Human Tibia Research Articles

Computational Analysis of Bone Remodeling in the Proximal Tibia Under Electrical Stimulation Considering the Piezoelectric Properties.

The piezoelectricity of bone is known to play a crucial role in bone adaptation and remodeling. The application of an external stimulus such as mechanical strain or electric field has the potential to enhance bone formation and implant osseointegration. Therefore, in the present study, the objective is to investigate bone remodeling under electromechanical stimulation as a step towards establishing therapeutic strategies. For the first time, piezoelectric bone remodeling in the human proximal tibia under electro-mechanical loads was analyzed using the finite element method in an open-source framework. The predicted bone density distributions were qualitatively and quantitatively assessed by comparing with the computed tomography (CT) scan and the bone mineral density (BMD) calculated from the CT, respectively. The effect of model parameters such as uniform initial bone density and reference stimulus on the final density distribution was investigated. Results of the parametric study showed that for different values of initial bone density the model predicted similar but not identical final density distribution. It was also shown that higher reference stimulus value yielded lower average bone density at the final time. The present study demonstrates an increase in bone density as a result of electrical stimulation. Thus, to minimize bone loss, for example, due to physical impairment or osteoporosis, mechanical loads during daily physical activities could be partially replaced by therapeutic electrical stimulation.

Observational Study of Gerdy's Tubercle on Fully Ossified Dry Human Left Tibia

Introduction: Gerdy's tubercle is a lateral tubercle of the upper end of tibia where the iliotibial tract inserts. The aim of this study is to find out the shape of Gerdy's tubercle on fully ossified dry human left tibia with their clinical association. Materials and methods: The present study is an observational analytic type of study which was performed on of two hundred (200) fully ossified dry human left tibia of unknown sex, conducted in the department of Anatomy, Sir Salimullah Medical College, from July 2014 to June 2015.In this study fully ossified dry human left tibia of unknown sex were collected from the department of Anatomy and also from the students of Sir Salimullah Medical College (SSMC), Dhaka, Ibrahim Medical College (IMC), Dhaka, Dhaka National Medical College (DNMC), Dhaka and Bangladesh Medical College (BMC), Dhaka. Results: The shape is evaluated subjectively and tubercles classified as type A was found in 55.0%, type B in 13.5 %, type C in 15.5%, type D in 4 %, type E in 9 % and type F in 3%. In male Type A was found in 58.2%, Type B in 15.3%, Type C in 12.2%, Type D in 4.1%, Type E in 8.2% and Type F in 2%. In female Type A was found in 52%, Type B in 11.8%, Type C in 8.6%, Type D in 3.9%, Type E in 9.8% and Type F in 3.9%. Conclusion: The different shapes of Gerdy’s tubercle demonstrated in the present study may contribute to produce significant effect on surgical interventions and some shapes may be more prone to traumatic injuries on it.

A mechanical study of personalised Ti6Al4V tibial fracture fixation plates with grooved surface by finite element analysis

Low shape matching and high stress shielding rates between bone plate and human bone are not conducive to the primary healing of fracture. In this study, taking the fracture site of the lower one-third of human tibia as an application case, six types of personalised Ti6Al4V tibial plates with grooved surface were designed and evaluated by reverse engineering and finite element analysis. The results showed that the grooved design can reduce the stress shielding rate of bone plate and promote the facture healing. Among the six types of bone plates, the ‘OUT-MI’ bone plate has the lowest stress shielding rate and the most uniform stress distribution. Meanwhile, with the increasing tibial load during the convalescence, the average stress and maximum axial displacement of the tibial fracture surface increased, which can effectively improve the bone regeneration in the tibial fracture area. Moreover, there was no significant difference in four-point bending performance between the ‘OUT-MI’ bone plate and the ‘STR-BE’ bone plate, indicating that the mechanical properties of this bone plate were reliable. The results provide a theoretical basis for the design of fracture fixation plates on clinical treatment.

Fracture behavior of human cortical bone: Role of advanced glycation end-products and microstructural features

Diabetes is associated with increased fracture risk in human bone, especially in the elderly population. In the present study, we investigate how simulated advanced glycation end-products (AGEs) and materials heterogeneity affect crack growth trajectory in human cortical bone. We used a phase field fracture framework on 2D models of cortical microstructure created from human tibias to analyze crack propagation. The increased AGEs level results in a higher rate of crack formation. The simulations also indicate that the mismatch between the fracture properties (e.g., critical energy release rate) of osteons and interstitial tissue can alter the post-yielding behavior. The results show that if the critical energy release rate of cement lines is lower than that of osteons and the surrounding interstitial matrix, cracks can be arrested by cement lines. Additionally, activation of toughening mechanisms such as crack merging and branching depends on bone microstructural morphology (i.e., osteons geometrical parameters, canals, and lacunae porosities). In conclusion, the present findings suggest that materials heterogeneity of microstructural features and the crack-microstructure interactions can play important roles in bone fragility.

Radiographic cortical thickness parameters as predictors of rotational alignment in proximal tibial shaft fractures: a cadaveric study

AimThe treatment of tibial fractures with an intramedullary nail is an established procedure. However, torsional control remains challenging using intraoperatively diagnostic tools.Radiographic tools such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DDS) may serve as tools for diagnosing a relevant malrotation. The aim of this study was to investigate the effect of torsional malalignment on CSS and DDS parameters and to construct a prognostic model to detect malalignment.MethodsA proximal tibial shaft fracture was set in human tibiae. Torsion was set stepwise from 0° to 30° in external and internal torsion. Images were obtained with a C-arm and transferred to a PC for measuring the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in AP and the anterior cortical thickness (ACT) as well as the posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and the distal main fragment.ResultsThere were significant differences between the various degrees of torsion for each of the absolute values of the examined variables. The parameters with the highest correlation were TD, LCT and ACT. A model combining ACT, LCT, PCT and TD lateral was most suitable model in identifying torsional malalignment. The best prediction of clinically relevant torsional malalignment, namely 15°, was obtained with the TD and the ACT.ConclusionThis study shows that the CSS and DDS are useful tools for the intraoperative detection of torsional malalignment in proximal tibial shaft fractures and should be used to prevent maltorsion.

Lattice implants that generate homeostatic and remodeling strains in bone.

Bone remodeling is mediated by several factors including strain. An increase in strain between 1% and 10% compared to homeostasis can trigger bone formation. We aim to create an orthopedic implant using clinically established imaging and manufacturing methods that induces this strain control in human bone. Titanium scaffolds were manufactured with multiaxial apparent modulus tailored to the mechanical properties of bone defined from computed tomography scans of cadaver human tibiae. Five bone cubes were tested with corresponding titanium scaffolds by loading under compression, which is similar to the implanted tibia loading condition. Bone strain was precisely controlled by varying the scaffold modulus, from 0% to 15% bone strain increase. This strain increase is the magnitude reported to invoke bone's positive remodeling. Axial modulus was closely matched between titanium scaffolds and bone, ranging from 48-728 and 81-800 MPa, respectively, whereby scaffold axial modulus was within 2% of nominal target values. Fine control of multiaxial moduli resulted in transverse modulus that matched bone well; ranging from 42-648 and 47-585 MPa in scaffolds and bone respectively. The scaffold manufacturing material and method are already used in the orthopedic industry. This study has significant clinical implications as it enables the design of implants which positively harness bone's natural mechanoresponse and respect bone's mechanical anisotropy and heterogeneity.

Virtual implantation technique to estimate endoprosthetic contact of percutaneous osseointegrated devices in the tibia

Percutaneous osseointegrated (OI) devices have an endoprosthesis attached to the residual bone of an amputated limb, then pass permanently through the skin to be connected to the distal prosthetic componentry outside of the body. Whether the bone-anchoring region of current OI endoprostheses are cylindrical, and/or conical, they require intimate bone-endoprosthesis contact to promote stabilizing bone attachment. However, removing too much cortical bone to achieve more contact leads to thinner and, subsequently, weaker cortical walls. Endoprostheses need to be designed to balance these factors, namely maximizing the contact, while minimizing the volume of bone removed. In this study, 27 human tibias were used to develop and validate a virtual implantation method. Then, 40 additional tibias were virtually implanted with mock cylindrical and conical bone-anchoring regions at seven residual limb lengths to measure resultant bone-endoprosthesis contact and bone removal. The ratio of bone-endoprosthesis contact to bone volume removed showed the conical geometry had more contact area per volume bone removed for all amputation levels (p ≤ 0.001). In both mock devices, cortical penetration of the endoprosthesis at 20% residual length occurred in 74% of cases evaluated, indicating that alternative endoprosthesis geometries may be needed for clinical success in that region of bone.

Crack Propagation in the Tibia Bone within Total Knee Replacement Using the eXtended Finite Element Method

Understanding of fracture mechanics of the human knee structures within total knee replacement (TKR) allows a better decision support for bone fracture prevention. Numerous studies addressed these complex injuries involving the femur bones but the full macro-crack propagation from crack initiation to final failure and age-related effects on the tibia bone were not extensively studied. The present study aimed to develop a patient-specific model of the human tibia bone and the associated TKR implant, to study fatigue and fracture behaviors under physiological and pathological (i.e., age-related effect) conditions. Computed tomography (CT) data were used to develop a patient-specific computational model of the human tibia bone (cortical and cancellous) and associated implants. First, segmentation and 3D-reconstruction of the geometrical models of the tibia and implant were performed. Then, meshes were generated. The locations of crack initiation were identified using the clinical observation and the fatigue crack initiation model. Then, the propagation of the crack in the bone until final failure was investigated using the eXtended finite element method (X-FEM). Finally, the obtained outcomes were analyzed and evaluated to investigate the age-effects on the crack propagation behaviors of the bone. For fatigue crack initiation analysis, the stress amplitude–life S–N curve witnessed a decrease with increasing age. The maximal stress concentration caused by cyclic loading resulted in the weakening of the tibia bone under TKR. For fatigue crack propagation analysis, regarding simulation with the implant, the stress intensity factorand the energy release rate tended to decrease, as compared to the tibia model without the implant, from 0.152.5 to 0.111.9 (MPa) and from 10240 to 5133 (J), respectively. This led to the drop in crack propagation speed. This study provided, for the first time, a detailed view on the full crack path from crack initiation to final failure of the tibia bone within the TKR implant. The obtained outcomes also suggested that age (i.e., bone strength) also plays an important role in tibia crack and bone fracture. In perspective, patient-specific bone properties and dynamic loadings (e.g., during walking or running) are incorporated to provide objective and quantitative indicators for crack and fracture prevention, during daily activities.

Remodelling of trabecular bone in human distal tibia: A model based on an in-vivo HR-pQCT study

An abnormal remodelling process of bones can lead to various bone disorders, such as osteoporosis, making them prone to fracture. Simulations of load-induced remodelling of trabecular bone were used to investigate its response to mechanical signal. However, the role of mechanostat in trabecular-bone remodelling has not yet been investigated in simulations underpinned by a longitudinal in-vivo study in humans.In this work, a finite-element model based on a 6-month longitudinal in-vivo HR-pQCT study was developed and validated to investigate the effect of mechanical stimuli on bone remodelling. The simulated changes in microstructural parameters and density of trabecular bone were compared with respective experimental results. A maximum principal strain (MPS) and a maximum principal strain gradient (∇MPS) were used as mechanical signals to drive a five-stage mechanostat remodelling model, including additional over-strain and damage stages. It was found that the density distribution varied with the studied mechanical signals, along with decreasing with time levels of bone volume fraction BV/TV, trabecular thickness Tb.Th and bone surface area Tb.BS as well as increased trabecular separation Tb.Sp. Among these parameters, BV/TV and Tb.Th together with the bone-remodelling parameters from the MPS model demonstrated a significant correlation with the experimental data. The developed model provides a good foundation for further development and investigation of the relationships between mechanical loading and human-bone microarchitecture.

A data process of human knee joint kinematics obtained by motion-capture measurement

BackgroundThe motion capture has been used as the usual method for measuring movement parameters of human, and most of the measuring data are obtained by partial manual process based on commercial software. An automatic kinematics data process was developed by programming on MATLAB software in this paper.MethodsThe motion capture measurement of healthy volunteers was carried out and the MATLAB program was used for data process. Firstly, the coordinate data of markers and anatomical points on human lower limb measured by motion capture system were read and repaired through the usual and the patch program. Meantime, the local coordinate systems of human femur and tibia were established with anatomical points. Then flexion/extension, abduction/adduction and internal/external rotation of human knee tibiofemoral joint were obtained by special coordinate transformation program.ResultsUsing the above methods, motion capture measurements and batch data processing were carried out on squatting and climbing stairs of 29 healthy volunteers. And the motion characteristics (flexion/extension, internal/external rotation and adduction/abduction) of the knee joint were obtained. For example, the maximum internal/external rotation in squatting and climbing stairs were respectively was 30.5 degrees and 14 degrees, etc. Meantime, the results of this paper also were respectively compared with the results processed by other research methods, and the results were basically consistent, thus the reliability of our research method was verified. After calibration processing, the compiled MATLAB program of this paper can directly be used for efficient batch processing and avoiding manual modeling one by one.ConclusionA novel Patch Program of this paper has been developed, which can make reasonable compensation for missing and noise signals to obtain more complete motion data. At the same time, a universal data processing program has also been developed for obtaining the relative movement of various components of the human body, and the program can be modified for detail special analysis. These motion capture technologies can be used to judge whether the human body functions are abnormal, provide a reference for rehabilitation treatment and design of rehabilitation equipment, and evaluate the effectiveness before and after surgery.

A novel calibration for L-shell x-ray fluorescence measurements of bone lead concentration using the strontium Kβ/Kα ratio

Objective. Lead (Pb) is a well-known toxic element. In vivo bone Pb concentration measurement is a long-term exposure metric complementary to blood Pb concentration measurement which is a metric of recent exposure. In vivo human tibia bone Pb measurements using Pb K-shell or L-shell x-ray fluorescence (KXRF or LXRF) emissions were developed in the 1980s. KXRF bone Pb measurements using Cd-109 gamma rays and coherent-to-fluorescence ratio to account for differences between phantom and in vivo measurements, was employed in human studies. Bone Pb LXRF method employed x-ray tubes. However, calibration procedures using ultrasound measurements of the soft tissue thickness (STT) proved inaccurate. Approach. In this study, bone and soft tissue (ST) phantoms simulated in vivo bone Pb measurements. Seven plaster-of-Paris cylindrical bone phantoms containing 1.01 mg g−1 of strontium (Sr) were doped with Pb in 0, 8, 16, 29, 44, 59, and 74 μg g−1 concentrations. Polyoxymethylene (POM), resin, and wax were each used to fabricate four ST phantoms in the approximate 1–4 mm thickness range. Pb LXRF measurements were performed using a previously developed optimal grazing incidence position method. Main results. Linear attenuation coefficients measurements of ST materials indicated that POM and resin mimicked well attenuation of Pb x-rays in skin and adipose tissue, respectively. POM and resin data indicated a bone Pb detection limit of 20 μg g−1 for a 2 mm STT. Derived relationships between the Pb concentration, Pb LXRF and Sr K β /K α ratio data did not require STT knowledge. Applied to POM and resin data, the new calibration method yielded unbiased results. Significance. In vivo bone Pb measurements in children were suggested following considerations of radiation dose, STT, detectability and distribution of Pb and Sr in bone. This research meets with the concerns regarding the negative effects of low levels of Pb exposure on neurodevelopment of children.

English

BACKGROUND Tibia is the weight bearing bone of the leg. Usually it has a single nutrient foramen located posteriorly near the soleal line and transmits a branch of posterior tibial artery. The nutrient artery is the principal source of supply to a long bone. We carried out this study to find out the number, size, location, position and direction of the diaphyseal nutrient foramen in dried human tibia in Goan population. METHODS The study was carried out on 66 unpaired dry human tibiae of unknown age, gender and without deformity in the Department of Anatomy, Goa Medical College, using sliding and digital Vernier callipers, 20- and 24-gauge needles. Hughes formula was used to compute foraminal index. The data was statistically analysed with SPSS software version 23. RESULTS Most of the tibia in our study had a single nutrient foramen. Majority of the nutrient foramina were medium sized and directed downwards in our study. In 81.42 % tibiae, the nutrient foramina were present in the upper 1 / 3 rd of the shaft and in 18.57 % in the middle 1 / 3 rd of the shaft of the bone. Almost all nutrient foramina in the upper 1 / 3 rd of posterior surface were situated lateral to the soleal line. We computed the mean foraminal index as 30.25 % with standard deviation of 6.14. CONCLUSIONS A proper knowledge of morphometry and topography of the nutrient foramen is of utmost importance to orthopaedic surgeons as the nutrient artery may get damaged if fracture line passes through the nutrient canal. Also, it will help the surgeon to conserve vascular supply while performing bone grafting and fracture reduction. KEYWORDS Nutrient Foramen, Morphometry, Foraminal Index, Soleal Line

No effect in primary stability after increasing interference fit in cementless TKA tibial components

Cementless total knee arthroplasty (TKA) implants rely on interference fit to achieve initial stability. However, the optimal interference fit is unknown. This study investigates the effect of using different interference fit on the initial stability of tibial TKA implants. Experiments were performed on human cadaveric tibias using a low interference fit of 350 μm of a clinically established cementless porous-coated tibial implant and a high interference fit of 700 μm. The Orthoload peak loads of gait and squat were applied to the specimens with a custom-made load applicator. Micromotions and gaps opening/closing were measured at the bone-implant interface using Digital Image Correlation (DIC) in 6 regions of interest (ROIs). Two multilevel linear mixed-effect models were created with micromotions and gaps as dependent variables. The results revealed no significant differences for micromotions between the two interference fits (gait p = 0.755, squat p = 0.232), nor for gaps opening/closing (gait p = 0.474, squat p = 0.269). In contrast, significant differences were found for the ROIs in the two dependent variables (p < 0.001), where more gap closing was seen in the posterior ROIs than in the anterior ROIs during both loading configurations. This study showed that increasing the interference fit from 350 to 700 μm did not influence initial stability.

Identification of long-range ultrasonic guided wave characteristics in cortical bone by modelling

The propagation of ultrasonic guided waves in cortical bone has potential to inform medical caregivers about the condition of the bone structure. However, as waveguides, human long bones such as the tibia are complex in terms of their material behavior and their geometric features. They exhibit anisotropic elasticity and internal damping. For the first time, wave propagation is modelled in the irregular hollow tibial cross-section, which varies along its long axis. Semi-analytical, frequency domain, and time domain finite element analyses providing complimentary information about long-range wave propagation characteristics in such a waveguide are applied to the mid-diaphyseal region of a human tibia. Simulating the guided waves generated by a contact transducer, the signals received in axial transmission indicate the consistent presence of low phase velocity non-dispersive propagating modes. The guided waves capable of traveling long distances have strong potential for diagnosis of fracture healing.

Custom-made polyurethane-based synthetic bones mimic screw cut-through of intramedullary nails in human long bones

Intramedullary nails are considered the gold standard for the treatment of tibial shaft fractures. Thereby, the screw-bone interface is considered the weakest link. For biomechanical evaluation of osteosyntheses synthetic bones are often used to overcome the disadvantages of human specimens. However, commercially available synthetic bones cannot adequately mimic the local mechanical properties of human bone. Thus, the aim of this study was to develop and evaluate novel cortical bone surrogate materials that mimic human tibial shafts in the screw-loosening mechanisms of intramedullary nails.Bone surrogates, based on two different polyurethanes, were developed and shaped as simple tubes with varying cortical thicknesses to simulate the diaphyseal cortex of human tibiae. Fresh frozen human tibiae and commercially available synthetic bones with similar cortical thickness were used as references. All specimens were treated with a nail dummy and bicortical locking screws to simulate treatment of a distal tibia shaft fracture. The nail-bone construct was loaded in a combined axial-torsional-sinusoidal loading protocol to simulate the physiological load during human gait. The loads to failure as well as the number of load cycles were evaluated. Furthermore, the cut-through length of the screws was analysed by additional micro computed -tomography images of the tested specimens.The failure load of custom made synthetic bone tubes with 6 mm cortical thickness (3242 ± 136 N) was in accordance with the failure load of human samples (3300 ± 307 N, p = 0.418) with a similar cortical thickness of 4.9 ± 1.4 mm. Commercially available synthetic bones with similar cortical thickness of 4.5 ± 0.7 mm were significantly stronger (4575 ± 795 N, p = 0.008). Oval-shaped migration patterns were “cut” into the cortices by the screws due to the cyclical loading. The cut-through length of the self-developed synthetic bones with 6 mm cortices (0.8 ± 0.6 mm, p = 0.516) matched the cut-through of the human tibiae (0.7 ± 0.6 mm). The cut-through of commercially available epoxy-based synthetic bones deviated from the human reference (0.2 ± 0.1 mm, p < 0.001).The results of this study indicate that the novel bone surrogates realistically mimic the failure and screw migration behaviour in human tibiae. Thus, they offer a new possibility to serve as substrate for biomechanical testing. The use of commercially available surrogates is discouraged for biomechanical testing as there is a risk of drawing incorrect conclusions.

JOHNSON–COOK MODEL COMBINED WITH COWPER–SYMONDS MODEL FOR BONE CUTTING SIMULATION WITH EXPERIMENTAL VALIDATION

Constitutive models are widely used to predict the mechanical behavior of different kinds of materials. Although the Johnson–Cook model for bovine bone and Cowper–Symonds model for human thoracic rib and tibia was developed, the predictability of these models was found good only at particular strain rates. This study addresses this lack of information by investigating the Cowper–Symonds model, Johnson–Cook model, and Johnson–Cook model combined with Cowper–Symonds model at different strain rates to utilize in the bone cutting simulation. Specimens prepared using two rear femurs harvested from a 3.50-year-old bovine were investigated at different strain rates (0.00001–1/s). A comparative study made among the stresses predicted from these models showed 29.41%, 10.91%, and 11.11% mean absolute percentage errors using Cowper–Symonds model, and 2.03%, 7.19%, and 3.62% mean absolute percentage errors using Johnson–Cook model, respectively, at 0.0001, 0.001 and 1/s strain rates. However, the Johnson–Cook model combined with the Cowper–Symonds model predicted the stress with a maximum of only 2.03% mean absolute percentage error. The potential of each model to utilize in the orthogonal bone cutting was also evaluated using Ansys® and found that the combined model predicted the cutting force close to experimental cutting force with minimal error (5.20%). The outcomes of this study can be used in the surgical practice and osteotomy procedure before commencing actual surgery.

Microstructural abnormalities are evident by histology but not HR-pQCT at the periosteal cortex of the human tibia under CVD and T2D conditions

Cortical bone microstructure deficits may increase fracture risk in individuals with cardiovascular disease and diabetes. High resolution peripheral quantitative computed tomography (HR-pQCT) enables in vivo microstructure characterization but is limited in its ability to visualize important biological features. We conducted histological analyses and HR-pQCT imaging of distal tibia bone samples from 6 donors with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). Histology but not HR-pQCT identified previously undocumented morphopathological deficits that may contribute to cortical bone fragility. These observations may provide guidance for improved HR-pQCT microstructural characterization as well as insight into mechanisms of cortical bone degradation.

A comparative finite element simulation of locking compression plate materials for tibial fracture treatment

The locking compression plate (LCP) system has several advantages in fracture fixation combining angular stability with the use of locking screws with traditional fixation techniques. However, the system is complex and requiring careful attention to biomechanical principles and good surgical technique. Due to the set of complicate stresses and strains in the LCP system after implantation, the material, which is being used here, is deemed important. However, so far the materials have been limited to the stainless steel (SS) or titanium (Ti). This study was therefore aimed at investigate the biomechanical performance of the internal tibial locked plates at different material properties, including SS, Ti, carbon/polyether ether ketone (PEEK) composite, in treating medial tibial fracture using patient-specific finite element (FE) model of the human tibia. The carbon/PEEK composite materials were used at three different fiber plies configurations. Simulated loading was applied at 60:40 ratios on the medial:lateral aspect. The model was fixed distally in all degrees of freedom. The results revealed the highest stress (307.10 MPa) and the lowest strain (0.14%) at Ti LCP system. The carbon/PEEK LCP system at configuration I and III showed low stress (∼60 MPa) and high strain (0.70%), which are suitable points for designing of an internal LCP system. On the other hand, the highest value of stress in callus region was 4.78 MPa (Carbon PEEK/Configuration I) and the strain variations of callus region were between 1.46% and 3.82% among all materials. These results implied the advantage of carbon/PEEK composite materials in LCP system as they can tolerate higher strains at lower stresses.

Nonlinear Viscoelastic Modeling of Synthesized Silicate-Based Bioactive Glass/Polysulfone Composite: Theory and Medical Applications

Bioactive glass/Polysulfone composite has been considered as an appropriate material for biomechanical and medical applications. Time-dependency and nonlinear-elasticity are significant mechanical behaviors of these type of materials. Hence, in this research, the 20% vol. 58 s bioactive glass/polysulfone composite was prepared using the solvent casting method, and tensile tests with 3 different strain rates were performed on the samples. Also, a nonlinear-viscoelastic model based on the Ogden nonlinear-elastic strain energy was generalized to investigate the mechanical behavior of the 20 vol.% 58 s bioactive glass/polysulfone composite. To show the agreement of the model with the experimental results, a rate dependent tensile test was simulated by ABAQUS which validated the results. The tensile test showed a maximum stress of 15 ~ 25 MPa, based on the test speed; also, the simulation demonstrated a 16.2 MPa stress for the 5 mm/min test speed, which were in good agreement. Later, a model of a human tibia bone was constructed using MIMICS, SOLIDWORKS and ABAQUS to study the application of the 58 s bioactive glass/polysulfone composite as an implant. The results revealed that the stress tolerated by the implant was neglectable, and most of the stress was tolerated by the bone itself.

Intraoperative torsion control using the cortical step sign and diameter difference in tibial mid-shaft fractures.

Intramedullar nailing of tibial mid-shaft fractures is a common surgical treatment. Fracture reduction, however, remains challenging and maltorsion is a common discrepancy which aggravates functional impairment of gait and stability. The use of radiographic tools such as the cortical step sign (CSS) and the diameter difference sign (DDS) could improve fracture reduction. Therefore, the validity of the CSS and DDS was analyzed to facilitate detection of maltorsion in tibial mid-shaft fractures. Tibial mid-shaft fractures were induced in human cadaveric tibiae according to the AO classification type A3. Torsional discrepancies from 0° to 30° in-/external direction were enforced after intramedullary nailing. Fluoroscopic-guided fracture reduction was assessed in two planes via analysis of the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD), anterior cortical thickness (ACT), posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and distal fracture fragment. The TD, LCT and ACT have shown a highly significant correlation to predict tibial maltorsion. While a model combining ACT, LCT, PCT and TD lateral was most suitable model to identify tibial maltorsion, a torsional discrepancy of 15°was most reliably detected with use of the TD and ACT. The present study has shown, that maltorsion can be reliably assessed by the CSS and DDS during fluoroscopy. Thus, torsional discrepancies in tibial mid-shaft fractures can be most reliably assessed in the lateral plane by analysis of the LCT and TD.