A statistical shape model of the tibia-fibula complex: sexual dimorphism and effects of age on reconstruction accuracy from anatomical landmarks

Integration of Swin UNETR and statistical shape modeling for a semi-automated segmentation of the knee and biomechanical modeling of articular cartilage

Simulation studies, such as finite element (FE) modeling, provide insight into knee joint mechanics without patient involvement. Generic FE models mimic the biomechanical behavior of the tissue, but overlook variations in geometry, loading, and material properties of a population. Conversely, subject-specific models include these factors, resulting in enhanced predictive precision, but are laborious and time intensive. The present study aimed to enhance subject-specific knee joint FE modeling by incorporating a semi-automated segmentation algorithm using a 3D Swin UNETR for an initial segmentation of the femur and tibia, followed by a statistical shape model (SSM) adjustment to improve surface roughness and continuity. For comparison, a manual FE model was developed through manual segmentation (i.e., the de-facto standard approach). Both FE models were subjected to gait loading and the predicted mechanical response was compared. The semi-automated segmentation achieved a Dice similarity coefficient (DSC) of over 98% for both the femur and tibia. Hausdorff distance (mm) between the semi-automated and manual segmentation was 1.4 mm. The mechanical results (max principal stress and strain, fluid pressure, fibril strain, and contact area) showed no significant differences between the manual and semi-automated FE models, indicating the effectiveness of the proposed semi-automated segmentation in creating accurate knee joint FE models. We have made our semi-automated models publicly accessible to support and facilitate biomechanical modeling and medical image segmentation efforts ( https://data.mendeley.com/datasets/k5hdc9cz7w/1 ).

Variability in tibia-fibular geometry is associated with increased tibial strain from running loads

Variation in tibial geometry may alter strain magnitude and distribution during locomotion. We investigated the effect of tibia-fibula geometric variations on tibial strain with running loads applied at various speeds. Participant-specific three-dimensional models of the tibia-fibula were created using lower limb computed tomography scans from 30 cadavers. Finite-element models were developed in FEBio, and running loads from 3, 4 and 5 m s-1 were applied to extract effective strain from the tibial shaft. Linear regression models evaluated the relationship between geometric characteristics and effective strain along the tibial shaft. We found a statistically significant positive relationship between: (i) increased thickness of the midshaft to upper tibia with increased condyle prominence and effective strain at points along the distal anterolateral and proximal posterior regions of the tibial shaft; and (ii) increased midshaft cortical thickness and effective strain at points along the medial aspect of the distal tibial shaft. It is possible that increased thickness in the more proximal region of the tibia causes strain to redistribute to areas that are more susceptible to the applied loads. A thickness imbalance between the upper and distal portions of the tibial shaft could have a negative impact on tibial stress injury risk.

Morphologic analysis of the 1st and 2nd tarsometatarsal joint articular surfaces

Tarsometatarsal joint arthrodesis is used to treat a variety of injuries and deformities in the midfoot. However, the surgical technique has not been optimized, in part due to limited knowledge of morphologic features and variation in the related joints. Previous research has relied primarily on dissection-based anatomical analysis, but quantitative imaging may allow for a more sophisticated description of this complex. Here, we used quantitative micro-CT imaging to examine dimensions, distance maps, and curvature of the four articular surfaces in the first and second tarsometatarsal joints. Image segmentation, articular surface identification, and anatomic coordinate systems were all done with semi or fully automatic methods, and distance and size measurements were all taken utilizing these anatomic planes. Surface curvature was studied using Gaussian curvature and a newly defined measure of curvature similarity on the whole joint and on four subregions of each surface. These data show larger articular surfaces on the cuneiforms, rather than metatarsals, and define the generally tall and narrow articular surfaces seen in these joints. Curvature analysis shows minimally curved opposing convex surfaces. Our results are valuable for furthering knowledge of surgical anatomy in this poorly understood region of the foot.

Biomechanical Insights Afforded by Shape Modeling in the Foot and Ankle

Advancements in volumetric imaging makes it possible to generate high-resolution three-dimensional reconstructions of bones in throughout the foot and ankle. The use of weightbearing computed tomography allows for the analysis of joint relationships in a consistent natural position that can be used for statistical shape modeling. Using statistical shape modeling, a population-based statistical model is created that can be used to compare mean bone shape morphology and identify anatomical modes of variation. A review is presented to highlight the current work using statistical shape modeling in the foot and ankle with a future view of the impact on clinical care.

Geometric variation of the human tibia-fibula: a public dataset of tibia-fibula surface meshes and statistical shape model

Background

Variation in tibia geometry is a risk factor for tibial stress fractures. Geometric variability in bones is often quantified using statistical shape modelling. Statistical shape models (SSM) offer a method to assess three-dimensional variation of structures and identify the source of variation. Although SSM have been used widely to assess long bones, there is limited open-source datasets of this kind. Overall, the creation of SSM can be an expensive process, that requires advanced skills. A publicly available tibia shape model would be beneficial as it enables researchers to improve skills. Further, it could benefit health, sport and medicine with the potential to assess geometries suitable for medical equipment, and aid in clinical diagnosis. This study aimed to: (i) quantify tibial geometry using a SSM; and (ii) provide the SSM and associated code as an open-source dataset.

Methods

Lower limb computed tomography (CT) scans from the right tibia-fibula of 30 cadavers (male n = 20, female n = 10) were obtained from the New Mexico Decedent Image Database. Tibias were segmented and reconstructed into both cortical and trabecular sections. Fibulas were segmented as a singular surface. The segmented bones were used to develop three SSM of the: (i) tibia; (ii) tibia-fibula; and (iii) cortical-trabecular. Principal component analysis was applied to obtain the three SSM, with the principal components that explained 95% of geometric variation retained.

Results

Overall size was the main source of variation in all three models accounting for 90.31%, 84.24% and 85.06%. Other sources of geometric variation in the tibia surface models included overall and midshaft thickness; prominence and size of the condyle plateau, tibial tuberosity, and anterior crest; and axial torsion of the tibial shaft. Further variations in the tibia-fibula model included midshaft thickness of the fibula; fibula head position relative to the tibia; tibia and fibula anterior-posterior curvature; fibula posterior curvature; tibia plateau rotation; and interosseous width. The main sources of variation in the cortical-trabecular model other than general size included variation in the medulla cavity diameter; cortical thickness; anterior-posterior shaft curvature; and the volume of trabecular bone in the proximal and distal ends of the bone.

Conclusion

Variations that could increase the risk of tibial stress injury were observed, these included general tibial thickness, midshaft thickness, tibial length and medulla cavity diameter (indicative of cortical thickness). Further research is needed to better understand the effect of these tibial-fibula shape characteristics on tibial stress and injury risk. This SSM, the associated code, and three use examples for the SSM have been provided in an open-source dataset. The developed tibial surface models and statistical shape model will be made available for use at: https://simtk.org/projects/ssm_tibia.

Sexual Dimorphism in the Fibular Extremities of Italians and South Africans of Identified Modern Human Skeletal Collections: A Geometric Morphometric Approach

Simple Summary

The extremities of the fibula may reflect differences between males and females, although so far only few studies included this bone for post-cranial sex assessment. Our work explored shape and size variation between sexes in identified skeletal samples comprising different populations from Italy and South Africa and showed that fibular extremities are significantly smaller, with narrower articular surfaces in females than in males. Consistent sex-related differences are revealed in fibular form and size in Italians but not in South Africans. Potential application in forensic and bioarcheological contexts may benefit from the use of this approach.

Abstract

Fibular metric variations have revealed their potential in distinguishing between males and females; however the fibula remains scarcely analyzed in studies of sexual dimorphism. This work aims at investigating sexually dimorphic features in fibular proximal and distal epiphyses through geometric morphometrics methods. A total of 136 left fibulae, from two Italian and one South African identified skeletal collections were virtually acquired through CT and laser scanning and analyzed using geometric morphometric methods. Statistical analyses were performed on shape, form, and size variables. Results show that fibular epiphyses are smaller with narrower articular surfaces in females than in males in both extremities. Relevant sexual differences emerge in fibular form and size for the two Italian samples but not for the South African one, likely for its small sample size. Discriminant analysis on form principal components (PCs) offers accuracy above 80% when the samples are pooled, and reaches accuracy of 80–93% when the Italian samples are considered separately. However, our method on form PCs was not successful for the South African sample (50–53% accuracy), possibly due to the small sample size. These results show relevant morphological variation in relation to fibular form and size, with a degree of accuracy that indicates the utility of the present method for sexing human fibulae in both forensic and bioarchaeological contexts for Italian samples.