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Lehmann W, Cagirici R, Al Askar Y, Spering C. [Diagnostics and treatment of insufficiency fractures of the pelvis]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:273-282. [PMID: 38302736 DOI: 10.1007/s00113-023-01409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
Insufficiency fractures of the pelvis have increased in recent years, primarily due to the demographic change and the incidence will continue to rise. In addition to conventional X‑rays, the diagnostics always require slice imaging. Unlike high-energy trauma magnetic resonance imaging (MRI) plays an important role in insufficiency fractures. Once the fracture has been diagnosed, in addition to the extent of instability in the anterior and posterior pelvic rings, the pain symptoms are crucial for the decision on surgical treatment. The basic principle is to stabilize as little as possible but as much as necessary. There are currently a variety of procedures that can be applied as a minimally invasive procedure, especially for the often slightly or displaced insufficiency fractures. The decisive factor for treatment is that it enables early mobilization of the patients. All of these measures must be accompanied by thorough diagnostics of osteoporosis and the appropriate treatment.
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Affiliation(s)
- Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland.
| | - Recep Cagirici
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - Yamen Al Askar
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
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Bolgova O, Mavrych V. Pediatric Solid-State 3D Models of Lumbar Vertebrae and Spine. Cureus 2024; 16:e58938. [PMID: 38800205 PMCID: PMC11124468 DOI: 10.7759/cureus.58938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction While various 3D vertebral models have been utilized in numerous studies, there is a notable gap in the representation of pediatric lumbar vertebrae and spine. This study aimed to describe the changing shapes of lumbar vertebrae and spine with age and to develop precise 3D models. Materials and methods Solid-state 3D models of pediatric lumbar vertebrae and spine were created using SOLIDWORKS® Simulation software for five age groups: newborns, infants (ages 0-1), toddlers (ages 1-3), middle childhood (ages 4-7), and preadolescents (ages 8-12). Models were composed of components with varying biomechanical characteristics. Results Created 3D models replicate variations in the dimensions and configurations of vertebrae, taking into account osteometric analyses conducted on actual vertebral specimens. These models also include elements made of cartilage, representing various phases of vertebral growth during ontogeny. Additionally, through 3D parametric design, we developed comprehensive lumbar spine models, incorporating both the vertebrae and intervertebral disks. Conclusion Created pediatric solid-state vertebral 3D models can be utilized in developing virtual or augmented reality applications and for medical research. Users can interact with models, allowing virtual exploration and manipulation, enhancing learning experiences and facilitating a better understanding of spatial relationships. These solid-state 3D models allow finite element analysis and can be used for further research to calculate internal relative deformations and stress distribution under different conditions.
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Affiliation(s)
- Olena Bolgova
- Anatomy and Genetics, College of Medicine Alfaisal University, Riyadh, SAU
| | - Volodymyr Mavrych
- Anatomical Sciences, College of Medicine Alfaisal University, Riyadh, SAU
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Doulgeris J, Lin M, Lee W, Aghayev K, Papanastassiou ID, Tsai CT, Vrionis FD. Inter-Specimen Analysis of Diverse Finite Element Models of the Lumbar Spine. Bioengineering (Basel) 2023; 11:24. [PMID: 38247901 PMCID: PMC10813462 DOI: 10.3390/bioengineering11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Over the past few decades, there has been a growing popularity in utilizing finite element analysis to study the spine. However, most current studies tend to use one specimen for their models. This research aimed to validate multiple finite element models by comparing them with data from in vivo experiments and other existing finite element studies. Additionally, this study sought to analyze the data based on the gender and age of the specimens. For this study, eight lumbar spine (L2-L5) finite element models were developed. These models were then subjected to finite element analysis to simulate the six fundamental motions. CT scans were obtained from a total of eight individuals, four males and four females, ranging in age from forty-four (44) to seventy-three (73) years old. The CT scans were preprocessed and used to construct finite element models that accurately emulated the motions of flexion, extension, lateral bending, and axial rotation. Preloads and moments were applied to the models to replicate physiological loading conditions. This study focused on analyzing various parameters such as vertebral rotation, facet forces, and intradiscal pressure in all loading directions. The obtained data were then compared with the results of other finite element analyses and in vivo experimental measurements found in the existing literature to ensure their validity. This study successfully validated the intervertebral rotation, intradiscal pressure, and facet force results by comparing them with previous research findings. Notably, this study concluded that gender did not have a significant impact on the results. However, the results did highlight the importance of age as a critical variable when modeling the lumbar spine.
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Affiliation(s)
- James Doulgeris
- Department of Medical Engineering, University of South Florida, Tampa, FL 33620, USA; (J.D.); (W.L.)
| | - Maohua Lin
- Department of Ocean & Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - William Lee
- Department of Medical Engineering, University of South Florida, Tampa, FL 33620, USA; (J.D.); (W.L.)
| | - Kamran Aghayev
- Department of Neurosurgery, Esencan Hospital, Baglarcesme Mahallesi, Istanbul 34510, Turkey;
| | | | - Chi-Tay Tsai
- Department of Ocean & Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Frank D. Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL 33486, USA
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Turbucz M, Pokorni AJ, Bigdon SF, Hajnal B, Koch K, Szoverfi Z, Lazary A, Eltes PE. Patient-specific bone material modelling can improve the predicted biomechanical outcomes of sacral fracture fixation techniques: A comparative finite element study. Injury 2023; 54:111162. [PMID: 37945416 DOI: 10.1016/j.injury.2023.111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate and compare the biomechanical efficacy of six iliosacral screw fixation techniques for treating unilateral AO Type B2 (Denis Type II) sacral fractures using literature-based and QCT-based bone material properties in finite element (FE) models. METHODS Two FE models of the intact pelvis were constructed: the literature-based model (LBM) with bone material properties taken from the literature, and the patient-specific model (PSM) with QCT-derived bone material properties. Unilateral transforaminal sacral fracture was modelled to assess different fixation techniques: iliosacral screw (ISS) at the first sacral vertebra (S1) (ISS1), ISS at the second sacral vertebra (S2) (ISS2), ISS at S1 and S2 (ISS12), transverse iliosacral screws (TISS) at S1 (TISS1), TISS at S2 (TISS2), and TISS at S1 and S2 (TISS12). A 600 N vertical load with both acetabula fixed was applied. Vertical stiffness (VS), relative interfragmentary displacement (RID), and the von Mises stress values in the screws and fracture interface were analysed. RESULTS The lowest and highest normalised VS was given by ISS1 and TISS12 techniques for LBM and PSM, with 137 % and 149 %, and 375 % and 472 %, respectively. In comparison with the LBM, the patient-specific bone modelling increased the maximum screw stress values by 19.3, 16.3, 27.8, 2.3, 24.4 and 7.8 % for ISS1, ISS2, ISS12, TISS1, TISS2 and TISS12, respectively. The maximum RID values were between 0.10 mm and 0.47 mm for all fixation techniques in both models. The maximum von Mises stress results on the fracture interface show a substantial difference between the two models, as PSM (mean ± SD of 15.76 ± 8.26 MPa) gave lower stress values for all fixation techniques than LBM (mean ± SD of 28.95 ± 6.91 MPa). CONCLUSION The differences in stress distribution underline the importance of considering locally defined bone material properties when investigating internal mechanical parameters. Based on the results, all techniques demonstrated clinically sufficient stability, with TISS12 being superior from a biomechanical standpoint. Both LBM and PSM models indicated a consistent trend in ranking the fixation techniques based on stability. However, long-term clinical trials are recommended to confirm the findings of the study.
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Affiliation(s)
- Mate Turbucz
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Agoston Jakab Pokorni
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Switzerland
| | - Benjamin Hajnal
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Kristof Koch
- School of PhD Studies, Semmelweis University, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
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Xue H, Deng J, Zhang Z, Knoedler S, Panayi AC, Knoedler L, Mi B, Liu M, Dai G, Liu G. Different internal fixation methods for Hoffa-like fractures of the tibial plateau: a finite element analysis. Front Med (Lausanne) 2023; 10:1172377. [PMID: 37465644 PMCID: PMC10351422 DOI: 10.3389/fmed.2023.1172377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Junrong Deng
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bobin Mi
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guandong Dai
- Pingshan District People’s Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Guohui Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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