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Liu J, Ge Y, Wang Y, Yang Q, Yibulayimu S, Wu X, Tian W, Shi C, Liu Y, Yang M. Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study. Heliyon 2024; 10:e28606. [PMID: 38571577 PMCID: PMC10988050 DOI: 10.1016/j.heliyon.2024.e28606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Hip fracture, increasing exponentially with age, is osteoporosis's most severe clinical consequence. Intertrochanteric fracture, one of the main types of hip fracture, is associated with higher mortality and morbidity. The current research hotspots lay in improving the treatment effect and optimizing the secondary stability after intertrochanteric fracture surgery. Cortex buttress reduction is a widely accepted method for treating intertrochanteric fracture by allowing the head-neck fragment to slide and rigidly contact the femoral shaft's cortex. Medial cortical support is considered a more effective option in treating young patients. However, osteo-degenerations features, including bone weakness and cortical thickness thinning, affect the performance of cortex support in geriatric intertrochanteric fracture treatment. Literature focusing on the age-specific difference in cortex performance in the fractured hip is scarce. We hypothesized that this osteo-19 degenerative feature affects the performance of cortex support in treating intertrochanteric fractures between the young and the elderly. We established twenty models for the old and the young with intertrochanteric fractures and performed static and dynamic simulations under one-legged stance and walking cycle conditions. The von Mises stress and displacement on the femur, proximal femoral nail anti-rotation (PFNA) implant, fracture plane, and the cutting volume of cancellous bone of the femur were compared. It was observed that defects in the anterior and posterior cortical bone walls significantly increase the stress on the PFNA implant, the displacement of the fracture surface, and cause a greater volume of cancellous bone to be resected. We concluded that ensuring the integrity and alignment of the anterior and posterior cortical bones is essential for elderly patients, and sagittal support is recommended. This finding suggests that the treatment method for intertrochanteric fracture may differ, considering the patient's age difference.
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Affiliation(s)
- Jixuan Liu
- Institue of Medical Equipment Science and Engineering (IMESE), Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Qing Yang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Sutuke Yibulayimu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wei Tian
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yanzhen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Huneidi M, Bailly N, Farah K, May A, Arnoux PJ, Fuentes S. Iatrogenic vertebral fracture in ankylosed spine during liver transplantation: a case report and biomechanical study using finite element method. Eur Spine J 2024; 33:1332-1339. [PMID: 38172415 DOI: 10.1007/s00586-023-08103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The occurrence of an iatrogenic vertebral fracture during non-spinal digestive surgery is an exceptional event that has not been previously documented. Our study aims to explain the occurrence of this fracture from a biomechanical perspective, given its rarity. Using a finite element model of the spine, we will evaluate the strength required to induce a vertebral fracture through a hyperextension mechanism, considering the structure of the patient's spine, whether it is ossified or healthy. METHODS A 70-year-old patient was diagnosed T12 fracture during a liver transplantation on ankylosed spine. We use a finite element model of the spine. Different mechanical properties were applied to the spine model: first to a healthy spine, the second to a osteoporotic ossified spine. The displacement and force imposed at the Sacrum, the time and location of fractures initiation were recorded and compared between the two spine conditions. RESULTS A surgical treatment is done associating decompression with posterior fixation. After biomechanical study, we found that the fracture initiation occurred for the ossified spine after a sacrum displacement of 29 mm corresponding to an applied force of 65 N. For the healthy spine it occurred at a sacrum displacement of 52 mm corresponding to an applied force of 350 N. CONCLUSION The force required to produce a type B fracture in an ankylosed spine is 5 times less than in a healthy spine. These data enable us to propose several points of management to avoid unexpected complications with ankylosed spines during surgical procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxime Huneidi
- Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, CHU Bordeaux, France.
| | - Nicolas Bailly
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Kaissar Farah
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Adrien May
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Stéphane Fuentes
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
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Sturla F, Votta E. Biomechanical imbalance of neochordal forces: the dark side of mitral valve prolapse repair. Eur J Cardiothorac Surg 2024; 65:ezae073. [PMID: 38439543 DOI: 10.1093/ejcts/ezae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Twinprai N, Twinprai P, Sripaduangkul S, Samrid R, Nimpisut N, Apinyankul R, Laonapakul T, Chindaprasirt P. Biomechanical analysis of posteromedial tibial plateau fracture fixation in fresh cadaveric bone. Injury 2024; 55:111316. [PMID: 38215570 DOI: 10.1016/j.injury.2024.111316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
This study aims to compare the mechanical strength of three different posterior-based internal fixation methods for posteromedial tibial plateau fractures. The study utilized 12 tibial plateaus harvested from fresh-frozen cadavers, and the posteromedial fracture fragments were created. The bones were then randomly assigned to one of three fixation methods: two posteroanterior lag screws (LS) size 4.0 mm, posterior buttress plate using a 3.5 mm small dynamic compression plate (DCP), or posterior buttress plate using a 3.5 mm T-shaped plate (TP). Biomechanical testing was performed by applying vertical compression force to the center of the posteromedial fracture fragment until the load to failure (displacement ≥ 3 mm) was reached, and displacement of the fragment was measured using a motion sensor. The data exhibited normal distribution, and one-way analysis of variance (ANOVA) was used to determine the load to failure, followed by Fisher post hoc Least-Significant Difference (LSD) to correct for multiple comparisons. The statistical analysis demonstrated significantly higher mean load to failure values in the T-shaped plate group compared to both the small dynamic compression plate group and the lag screw group (p < 0.05). However, after conducting further post hoc analysis, the observed significant differences were solely between the LS and TP groups (p = 0.021). These findings suggest that the T-shaped plate represents the most effective method for internally fixing posteromedial tibial plateau fractures.
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Affiliation(s)
- Nattaphon Twinprai
- Trauma unit, Department of Orthopedics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Prin Twinprai
- Musculoskeletal Unit, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Suwitcha Sripaduangkul
- Trauma unit, Department of Orthopedics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Rarinthorn Samrid
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Thailand
| | - Nakarin Nimpisut
- Trauma unit, Department of Orthopedics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Rit Apinyankul
- Trauma unit, Department of Orthopedics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Teerawat Laonapakul
- Department of Industrial Engineering, Faculty of Engineering, Khon Kaen University, Thailand
| | - Prinya Chindaprasirt
- Sustainable Infrastructure Research and Development Center, Department of Civil Engineering, Faculty of Engineering, Khon Kaen University, Thailand
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Bhat SS, Bui HT, Farnan A, Vietmeyer K, Armstrong AK, Breuer CK, Dasi LP. Development of Novel Sutureless Balloon Expandable Fetal Heart Valve Device Using Absorbable Polycaprolactone Leaflets. Ann Biomed Eng 2024; 52:386-395. [PMID: 37864043 DOI: 10.1007/s10439-023-03386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
Congenital heart disease (CHD) accounts for nearly one-third of all congenital defects, and patients often require repeated heart valve replacements throughout their lives, due to failed surgical repairs and lack of durability of bioprosthetic valve implants. This objective of this study is to develop and in vitro test a fetal transcatheter pulmonary valve replacement (FTPVR) using sutureless techniques to attach leaflets, as an option to correct congenital defects such as pulmonary atresia with intact ventricular septum (PA/IVS), in utero. A balloon expandable design was analyzed using computational simulations to identify areas of failure. Five manufactured valves were assembled using the unique sutureless approach and tested in the fetal right heart simulator (FRHS) to evaluate hemodynamic characteristics. Computational simulations showed that the commissural loads on the leaflet material were significantly reduced by changing the attachment techniques. Hemodynamic analysis showed an effective orifice area of 0.08 cm2, a mean transvalvular pressure gradient of 7.52 mmHg, and a regurgitation fraction of 8.42%, calculated over 100 consecutive cardiac cycles. In conclusion, the FTPVR exhibited good hemodynamic characteristics, and studies with biodegradable stent materials are underway.
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Affiliation(s)
- Sanchita S Bhat
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Hieu T Bui
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Anna Farnan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Katherine Vietmeyer
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Christopher K Breuer
- Department of General Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
| | - Lakshmi Prasad Dasi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA.
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Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S. Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 2024; 169:107887. [PMID: 38160502 DOI: 10.1016/j.compbiomed.2023.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Katrina Zaraska
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Atabak Eghbal
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sophie McGregor
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Eitan Prisman
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sidney Fels
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
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Zhang X, Nan N, Tong X, Chen H, Zhang X, Li S, Zhang M, Gao B, Wang X, Song X, Chen D. Validation of biomechanical assessment of coronary plaque vulnerability based on intravascular optical coherence tomography and digital subtraction angiography. Quant Imaging Med Surg 2024; 14:1477-1492. [PMID: 38415169 PMCID: PMC10895097 DOI: 10.21037/qims-23-1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/28/2023] [Indexed: 02/29/2024]
Abstract
Background It has been suggested that biomechanical factors may influence plaque development. However, key determinants for assessing plaque vulnerability remain speculative. Methods In this study, a two-dimensional (2D) structural mechanical analysis and a three-dimensional (3D) fluid-structure interaction (FSI) analysis were conducted based on intravascular optical coherence tomography (IV-OCT) and digital subtraction angiography (DSA) data sets. In the 2D study, 103 IV-OCT slices were analyzed. An in-depth morpho-mechanic analysis and a weighted least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to identify the crucial features related to plaque vulnerability via the tuning parameter (λ). In the 3D study, the coronary model was reconstructed by fusing the IV-OCT and DSA data, and a FSI analysis was subsequently performed. The relationship between vulnerable plaque and wall shear stress (WSS) was investigated. Results The influential factors were selected using the minimum criteria (λ-min) and one-standard error criteria (λ-1se). In addition to the common vulnerable factor of the minimum fibrous cap thickness (FCTmin), four biomechanical factors were selected by λ-min, including the average/maximal displacements and average/maximal stress, and two biomechanical factors were selected by λ-1se, including the average/maximal displacements. Additionally, the positions of the vulnerable plaques were consistent with the sites of high WSS. Conclusions Functional indices are crucial for plaque status assessment. An evaluation based on biomechanical simulations might provide insights into risk identification and guide therapeutic decisions.
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Affiliation(s)
- Xuehuan Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, China
| | - Xinyu Tong
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Huyang Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Shilong Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, China
| | - Bingyu Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, China
| | - Xifu Wang
- Department of Emergency, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, China
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
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Zhong S, Shi Q, Van Dessel J, Gu Y, Lübbers HT, Yang S, Sun Y, Politis C. Biomechanical feasibility of non-locking system in patient-specific mandibular reconstruction using fibular free flaps. J Mech Behav Biomed Mater 2023; 148:106197. [PMID: 37875041 DOI: 10.1016/j.jmbbm.2023.106197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
Mandibular reconstruction with free fibular flaps is frequently used to restore segmental defects. The osteosythesis, including locking and non-locking plate/screw systems, is essential to the mandibular reconstruction. Compared with the non-locking system that requires good adaption between plate and bone, the locking system appears to present a better performance by locking the plate to fixation screws. However, it also brings about limitations on screw options, a higher risk of screw failure, and difficulties in screw placement. Furthermore, its superiority is undermined by the advancing of patient-specific implant design and additive manufacturing. A customized plate can be designed and fabricated to accurately match the mandibular contour for patient-specific mandibular reconstruction. Consequently, the non-locking system seems more practicable with such personalized plates, and its biomechanical feasibility ought to be estimated. Finite element analyses of mandibular reconstruction assemblies were conducted for four most common segmental mandibular reconstructions regarding locking and non-locking systems under incisal biting and right molars clenching, during which the influencing factor of muscles' capacity was introduced to simulate the practical loadings after mandibular resection and reconstruction surgeries. Much higher, somewhat lower, and similar maximum von Mises stresses are separately manifested by the patient-specific mandibular reconstruction plate (PSMRP), fixation screws, and reconstructed mandible with the non-locking system than those with the locking system. Equivalent maximum displacements are identified between PSMRPs, fixation screws, and reconstructed mandibles with the non-locking and locking system in all four reconstruction types during two masticatory tasks. Parallel maximum and minimum principal strain distributions are shared by the reconstructed mandibles with the non-locking and locking system in four mandibular reconstructions during both occlusions. Conclusively, it is feasible to use the non-locking system in case of patient-specific mandibular reconstruction with fibular free flaps based on the adequate safety, comparable stability, and analogous mechanobiology it presents compared with the locking system in a more manufacturable and economical way.
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Affiliation(s)
- Shengping Zhong
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Qimin Shi
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China
| | - Jeroen Van Dessel
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Yifei Gu
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Department of Dentistry, Dushu Lake Hospital Affiliated to Soochow University, Chongwen Road 9, 215000, Suzhou, PR China
| | - Heinz-Theo Lübbers
- Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, Zurich, CH-8091, Switzerland
| | - Shoufeng Yang
- Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China.
| | - Yi Sun
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Constantinus Politis
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Zhu Y, Huang J, Ma X, Chen WM. A neuromusculoskeletal modelling approach to bilateral hip mechanics due to unexpected lateral perturbations during overground walking. BMC Musculoskelet Disord 2023; 24:775. [PMID: 37784076 PMCID: PMC10544490 DOI: 10.1186/s12891-023-06897-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Current studies on how external perturbations impact gait dynamics have primarily focused on the changes in the body's center of mass (CoM) during treadmill walking. The biomechanical responses, in particular to the multi-planar hip joint coordination, following perturbations in overground walking conditions are not completely known. METHODS In this study, a customized gait-perturbing device was designed to impose controlled lateral forces onto the subject's pelvis during overground walking. The biomechanical responses of bilateral hips were simulated by subject-specific neuromusculoskeletal models (NMS) driven by in-vivo motion data, which were further evaluated by statistical parameter mapping (SPM) and muscle coactivation index (CI) analysis. The validity of the subject-specific NMS was confirmed through comparison with measured surface electromyographic signals. RESULTS Following perturbations, the sagittal-plane hip motions were reduced for the leading leg by 18.39° and for the trailing leg by 8.23°, while motions in the frontal and transverse plane were increased, with increased hip abduction for the leading leg by 10.71° and external rotation by 9.06°, respectively. For the hip kinetics, both the bilateral hip joints showed increased abductor moments during midstance (20%-30% gait cycle) and decreased values during terminal stance (38%-48%). Muscle CI in both sagittal and frontal planes was significantly decreased for perturbed walking (p < 0.05), except for the leading leg in the sagittal plane. CONCLUSION The distinctive phase-dependent biomechanical response of the hip demonstrated its coordinated control strategy for balance recovery due to gait perturbations. And the changes in muscle CI suggested a potential mechanism for rapid and precise control of foot placement through modulation of joint stiffness properties. These findings obtained during actual overground perturbation conditions could have implications for the improved design of wearable robotic devices for balance assistance.
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Affiliation(s)
- Yunchao Zhu
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, 200433, China
| | - Ji Huang
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, 200433, China
| | - Xin Ma
- National Clinical Research Center for Geriatric Diseases (NCRCGD), Huashan Hospital Affiliated to Fudan University, No.12, Wulumuqi Middle Rd., Shanghai, 200040, China
| | - Wen-Ming Chen
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, 200433, China.
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Manekar VS, Datarkar AN, Ghormode A, Daware S, Pandilwar P, Sapkal P. Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis. J Maxillofac Oral Surg 2023; 22:688-694. [PMID: 37534346 PMCID: PMC10390377 DOI: 10.1007/s12663-023-01950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.
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Affiliation(s)
- Varsha Sunil Manekar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Abhay N. Datarkar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Ashlesha Ghormode
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Surendra Daware
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Prashant Pandilwar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
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Seo J, Kim H, Min J, Kim Y, Jeon IH, D'Lima D, Koh KH. Development of in vitro osteoporosis model in minipig proximal humerus and femur: validation in histological and biomechanical study. J Orthop Surg Res 2023; 18:615. [PMID: 37608307 PMCID: PMC10463625 DOI: 10.1186/s13018-023-04102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The minipig has been used for research in various fields of medicine, even in orthopedics. Though previous studies have already suggested other methods to create osteoporotic bone, those methods had some disadvantages for taking time and efforts. Therefore, we aimed to generate osteoporotic proximal humerus and proximal femur of minipig using EDTA solution and validate their properties through dual energy X-ray absorptiometry (DEXA), micro-CT study, histological and biomechanical ways. METHODS Six minipigs were used. Out of a total of 12 proximal humerus (PH) and 12 proximal femurs (PF), 6 PH and 6 PF were used as the decalcified group and the opposite side as the non-decalcified group. In vitro decalcification with Ca-chelating agents (0.5 M EDTA solution, pH 7.4) was used. Area BMD (aBMD) was measured using DEXA, Volumetric BMD (vBMD), and microstructure were measured using micro-CT. Universal testing machine was used to measure ultimate load to failure (ULTF). Each group was compared using two types of suture anchors (all-suture anchor, ASA, and conventional screw type anchor, CA). RESULTS There was a significant difference in aBMD and cortical thickness (aBMD: decalcified, 0.433 ± 0.073 g/cm2, undecalcified, 0.962 ± 0.123 g/cm2, p < 0.001; cortical thickness: decalcified, 0.33 ± 0.34 mm, undecalcified, 1.61 ± 0.45 mm, p < 0.001). In the case of ASA, the ULTF was significantly lower in the decalcified group (decalcified: 176.6 ± 74.2 N, non-decalcified: 307.7 ± 116.5 N, p = 0.003). In the case of CA, there was no significant difference (decalcified: 265.1 ± 96.0 N, undecalcified: 289.4 ± 114.5 N, p = 0.578). CONCLUSION We demonstrated that decalcification with EDTA solution significantly decreased aBMD, vBMD, and cortical thickness. Decalcified minipig bone using EDTA resulted in similar biomechanical properties as osteoporotic human bone with respect to anchor pull-out.
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Affiliation(s)
- Jeonghyeon Seo
- Department of Orthopedic Surgery, Areumcheil Hospital, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Joongkee Min
- Asan Medical Center, Convergence Medicine Research Center, Computerized Tomography Core, Seoul, Republic of Korea
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Darry D'Lima
- Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, San Diego, CA, USA
| | - Kyoung Hwan Koh
- Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA.
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, San Diego, CA, USA.
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Republic of Korea.
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Romero Arias T, Redondo Cortés I, Pérez Del Olmo A. Biomechanical Parameters of Voice in Parkinson's Disease Patients. Folia Phoniatr Logop 2023; 76:91-101. [PMID: 37499642 DOI: 10.1159/000533289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Previous research on voice in Parkinson's disease (PD) has consistently demonstrated alterations in acoustic parameters, including fundamental frequency (F0), maximum phonation time, Shimmer, and Jitter. However, investigations into acoustic parameter alterations in individuals with PD are limited. METHODS We conducted an experimental study involving 20 PD patients (six women and fourteen men). Subjective measures of voice (VHI-30 scale and GRBAS) and objective measures using the OnlineLAB App tool for analyzing biomechanical correlates of voice were recorded. The app analyzed a total of 22 biomechanical parameters of voice. RESULTS The results of subjective measures were consistent with findings from previous studies. However, the results of objective measures did not align with studies that employed acoustic measures. CONCLUSIONS The biomechanical analysis revealed alterations in various parameters according to gender. These findings open up a new avenue of research in voice analysis for patients with PD, whether through acoustic or biomechanical analysis, aiming to determine whether the observed changes in these patients' voices are attributable to age or disease progression. This line of investigation will help elucidate the relative contribution of these factors to vocal alterations in PD patients and provide a more comprehensive understanding of the underlying mechanisms.
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Affiliation(s)
- Tatiana Romero Arias
- Faculty of Health Sciences, Speech Therapy Section, Pontifical University of Salamanca, Salamanca, Spain
| | - Inés Redondo Cortés
- Faculty of Health Sciences, Speech Therapy Section, Pontifical University of Salamanca, Salamanca, Spain
| | - Adrián Pérez Del Olmo
- Faculty of Health Sciences, Speech Therapy Section, Pontifical University of Salamanca, Salamanca, Spain
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Wu C, Wang X, Zhang H, Xie S, He J. Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis. Injury 2023:110917. [PMID: 37400327 DOI: 10.1016/j.injury.2023.110917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. METHODS Finite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. RESULTS Group A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. CONCLUSION Combining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).
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Affiliation(s)
- Chaomeng Wu
- Jiangxi university of Traditional Chinese Medicine, Nanchang 33004, China
| | - Xingyu Wang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Hao Zhang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Shuihua Xie
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Jianhua He
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China.
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Schleifenbaum S, Vogl AC, Heilmann R, von der Hoeh NH, Heyde CE, Jarvers JS. Biomechanical comparative study of midline cortical vs. traditional pedicle screw trajectory in osteoporotic bone. BMC Musculoskelet Disord 2023; 24:395. [PMID: 37198565 PMCID: PMC10193652 DOI: 10.1186/s12891-023-06502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION In lumbar spinal stabilization pedicle screws are used as standard. However, especially in osteoporosis, screw anchorage is a problem. Cortical bone trajectory (CBT) is an alternative technique designed to increase stability without the use of cement. In this regard, comparative studies showed biomechanical superiority of the MC (midline cortical bone trajectory) technique with longer cortical progression over the CBT technique. The aim of this biomechanical study was to comparatively investigate the MC technique against the not cemented pedicle screws (TT) in terms of their pullout forces and anchorage properties during sagittal cyclic loading according to the ASTM F1717 test. METHODS Five cadavers (L1 to L5), whose mean age was 83.3 ± 9.9 years and mean T Score of -3.92 ± 0.38, were dissected and the vertebral bodies embedded in polyurethane casting resin. Then, one screw was randomly inserted into each vertebra using a template according to the MC technique and a second one was inserted by freehand technique with traditional trajectory (TT). The screws were quasi-static extracted from vertebrae L1 and L3, while for L2, L4 and L5 they were first tested dynamically according to ASTM standard F1717 (10,000 cycles at 1 Hz between 10 and 110 N) and then quasi-static extracted. In order to determine possible screw loosening, there movements were recorded during the dynamic tests using an optical measurement system. RESULTS The pull-out tests show a higher pull-out strength for the MC technique of 555.4 ± 237.0 N compared to the TT technique 448.8 ± 303.2 N. During the dynamic tests (L2, L4, L5), 8 out of the 15 TT screws became loose before completing 10,000 cycles. In contrast, all 15 MC screws did not exceed the termination criterion and were thus able to complete the full test procedure. For the runners, the optical measurement showed greater relative movement of the TT variant compared to the MC variant. The pull-out tests also revealed that the MC variant had a higher pull-out strength, measuring at766.7 ± 385.4 N, while the TT variant measured 637.4 ± 435.6 N. CONCLUSION The highest pullout forces were achieved by the MC technique. The main difference between the techniques was observed in the dynamic measurements, where the MC technique exhibited superior primary stability compared to the conventional technique in terms of primary stability. Overall, the MC technique in combination with template-guided insertion represents the best alternative for anchoring screws in osteoporotic bone without cement.
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Affiliation(s)
- Stefan Schleifenbaum
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Ann-Cathrin Vogl
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Robin Heilmann
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Nicolas Heinz von der Hoeh
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany.
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Buttin P, Goin B, Crumière AJJ, Viguier E, Massenzio M, Lafon Y, Cachon T. Ex-vivo biomechanical analysis of an original repair of canine calcaneal tendon rupture using a synthetic implant as mechanical support fixed by sutures in the proximal tendinous part and by an interference screw in the bone distal part. Open Vet J 2023; 13:645-653. [PMID: 37304606 PMCID: PMC10257453 DOI: 10.5455/ovj.2023.v13.i5.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background Rupture of the common calcaneal tendon is the second most frequent tendon rupture in dogs and may lead to severe lameness and pain. Surgical repair consists of re-apposition of the damaged tendon ends using sutures, but this type of repair is not always possible especially if the tendon has retracted. Tendon augmentation with an ultra-high molecular weight polyethylene (UHMWPE) implant is a recent solution to support the sutures and allow the repair of the canine calcaneal tendon. However, its biomechanical fixation strength remains untested for this pathology. Aim To evaluate the biomechanical fixation strength of a UHMWPE implant for the repair of the canine calcaneal tendon. Methods Ex-vivo biomechanical study was carried out on eight cadaveric hindlimbs from four adult dogs. Hindlimbs were tested under two independent modalities: proximal tendinous fixation (PTF) and distal calcaneus fixation (DCF), using a testing machine. PTF was achieved by eight simple interrupted polypropylene sutures performed through the UHMWPE implant. The latter was sandwiched inside the gastrocnemius tendon, which had previously been incised over about 5 cm longitudinally, and through the tendon of the superficial digital flexor. DCF was performed using an interference screw, which locked the UHMWPE implant into a calcaneus tunnel drilled perpendicularly. Results Yield, failure load, and linear stiffness (mean ± SD) for the DCF modality were 920 ± 139 N, 1,007 ± 146 N, and 92 ± 15.21, respectively, which were greater than for the PTF modality (663 ± 92 N, 685 ± 84 N and 25.71 ± 5.74, respectively, p < 0.05). Failure modes were different between fixation modalities: for PTF it was suture breakage (n = 7/8), while for DCF it was implant damage and slippage (n = 8/8). Conclusion The biomechanical fixation strength of the UHMWPE implant was greater for DCF than that of PTF, and should be suitable for calcaneal tendon repair in dogs. The clinical prediction of rupture of this calcaneal tendon repair will occur at the level of the PTF.
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Affiliation(s)
- Philippe Buttin
- Itinerant Surgeon, Villaz, France
- These authors contributed equally to this work
| | - Bastien Goin
- Université de Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, Lyon, France
- Novetech Surgery, Monaco, Monaco
- These authors contributed equally to this work
| | | | - Eric Viguier
- Université de Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
| | - Michel Massenzio
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, Lyon, France
| | - Yoann Lafon
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, Lyon, France
| | - Thibaut Cachon
- Université de Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
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Mackert GA, Harder M, Harhaus H, Schulte M, Trinler U, Jaeger S, Kneser U, Harhaus L, Wölfl C. Validation of a novel testing machine for the investigation of the biomechanical properties of lumbar vertebrae in an osteoporotic rat model. J Orthop Surg Res 2023; 18:263. [PMID: 37004118 PMCID: PMC10067285 DOI: 10.1186/s13018-023-03751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND For the investigation of the biomechanical properties of bone, various testing devices have been described. However, only a limited number have been developed to test the vertebral body of small animals. The aim of this study was to develop and validate a new bone testing device, which investigates the different biomechanical properties in small-animal vertebrae as a whole, three-dimensional unit, respecting its anatomical structure. METHODS Thirty-five twelve-week-old female Sprague Dawley rats were utilized. Group 1 was composed of 17 rats with a normal bone metabolism without osteoporosis, while Group 2 consisted of 18 rats with manifest osteoporosis, 8 weeks after ovariectomy. The 5th lumbar vertebra of each animal was tested using the new bone testing device. This device has the ability to be adjusted to the slanted nature of each individual vertebral body and fix the vertebra in a natural position to allow for a non-dislocating axial force application. The device is designed to respect the anatomical three-dimensional shape of the vertebral body, thus avoiding the application of non-anatomic, non-physiological forces and thus preventing a distortion of the biomechanical testing results. The parameters investigated were stiffness, yield load, maximum load and failure load, and the results were compared to current literature values. RESULTS The conduction of the biomechanical bone testing of the vertebral bodies with the new device was conductible without any instances of dislocation of the vertebrae or machine malfunctions. Significant differences were found for stiffness, maximum load and failure load between groups, with a lower value in the osteoporotic rats in each parameter tested. The yield load was also lower in the osteoporotic group, however not significantly. The values achieved correlate with those in current literature. CONCLUSIONS This study demonstrates that the newly developed testing machine is easy to handle and produces valid data sets for testing biomechanical bone parameters of whole vertebral bodies in an established small animal model. Therefore, it can be utilized, also as reference data, to test different structural properties and changes in vertebral bone, for example, in different metabolic settings or under the influence of different pharmaceutical entities in further studies.
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Affiliation(s)
- G A Mackert
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic Surgery of the University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany.
| | - M Harder
- Department of Orthopedics and Trauma Surgery, GRN Clinic Weinheim, Weinheim, Germany
| | - H Harhaus
- Technical and Medical Devices Development and Invention Center, Remscheid, Germany
| | - M Schulte
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic Surgery of the University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany
| | - U Trinler
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic Surgery of the University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany
| | - S Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - U Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic Surgery of the University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany
| | - L Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic Surgery of the University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany
| | - C Wölfl
- Department of Orthopedics and Trauma Surgery, Marienhausklinikum Neuwied, Teaching Hospital of the Johannes Gutenberg-University, Mainz, Germany
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Sebastian L, Alina J, Fabinshy T, Dominik R, Axel S, Jens H, Kilian W, Claudia R, Leonidas K, Julia R, Nadja T, Christian E. AbsorbaTack™ vs. ProTack™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2023; 307:863-871. [PMID: 36404354 PMCID: PMC9984508 DOI: 10.1007/s00404-022-06827-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. METHODS A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. RESULTS There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. CONCLUSION The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
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Affiliation(s)
- Ludwig Sebastian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.
| | - Jansen Alina
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Thangarajah Fabinshy
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Ratiu Dominik
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Sauerwald Axel
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Hachenberg Jens
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wegmann Kilian
- Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rudroff Claudia
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Karapanos Leonidas
- Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Radosa Julia
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Trageser Nadja
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Eichler Christian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.,Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany
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Tan JHI, Mat Jais IS, Wong KPL, Lee NKL, Wong YR, Chia DSY, Chew EM. The right turn around: Penrose tourniquet application in paediatrics. Injury 2023; 54:910-916. [PMID: 36635103 DOI: 10.1016/j.injury.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Commercially available tourniquets are ill-suited for paediatric patients with limb circumferences smaller than the required mechanism, forcing surgeons to improvise. This study aimed to quantify pressures exerted by the Penrose tourniquet when applied on a phantom model and evaluate the intra-/inter-rater reproducibility of the technique previously proposed. METHODS Eight calibrated pressure sensors were distributed evenly along the inner and outer circumference of a silicon-based model. A 30cm-by-3.2 cm ARGYLE Penrose drain, 4-by-4 gauze, marker and ruler were used. The optimal interval for arterial occlusion was determined to be 70% of limb circumference. The tourniquet was secured using two half-knots formed by gauze. RESULTS Two-turns of the tourniquet about the model generated mean pressures (SD) of 209.43 (SD:35.98 mmHg) (95%CI: 195.85-224.00 mmHg) (outer-sensor) and 246.32 (SD:61.92 mmHg) (95%CI: 221.02-273.49 mmHg) (inner-sensor). Three-turns generated mean pressures of 302.07 (SD:23.98 mmHg) (95%CI: 292.29-312.53 mmHg) (outer-sensor) and 314.44 (SD:56.70 mmHg) (95%CI: 291.25-338.25 mmHg) (inner-sensor). CONCLUSION The Penrose tourniquet has clinical utility, particularly for patients where commercially available tourniquets are not suitable. Current application techniques generate inconsistent pressures. Using the existing model, further refinement can be done to improve the consistency and safety of the application. We recommend using intervals of slightly more than 70% of limb circumference and only two turns of the Penrose tourniquet during application. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Joelle Hwee Inn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Nicole Kim Luan Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biomechanics Laboratory, Singapore General Hospital, Singapore; Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore; Division of Surgery, KK Women's and Children's HospitalDivision of Surgery, KK Women's and Children's Hospital
| | - Yoke-Rung Wong
- Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - Dawn Sinn Yii Chia
- Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore
| | - Ee Ming Chew
- Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore
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Meijering D, Duijn RGA, Murgia A, Boerboom AL, Eygendaal D, van den Bekerom MPJ, Bulstra SK, Stevens M, Vegter RJK. Elbow joint biomechanics during ADL focusing on total elbow arthroplasty - a scoping review. BMC Musculoskelet Disord 2023; 24:42. [PMID: 36653765 PMCID: PMC9847152 DOI: 10.1186/s12891-023-06149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Overloading is hypothesized to be one of the failure mechanisms following total elbow arthroplasty (TEA). It is unclear whether the current post-operative loading instruction is compliant with reported failure mechanisms. Aim is therefore to evaluate the elbow joint load during activities of daily living (ADL) and compare these loads with reported failure limits from retrieval and finite element studies. METHODS A scoping review of studies until 23 November 2021 investigating elbow joint load during ADL were identified by searching PubMed/Medline and Web of Science. Studies were eligible when: (1) reporting on the elbow joint load in native elbows or elbows with an elbow arthroplasty in adults; (2) full-text article was available. RESULTS Twenty-eight studies with a total of 256 participants were included. Methodological quality was low in 3, moderate in 22 and high in 3 studies. Studies were categorized as 1) close to the body and 2) further away from the body. Tasks were then subdivided into: 1) cyclic flexion/extension, 2) push-up, 3) reaching, 4) self-care, 5) work. Mean flexion-extension joint load was 17 Nm, mean varus-valgus joint load 9 Nm, mean pronation-supination joint load 8 Nm and mean bone-on-bone contact force 337 N. CONCLUSION The results of our scoping review give a first overview of the current knowledge on elbow joint loads during ADL. Surprisingly, the current literature is not sufficient to formulate a postoperative instruction for elbow joint loading, which is compliant with failure limits of the prosthesis. In addition, our current instruction does not appear to be evidence-based. Our recommendations offer a starting point to assist clinicians in providing informed decisions about post-operative instructions for their patients.
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Affiliation(s)
- Daniëlle Meijering
- grid.4494.d0000 0000 9558 4598Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roos GA Duijn
- grid.4494.d0000 0000 9558 4598Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alessio Murgia
- grid.4494.d0000 0000 9558 4598Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L. Boerboom
- grid.4494.d0000 0000 9558 4598Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- grid.5645.2000000040459992XDepartment of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michel PJ van den Bekerom
- grid.440209.b0000 0004 0501 8269Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Sjoerd K. Bulstra
- grid.4494.d0000 0000 9558 4598Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- grid.4494.d0000 0000 9558 4598Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer JK Vegter
- grid.4494.d0000 0000 9558 4598Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Su H, Zhong S, Ma T, Wu W, Lu Y, Wang D. Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures. BMC Musculoskelet Disord 2023; 24:39. [PMID: 36650508 PMCID: PMC9847071 DOI: 10.1186/s12891-023-06150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability. METHODS In this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator (Group CEF-22) frames were used to fix unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments. RESULTS It was found that the torsional and flexural stiffnesses of group EF-44 and group EF-33 were higher than those of group IT-44 and group ET-44 (p < 0.05); the flexural stiffness of group EF-22 was similar to that of group IT-44 (p > 0.05); and the compressive stiffness of all three EF groups was higher than that of group ET-44 (p < 0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p < 0.05), while the torsional stiffness of the three groups did not differ significantly between the two adjacent groups (p > 0.05). Group CEF-22 showed the highest stiffnesses, while group ET-44 had the lowest stiffnesses (P < 0.05). CONCLUSIONS The study shows that the distal femoral LCP has good biomechanical stability and adjustability and is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.
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Affiliation(s)
- Huan Su
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Siyang Zhong
- grid.417409.f0000 0001 0240 6969Zunyi Medical University Zhuhai Campus, No. 368, Jinwan Road, Jinwan District, Zhuhai, 519041 China
| | - Tianyong Ma
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Weidong Wu
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Yihong Lu
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Dewei Wang
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
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Wiegand K, Tandy R, Silvernail JF. Two-Year Injury Incidence and Movement Characteristics Among Division-I Cross-Country Athletes. Int J Exerc Sci 2023; 16:159-171. [PMID: 37113262 PMCID: PMC10124720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
While research on running injuries is common, there is a lack of definitive causal relationships between running injuries and gait mechanics. Additionally, there is a paucity of longitudinal research to understand the development of running injuries. The purpose of this study was to assess the incidence of running injuries and investigate movement characteristics as they relate to injury development in Division-I cross-country athletes over a two-year period. Athletes were evaluated at pre- and post-season with three-dimensional kinematic and kinetic gait analyses. A total of 17 female athletes were evaluated, though sample size varied at each time point. Self-reported injury occurrence data was collected via questionnaires and injury reports were obtained from athletic training staff. Sixteen of the athletes reported at least one injury during the study. The percentage of participants self-reporting injury was greater than the percentage of participants who were evaluated and diagnosed by medical staff each year (year one: 67% vs. 33%; year two: 70% vs. 50%). The most common self-reported and medically confirmed injury location was the left foot, with 7 total reports out of 17 participants. Inferential statistics were not feasible due to an inherently limited sample size, thus effect size (Cohen's d s ) was used to assess differences in mechanics between athletes with and without left foot injury. Several variables, including peak ankle plantarflexion, dorsiflexion, and inversion, peak knee abduction, and hip abduction and adduction were associated with moderate-to-large effect sizes (d s > 0.50). This study demonstrates that injury rates in the literature may be influenced by reporting method. Additionally, this study provides promising information regarding movement characteristics in injured runners and demonstrates the necessity of longitudinal studies of homogenous groups.
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Affiliation(s)
- Kristyne Wiegand
- Department of Kinesiology, University of Nevada-Las Vegas, Las Vegas, NV, USA
- Department of Wellness and Movement Sciences, Eastern Washington University, Cheney, WA, USA
| | - Richard Tandy
- Department of Kinesiology, University of Nevada-Las Vegas, Las Vegas, NV, USA
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Tang B, Yang J, Zhang Y, Ren X, Jiang T, Mo Z, Fan Y. Incorporating strategy in hybrid surgery for continuous two-level cervical spondylosis from a biomechanical perspective. Comput Methods Programs Biomed 2022; 226:107193. [PMID: 36288687 DOI: 10.1016/j.cmpb.2022.107193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Hybrid surgery, incorporating cervical disc replacement and anterior cervical discectomy and fusion, has shown good clinical results in the treatment of multilevel cervical spondylosis according to early follow-ups. This study investigated the surgical strategy of hybrid surgery for two-level cervical spondylosis by distinguishing the biomechanical characteristics with different incorporating modes. METHOD A finite element model of a healthy cervical spine including C2-T1 was developed, and hybrid surgery was simulated by replacing at one level with Prestige-LP and fusion at another level with the anterior plate in C3-C5 (Hybrid-S1: replaced at C3-C4, Hybrid-S2: replaced at C4-C5), and in C4-C6 (Hybrid-M1: replaced at C4-C5, Hybrid-M2: replaced at C5-C6) and in C5-C7 (Hybrid-U1: replaced at C5-C6, Hybrid-U2: replaced at C6-C7). The motion of C2 vertebrae in flexion, extension, axial rotation, and lateral bending was imposed on all hybrid models following the displacement control testing protocol. RESULTS The largest range of motion (ROM) in a healthy spine was observed at C5-C6, followed by C3-C4, C4-C5 and C6-C7. On average, the ROM at the replaced segment increased by 175.7%, 202.7%, 176.3%, 117.1%, 139.4%, and 236.0% in Hybrid-S1, Hybrid-S2, Hybrid-M1, Hybrid-M2, Hybrid-U1, and Hybrid-U2, respectively. The facet joint stress at the replaced segment increased by 186.9%, 124.4%, 111.1%, 60.3%, 62.7%, and 144.7%, and the adjacent intradiscal pressure (IDP) increased by 45.2%, 38.7%, 2.7%, 2.1%, 13.9%, and 20.1%. CONCLUSIONS Incorporating mode in hybrid surgery affects cervical biomechanics. Hybrid surgery with replacement at a segment with a greater ROM and fusion at a segment with a lower ROM can results in fewer changes in terms of overall cervical stiffness, ROM at the operative level, facet joint stress, and adjacent IDP. In hybrid surgery, it is better to implement disc replacement at a level with a greater ROM and fusion of another segment.
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Affiliation(s)
- Beichuan Tang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037, Chongqing, PR China
| | - Jiemeng Yang
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, PR China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing 100083, PR China
| | - Yingying Zhang
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, PR China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing 100083, PR China
| | - Xianjun Ren
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037, Chongqing, PR China
| | - Tao Jiang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037, Chongqing, PR China.
| | - Zhongjun Mo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176, Beijing, PR China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing 100083, PR China.
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23
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Erpala F, Ozturk T, Burtac Eren M, Ertem H, Cagatay Zengin E. Comparison of biomechanical analysis of four different tibial tunnel fixations in a bovine model. Knee 2022; 38:193-200. [PMID: 36095927 DOI: 10.1016/j.knee.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/16/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the ideal fixation technique for an ACL reconstruction with a hamstring graft, multiple studies have been undertaken to define the initial biomechanical properties of tibial fixation. PURPOSE The aim of this study was to compare the biomechanical properties of tibial fixation methods by creating single or hybrid systems. METHODS Bovine tibias and forefoot digital extensor tendons were prepared with four different tibial anterior cruciate ligament fixation methods and compared biomechanically. Fixation materials included polyethylene Ultrabraid high-strength sutures, Biosure interference screws (Smith and Nephew, Memphis, TN, USA), staples (Smith and Nephew, Richards Regular Fixation Staples without Spikes, Memphis, TN, USA), and knotless suture anchors (Multifix-S PEEK) (Smith and Nephew, Memphis, TN, USA). Four groups (n = 5 specimens) were established - group I: single fixation with interference screws; group II: single fixation with knotless anchors; group III: hybrid fixation with interference screws and staples; group IV: hybrid fixation with interference screws and knotless anchors. Each specimen underwent evaluations for cyclic displacement, cyclic stiffness, initial loading strength, ultimate failure load, pull-out displacement, and pull-out stiffness. RESULTS All specimens completed cyclic loading and load-to-failure. The cyclic displacement in group II, which had a single fixation, indicated significantly greater elongation compared with the other groups (P = 0.002). The hybrid systems were more rigid than the single systems in terms of cyclic stiffness, and no statistically significant difference was observed between the hybrid systems (P = 0.461). Group IV was significantly superior in terms of the ultimate failure load (P = 0.004). No statistically significant differences were noted between the groups for pull-out displacement or pull-out stiffness. CONCLUSION Single fixation with bioscrews as an in-tunnel tibia fixation method was as successful as hybrid systems. Multifix-S PEEK knotless suture anchors, which can be combined with bioscrews, can be a superior fixation alternative due to its flexibility and ultimate failure load values.
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24
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Letesson J, Goin B, Viguier E, Cachon T. Validation of a biomechanical testing protocol of craniodorsal hip luxation in feline cadavers and comparison of two ultra-high molecular weight polyethylene materials used for extra-articular hip stabilisation. J Feline Med Surg 2022; 24:e360-e369. [PMID: 36074899 DOI: 10.1177/1098612x221114851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of our study was to describe a biomechanical testing protocol to reproduce ex vivo craniodorsal hip luxation specific to the feline model, and evaluate the biomechanical properties of an intact hip joint compared with the fixation strength of two different techniques of extra-articular hip stabilisation. METHODS Eighteen hip joints (femur and hemipelvis) were harvested from nine mature feline cadavers. CT was performed for each hip joint so that a biomechanical base specific to each joint morphotype could be created using computer-aided design. The biomechanical bases were then produced using a three-dimensional printer to secure the hip joints during testing. A total of 34 biomechanical compression tests were performed. Eighteen compression tests were performed in the control group, of which two fractured. The remaining 16 hip joints were then randomly assigned either to group A (hip joints stabilised with an extra-articular ultra-high molecular weight polyethylene (UHMWPE) implant secured by an interference screw [n = 8]) or to group B (hip joints stabilised with a UHMWPE iliofemoral suture [n = 8]). RESULTS Mean ± SD yield, failure load and linear stiffness in the control group were 616 ± 168 N, 666 ± 158 N and 231 ± 50 N/mm, respectively. The relative fixation strength (% of intact joint) before hip luxation in groups A and B was 43.8% and 34.7%, respectively. No statistical difference was found between groups A and B for yield and failure load. However, the reoccurrence of craniodorsal hip luxation was higher in group B than in group A, in 5/8 and 0/8 tests, respectively. Moreover, in group A, the extra-articular UHMWPE implant induced caudodorsal hip luxation, reported as failure mode in 7/8 cases. CONCLUSIONS AND RELEVANCE This modified biomechanical protocol for testing craniodorsal hip luxation in a feline model was validated as repeatable and with acceptable variance. The extra-articular UHMWPE implant stabilisation technique proved to be more efficient in avoiding reoccurrence of craniodorsal hip luxation than UHMWPE iliofemoral suture.
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Affiliation(s)
| | - Bastien Goin
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l'Etoile, France.,Novetech Surgery, Monaco
| | - Eric Viguier
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l'Etoile, France
| | - Thibaut Cachon
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l'Etoile, France
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Zhong S, Shi Q, Van Dessel J, Gu Y, Sun Y, Yang S. Biomechanical validation of structural optimized patient-specific mandibular reconstruction plate orienting additive manufacturing. Comput Methods Programs Biomed 2022; 224:107023. [PMID: 35872386 DOI: 10.1016/j.cmpb.2022.107023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Owing to the unexpected in vivo fracture failure of the original design, structural optimized patient-specific mandibular reconstruction plates (PSMRPs) were created to boost the biomechanical performance of bridging segmental bony defect in the mandibular reconstruction after tumor resection. This work aimed to validate the biomechanical benefit of the structural optimized PSMRPs relative to the original design and compare the biomechanical performance between PSMRP1 with generic contour customization and PSMRP2 with a tangent arc upper margin in mandibular angle region. METHODS Finite Element Analysis (FEA) was used to evaluate the biomechanical behavior of mandibular reconstruction assemblies (MRAs) concerning these two structural optimized PSMRPs by simulating momentary left group clenching and incisal clenching tasks. Bonded contact was set between mandibular bone and fixation screws and between PSMRP and fixation screws in the MRA, while the frictionless connection was allocated between mandibular bone and PSMRP. The loads were applied on four principal muscles, including masseter, temporalis, lateral and medial pterygoid, whose magnitudes along the three orthogonal directions. The mandibular condyles were retrained in all three directions, and either the left molars or incisors area were restrained from moving vertically. RESULTS The peak von Mises stresses of structural optimized PSMRPs (264 MPa, 296 MPa) were way lower than that of the initial PSMRP design (393 MPa), with 33 and 25% reduction during left group clenching. The peak magnitude of von Mises stress, minimum principal stress, and maximum principal strain of PSMRP1 (264 MPa, 254 MPa; -297 MPa, -285 MPa; 0.0020, 0.0020) was lower than that of PSMRP2 (296 MPa, 286 MPa; -319 MPa, -306 MPa; 0.0022, 0.0020), while the peak maximum principal stress of PSMRP1 (275 MPa, 257 MPa) was higher than that of PSMRP2 (254 MPa, 235 MPa) during both left group clenching and incisal clenching tasks. CONCLUSIONS The structural optimized PSMRPs reveal their biomechanical advantage compared with the original design. The PSMRP1 presents better biomechanical performance to the patient-specific mandibular reconstruction than PSMRP2 as a result of its superior safety, preferable flexibility, and comparable stability. The PSMRP2 provides biomechanical benefit in reducing the maximum tension than PSMRP1, indicated by lower peak maximum principal stress, through tangent arc upper margin in mandibular angle region.
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Affiliation(s)
- Shengping Zhong
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Qimin Shi
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Jeroen Van Dessel
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Yifei Gu
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium
| | - Yi Sun
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium.
| | - Shoufeng Yang
- Faculty of Engineering and Physical Sciences, Highfield, University of Southampton, Southampton SO17 1BJ, United Kingdom.
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Qi Y, Yao L, Long Y, Zuo G, Zhang Q, Liu Z, Wang W. Effectiveness and Biomechanical Analysis of the Ortho-Bridge System on Femoral Fracture Healing: A Retrospective Analysis. Indian J Orthop 2022; 56:1795-803. [PMID: 36187589 DOI: 10.1007/s43465-022-00687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Among the surgical methods for femoral fractures, the Ortho-Bridge System (OBS) appears to heal fractures via an uncommon process. We compared its effectiveness and biomechanical aspects to those of a locking compression plate (LCP) and explained the healing process demonstrated by the OBS. METHODS Eleven femoral shaft fracture cases treated with OBS between July 2017 and May 2020 were retrospectively reviewed. Clinical and radiographic data were collected during regular postoperative follow-up visits and assessed via the Harris Hip Score and Knee Society Score. We performed biomechanical experiments of OBS. We simulated different fracture conditions and selected appropriate screw holes at the fracture's far and near segments. The OBS module was placed according to the position of LCP's locking hole at both ends of the fracture; then, a static three-point bending test was performed. RESULTS All patients had contralateral callus growth with secondary fracture healing. Healing time was 3-5 months with excellent hip and knee function. When the key screw distance was 22-34 mm, the OBS was significantly less stiff than the LCP (P < 0.05). The stiffness of LCP and OBS decreased significantly when the key screw distance was 49-82 mm, with the LCP being slightly stronger (P < 0.05). CONCLUSIONS Femoral shaft fracture treatment with OBS demonstrated secondary healing. When the distance between the key screws was 20-40 mm, the elasticity was higher in OBS than in LCP, possibly producing axial micro-motion to stimulate callus formation and promote fracture healing, which differ from the plate's primary healing process.
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Liu J, Cheng X, Wang Y, Zhang P, Gao L, Yang X, He S, Liu Y, Zhang W. Biomechanical analysis of vertebral wedge deformity in elderly women with quantitative CT-based finite element analysis. BMC Musculoskelet Disord 2022; 23:575. [PMID: 35701750 PMCID: PMC9195195 DOI: 10.1186/s12891-022-05518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the vertebral deformity angle (VD angle) of 1st lumbar vertebral body (L1) in elderly women, investigate the influence of VD on vertebral stiffness (VS) by biomechanical analysis using quantitative computed tomography-based finite element analysis (QCT-FEA). METHODS Two hundred seventy eight participants were recruited, and underwent QCT scan. Measured VD angles of L1, and constructed QCT-FEA models of L1 with the minimum (0.59°), median (5.79°) and maximum (11.15°) VD angles, respectively. Loads in two directions were applied on the upper edge of L1 with a force of 700 N, and vertebral stiffness (VS) was defined as the ratio of 700 N and displacement at the superior reference point: (1) perpendicular to the upper edge of L1 (defined as VS-U); (2) perpendicular to the lower edge of L1(defined as VS-L). RESULTS Age was very weak positively correlated with VD angle, moderate negatively correlated with vBMD, and moderate negatively correlated with VS (P < 0.05). VS-U was significantly different among three VD angles, so was VS-L (P < 0.001). VS-U was higher than VS-L in 5.79° and 11.15° VD angles (P < 0.05), however no difference in 0.59° VD angles (P > 0.10). CONCLUSIONS VD angle of L1 was slightly increased with age and not correlated with vBMD, and VS was moderate negatively correlated with age, showing that the vertebral body was more likely to fracture with aging. VS-U and VS-L were gradually decreased with the increase of VD angle, and VS-L was lower than VS-U with the increase of VD angle, which showed that vertebral body was more prone to fracture when the load was perpendicular to the lower edge of the vertebral body as the VD angle increasing.
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Affiliation(s)
- Jing Liu
- Department of Radiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China
| | - Xiaodong Cheng
- Key Laboratory of Biomechanics of Hebei Province and Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050000, Hebei, China
| | - Yan Wang
- Department of Endocrinology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhaung, Hebei, CN 050000, China
| | - Ping Zhang
- Department of CT/MRI, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China
| | - Lei Gao
- Department of CT/MRI, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China
| | - Xingyuan Yang
- Department of Radiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China
| | - Shaoqiang He
- Department of Radiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China
| | - Ying Liu
- Department of CT/MRI, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China.
| | - Wei Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang St, Qiaoxi District, Shijiazhuang, Hebei, CN 050050, China.
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Schanda JE, Obermayer-Pietsch B, Sommer G, Heuberer PR, Laky B, Muschitz C, Pastl K, Pastl E, Fialka C, Mittermayr R, Grillari J, Foessl I. Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair. BMC Musculoskelet Disord 2022; 23:422. [PMID: 35513813 PMCID: PMC9069722 DOI: 10.1186/s12891-022-05371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Suture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters. Methods First, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60° angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135°. Results Mean age of all specimens was 53.6 ± 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems. Conclusions The AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05371-0.
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Affiliation(s)
- Jakob E Schanda
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria. .,Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria. .,Michael Ogon Laboratory for Orthopaedic Research, Vienna, Austria.
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Philipp R Heuberer
- healthPi Medical Center, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Christian Muschitz
- II Medical Department, Vinforce, St. Vincent Hospital Vienna, Vienna, Austria
| | | | - Eva Pastl
- surgebright GmbH, Lichtenberg, Austria
| | - Christian Fialka
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Department of Traumatology, Sigmund Freud Medical University Vienna, Vienna, Austria
| | - Rainer Mittermayr
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Science (BOKU), Vienna, Austria
| | - Ines Foessl
- Michael Ogon Laboratory for Orthopaedic Research, Vienna, Austria
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Hinz N, Dehoust J, Münch M, Seide K, Barth T, Schulz AP, Frosch KH, Hartel MJ. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg 2022; 48:3541-3560. [PMID: 35305114 PMCID: PMC9532317 DOI: 10.1007/s00068-022-01936-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01936-9.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Arndt-Peter Schulz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Shao B, Teng H, Dong S, Liu Z. Finite element contact stress analysis of the temporomandibular joints of patients with temporomandibular disorders under mastication. Comput Methods Programs Biomed 2022; 213:106526. [PMID: 34813983 DOI: 10.1016/j.cmpb.2021.106526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Temporomandibular disorders (TMD) represent a group of diseases occurred in the temporomandibular joint (TMJ) and its surrounding tissues. In epidemiological studies, up to 75% of adults have shown at least one sign of temporomandibular disorders during their examinations. The incongruous biomechanical environment in the TMJ is the main pathogenic factor of TMD. This study attempts to determine the mechanical differences in different groups of TMD patients through biomechanics and to explain the mechanical pathogenesis of TMD according to various cases. METHODS Eleven control subjects and eleven TMD patients were selected and divided into three groups: the control group, bilateral TMD group, and unilateral TMD group. The contact stresses of the articular discs, condyles and temporal bones were analyzed using finite element method and statistical analysis of variance. RESULTS The results indicated that the contact stresses in the joints with TMD were significantly greater in the Bi-Group (Bilateral TMD patients) compared to the Control-Group. The TMD side always exhibited greater stresses in the Uni-Group [Unilateral TMD patients) under various conditions (clenching on the TMD side or asymptomatic side). The greatest stress of all the groups occurred at the contralateral side with TMD when clenching on the asymptomatic side. CONCLUSIONS Excessive protection would lead to greater stress on the affected side and increased TMD risk on the asymptomatic side. Clinically, the abnormal stress distributions of the disc represented poor buffering and articular clicking. The asymmetric distributions of the articular fossa manifested the deviation of mouth opening or inconsistent TMJ loading.
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Affiliation(s)
- Bingmei Shao
- Basic Mechanics Lab, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, 644600, China
| | - Haidong Teng
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, 644600, China
| | - Shiming Dong
- Department of Mechanics & Engineering, College of Architecture and Environment, Sichuan University, Chengdu 610065, China
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, 644600, China.
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Wang K, Ni M, Liao P, Dou B, Yan X, Lv L, Zhang F, Mei J. Fracture morphology and biomechanical characteristics of Pauwels III femoral neck fractures in young adults. Injury 2021; 52:3227-3238. [PMID: 34481668 DOI: 10.1016/j.injury.2021.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pauwels classification, which categorizes types of femoral neck fractures, cannot fully reflect the three-dimensional characteristics of this injury. The purpose of our study was to determine the morphological characteristics of Pauwels III fractures through computed tomography image analysis and summarize the relevant biomechanical characteristics of different morphological fractures. METHODS We retrospectively reviewed a total of 209 patients diagnosed with Pauwels type III femoral neck fractures. Fracture reduction was simulated based on mirror symmetry of the bilateral femur by Mimics. The fracture angle was measured and subtypes were defined. Biomechanical characteristics were compared by finite element analysis and validated using a biomechanical experiment, which was performed on a cadaveric sample. RESULTS Pauwels III femoral neck fractures can be divided into three subtypes: anterior, posterior, and classical. The proportion of three subtypes was 28.71%, 67.46%, and 3.82%, respectively. The anterior subtype showed the lowest axial stiffness but highest implant and bone stress. High stress distributions was concentrated on the screw-bone interface and screw-plate connections. CONCLUSIONS Biomechanical differences across the three subtypes of Pauwels III femoral neck fractures could increase our understanding of the biomechanical characteristics that underlie the Pauwels type III femoral neck fractures (such as, three-dimensional morphology and the stress distribution of bone and implant) that have been associated with high failure rates.
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Affiliation(s)
- Kaiyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, P.R.China.
| | - Ming Ni
- Department of Orthopedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine&Health Sciences, No.490 Chuanhuan South Rd., Shanghai 201299, China.
| | - Peng Liao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, P.R.China.
| | - Bang Dou
- Department of Orthopedic Surgery, Songjiang District Central Hospital, No.746 Zhongshan Middle Rd., Shanghai 201600, China.
| | - Xu Yan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, P.R.China.
| | - Lin Lv
- Department of Orthopedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine&Health Sciences, No.490 Chuanhuan South Rd., Shanghai 201299, China.
| | - Fangfang Zhang
- Department of Orthopedic Surgery, Tongji University School of Medicine, Tongji Hospital, No.200 People's Avenue, Shanghai , 200065, China.
| | - Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, P.R.China.
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Ott N, Harland A, Knevels M, Hackl M, Leschinger T, Lanzerath F, Scaal M, Wegmann K, Müller LP. The role of the brachialis muscle in elbow stability with collateral ligament injury: A biomechanical investigation. Clin Biomech (Bristol, Avon) 2021; 89:105478. [PMID: 34517193 DOI: 10.1016/j.clinbiomech.2021.105478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/21/2021] [Accepted: 09/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The brachialis muscle lies in close anatomic relation to the anterior capsule of the elbow joint. The contribution of the brachialis muscle to elbow stability has not yet been fully investigated. Therefore, the aim of this biomechanical in-vitro study was to analyze its influence on joint stability. METHODS Nine fresh frozen cadaveric elbows were evaluated for stability against valgus and varus/posterolateral rotatory forces. Brachialis loading was measured indirectly using strain gauges. Three distinct scenarios were analyzed: A) with intact lateral ulnar and ulnar collateral ligaments B) with a ruptured lateral ulnar collateral ligament C) with ruptured lateral ulnar and ulnar collateral ligaments. FINDINGS In all scenarios, an increased strain was observed under posterolateral rotatory/varus forces. The maximum measured strain occurred with elbow flexion of 30° and pronation of the forearm. The strain was significantly higher with dual-ligament rupture (mean - 210.5 μm/m; min. 97.8 μm/m; max. -310 μm/m; SD 107.8 μm/m; p = .034) compared to intact ligaments (mean - 106.9 μm/m; min. -32.51 μm/m, max. -287 μm/m; SD 100.2 μm/m) and single-ligament rupture (mean - 109.5 μm/m; min. - 96.7 μm/m; max - 130.4 μm/m; SD 18.2). INTERPRETATION A strain of the brachialis muscle was observed under varus/posterolateral rotatory forces with a pronated forearm and the strain increased significantly in the event of a dual-ligament rupture. This suggests that the brachialis muscle may influence varus/posterolateral rotatory stability of the elbow. Hence, a concomitant tear of the brachialis muscle might result in pronounced instability following simple elbow dislocation. LEVEL OF EVIDENCE Basic Science Study, Biomechanics.
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Zhang Q, Chon T, Zhang Y, Baker JS, Gu Y. Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads. Comput Biol Med 2021; 136:104745. [PMID: 34388472 DOI: 10.1016/j.compbiomed.2021.104745] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - TeoEe Chon
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China; School of Chemical and Biomedical Engineering, Nanyang Technological University, 639798, Singapore
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Julien S Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China.
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Kamara A, Ji X, Liu C, Liu T, Wang E. The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model. Injury 2021; 52:1310-1315. [PMID: 33516568 DOI: 10.1016/j.injury.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/01/2021] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed at finding out the effect of exit height, trajectory and number of pins on the stability of cross and divergent-lateral pins used in the fixation of extension-type, transverse supracondylar humerus fracture (SHF) in children, based on finite element analysis. METHODS Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and divergent-lateral pinning models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. RESULTS Two-cross pins and 2-divergent-lateral pins were more stable against torsional and translation forces respectively, while 3-cross pins were the most stable against all forces. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a middle third ONC distal pin provided the best stiffness among the 2-lateral pins. A third olecranon fossa pin greatly enhanced stability of the 2-lateral pins. CONCLUSION For typical transverse fractures, 2-cross pins are found to be superior to 2-divergent lateral pins only against torsional forces. Pins exiting at the upper border of the MDJ provides the best mechanical stability with 2-cross pins. Two-divergent-lateral pins with a distal pin going through the middle third of the ONC provides the best mechanical stability against translation forces for these transverse fractures. Three-cross pins however offer the best mechanical stability against both translation and torsional forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.
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Affiliation(s)
- Allieu Kamara
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China; Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, 1 Percival Street, Freetown, Sierra Leone
| | - Xianglu Ji
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chuang Liu
- State Key Laboratory of Mechanical Behavior and System Safety of Traffic Engineering Structures, Shijiazhuang Tiedao University, Shijiazhuang 050000, Hebei Province, China
| | - Tianjing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
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Jarvers JS, Schleifenbaum S, Pfeifle C, Oefner C, Edel M, von der Höh N, Heyde CE. Comparison of three different screw trajectories in osteoporotic vertebrae: a biomechanical investigation. BMC Musculoskelet Disord 2021; 22:418. [PMID: 33952236 PMCID: PMC8101169 DOI: 10.1186/s12891-021-04254-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pedicle screw insertion in osteoporotic patients is challenging. Achieving more screw-cortical bone purchase and invasiveness minimization, the cortical bone trajectory and the midline cortical techniques represent alternatives to traditional pedicle screws. This study compares the fatigue behavior and fixation strength of the cement-augmented traditional trajectory (TT), the cortical bone trajectory (CBT), and the midline cortical (MC). METHODS Ten human cadaveric spine specimens (L1 - L5) were examined. The average age was 86.3 ± 7.2 years. CT scans were provided for preoperative planning. CBT and MC were implanted by using the patient-specific 3D-printed placement guide (MySpine®, Medacta International), TT were implanted freehand. All ten cadaveric specimens were randomized to group A (CBT vs. MC) or group B (MC vs. TT). Each screw was loaded for 10,000 cycles. The failure criterion was doubling of the initial screw displacement resulting from the compressive force (60 N) at the first cycle, the stop criterion was a doubling of the initial screw displacement. After dynamic testing, screws were pulled out axially at 5 mm/min to determine their remaining fixation strength. RESULTS The mean pull-out forces did not differ significantly. Concerning the fatigue performance, only one out of ten MC of group A failed prematurely due to loosening after 1500 cycles (L3). Five CBT already loosened during the first 500 cycles. The mean displacement was always lower in the MC. In group B, all TT showed no signs of failure or loosening. Three MC failed already after 26 cycles, 1510 cycles or 2144 cycles. The TT showed always a lower mean displacement. In the subsequent pull-out tests, the remaining mean fixation strength of the MC (449.6 ± 298.9 N) was slightly higher compared to the mean pull-out force of the CBT (401.2 ± 261.4 N). However, MC (714.5 ± 488.0 N) were inferior to TT (990.2 ± 451.9 N). CONCLUSION The current study demonstrated that cement-augmented TT have the best fatigue and pull-out characteristics in osteoporotic lumbar vertebrae, followed by the MC and CBT. MC represent a promising alternative in osteoporotic bone if cement augmentation should be avoided. Using the patient-specific placement guide contributes to the improvement of screws' biomechanical properties.
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Affiliation(s)
- J-S Jarvers
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.
| | - S Schleifenbaum
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - C Pfeifle
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C Oefner
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - M Edel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - N von der Höh
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
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Yao Y, Yuan H, Huang H, Liu J, Wang L, Fan Y. Biomechanical design and analysis of auxetic pedicle screw to resist loosening. Comput Biol Med 2021; 133:104386. [PMID: 33878515 DOI: 10.1016/j.compbiomed.2021.104386] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pedicle screws are widely used in fusion surgery, while screw loosening often occurrs. An auxetic structures based pedicle screw was proposed to improve the bone-screw fixation by radial expansion of the screw body under tensile force to resist pulling out. It was optimized to obtain excellent anti-pullout ability for a particular bone based on the biomechanical interaction between screw and surrounding bone. METHODS The screw was designed based on re-entrant unit cells. The mechanical properties of it were adjusted by the wall thickness (t) and re-entrant angle (θ) of the unit cell, and characterized using finite element (FE) method. The designed screws were manufactured using 3D-printing, and Ti6Al4V as the materials. Subsequently, the pullout FE models were established, and verified by pulling the fabricated screws out of Sawbone blocks. The pulling out processes of screws from bone were simulated to explore the optimizing design of the screw. RESULTS The mechanical properties of the screw could be adjusted in a wide range. The biomechanical interaction between the screw and bone can affect the anti-pullout performance of the screw. With an identical elastic modulus (E), better auxiticity of the screw, resulted in a better anti-pullout performance; while an appropriate E is the necessary condition for its excellent anti-pullout performance for a particular bone. CONCLUSION Appropriate mechanical properties are necessary for the auxetic pedicle screw with excellent screw-bone fixation performance for a particular bone, which can be obtained by rationally designing the wall thickness and re-entrant angle of the unit cells.
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Affiliation(s)
- Yan Yao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Hao Yuan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Huiwen Huang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Jinglong Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; School of Engineering Medicine, Beihang University, Beijing, 100191, China.
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Kang J, Zhang J, Zheng J, Wang L, Li D, Liu S. 3D-printed PEEK implant for mandibular defects repair - a new method. J Mech Behav Biomed Mater 2021; 116:104335. [PMID: 33494021 DOI: 10.1016/j.jmbbm.2021.104335] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Functional reconstruction of large-size mandibular continuity defect is still a major challenge in the oral and maxillofacial surgery due to the unsatisfactory repair effects and various complications. This study aimed to develop a new functional repair method for mandibular defects combined with 3D-printed polyetheretherketone (PEEK) implant and the free vascularized fibula graft, and evaluated the service performance of the implant under whole masticatory motion. The design criteria and workflows of the mandibular reconstruction were established based on the requirements of safety, functionality, and shape consistency. Both the biomechanical behavior and the mechanobiological property of mandibular reconstruction under various masticatory motion were investigated by the finite element analysis. The maximum von Mises stress of each component was lower than the yield strength of the corresponding material and the safety factor was more than 2.3 times, which indicated the security of the repair method can be guaranteed. Moreover, the actual deformation of the reconstruction model was lower than that of the normal mandible under most clenching tasks, which assured the primary stability. More than 80% of the volume elements in the bone graft can obtain effective mechanical stimulation, which benefited to reduce the risks of bone resorption. Finally, the novel repair method was applied in clinic and good clinical performances have been achieved. Compared with the conventional fibular bone graft for surgical mandibular reconstruction, this study provides excellent safety and stability to accomplish the functional reconstruction and aesthetic restoration of the mandible defect.
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Bliemel C, Anrich D, Knauf T, Oberkircher L, Eschbach D, Klasan A, Debus F, Ruchholtz S, Bäumlein M. More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures. Arch Orthop Trauma Surg 2021; 141:1197-1205. [PMID: 32856181 PMCID: PMC8215035 DOI: 10.1007/s00402-020-03586-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Surgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure. This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures. MATERIALS AND METHODS On eight pairs of non-osteoporotic human femora (mean age 74 years; range 57-95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode. RESULTS Specimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996-2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662-3538 N) (p = 0.018). Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035). CONCLUSIONS An additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.
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Affiliation(s)
- Christopher Bliemel
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Dan Anrich
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Tom Knauf
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Ludwig Oberkircher
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Daphne Eschbach
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Antonio Klasan
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Florian Debus
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Steffen Ruchholtz
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Martin Bäumlein
- grid.411067.50000 0000 8584 9230Center for Orthopaedics and Trauma Surgery, University Hospital Giessen-Marburg, Baldingerstrasse, 35043 Marburg, Germany
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Brunasso L, Alotta G, Zingales M, Iacopino DG, Graziano F. Can biomechanical analysis shed some light on aneurysmal pathophysiology? Preliminary study on ex vivo cerebral arterial walls. Clin Biomech (Bristol, Avon) 2021; 81:105184. [PMID: 33309932 DOI: 10.1016/j.clinbiomech.2020.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pathophysiology of cerebral aneurysm is complex and poorly understood, and it can have the most catastrophic clinical presentation. Flow dynamics is a key player in the initiation and progression of aneurysm. Better understanding the interaction between hemodynamic loading and biomechanical wall responses can help to add the missing piece on aneurysmal pathophysiology. In this laboratory study we aimed to analyze the effect of the application of a mechanical force to cerebral arterial walls. METHODS Displacement control tests were performed on five porcine cerebral arteries. The test machine was the T150 Nanotensile. The stiffness variation with the increment of the strain level is modeled as the outcome of an isotropic hyperelastic material model. FINDINGS Through the application of an axial force we obtained Stress/Strain curves that showed a marked isotropic hyperelastic behavior, characterized by an increasing of stiffness with the level of strain. This behavior of the cerebral arterial wall is different from the well-established behavior of other arterial vessel (as the aortic vessel) characterized by a marked anisotropic behavior. Additionally, the data scattering observed for higher values of the applied stress are related to different individual packing of collagen fibers that represent the load-bearing mechanics at higher level of the strain. INTERPRETATION The data obtained by test in this paper represent a first step in our ongoing research about the mechanics of multi-axial loads on cerebral arterial walls, and in producing more comprehensive patient-specific calculations for potential applications on cerebral aneurysm management.
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Affiliation(s)
- L Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - G Alotta
- Dipartimento di Ingegneria Civile, dell'Energia, dell'Ambiente, e dei Material, Università degli Studi "Mediterranea" di Reggio Calabria, Via Graziella-Vito, 89122 Reggio Calabria, RC, Italy
| | - M Zingales
- Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, Università degli Studi di Palermo, Viale delle Scienze ed.18, Palermo, Italy; Dipartimento di Ingegneria, Viale delle Scienze, Università degli Studi di Palermo,ed.8, 90128 Palermo, Italy.
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy; Azienda ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS), "G. Garibaldi", Piazza S. Maria di Gesù n.5, 95124 Catania, Italy
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Wolfsegger T, Hauser A, Wimmer S, Neuwirth K, Assar H, Topakian R. A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2020; 201:106402. [PMID: 33348122 DOI: 10.1016/j.clineuro.2020.106402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND A systematic approach to patients with suspected idiopathic normal pressure hydrocephalus (iNPH) is essential to recognize the subset of patients who may benefit from ventriculoperitoneal shunt surgery (VPS). Quantitative biomechanical analysis of gait and balance (QBAGB) may help objectify the response to the cerebrospinal fluid tap test (CSF-TT) and VPS outcome after 3 months and support identification of candidates for VPS. METHODS We retrospectively reviewed data from all patients with probable iNPH who 1) underwent clinico-radiological and neuropsychological assessments using validated scales (iNPH Scale and iNPH Radscale) at our centre in the period from January to December 2018; and 2) had completed QBAGB before CSF-TT ('baseline'), shortly after CSF-TT, and at three months after either VPS or conservative treatment. RESULTS At the time-points 'after CSF-TT' and '3 months', patients with iNPH and VPS (n = 11) significantly improved on the Kiefer Scale score, iNPH Scale total score and gait domain score, as well as in gait velocity and step length measured by QBAGB. In contrast, patients without surgery (n = 10) had unchanged iNPH Scale scores and motor performance throughout. Using data from all patients, we calculated cut-off levels for substantial improvements in gait velocity, step length, and the iNPH Scale domain gait score at the time-point 'after CSF-TT'. CONCLUSION QBAGB helps to objectify the response to CSF-TT to select candidates for VPS and corroborates clinico-radiological and neuropsychological data derived from validated scales. The QBAGB cut-off values for substantial improvement after CSF-TT need further elucidation in larger, preferably prospective studies.
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Affiliation(s)
- Thomas Wolfsegger
- Department of Neurology 1, Kepler University Hospital, Neuromed Campus, Linz, Austria.
| | - Anna Hauser
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Sibylle Wimmer
- Institute of Neuroradiology, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Katharina Neuwirth
- Clinical Psychology, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Hamid Assar
- Department of Neurology 1, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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Wisanuyotin T, Sirichativapee W, Paholpak P, Kosuwon W, Kasai Y. Optimal configuration of a dual locking plate for femoral allograft or recycled autograft bone fixation: A finite element and biomechanical analysis. Clin Biomech (Bristol, Avon) 2020; 80:105156. [PMID: 32862075 DOI: 10.1016/j.clinbiomech.2020.105156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Allografts and recycled bone autograft are commonly used for biological reconstruction. The dual locking plates fixation method has been advocated for increasing allograft stability and preventing fixation failure; however, the biomechanical properties of the various configurations of dual locking plates have not been extensively studied. METHODS In a finite element (FE) analysis, we developed 6 patterns of different dual locking plate configurations for fixation of the mid shaft of the femur. The maximum strains were recorded for each of the 6 models then axial, bending and torsion stiffness were calculated. The FE analysis was validated the results with mechanical testing (axial compression, bending, and torsional stiffness) on a cadaveric femur. FINDINGS The highest axial compression (715.41 N/mm) and lateral bending (2981.24 N/mm) was found in Model 4 (with two 10-hole locking plates placed at the medial and lateral side), while the highest torsional stiffness (193.59 N·mm /mm) was found in Model 3 (with 8- and 10-hole locking plates placed at the posterior and lateral side). Excellent agreement was found between the finite element analysis and biomechanical testing (r2 = 0.98). INTERPRETATION The dual locking plate configuration with medial and lateral, 10-hole locking plates provided the most rigid and strongest fixation of the femur; both in terms of axial compression and lateral bending stiffness.
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Affiliation(s)
- Taweechok Wisanuyotin
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, 40002, Thailand.
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Weerachai Kosuwon
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Yuichi Kasai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, 40002, Thailand
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Xu H, Li X, Shi Y, An L, Taylor D, Christman M, Morse J, Merryweather A. Hospital bed height influences biomechanics during bed egress: A comparative controlled study of patients with Parkinson disease. J Biomech 2020; 115:110116. [PMID: 33228960 DOI: 10.1016/j.jbiomech.2020.110116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
Although a significant proportion of patient falls occur during egress from the hospital bed, the biomechanical adaptations during egress from different bed heights are still largely unknown. The purpose of this study was to evaluate the effect of hospital bed height on natural transition during egress in patients with Parkinson disease (PD). Twelve patients with PD and fourteen healthy elderly adults (HEA) were recruited and the natural transition during egress from three different bed heights (low, medium and high) were recorded for each participant using a motion capture system and force plates. The bed egress time, joint kinematics, ground reaction force and center of mass (CoM) were compared using a two-factor repeated ANOVA to determine the effects of three bed heights and two groups. The results showed that patients with PD had a significantly increased bed egress time, decreased peak of pelvis anterior tilt, hip flexion, and anteroposterior distance between pelvis center and CoM compared to HEA. Additionally, both PD and HEA groups increased the peak of trunk, hip and knee flexions to generate forward CoM momentum and joint torque to rise from a low bed height. These findings indicated that patients with PD invoked a more conservative movement pattern than HEA during egress to improve postural stability. The low bed height increased demands of balance and postural control during egress which exacerbates the risk of falls for patients with PD.
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Affiliation(s)
- Hang Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Xiaotong Li
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Yuanyuan Shi
- The Second Clinical Medicine College, Xuzhou Medical University, Xuzhou, China
| | - Lun An
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Dorothy Taylor
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Marissa Christman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Janice Morse
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
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Matthews JR, Wang J, Zhao J, Kluczynski MA, Bisson LJ. The influence of suture materials on the biomechanical behavior of suture-meniscal specimens: a comparative study in a porcine model. Knee Surg Relat Res 2020; 32:42. [PMID: 32859270 PMCID: PMC7453549 DOI: 10.1186/s43019-020-00053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Repair of a meniscal tear is indicated in certain conditions. Despite extensive research on the biomechanics of various repair methods, there has been minimal investigation of whether the suture material influences the meniscal-suture construct. The purpose of this study was to compare the biomechanical properties of nine different suture materials under cyclic and load-to-failure conditions. Methods Ninety porcine menisci were randomly allocated to simple suture placement using either Ultrabraid®, Ultratape®, Magnum Wire®, TigerWire®, TigerTape®, LabralTape®, Orthocord®, 0 FiberWire®, or 2-0 FiberWire®. Each suture-meniscus specimen underwent cyclic loading followed by load-to-failure testing. Elongation, maximum load to failure, stiffness, and mode of failure were recorded and compared between each suture type using non-parametric testing. Mean ± standard deviation was reported and the statistical significance was p < 0.05. Results Elongation during cyclic loading was lowest with 2-0 FiberWire (0.95 ± 0.17 mm); this value was statistically significantly different than the results for all other sutures except 0 FiberWire® (1.09 ± 0.17 mm, p = 0.79), TigerWire® (1.09 ± 0.29 mm, p = 0.85), TigerTape® (1.39 ± 0.29 mm, p = 0.08), and LabralTape® (1.20 ± 0.33 mm, p = 0.41). The highest elongation was seen with Ultrabraid® (1.91 ± 0.34 mm); this value was statistically significantly greater than the results for all other suture materials except Orthocord® (1.59 mm ± 0.31 mm, p = 0.46) and Magnum Wire® (1.43 ± 0.25 mm, p = 0.14). Load to failure was highest for TigerTape® (287.43 ± 41.15 N), and this result was statistically significantly different than the results for all other sutures except LabralTape® (271.34 ± 48.48 N, p = 0.99) and TigerWire® (251.03 ± 25.8 N, p = 0.51). Stiffness was highest for LabralTape® (195.77 ± 49.06 N/mm), and this result was statistically significantly different than the results for all other sutures except TigerWire® (186.49 ± 19.83 N/mm, p = 0.45) and TigerTape® (173.35 ± 15.60 N/mm, p = 0.19). The majority of sutures failed by pullout (n = 46, 51%) or tearing (n = 40, 45%). Conclusion Suture design and material affect the biomechanical behavior of porcine meniscal-suture specimens. LabralTape®, TigerWire®, and TigerTape® demonstrated better overall combinations of low elongation, high maximum load to failure, and high stiffness.
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Affiliation(s)
- John Reza Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Jiefei Wang
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jiwei Zhao
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Wang X, Yeung K, Cheung JPY, Lau JY, Qi W, Cheung KM, Aubin CE. A novel scoliosis instrumentation using special superelastic nickel-titanium shape memory rods: a biomechanical analysis using a calibrated computer model and data from a clinical trial. Spine Deform 2020; 8:369-79. [PMID: 32096138 DOI: 10.1007/s43390-020-00075-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/01/2019] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Biomechanical analysis of scoliosis instrumentation using superelastic Nickel-titanium shape memory (SNT) rods. OBJECTIVE To compare SNT with conventional Titanium (Ti) and Cobalt-chrome (Co-Cr) rods. A clinical trial has documented comparable efficacy between two adolescent idiopathic scoliosis (AIS) cohorts instrumented using SNT versus conventional Ti rods. The shape memory and superelasticity of the SNT rod are thought to allow easy rod insertion, progressive curve correction, and correction from spinal tissue relaxation, but study is yet to be done to assess the effects of the shape memory and superelasticity. METHODS Instrumentations of AIS patients from the clinical trial were computationally simulated using SNT, Ti and Co-Cr rods (5.5 or 6 mm; 30°, 50° or 60° sagittal contouring angles; 0°, 25° or 50° coronal over-contouring angles). Curve correction, its improvement from stress relaxation in the spine, and loads in the instrumentation constructs were computed and compared. RESULTS The simulated main thoracic Cobb angles (MT) and thoracic kyphosis with the SNT rods were 4°-7° higher and 1°-2° lower than the Ti and Co-Cr rods, respectively. Bone-implant forces with Ti and Co-Cr rods were higher than the SNT rods by 84% and 130% at 18 °C and 35% and 65% at 37 °C, respectively (p < 0.001). Further corrections of the MT from the simulated stress relaxation in the spine were 4°-8° with the SNT rods versus 2°-5° with the Ti and Co-Cr rods (p < 0.001). CONCLUSION This study concurs with clinical observation that the SNT rods are easier to insert and can result in similar correction to the conventional rods. The SNT rods allow significantly lower bone-implant forces and have the ability to take advantage of post-instrumentation correction as the tissues relax.
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Christen S, Larsson P, Hainich J, Gruenert J, Brodbeck M. Biomechanical analysis of a new 8-strand technique for flexor tendon repair. Hand Surg Rehabil 2020; 39:442-7. [PMID: 32450161 DOI: 10.1016/j.hansur.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/25/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022]
Abstract
We sought to compare the strength and rupture sites of a new 8-strand suture technique with those of an established 6-strand flexor tendon repair through biomechanical analysis. This new 8-strand suture pattern places minimal suture material in the remodeling zone and focuses on protecting the knot, a well-known weak point of the suture construct. The knot was buried within the tendon so as to not interfere with tendon gliding. In a biomechanical simulation, strength and rupture sites were compared with those of the 6-strand repair. We repaired a total of 54 porcine flexor tendons using one of the two techniques (n=27 each). Tensile strength at 2-mm gap formation and ultimate failure load were determined. Afterwards, we dissected the tendons to identify the rupture site of the suture material. The new 8-strand suture had a significant higher ultimate load to failure (87.7N) and 2-mm gap load (71.6N) compared to the 6-strand technique (57.7N and 45.9N) (P<0.001). Whereas the rupture site of the core suture in the 6-strand technique was mainly located next to the knot (81.5%), the suture seemed to fail independently from this weak spot in the 8-strand technique (11.1%). This new 8-strand technique achieves a strong flexor tendon repair in a biomechanical model. Additional cross-locking on either side of the knot seems to contribute to the repair's strength. The resulting higher ultimate failure load and 2-mm gap load may allow more aggressive active motion-based postoperative rehabilitation.
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Ota T, Demura S, Kato S, Yoshioka K, Hayashi H, Inoue K, Shinmura K, Yokogawa N, Shirai T, Murakami H, Tsuchiya H. A comparison of bone conductivity on titanium screws inserted into the vertebra using different surface processing. J Exp Orthop 2020; 7:29. [PMID: 32405666 PMCID: PMC7221053 DOI: 10.1186/s40634-020-00250-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Antibacterial iodine-supported titanium has an anodized oxide layer; thus, it can be expected to have a higher osteoconductivity than untreated titanium. This study aimed to compare the osteoconductivity between untreated titanium (Ti), anodically oxidized titanium (AO-Ti), and iodine-supported titanium (I-Ti) screws. METHODS The screws were inserted into the vertebral bodies of 30 dogs (12 for the biomechanical, and 18 for the histological examination). The vertebral bodies were analyzed at 4 or 8 weeks after screw insertion. Biomechanically, rotational torque of the screw was measured. Histologically, bone formation index (ratio of the length of the part where the bone directly contacts with the length of the screw) and bone volume density (ratio of the area of the bone tissue to the area between the threads of the screw) were measured. RESULT At 4 weeks, the torque value was significantly higher in the AO-Ti (0.59 ± 0.16 Nm) and I-Ti (0.72 ± 0.14 Nm) groups than in the Ti group (0.39 ± 0.12 Nm), with the AO-Ti and I-Ti groups showing no significant difference. Bone formation index was significantly higher in the AO-Ti (72.5% ± 0.8%) and I-Ti (73.4% ± 1.5%) groups than in the Ti group (64.6% ±1.7%), with the AO-Ti and I-Ti groups showing no significant difference. Bone volume density did not show a significant difference. At 8 weeks, the results were similar to those at 4 weeks. CONCLUSIONS I-Ti had a higher osteoconductivity than Ti, indicating that iodine coating did not adversely affect osteoconductivity.
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Affiliation(s)
- Takashi Ota
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Kei Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Medical School, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
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Bäumlein M, Klasan A, Klötzer C, Bockmann B, Eschbach D, Knobe M, Bücking B, Ruchholtz S, Bliemel C. Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures - biomechanical investigation of a new fixation device. BMC Musculoskelet Disord 2020; 21:226. [PMID: 32278344 PMCID: PMC7149902 DOI: 10.1186/s12891-020-03215-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Implant anchorage in highly osteoporotic bone is challenging, since it often leads to osteosynthesis failure in geriatric patients with supracondylar femoral fractures. Cementation of screws is presumed to prevent such osteosynthesis failure. This study aimed to investigate the effect of a newly designed, cementable fenestrated condylar screw for plate fixation in a biomechanical setting. Methods Eight pairs of osteoporotic cadaver femora with an average age of 77 years, ranging between 62 and 88 years, were randomly assigned to either an augmented or a non-augmented group. In both groups an instable 33-A3 fracture according to the AO / OTA classification was fixed with an angular stable locking plate. All right samples received a cement augmentation of their fenestrated condylar screws with calcium phosphate bone cement (CPC). Mechanical testing was performed at a load to failure mode by cyclic axial loading, using a servohydraulic testing machine. Results With a mean of 2475 N (95% CI: 1727–3223 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimen with cemented condylar screws as compared to non-cemented samples (1875 N (95% CI: 1320–2430 N)) (p = 0.024). In both groups the deformation of the constructs, with the distal screws cutting through the condylar bone, were the most frequent cause for failure. Analysis of axial stiffness (p = 0.889) and irreversible deformity of the specimens revealed no differences between the both groups (p = 0.161). No cement leakage through the joint line or the medial cortex was observed. Conclusion Based on the present study results, the newly introduced, cementable condylar screw could be an encouraging feature for the fixation of supracondylar femoral fractures in patients with reduced bone quality in terms of load to failure accuracy of the cement application.
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Affiliation(s)
- Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Antonio Klasan
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christine Klötzer
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Benjamin Bücking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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Virk MS, Aiyash SS, Frank RM, Mellano CS, Shewman EF, Wang VM, Romeo AA. Biomechanical comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair technique in a cadaveric arthroplasty model. J Orthop Surg Res 2019; 14:391. [PMID: 31779665 PMCID: PMC6883688 DOI: 10.1186/s13018-019-1372-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Management of the subscapularis during shoulder arthroplasty is controversial. The purpose of this study was to compare the biomechanical performance of subscapularis peel (SP) and lesser tuberosity osteotomy (LTO) in a cadaveric model. METHODS The subscapularis and proximal humerus were dissected from all soft tissues in 21 fresh-frozen human cadaveric shoulders and randomized to undergo SP, LTO, or standard subscapularis tenotomy (ST, control). For SP and LTO, six #5 sutures were passed through eyelets in the implant (on lateral border and through drill holes in bicipital groove [2] and under trunion [4]). Double-row repair was performed using two lateral row transosseous sutures and four medial row sutures through the tendon (SP) or osseotendinous junction (LTO). Biomechanical properties and mode of failure were tested. RESULTS There were no significant differences in elongation amplitude, cyclic elongation, or maximum load to failure between the three groups (P > 0.05). Mean stiffness was significantly higher in LTO (P = 0.009 vs. SP and ST). In the ST group, 7/7 specimens failed at the tendon-suture interface. For SP, 4/7 failed at the tendon-suture interface, one at the suture-bone interface, one fractured around the implant stem, and one at the knots. For LTO, 3/7 failed at the tendon-suture interface, two at the suture-bone interface and two fractured around the implant stem. CONCLUSIONS In this cadaveric model, subscapularis repair via ST, SP, and LTO techniques was biomechanically equivalent. Additional studies are needed to confirm these findings and determine the influence of biologic healing on healing rates and clinical outcomes. LEVEL OF EVIDENCE N/a, biomechanical laboratory study.
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Affiliation(s)
- Mandeep S Virk
- Department of Orthopaedic Surgery, Division of Shoulder & Elbow, New York University Langone Health, New York, NY, USA
| | - Saleh S Aiyash
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Christopher S Mellano
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Elizabeth F Shewman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Vincent M Wang
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Anthony A Romeo
- Rothman Orthopaedics- New York, 176 3rd Ave, New York, NY, 10003, USA.
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Meng Z, Wang C, Guo X, Chen W, Ding W. Analysis of the disc pressure of the upper thoracic spine using pressure-sensitive film: an experimental study in porcine model-implications for scoliosis progression. Australas Phys Eng Sci Med 2019; 42:1069-1079. [PMID: 31617153 DOI: 10.1007/s13246-019-00804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
There has been few studies focusing on the disc pressure of the upper thoracic spine and it still lacks the quantitative pressure measurement of each spinal disc segment. The aim of this study was to study the pressure changes of intervertebral disc in porcine upper thoracic spine using pressure-sensitive film. Twelve porcine thoracic motion segments were harvested and successively loaded with vertical loads of 100 N, 150 N, and 200 N during 5° of anterior flexion, 5° of posterior extension and 5° of lateral bending. The resulting pressure values were measured. During anterior flexion, the anterior annulus of all segments at all loads showed higher mean pressure values than those during vertical compression, whereas the posterior annulus did not show higher mean values. During posterior extension, the anterior annulus of all segments showed lower mean pressure values than those during vertical compression, whereas the posterior annulus did not show lower mean pressure values. During lateral bending, the annulus of all segments showed higher mean pressure values than those during vertical compression. The posterior thoracic vertebra plays an important role in the motion of the upper thoracic vertebral segment and pressure distribution. During lateral bending, the concave side pressure of the annulus increases obviously, suggesting that asymmetrical force is a contributory factor for scoliosis progression.
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Affiliation(s)
- Zhao Meng
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China.
| | - Chen Wang
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China
| | - Xuzhao Guo
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China
| | - Wei Chen
- Department of Traumatology Orthopaedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Rezaei A, Giambini H, Carlson KD, Xu H, Uthamaraj S, Dragomir-Daescu D, Yaszemski MJ, Lu L. Mechanical testing setups affect spine segment fracture outcomes. J Mech Behav Biomed Mater 2019; 100:103399. [PMID: 31479817 DOI: 10.1016/j.jmbbm.2019.103399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/10/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022]
Abstract
The purpose of the work presented here was to establish an experimental testing configuration that would generate a bending compression fracture in a laboratory setting. To this end, we designed and fabricated a fixture to accommodate a three level spine segment and to be able to perform mechanical testing by applying an off-centric compressive loading to create a flexion-type motion. Forces and moments occurring during testing were measured with a six-channel load cell. The initial testing configuration (Fixture A) included plates connected to the superior potted vertebral body and to the ball-socket joint of the testing system ram. Surprisingly, while all cadaveric specimens underwent a similar off-centric compressive loading, most of the specimens showed extension outcomes as opposed to the intended pure-flexion motion. The extension was due to fixture size and weight; by applying an off-centric load directly on the top plate, unintended large shear forces were generated. To resolve the issue, several modifications were made to the original fixture configuration. These modifications included the removal of the superior plates and the implementation of wedges at the superior surface of the fixture (Fixture B). A synthetic sample was used during this modification phase to minimize the number of cadaveric specimens while optimizing the process. The best outcomes were consistently observed when a 15°-wedge was used to provide flexion-type loading. Cadaveric specimens were then experimentally tested to fracture using the modified testing configuration (Fixture B). A comparison between both fixtures, A and B, revealed that almost all biomechanical parameters, including force, moment, and displacement data, were affected by the testing setup. These results suggest that fixture design and implementation for testing is of extreme importance, and can influence the fracture properties and affect the intended motion.
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Affiliation(s)
- Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Kent D Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hao Xu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Michael J Yaszemski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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