biomechanical investigations in defining experimental protocols as well as numerical modeling of the sacropelvic structures. The sacroiliac joint is characterized by a large variability of shape and ranges of motion among individuals. Although the ligament network and the anatomical features strongly limit the joint movements, sacroiliac displacements and rotations are not negligible. Currently available treatments for sacroiliac joint dysfunction include physical therapy, steroid injections, Radio-frequency ablation of specific neural structures, and open or minimally invasive SIJ fusion. In long posterior construct, the most common solutions are the iliac screws and the S2 alar - iliac screws, whereas for the joint fixation alone, mini - invasive alternative system can be used. Several studies reported the clinical outcomes of the different techniques and investigated the biomechanical stability of the relative construct, but the effect of sacropelvic fixation techniques on the joint flexibility and on the stress generated into the bone is still unknown. In our opinion, more biomechanical analyses on the behavior of the sacroiliac joint may be performed in order to better predict the risk of failure or instability of the joint.

Sacroiliac Joint Asymmetry Regarding Inflammation and Bone Turnover: Assessment by FDG and NaF PET/CT

Objectives

This study was undertaken to determine the role of computed tomography (CT)-based methodology to segment the SI joint and quantify the metabolic activity using positron emission tomography (PET). We measured tracer uptake in the right and left SI joints independently to look for differences between the two sides. Further, we correlated tracer uptake with BMI and studied the inter-observer variation with regard to estimated tracer uptake in the SI joints.

Methods

In this retrospective study, a total of 103 subjects (48 females, 55 males) from the CAMONA study database collected 2012-2016 at Odense University Hospital in Denmark were included. Mean age was 48±14.59 years, mean BMI was 26.68±4.31 kg/m². The SI joints were segmented on fused PET/CT images using a 3D growing algorithm with adjustable upper and lower Hounsfield Units (HU) thresholds. The metabolic activities on the two sides were correlated with BMI.

Results

For FDG, we found a higher average SUV_mean on the right side (right: 1.3±0.33, left: 1.13±0.30; <0.0001). Similarly, for NaF, the uptake was higher on the right side (right: 5.9±1.29, left: 4.27±1.23; <0.0001). Positive correlations were present between BMI and FDG uptake (P<0.01) as well as NaF uptake (P<0.01).

Conclusion

The PET-based molecular imaging probes along with the CT-based segmentation techniques revealed a significant difference in the metabolic activity between the two SI joints with higher inflammation and reactive bone formation on the right side. FDG and NaF uptakes correlated significantly and positively with BMI.

Evaluation of iliac screw, S2 alar-iliac screw and laterally placed triangular titanium implants for sacropelvic fixation in combination with posterior lumbar instrumentation: a finite element study

PURPOSE

This study aimed to implement laterally placed triangular titanium implants as a technique of sacropelvic fixation in long posterior lumbar instrumentation and to characterize the effects of iliac screws, S2 alar-iliac screws and of triangular implants on rod and S1 pedicle screw stresses.

METHODS

Four female models of the lumbopelvic spine were created. For each of them, five finite element models replicating the following configurations were generated: intact, posterior fixation with pedicle screws to S1 (PED), with PED and iliac screws (IL), with PED and S2 alar-iliac (S2AI) screws, and with PED and bilateral triangular titanium implants (SI). Simulations were conducted in compression, flexion-extension, lateral bending and axial rotation. Rod stresses in the L5-S1 segment as well as in the S1 pedicle screws were compared.

RESULTS

One anatomical model was not simulated due to dysmorphia of the sacroiliac joints. PED resulted in the highest implant stresses. Values up to 337 MPa in lateral bending were noted, which were more than double than the other configurations. When compared with IL, S2AI and SI resulted in lower stresses in both screws and rods (on average 33% and 41% for S2AI and 17% and 50% for SI).

CONCLUSIONS

Implant stresses after S2AI and SI fixations were lower than those attributable to IL. Therefore, pedicle screws and rods may have a lower risk of mechanical failure when coupled with sacropelvic fixation via S2AI or triangular titanium implants, although the risk of clinical loosening remains an area of further investigation. These slides can be retrieved under Electronic Supplementary Material.

Reliability and validity of a new clinical test for assessment of the sacroiliac joint dysfunction

Background:

Dysfunctional sacroiliac joint (SIJ) has been cited as a source of low backache (LBA). Numerous non-invasive clinical tests are available for its assessment having poor validity and reliability which challenges their clinical utility. Thus, introduction of a new clinical test may be necessary.

Objective:

To assess reliability and validity of a new clinical test for the assessment of patients with SIJ movement dysfunction.

Methods:

Forty-five subjects (23 having LBA of SIJ origin and 22 healthy asymptomatic volunteers) with mean age 28.62 +∕− 5.26 years were assessed by 2 blinded examiners for 3 different clinical tests of SIJ, including the new test. The obtained values were assessed for reliability by intraclass correlation, kappa coefficient and percentage agreement. Validity was assessed by averaging sensitivity and specificity. Positive and negative predictive values and accuracy were assessed.

Results:

The new test demonstrates good intra- (r=0.81) and inter-rater (r=0.82) reliability with substantial agreement between raters (k>0.60). It has 79.9% validity, 82% sensitivity, 77% specificity, 79% positive-predictive, 80% negative-predictive value and accuracy.

Conclusion:

The new “Shimpi Prone SIJ test” has a good intra- and inter-rater reliability with a substantial rater agreement and a good validity and accuracy for the assessment of patients with SIJ movement dysfunction.

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

OBJECTIVE

To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures.

METHODS

Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one-third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques.

RESULTS

The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models.

CONCLUSION

Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.

In Silico Pelvis and Sacroiliac Joint Motion: Refining a Model of the Human Osteoligamentous Pelvis for Assessing Physiological Load Deformation Using an Inverted Validation Approach

Introduction. Computational modeling of the human pelvis using the finite elements (FE) method has become increasingly important to understand the mechanisms of load distribution under both healthy and pathologically altered conditions and to develop and assess novel treatment strategies. The number of accurate and validated FE models is however small, and given models fail resembling the physiologic joint motion in particular of the sacroiliac joint. This study is aimed at using an inverted validation approach, using in vitro load deformation data to refine an existing FE model under the same mode of load application and to parametrically assess the influence of altered morphology and mechanical data on the kinematics of the model. Materials and Methods. An osteoligamentous FE model of the pelvis including the fifth lumbar vertebra was used, with highly accurate representations of ligament orientations. Material properties were altered parametrically for bone, cartilage, and ligaments, followed by changes in bone geometry (solid versus 3 and 2 mm shell) and material models (linear elastic, viscoelastic, and hyperelastic isotropic), and the effects of varying ligament fiber orientations were assessed. Results. Elastic modulus changes were more decisive in both linear elastic and viscoelastic bone, cartilage, and ligaments models, especially if shell geometries were used for the pelvic bones. Viscoelastic material properties gave more realistic results. Surprisingly little change was observed as a consequence of altering SIJ ligament orientations. Validation with in vitro experiments using cadavers showed close correlations for movements especially for 3 mm shell viscoelastic model. Discussion. This study has used an inverted validation approach to refine an existing FE model, to give realistic and accurate load deformation data of the osteoligamentous pelvis and showed which variation in the outcomes of the models are attributed to altered material properties and models. The given approach furthermore shows the value of accurate validation and of using the validation data to fine tune FE models.

Influence of energy absorbers on Malgaigne fracture mechanism in lumbar-pelvic system under vertical impact load

Malgaigne fractures are the most common and widespread pelvic injuries resulting from the shear forces the action mechanism of which has not been explained in the literature yet. Military accidents with improvised explosive devices (IED) perfectly reflect this type of pelvic fracture. The finite element (FE) model of lumbar-pelvic complex (LPC) was developed based on computed tomography (CT) scans with the seat including steel frame, padding and soft tissue. The correlation coefficients of both low (100 N) and high (500 N) loads were greater than that currently obtained in the literature due to the presence of muscle force, pubic symphysis and joint cartilage. The dynamic analysis was performed to determine the influence of varying kinds of foam materials i.e. polyurethane, aluminium honeycomb structured and polyurethane auxetic foam on the stress/strain distribution in LPC under vertical impact load with the velocity of 7 m/s. Performed analysis showed the first fracture occurred in the L5 vertebrae resulting in the sacroiliac ligaments disruption and stress concentration in the pelvic ring causing further fractures of the wing of ilium, pubis and ischium bones. This results clearly explain the inconclusive findings about the second fracture that occurs in the pelvic area under a vertical impact load. The applied seat padding foam significantly reduced the stresses transmitted to the anatomical structures, thereby avoiding the risk of pelvic fracture. The analysis has proven that the auxetic polyurethane foam can be used as a good energy absorber.

In-silico pelvis and sacroiliac joint motion-A review on published research using numerical analyses

BACKGROUND

Computational models of the human pelvis have become highly useful tools to assess mechanisms of injury, diagnostics and treatment options. The purpose of this systematic literature review was to summarize existing pelvic computer models, to assess their comparability and the measures taken for experimental validation.

METHODS

Research on virtual simulations of the posterior pelvis and sacroiliac joint available from the ISI Web of Knowledge, PubMed and Scopus databases available until January 2018 were included.

FINDINGS

From a total of 3938 articles, 33 studies matched the criteria. Thirteen studies reported on experimental biomechanics, of which seven were parametric. Thirteen studies focused on pelvic injury and surgery, three were clinical case reports. One study assessed the effects of lumbar surgery on the sacroiliac joint, three studies on diagnostics and the non-surgical treatment of the sacroiliac joint. The mode of load application, geometry, material laws and boundary conditions varied vastly between the studies. The majority excluded the lumbosacral transition as part of pelvic biomechanics, and used isotropic linear elastic material properties. Outcomes of the analyses were reported inconsistently with negative impact on their comparability, and validation was commonly conducted by literature with varying agreement of the loading conditions.

INTERPRETATION

Comparability and validation are two major issues of present computational biomechanics of the pelvis. These issues diminish the transferability of the in-silico findings into real-life scenarios. In-vitro cadaveric models remain the realistic standard to account for the present computational analyses which simplify the complex nature of musculoskeletal tissues of the pelvis.

A systematic review of the morphology and function of the sacrotuberous ligament

The sacrotuberous ligament (STL) has been linked to conditions such as pelvic girdle pain and pudendal nerve entrapment, yet its contribution to pelvic stability is debated. The purpose of this review was to explore the current understanding of the STL and highlight any gaps in knowledge regarding its anatomy and function. A systematic search of the literature was conducted, focussing on the morphology and attachments of the STL, the relationship of the STL with surrounding structures, and its neurovascular supply and function. A total of 67 papers and four textbooks were obtained. The attachment sites of the STL are largely consistent; however, the extent of its connections with the long head of biceps femoris, gluteus maximus, piriformis, the posterior layer of the thoracolumbar fascia, and sacrospinous ligament are unclear. Morphometric parameters, such as mean STL length (6.4-9.4 cm), depth (0.3-0.4 cm), and width (1.8-3.5 cm, at its mid-point) are variable within and between studies, and little is known about potential side-, age-, or sex-related differences. The STL is pierced in several sites by the inferior and superior gluteal arteries, but information on its innervation pattern is sparse. Functionally, the STL may limit sacral nutation but it appears to have a limited contribution to pelvic stability. Some morphological aspects of the STL warrant further investigation, particularly its connections with surrounding structures, innervation pattern and function. Knowledge of the detailed anatomy and function of this ligament is important to better understanding its role in clinical conditions. Clin. Anat. 32:396-407, 2019. © 2018 Wiley Periodicals, Inc.

Quantifying the force transmission through the pelvic joints during total hip arthroplasty: A pilot cadaveric study

BACKGROUND

Total hip arthroplasty is one of the most successful and cost effective procedures in orthopedics. The purpose of this study is to investigate force transmission through the sacroiliac joint as a possible source of post-operative pain after total hip arthroplasty through the following three questions: Does the ipsilateral sacroiliac joint, contralateral sacroiliac joint, or pubic symphysis experience more force during placement? Does the larger mallet used to seat the implant generate a higher force? Does the specimen's bone density or BMI alter force transmission?

METHODS

A solid design acetabular component was impacted into five human cadaver pelves with intact soft tissues. The pressure at both sacroiliac joints and the pubic symphysis was measured during cup placement. This same procedure was replicated using an existing pelvis finite element model to use for comparison.

FINDINGS

The location of the peak force for each hammer strike was found to be specimen specific. The finite model results indicated the ipsilateral sacroiliac joint had the highest pressure and strain followed by the pubic symphysis over the course of the full simulation. The heft of the mallet and bone mineral density did not predict force values or locations. The largest median force was generated in extremely obese specimens.

INTERPRETATION

Contrary to previous ideas, it is highly unlikely that forces experienced at the pelvic joints are large enough to contribute post-operative pain during impaction of an acetabular component. These results indicate more force is conveyed to the pubic symphysis compared to the sacroiliac joints.

Finite element analysis of the pelvis including gait muscle forces: an investigation into the effect of rami fractures on load transmission

BACKGROUND

The objective of the study is to investigate the load transmission within the pelvic ring under physiological loading during gait and to correlate these results with clinical findings. In a second approach, we analysed how load distribution is altered by fractures of the anterior pelvic ring.

METHODS

Muscle forces and joint reaction forces are calculated by inverse dynamics and implemented in a finite element pelvis model including the joints.

RESULTS

With the intact configuration and according to the moment of the gait, left and right superior and inferior rami show the highest stresses of the model, corresponding to the typical location of an anterior pelvic ring fracture. A superior ramus fracture induces larger stresses to the lower ramus and a slight increase of stresses on the posterior structures. A total disruption of anterior rami redirects the loads to the back of the pelvis and introduces significantly higher stresses on the posterior structures.

CONCLUSIONS

This investigation enhances the understanding of the biomechanics of the pelvis and highlights the important role of the rami in load carrying and in maintaining integrity of the pelvic ring.

Influence of Different Boundary Conditions in Finite Element Analysis on Pelvic Biomechanical Load Transmission

OBJECTIVE

To observe the effects of boundary conditions and connect conditions on biomechanics predictions in finite element (FE) pelvic models.

METHODS

Three FE pelvic models were constructed to analyze the effect of boundary conditions and connect conditions in the hip joint: an intact pelvic model assumed contact of the hip joint on both sides (Model I); and a pelvic model assumed the hip joint connecting surfaces fused together with (Model II) or without proximal femurs (Model III). The model was validated by bone surface strains obtained from strain gauges in an in vitro pelvic experiment. Vertical load was applied to the pelvic specimen, and the same load was simulated in the FE model.

RESULTS

There was a strong correlation between the FE analysis results of Model I and the experimental results (R ² = 0.979); meanwhile, the correlation coefficient and the linear regression function increased slightly with increasing load force. Comparing the three models, the stress values in the point near the pubic symphysis in Model III were 48.52 and 39.1% lower, respectively, in comparison with Models I and II. Furthermore, the stress values on the dome region of the acetabulum in Models II and III were 103.61 and 390.53% less than those of Model I. Besides, the posterior acetabular wall stress values of Model II were 197.15 and 305.17% higher than those of Models I and III, respectively.

CONCLUSIONS

These findings suggest that the effect of the connect condition in the hip joint should not be neglected, especially in studies related to clinical applications.

Finite Element Analysis of Sacroiliac Joint Fixation under Compression Loads

BACKGROUND

Sacroiliac joint (SIJ) is a known chronic pain-generator. The last resort of treatment is the arthrodesis. Different implants allow fixation of the joint, but to date there is no tool to analyze their influence on the SIJ biomechanics under physiological loads. The objective was to develop a computational model to biomechanically analyze different parameters of the stable SIJ fixation instrumentation.

METHODS

A comprehensive finite element model (FEM) of the pelvis was built with detailed SIJ representation. Bone and sacroiliac joint ligament material properties were calibrated against experimentally acquired load-displacement data of the SIJ. Model evaluation was performed with experimental load-displacement measurements of instrumented cadaveric SIJ. Then six fixation scenarios with one or two implants on one side with two different trajectories (proximal, distal) were simulated and assessed with the FEM under vertical compression loads.

RESULTS

The simulated S1 endplate displacement reduction achieved with the fixation devices was within 3% of the experimentally measured data. Under compression loads, the uninstrumented sacrum exhibited mainly a rotation motion (nutation) of 1.38° and 2.80° respectively at 600 N and 1000 N, with a combined relative translation (0.3 mm). The instrumentation with one screw reduced the local displacement within the SIJ by up to 62.5% for the proximal trajectory vs. 15.6% for the distal trajectory. Adding a second implant had no significant additional effect.

CONCLUSION

A comprehensive finite element model was developed to assess the biomechanics of SIJ fixation. SIJ devices enable to reduce the motion, mainly rotational, between the sacrum and ilium. Positioning the implant farther from the SIJ instantaneous rotation center was an important factor to reduce the intra-articular displacement.

CLINICAL RELEVANCE

Knowledge provided by this biomechanical study enables improvement of SIJ fixation through optimal implant trajectory.

The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.

Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture

This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2), anterior column plate combined with posterior column screws (P + PS), and anterior column plate combined with quadrilateral area screws (P + QS)) were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS) was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems.