Evaluating the stability of external fixators following pelvic injury: A systematic review of biomechanical testing methods

INTRODUCTION

This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs.

METHODS

A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials.

RESULTS

Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques.

DISCUSSION AND CONCLUSION

An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.

Shape or size matters? Towards standard reporting of tensile testing parameters for human soft tissues: systematic review and finite element analysis

Material properties of soft-tissue samples are often derived through uniaxial tensile testing. For engineering materials, testing parameters (e.g., sample geometries and clamping conditions) are described by international standards; for biological tissues, such standards do not exist. To investigate what testing parameters have been reported for tensile testing of human soft-tissue samples, a systematic review of the literature was performed using PRISMA guidelines. Soft tissues are described as anisotropic and/or hyperelastic. Thus, we explored how the retrieved parameters compared against standards for engineering materials of similar characteristics. All research articles published in English, with an Abstract, and before 1 January 2023 were retrieved from databases of PubMed, Web of Science, and BASE. After screening of articles based on search terms and exclusion criteria, a total 1,096 articles were assessed for eligibility, from which 361 studies were retrieved and included in this review. We found that a non-tapered shape is most common (209 of 361), followed by a tapered sample shape (92 of 361). However, clamping conditions varied and were underreported (156 of 361). As a preliminary attempt to explore how the retrieved parameters might influence the stress distribution under tensile loading, a pilot study was performed using finite element analysis (FEA) and constitutive modeling for a clamped sample of little or no fiber dispersion. The preliminary FE simulation results might suggest the hypothesis that different sample geometries could have a profound influence on the stress-distribution under tensile loading. However, no conclusions can be drawn from these simulations, and future studies should involve exploring different sample geometries under different computational models and sample parameters (such as fiber dispersion and clamping effects). Taken together, reporting and choice of testing parameters remain as challenges, and as such, recommendations towards standard reporting of uniaxial tensile testing parameters for human soft tissues are proposed.

Spatiotemporal monitoring of hard tissue development reveals unknown features of tooth and bone development

Mineralized tissues, such as bones or teeth, are essential structures of all vertebrates. They enable rapid movement, protection, and food processing, in addition to providing physiological functions. Although the development, regeneration, and pathogenesis of teeth and bones have been intensely studied, there is currently no tool to accurately follow the dynamics of growth and healing of these vital tissues in space and time. Here, we present the BEE-ST (Bones and tEEth Spatio-Temporal growth monitoring) approach, which allows precise quantification of development, regeneration, remodeling, and healing in any type of calcified tissue across different species. Using mouse teeth as model the turnover rate of continuously growing incisors was quantified, and role of hard/soft diet on molar root growth was shown. Furthermore, the dynamics of bones and teeth growth in lizards, frogs, birds, and zebrafish was uncovered. This approach represents an effective, highly reproducible, and versatile tool that opens up diverse possibilities in developmental biology, bone and tooth healing, tissue engineering, and disease modeling.

Sacrospinous and sacrotuberous ligaments influence in pelvis kinematics

The alteration in mechanical properties of posterior pelvis ligaments may cause a biased pelvis deformation which, in turn, may contribute to hip and spine instability and malfunction. Here, the effect of different mechanical properties of ligaments on lumbopelvic deformation is analyzed via the finite element method. First, the improved finite element model was validated using experimental data from previous studies and then used to calculate the sensitivity of lumbopelvic deformation to changes in ligament mechanical properties, load magnitude, and unilateral ligament resection. The deformation of the lumbopelvic complex relative to a given load was predominant in the medial plane. The effect of unilateral resection on deformation appeared to be counterintuitive, suggesting that ligaments have the ability to redistribute load and that they play an important role in the mechanics of the lumbopelvic complex.

From computed tomography to finite element space: A unified bone material mapping strategy

BACKGROUND

The spatially varying mechanical properties in finite element models of bone are most often derived from bone density data obtained via quantitative computed tomography. The key step is to accurately and efficiently map the density given in voxels to the finite element mesh.

METHODS

The density projection is first formulated in least-squares terms and then discretized using a continuous and discontinuous variant of the finite element method. Both discretization variants are compared with the nodal and element approaches known from the literature.

FINDINGS

In terms of accuracy in the L2 norm, energy distance and efficiency, the discontinuous zero-order variant appears to be the most advantageous. The proposed variant sufficiently preserves the spectrum of density at the edges, while keeping computational cost low.

INTERPRETATION

The continuous finite element method is analogous to the nodal formulation in the literature, while the discontinuous finite element method is analogous to the element formulation. The two variants differ in terms of implementation, computational cost and ability to preserve the density spectrum. These differences cannot be described and measured by known indirect methods from the literature.

Bone mineral density modeling via random field: Normality, stationarity, sex and age dependence

BACKGROUND AND OBJECTIVE

Capturing the population variability of bone properties is of paramount importance to biomedical engineering. The aim of the present paper is to describe variability and correlations in bone mineral density with a spatial random field inferred from routine computed tomography data.

METHODS

Random fields were simulated by transforming pairwise uncorrelated Gaussian random variables into correlated variables through the spectral decomposition of an age-detrended correlation matrix. The validity of the random field model was demonstrated in the spatiotemporal analysis of bone mineral density. The similarity between the computed tomography samples and those generated via random fields was analyzed with the energy distance metric.

RESULTS

The random field of bone mineral density was found to be approximately Gaussian/slightly left-skewed/strongly right-skewed at various locations. However, average bone density could be simulated well with the proposed Gaussian random field for which the energy distance, i.e., a measure that quantifies discrepancies between two distribution functions, is convergent with respect to the number of correlation eigenpairs.

CONCLUSIONS

The proposed random field model allows the enhancement of computational biomechanical models with variability in bone mineral density, which could increase the usability of the model and provides a step forward in in-silico medicine.

Mechanical metric for skeletal biomechanics derived from spectral analysis of stiffness matrix

A new metric for the quantitative and qualitative evaluation of bone stiffness is introduced. It is based on the spectral decomposition of stiffness matrix computed with finite element method. The here proposed metric is defined as an amplitude rescaled eigenvalues of stiffness matrix. The metric contains unique information on the principal stiffness of bone and reflects both bone shape and material properties. The metric was compared with anthropometrical measures and was tested for sex sensitivity on pelvis bone. Further, the smallest stiffness of pelvis was computed under a certain loading condition and analyzed with respect to sex and direction. The metric complements anthropometrical measures and provides a unique information about the smallest bone stiffness independent from the loading configuration and can be easily computed by state-of-the-art subject specified finite element algorithms.

Mechanical Properties of Polypropylene: Additive Manufacturing by Multi Jet Fusion Technology

Multi jet fusion (MJF) technology has proven its significance in recent years as this technology has continually increased its market share. Recently, polypropylene (PP) was introduced by Hewlett-Packard for the given technology. To our knowledge, little is known about the mechanical properties of polypropylene processed by MJF technology. During this study, standardised specimens were printed under all of the major orientations of the machine’s build space. Each of these orientations were represented by five samples. The specimens then underwent tensile, bending and Charpy impact tests to analyse their mechanical properties. The structural analysis was conducted to determine whether PP powder may be reused within the MJF process. The mechanical tests showed that the orientation of the samples significantly influences their mechanical response and must be carefully chosen to obtain the optimal mechanical properties of PP samples. We further showed that PP powder may be reused as the MJF process does not significantly alter its thermal and structural properties.

Shape morphing technique can accurately predict pelvic bone landmarks

Diffeomorphic shape registration allows for the seamless geometric alignment of shapes. In this study, we demonstrated the use of a registration algorithm to automatically seed anthropological landmarks on the CT images of the pelvis. We found a high correlation between manually and automatically seeded landmarks. The registration algorithm makes it possible to achieve a high degree of automation with the potential to reduce operator errors in the seeding of anthropological landmarks. The results of this study represent a promising step forward in effectively defining the anthropological measures of the human skeleton.

Optimal structural pattern for maximal compliance using topology optimization based on phasefields: Application to improve skin graft meshing efficiency

This article focuses on the problem of maximal compliance design of a hyper-elastic solid with the optimal design of human skin grafts as the application in mind. The solution method is a phasefield-based topology optimization method that supposes multiple local phasefields and a minimum distance constraint in order to prevent the phasefields from merging. Consequently, structurally disintegrating solutions such as by the coalescence of voids can be prevented. The method is used to find an optimal graft meshing pattern for a sample that is subjected to a biaxial extension of up to 150%, which corresponds to an expansion ratio of 1 : 2.25. Three prospective unitcell solutions that exhibit meta-material behavior are proposed for a periodic graft pattern. The results are a step toward improving the skin graft meshing efficiency. This work does not cover experimental validation.

Development of an acoustic measurement protocol to monitor acetabular implant fixation in cementless total hip Arthroplasty: A preliminary study

In cementless total hip arthroplasty (THA), the initial stability is obtained by press-fitting the implant in the bone to allow osseointegration for a long term secondary stability. However, finding the insertion endpoint that corresponds to a proper initial stability is currently based on the tactile and auditory experiences of the orthopedic surgeon, which can be challenging. This study presents a novel real-time method based on acoustic signals to monitor the acetabular implant fixation in cementless total hip arthroplasty. Twelve acoustic in vitro experiments were performed on three types of bone models; a simple bone block model, an artificial pelvic model and a cadaveric model. A custom made beam was screwed onto the implant which functioned as a sound enhancer and insertor. At each insertion step an acoustic measurement was performed. A significant acoustic resonance frequency shift was observed during the insertion process for the different bone models; 250 Hz (35%, second bending mode) to 180 Hz (13%, fourth bending mode) for the artificial bone block models and 120 Hz (11%, eighth bending mode) for the artificial pelvis model. No significant frequency shift was observed during the cadaveric experiment due to a lack of implant fixation in this model. This novel diagnostic method shows the potential of using acoustic signals to monitor the implant seating during insertion.