Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Angel D. Castro-Franco,Álvaro González-Ángeles,Ismael Mendoza-Muñoz,Samantha E. Cruz-Sotelo,Ana Maria Castañeda,Miriam Siqueiros-Hernández

doi:10.3390/app10186514

Angel D. Castro-Franco, Álvaro González-Ángeles + Show 4 more

Open Access

https://doi.org/10.3390/app10186514

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Journal: Applied sciences	Publication Date: Sep 18, 2020
Citations: 4	License type: CC BY 4.0

Affiliation: Autonomous University of Baja California

Abstract

Proximal humerus fractures are becoming more common due to the aging of the population, and more related scientific research is also emerging. Biomechanical studies attempt to optimize treatments, taking into consideration the factors involved, to obtain the best possible treatment scenario. To achieve this, the use of finite element analysis (FEA) is necessary, to experiment with situations that are difficult to replicate, and which are sometimes unethical. Furthermore, low costs and time requirements make FEA the perfect choice for biomechanical studies. Part of the complete process of an FEA involves three-dimensional (3D) bone modeling, mechanical properties assignment, and meshing the bone model to be analyzed. Due to the lack of standardization for bone modeling, properties assignment, and the meshing processes, this article aims to review the most widely used techniques to model the proximal humerus bone, according to its anatomy, for FEA. This study also seeks to understand the knowledge and bias behind mechanical properties assignment for bone, and the similarities/differences in mesh properties used in previous FEA studies of the proximal humerus. The best ways to achieve these processes, according to the evidence, will be analyzed and discussed, seeking to obtain the most accurate results for FEA simulations.

Highlights

Fracture of the proximal humerus is becoming one of the most common injuries among the elderly and is related to osteoporosis, which deteriorates the microstructure of the bone and decreases its bone mass [1,2,3,4,5]
Some characteristics are unavoidable in any study of the proximal humerus, such as the bone anatomy, which has to be the same in any model, unlike the bone geometry, which will be specific to the patient of the study
This review highlights the need for a characterization standard for the proximal humerus modeling process; that is, a series of parameters and model characteristics for the tridimensional bone model, which has been shown to better represent the real mechanical behavior of the proximal humerus and to be applicable to any patient-specific model, regardless of the geometry of the bone or the patient’s

Summary

Introduction

Fracture of the proximal humerus is becoming one of the most common injuries among the elderly and is related to osteoporosis, which deteriorates the microstructure of the bone and decreases its bone mass [1,2,3,4,5]. Fracture risk will increase with population aging [6,7,8]: the changes that come with the biological aging process make the elderly more susceptible to suffering a fracture, given that falls are the major risk factor for this group, along with osteoporosis [9,10,11,12]. The treatment for this type of fracture is still debatable, due to the fracture/patient factors involved in the treatment decision process, and the high complication rates of surgical treatments. Computational biomechanical studies have become more common, which try to solve and validate the different aspects of fracture treatments and enhance their outcomes through finite element analysis (FEA), providing a fast and low-cost experimentation technique and, most importantly, helping to prevent premature failures through fracture/treatment behavior analysis

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