Elastic properties of 3D printed clavicles are closer to cadaveric bones of elderly donors than commercial synthetic bones

Synthetic bone models have increasing utility in orthopaedic research due to their low cost and low variability and have been shown to be biomechanically equivalent to human bones in a variety of ways. The rise in additive manufacturing (AM) for orthopaedic applications presents an opportunity to construct synthetic whole-bone models for biomechanical testing applications, but there is a lack of research comparing these AM models to cadaveric or commercially available bone surrogates. This study compares the mechanical properties of 3D printed clavicle models to commercially available (4th generation Sawbones) and human cadaveric clavicles via nondestructive cyclic 4-point bending, axial compression, and torsion, and a final axial compression test to failure. Commercially available synthetic clavicles had 57.8-203% higher superior-inferior bending rigidity (p < 0.0001), 80.9-198% higher axial stiffness (p < 0.001), and 314-557% higher torsional rigidity (p < 0.05) on average than AM and cadaveric clavicles. Cadaveric and AM clavicles printed from a BoneMatrix/VeroWhite composite material had similar failure mechanisms under axial compression while AM VeroWhite clavicles experienced catastrophic failure, but these groups did not have significantly different ultimate failure loads. Together, these results demonstrate that current commercially available synthetic clavicles may be too rigid to emulate the mechanical properties of elderly cadaveric clavicles, and that AM bone models can closely mimic these cadaveric bones in a variety of biomechanical loading schemes. These results show promising applications for future work using 3D printed bone surrogates for biomechanical analysis of orthopaedic implants and other surgical repair techniques.

Material Properties and Engineering Performance of Bone Fracture Plates Made from Plant Fiber Reinforced Composites: A Review

Bone fracture plates are usually made from titanium alloy or stainless steel, which are much stiffer than bone. However, overly stiff plates can restrict axial interfragmentary motion at the fracture leading to delayed callus formation and healing, as well as causing bone "stress shielding" under the plate leading to bone atrophy, bone resorption, and plate loosening. Consequently, there have been many prior efforts to develop nonmetallic bone fracture plates with customized material properties using synthetic fibers (e.g., aramid, carbon, glass) in polymer resin. Even so, plant fibers (e.g., flax, roselle, sisal) offer additional advantages over synthetic fibers, such as availability, biodegradability, less toxicity during processing, lower financial cost, and recyclability. As such, there is an emerging interest in using plant fibers alone, or combined with synthetic fibers, to reinforce polymers for various applications. Thus, this is the first review article on the material properties and engineering performance of innovative bone fracture plates made from composite materials reinforced by plant fibers alone or supplemented using synthetic fibers. This article presents material-level fiber properties (e.g., elastic modulus, ultimate strength), material-level plate properties (e.g., fatigue strength, impact toughness), and bone-plate engineering performance (e.g., overall stiffness, plate stress), as well as discussing general findings, study quality, and future work. This article may help engineers and surgeons to design, fabricate, analyze, and utilize novel bone fracture plates.

Biomechanical effects of different loads and constraints on finite element modeling of the humerus

Currently, there is no established finite element (FE) method to apply physiologically realistic loads and constraints to the humerus. This FE study showed that 2 'simple' methods involving direct head loads, no head constraints, and rigid elbow or mid-length constraints created excessive stresses and bending. However, 2 'intermediate' methods involving direct head loads, but flexible head and elbow constraints, produced lower stresses and bending. Also, 2 'complex' methods involving muscles to generate head loads, plus flexible head and elbow constraints, generated the lowest stresses and moderate bending. This has implications for FE modeling research on intact and implanted humeri.

Mechanical Properties of Synthetic Bones Made by Synbone: A Review

Biomechanical engineers and physicists commonly employ biological bone for biomechanics studies, since they are good representations of living bone. Yet, there are challenges to using biological bone, such as cost, degradation, disease, ethics, shipping, sourcing, storage, variability, etc. Therefore, the Synbone® company has developed a series of synthetic bones that have been used by biomechanical investigators to offset some drawbacks of biological bone. There have been a number of published biomechanical reports using these bone surrogates for dental, injury, orthopedic, and other applications. But, there is no prior review paper that has summarized the mechanical properties of these synthetic bones in order to understand their general performance or how well they represent biological bone. Thus, the goal of this article was to survey the English-language literature on the mechanical properties of these synthetic bones. Studies were included if they quantitatively (a) characterized previously unknown values for synthetic bone, (b) validated synthetic versus biological bone, and/or (c) optimized synthetic bone performance by varying geometric or material parameters. This review of data, pros, cons, and future work will hopefully assist biomechanical engineers and physicists that use these synthetic bones as they develop experimental testing regimes and computational models.

The effect of shoulder prosthesis stem length on failure due to torsional loading. A biomechanical study in composite humeri

Background

Shoulder arthroplasty is becoming increasingly common. With evolving implant designs, multiple humeral stem options exist for the surgeon to choose from. New stemless and short-stem systems are modular, remove less native bone stock, and better adapt to patient anatomy. It has been suggested that shorter stem implants may be protective against periprosthetic fracture; however, this has not been mechanistically evaluated. Therefore, this study aimed to biomechanically test synthetic humeri with long-stem, short-stem, and stemless arthroplasty components in a torsional manner to evaluate their response to loading and characterize failure.

Methods

Twenty-four synthetic humeri were implanted with long stem, short stem, or stemless uncemented prosthesis, 8 in each group. Humeri were mounted in a custom testing jig with a morse taper interfacing with a mechanical testing system. After a 20N axial force, specimens were torsionally loaded to failure at 15 degrees/sec, with 50 Hz collection. Torque vs. rotation curves were generated for each specimen, and stiffness, yield, ultimate strength, and failure load were measured. ANOVA and post hoc pairwise comparisons were used to assess effect of stem type on mechanical test variable. The association of the stem type with fracture type was analyzed by a Fisher's Exact test. Statistical significance was set at P < .05.

Results

During torsional loading, long-stem implants were significantly stiffer than short or stemless implants. The angle of implant yielding was similar across stem designs; however, stemless implants had a lower yield torque. This correlated with a decreased yield energy in stemless compared to short stems as well. Maximum torque and failure torque was also significantly higher in short-stem and long-stem implants compared to stemless.

Discussion

Periprosthetic fractures in shoulder arthroplasty are a concern in low-energy trauma, and stem design likely plays a significant role in early implant-bone failure. Our results suggest stemless implants under torsional load fail at lower stress and are less stiff than stemmed implants. The failure mechanism of stemless implants through metaphyseal cancellous bone emphasizes the effect bone quality has on implant fixation. There is likely a balance of torsional stability to survive physiologic loads while minimizing diaphyseal stress and risk of diaphyseal periprosthetic fracture. This combined with revision and fixation options represent decisions the surgeon is faced with when performing shoulder arthroplasty.

Biomechanical properties of artificial bones made by Sawbones: A review

Biomedical engineers and physicists frequently use human or animal bone for orthopaedic biomechanics research because they are excellent approximations of living bone. But, there are drawbacks to biological bone, like degradation over time, ethical concerns, high financial costs, inter-specimen variability, storage requirements, supplier sourcing, transportation rules, etc. Consequently, since the late 1980s, the Sawbones® company has been one of the world's largest suppliers of artificial bones for biomechanical testing that counteract many disadvantages of biological bone. There have been many published reports using these bone analogs for research on joint replacement, bone fracture fixation, spine surgery, etc. But, there exists no prior review paper on these artificial bones that gives a comprehensive and in-depth look at the numerical data of interest to biomedical engineers and physicists. Thus, this paper critically reviews 25 years of English-language studies on the biomechanical properties of these artificial bones that (a) characterized unknown or unreported values, (b) validated them against biological bone, and/or (c) optimized different design parameters. This survey of data, advantages, disadvantages, and knowledge gaps will hopefully be useful to biomedical engineers and physicists in developing mechanical testing protocols and computational finite element models.

Experimental characterization and micromechanical modeling of the elastic response of the human humerus under bending impact

This paper investigates the characterization and numerical modeling of the elastic behavior of the human humerus bone using a recently developed micromechanical approach coupled to nanoindentation measurements. At first, standard three-point bending experiments were conducted under low static loading, using several humerus diaphysis in order to identify the apparent elastic modulus of the bone in static regime. Then, a drop tower impact experiment was used on the same set of humerus diaphysis specimens, in order to assess the elastic modulus in dynamic regime. These measurements will be used as reference bases for comparison purpose. The originality of this work, lies in the coupling between a two-phase micromechanical approach based on Mori-Tanaka homogenization scheme for cylindrical voids and nanoindentation measurements of the elastic modulus of the bone matrix phase. This model has been implemented using a user defined material subroutine VMAT in ABAQUS© Explicit code. The bone mechanical response prediction using the proposed methodology was validated against previous standard experimental data. Finally, it was shown that the numerical predictions are consistent with the physical measurements obtained on human humerus via the good estimation of the ultimate impact load.

Biomechanical properties and thermal characteristics of frozen versus thawed whole bone

Biomechanics research often requires cadaveric whole bones to be stored in a freezer and then thawed prior to use; however, the literature shows a variety of practices for thawing. Consequently, this is the first study to report the mechanical properties of fully frozen versus fully thawed whole bone as 'proof of principle'. Two groups of 10 porcine ribs each were statistically equivalent at baseline in length, cross-sectional area, and bone mineral density. The two groups were stored in a freezer for at least 24 h, thawed in air at 23 °C for 4 h while temperature readings were taken to establish the time needed for thawing, and once again returned to the freezer for at least 24 h. Mechanical tests to failure using three-point bending were then done on the 'frozen' group immediately after removal from the freezer and the 'thawed' group when steady-state ambient air temperature was reached. Temperature readings over the entire thawing period were described by the line-of-best-fit formula T = (28.34t - 6.69)/(t + 0.38), where T = temperature in degree Celsius and t = time in hours, such that frozen specimens at t = 0 h had a temperature of -17 °C and thawed specimens at t = 1.75 h reached a steady-state temperature of 20 °C-23 °C. Mechanical tests showed that frozen versus thawed specimens had an average of 32% higher stiffness k, 34% higher ultimate force F_u, 28% lower ultimate displacement δ_u, 40% lower ultimate work W_u, 43% higher elastic modulus E, 37% higher ultimate normal stress σ_u, and 33% higher ultimate shear stress τ_u. Whole ribs failed at midspan primarily by transverse cracking (16 of 20 cases), oblique cracking (three of 20 cases), or surface denting (one of 20 cases), each having unique shapes for force versus displacement graphs differentiated mainly by ultimate force location.

The Double Krackow Suture Technique Does Not Offer a Significant Benefit Compared to the Krackow Suture Technique in Subpectoral Biceps Tenodesis Using a Double-Loaded Suture Anchor

PURPOSE

To compare the biomechanical properties of the double simple suture (DSS) technique, Krackow suture (KS) technique, and double Krackow suture (DKS) technique in subpectoral biceps tenodesis using a double-loaded suture anchor in a porcine tendon model.

METHODS

A total of 30 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons with diameter of 4.5 mm were used. The sample size was determined based on the results of the pilot study. Metallic suture anchors with double-loaded No. 2 braided sutures were inserted at the subpectoral tenodesis site, 5 cm from the superomedial corner of the greater tuberosity. Three suture techniques were used to fix the tendons: a DSS used as the control, a KS, and a DKS, which is an alternative tendon graft fixation technique. A preload of 5 N was applied for 2 minutes, followed by cyclic loading for 500 cycles ranging from 5 to 70 N; next, a load-to-failure test at 1 mm/s was performed.

RESULTS

The KS (283.5 ± 57 N) and DKS (270.4 ± 50 N) groups had significantly greater ultimate failure loads as compared with the DSS group (84.1 ± 6.4 N) (P < .001). Meanwhile, the peak displacement at failure loads in the KS group (9.3 ± 2.2 mm) and DKS group (7.8 ± 1.7 mm) were significantly smaller than that of the DSS group (11.3 ± 2.9 mm) (P = .015). Stiffness in the DSS group (36.4 ± 3.0 N/mm), KS group (39.6 ± 2.5 N/mm), and DKS group (36.9 ± 4.6 N/mm) was not significantly different (P = .125). All DSS constructs and 6 KS constructs failed with tendons being cut through by the sutures, whereas the other 4 KS constructs and all DKS constructs failed resulting from suture breakage.

CONCLUSIONS

In this subpectoral biceps tenodesis model, both the KS technique and the DKS technique had similar time 0 biomechanical properties that were better than those of the double simple suture technique.

CLINICAL RELEVANCE

A sturdy suture-tendon structure could prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.

High correlation between mechanical properties and bone mineral parameters in embalmed femurs after long-term storage

BACKGROUND

Fresh frozen human femurs are considered "the gold standard" in biomechanical studies of hip fractures, resembling the in vivo situation mostly. A more readily available alternative is formalin embalmed femurs. However, to which extent formalin affects key features of bone; its mechanical properties, bone mineral content and their mutual relationship over time, remains unknown. Accordingly, we measured the mineral parameters and related them to the mechanical properties of formalin fixed femurs after long-term storage.

METHODS

36 paired femurs from human donors, fixed in formalin and stored for a mean period of 4.6 (3.5-6) years. Quantitative CT was performed to measure the bone mineral density and mass at the mainly cortical mid shaft and the center of the mainly cancellous condyles. Each pair was subjected to local tests by three-point bending and screw pullout of the shaft and lateral punch and metaphyseal cube compression of the condyles.

FINDINGS

Neither mechanical nor bone mineral data were significantly correlated to storage time. Well-known associations for bone parameters with age and gender were retrieved. Maximum force of the cortical bone tests was highly correlated to the diaphyseal bone mass; (r = 0.80-0.87, p = 0.01), while maximum force of the cancellous bone tests correlated well to the density of the condylar bone; (r = 0.70, p = 0.01).

INTERPRETATION

Our results indicate that mechanical and bone mineral data and their mutual relationship are conserved in formalin fixed femurs even after long-term storage. Formalin fixed femurs may serve as an alternative to fresh frozen femurs in biomechanical testing.

Biomechanical analysis of a new carbon fiber/flax/epoxy bone fracture plate shows less stress shielding compared to a standard clinical metal plate

Femur fracture at the tip of a total hip replacement (THR), commonly known as Vancouver B1 fracture, is mainly treated using rigid metallic bone plates which may result in "stress shielding" leading to bone resorption and implant loosening. To minimize stress shielding, a new carbon fiber (CF)/Flax/Epoxy composite plate has been developed and biomechanically compared to a standard clinical metal plate. For fatigue tests, experiments were done using six artificial femurs cyclically loaded through the femoral head in axial compression for four stages: Stage 1 (intact), stage 2 (after THR insertion), stage 3 (after plate fixation of a simulated Vancouver B1 femoral midshaft fracture gap), and stage 4 (after fracture gap healing). For fracture fixation, one group was fitted with the new CF/Flax/Epoxy plate (n = 3), whereas another group was repaired with a standard clinical metal plate (Zimmer, Warsaw, IN) (n = 3). In addition to axial stiffness measurements, infrared thermography technique was used to capture the femur and plate surface stresses during the testing. Moreover, finite element analysis (FEA) was performed to evaluate the composite plate's axial stiffness and surface stress field. Experimental results showed that the CF/Flax/Epoxy plated femur had comparable axial stiffness (fractured = 645 ± 67 N/mm; healed = 1731 ± 109 N/mm) to the metal-plated femur (fractured = 658 ± 69 N/mm; healed = 1751 ± 39 N/mm) (p = 1.00). However, the bone beneath the CF/Flax/Epoxy plate was the only area that had a significantly higher average surface stress (fractured = 2.10 ± 0.66 MPa; healed = 1.89 ± 0.39 MPa) compared to bone beneath the metal plate (fractured = 1.18 ± 0.93 MPa; healed = 0.71 ± 0.24 MPa) (p < 0.05). FEA bone surface stresses yielded peak of 13 MPa at distal epiphysis (stage 1), 16 MPa at distal epiphysis (stage 2), 85 MPa for composite and 129 MPa for metal-plated femurs at the vicinity of nearest screw just proximal to fracture (stage 3), 21 MPa for composite and 24 MPa for metal-plated femurs at the vicinity of screw farthest away distally from fracture (stage 4). These results confirm that the new CF/Flax/Epoxy material could be a potential candidate for bone fracture plate applications as it can simultaneously provide similar mechanical stiffness and lower stress shielding (i.e., higher bone stress) compared to a standard clinical metal bone plate.