Biomechanical Influence Research Articles

Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair.

Aim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue.Material and Methods: This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery.Results: The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired.Conclusion: The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair.

Getting the Message Out: the Many Modes of Host-Symbiont Communication during Early-Stage Establishment of the Squid-Vibrio Partnership

ABSTRACTSymbiosis, by its basic nature, depends on partner interactions that are mediated by cues and signals. This kind of critical reciprocal communication shapes the trajectory of host-microbe associations from their onset through their maturation and is typically mediated by both biochemical and biomechanical influences. Symbiotic partnerships often involve communities composed of dozens to hundreds of microbial species, for which resolving the precise nature of these partner interactions is highly challenging. Naturally occurring binary associations, such as those between certain legumes, nematodes, fishes, and squids, and their specific bacterial partner species offer the opportunity to examine interactions with high resolution and at the scale at which the interactions occur. The goals of this review are to provide the conceptual framework for evolutionarily conserved drivers of host-symbiont communication in animal associations and to offer a window into some mechanisms of this phenomenon as discovered through the study of the squid-vibrio model. The discussion focuses upon the early events that lead to persistence of the symbiotic partnership. The biophysical and biochemical determinants of the initial hours of dialogue between partners and how the symbiosis is shaped by the environment that is created by their reciprocal interactions are key topics that have been difficult to approach in more complex systems. Through our research on the squid-vibrio system, we provide insight into the intricate temporal and spatial complexity that underlies the molecular and cellular events mediating successful microbial colonization of the host animal.

The biomechanical effect of the relevant segments after facet-disectomy in different diameters under posterior lumbar percutaneous endoscopes: a three-dimensional finite element analysis

ObjectiveTo evaluate the biomechanical influence after percutaneous endoscopic lumbar facetectomy in different diameters on segmental range of motion (ROM) and intradiscal pressure (IDP) of the relevant segments by establishing three dimensional finite element (FE) model.MethodsAn intact L3–5 model was successfully constructed from the CT of a healthy volunteer as Model A (MA). The Model B (MB), Model C (MC) and Model D (MD) were obtained through facetectomy on L4 inferior facet in diameters 7.5 mm, 10 mm and 15 mm on MA for simulation. The ROM and IDP of L3/4 and L4/5 of four models were all compared in forward flexion, backward extension, left and right bending, left and right rotation.ResultsCompared with MA, the ROM of L4/5 of MB, MC and MD all increased. MD changed more significantly than MB and MC in backward extension, right bending and right rotation. But that of MB and MC on L3/4 had no prominent change, while MD had a slight increase in backward extension. The IDP of MB and MC on L4/5 in six states was similar to MA, yet MD increased obviously in backward extension, right bending, left and right rotation. The IDP on L3/4 of MB and MC was resemble to MA in six conditions, nevertheless MD increased slightly only in backward extension.ConclusionCompared with the facetectomy in diameters 7.5 mm and 10 mm, the mechanical effect brought by facetectomy in diameter 15 mm on the operating segment changed more significantly, and had a corresponding effect on the adjacent segments.

Making Blood from the Vessel: Extrinsic and Environmental Cues Guiding the Endothelial-to-Hematopoietic Transition.

It is increasingly recognized that specialized subsets of endothelial cells carry out unique functions in specific organs and regions of the vascular tree. Perhaps the most striking example of this specialization is the ability to contribute to the generation of the blood system, in which a distinct population of “hemogenic” endothelial cells in the embryo transforms irreversibly into hematopoietic stem and progenitor cells that produce circulating erythroid, myeloid and lymphoid cells for the lifetime of an animal. This review will focus on recent advances made in the zebrafish model organism uncovering the extrinsic and environmental factors that facilitate hemogenic commitment and the process of endothelial-to-hematopoietic transition that produces blood stem cells. We highlight in particular biomechanical influences of hemodynamic forces and the extracellular matrix, metabolic and sterile inflammatory cues present during this developmental stage, and outline new avenues opened by transcriptomic-based approaches to decipher cell–cell communication mechanisms as examples of key signals in the embryonic niche that regulate hematopoiesis.

Effects of Corneal Biomechanical Properties on Rebound Tonometry (Icare200) and Applanation Tonometry (Perkins) Readings in Patients With Primary Congenital Glaucoma.

The aim was to assess the influence of corneal biomechanics on intraocular pressure (IOP) measurements made with the Icare200 (IC200) rebound tonometer and the Perkins handheld applanation tonometer in patients with primary congenital glaucoma (PCG). A total of 40 PCG patients and 40 healthy controls, age, and sex-matched, were recruited. IOP was measured with the Ocular Response Analyzer (IOPc, IOPg), IC200 and Perkins. The variables age, IOP, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), best-corrected visual acuity, spherical equivalent, medications, and glaucoma surgeries were recorded for each subject. Univariate and multivariate analysis were used to detect effects of variables on IOP measurements. Mean CCT was 545.65±71.88 μm in PCG versus 558.78±27.58 μm in controls (P=0.284). CH and CRF were significantly lower in PCG group than in control group: mean CH 8.11±1.69 versus 11.15±1.63 mm Hg (P<0.001), and mean CRF 9.27±2.35 versus 10.71±1.75 mm Hg (P=0.002). Mean differences between IOP IC200-Perkins were 0.79±0.53 mm Hg in PCG versus 0.80±0.23 mm Hg in controls (P<0.001) and mean differences IC200-IOPc were -0.89±5.15 mm Hg in PCG (P<0.001) versus 1.60±3.03 mm Hg in controls (all P<0.009). Through multivariate analysis, CRF showed positive association and CH negative association with IOP measured with Perkins or IC200 in both subject groups. No association was detected for CCT, age, or sex. CH and CRF were identified as the main factors interfering with IOP measurements made with both tonometers in patients with PCG and healthy controls.

Biomechanical Evaluation of Different Implant-Abutment Connections, Retention Systems, and Restorative Materials in the Implant-Supported Single Crowns Using 3D Finite Element Analysis.

This is an in silico study aimed to evaluate the biomechanical influence of different implant-abutment interfaces (external hexagon and Morse taper implants), retention systems (cement and screw retained), and restorative crowns (metal-ceramic and monolithic) using 3-dimensional finite element analysis (3D-FEA). Eight 3D models were simulated for the maxillary first molar area using InVesalius, Rhinoceros, and SolidWorks and processed using Femap and NEi Nastran software. Axial and oblique forces of 200 and 100 N, respectively, were applied on the occlusal surface of the prostheses. Microstrain and von Mises stress maps were used to evaluate the deformation (cortical bone tissue) and stress (implants/fixation screws/crowns), respectively, for each model. For both loadings, Morse taper implants had lower microstrain values than the external hexagon implants. The retention system did not affect microstrain on the cortical bone tissue under both loadings. However, the cemented prosthesis displayed higher stress with the fixation screw than the external hexagon implants. No difference was observed between the metal-ceramic and zirconia monolithic crowns in terms of microstrain and stress distribution on the cortical bone, implants, or components. Morse taper implants can be considered as a good alternative for dental implant rehabilitation because they demonstrated better biomechanical behavior for the bone and fixation screw as compared to external hexagon implants. Cement-retained prosthesis increased the stress on the fixation screw of the external hexagon implants, thereby increasing the risk of screw loosening/fracture in the posterior maxillary area. The use of metal-ceramic or monolithic crowns did not affect the biomechanical behavior of the evaluated structures.

Comparison of stress distribution of TMJ with different mandibular deformities under incisal clenching

Temporomandibular joint (TMJ) is an important and complex joint in the human body. It is necessary to explore the biomechanical influence on the TMJs caused by different mandibular deformities. The maxillofacial models from 34 subjects were built to analyze the maximum and minimum principal stresses of the TMJs in the control group and three test groups. The results showed that only the deviation group had statistical differences between both sides. And these mandibular deformities decreased the tensile stresses of the temporal bones and increased the compressive stresses of the condyles and the discs. The patients with mandibular deviation had most risk with TMD.

Reproducing the Biomechanical Environment of the Chondrocyte for Cartilage Tissue Engineering.

It is well known that the biomechanical and tribological performance of articular cartilage is inextricably linked to its extracellular matrix (ECM) structure and zonal heterogeneity. Furthermore, it is understood that the presence of native ECM components, such as collagen II and aggrecan, promote healthy homeostasis in the resident chondrocytes. What is less frequently discussed is how chondrocyte metabolism is related to the extracellular mechanical environment, at both the macro and microscale. The chondrocyte is in immediate contact with the pericellular matrix of the chondron, which acts as a mechanocoupler, transmitting external applied loads from the ECM to the chondrocyte. Therefore, components of the pericellular matrix also play essential roles in chondrocyte mechanotransduction and metabolism. Recreating the biomechanical environment through tuning material properties of a scaffold and/or the use of external cyclic loading can induce biosynthetic responses in chondrocytes. Decellularized scaffolds, which retain the native tissue macro- and microstructure also represent an effective means of recapitulating such an environment. The use of such techniques in tissue engineering applications can ensure the regeneration of skeletally mature articular cartilage with appropriate biomechanical and tribological properties to restore joint function. Despite the pivotal role in graft maturation and performance, biomechanical and tribological properties of such interventions is often underrepresented. This review outlines the role of biomechanics in relation to native cartilage performance and chondrocyte metabolism, and how application of this theory can enhance the future development and successful translation of biomechanically relevant tissue engineering interventions. Impact statement Physiological cartilage function is a key criterion in the success of a cartilage tissue engineering solution. The in situ performance is dependent on the initial scaffold design as well as extracellular matrix deposition by endogenous or exogenous cells. Both biological and biomechanical stimuli serve as key regulators of cartilage homeostasis and maturation of the resulting tissue-engineered graft. An improved understanding of the influence of biomechanics on cellular function and consideration of the final biomechanical and tribological performance will help in the successful development and translation of tissue-engineered grafts to restore natural joint function postcartilage trauma or osteoarthritic degeneration, delaying the requirement for prosthetic intervention.

The biomechanical influence of facet joint parameters on corresponding segment in the lumbar spine: a new visualization method

Facet joints have been discussed as influential factors in the development of lumbar degeneration, which includes disc herniation and degenerative lumbar spondylolisthesis. Facet orientation (FO) and facet tropism (FT) are two important structural parameters of the lumbar facet joints. Many previous studies have focused on single parameter analysis of the lumbar spine. Owing to the correlation between independent variables, single-factor analysis cannot reflect the interaction between variables; however, there has been no corresponding biomechanical method developed to address this problem. To investigate the complex biomechanical influences on the lumbar spine when vertebral FO and FT are varied using finite element analysis (FEA) and contour maps visualization, and analyze the biomechanical role of facet joint structural parameters in the process of lumbar degenerative diseases. A biomechanical modelling, analysis, and verification study was performed. A three-dimensional non-linear FEA model of 3 denucleated intervertebral discs (L2-3, L3-4, L4-5) with adjacent vertebral bodies (L2-L5) was created. Previously performed in vitro experiments provided experimental data for the range of motion in each load direction that was used for calibration. For 12 lumbar models, different facet joint angles relative to the sagittal plane at both L3-4 facet joints were simulated for 35°≤FO≤50° and 0°≤FT≤15°. By modifying different values of FO and FT, FEA simulation of different lumbar spine models was performed. Contour maps were used to visualize the FO- and FT-relevant data. Under flexion, extension, and torsion moments, facet joint contact force and intradiscal stress increased with increasing FT. In the condition where FT remained 0° and increasing FO values, facet joint contact force and intradiscal stress remained low with no apparent increasing or decreasing trend when the model was under flexion, extension, and torsion moments. In the condition where FO and the FT values were varied at the same time, the highest force and stress regions in the contour maps were observed when all three types of moments were applied. Stress distributions of the L3-4 disc with different FT and FO values showed disc stress increased significantly with increases of FT and was concentrated on the ipsilateral region of the facet joint with the more sagittal orientation. The combination of FO and FT has an important impact on the corresponding disc and facet joints, but FT played a more significant role. Moreover, disc stress was concentrated on the ipsilateral region of facet joint with greater sagittal orientation when FT existed. FT with high sagittal orientation may increase risk of recurrent LDH due to increase ipsilateral disc pressure. These biomechanical findings may help clinicians to understand the prognosis of some lumbar degenerative conditions.

Correction to: Biomechanical Influence of Treatment Table Axis Location on Axial Rotation of Lumbar Spine

Correction to: Biomechanical Influence of Treatment Table Axis Location on Axial Rotation of Lumbar Spine

Assessment of generalized osteoarthritis phenotypes in the multicenter osteoarthritis study

Purpose: Identification of systemic biomarkers for knee OA has been difficult. This may be attributed to the dominating influence of biomechanics and mechanopathology on knee OA. The study of a generalized OA construct with multiple joint involvement may provide insights into systemic factors not provided by studies of individual joint sites. Generalized OA has long been recognized, yet poorly defined. Many have shown that hand OA may be a key component that is associated with an increased risk of OA at other joint sites.

Deciphering Myostatin's Regulatory, Metabolic, and Developmental Influence in Skeletal Diseases.

Current research findings in humans and other mammalian and non-mammalian species support the potent regulatory role of myostatin in the morphology and function of muscle as well as cellular differentiation and metabolism, with real-life implications in agricultural meat production and human disease. Myostatin null mice (mstn−/−) exhibit skeletal muscle fiber hyperplasia and hypertrophy whereas myostatin deficiency in larger mammals like sheep and pigs engender muscle fiber hyperplasia. Myostatin’s impact extends beyond muscles, with alterations in myostatin present in the pathophysiology of myocardial infarctions, inflammation, insulin resistance, diabetes, aging, cancer cachexia, and musculoskeletal disease. In this review, we explore myostatin’s role in skeletal integrity and bone cell biology either due to direct biochemical signaling or indirect mechanisms of mechanotransduction. In vitro, myostatin inhibits osteoblast differentiation and stimulates osteoclast activity in a dose-dependent manner. Mice deficient in myostatin also have decreased osteoclast numbers, increased cortical thickness, cortical tissue mineral density in the tibia, and increased vertebral bone mineral density. Further, we explore the implications of these biochemical and biomechanical influences of myostatin signaling in the pathophysiology of human disorders that involve musculoskeletal degeneration. The pharmacological inhibition of myostatin directly or via decoy receptors has revealed improvements in muscle and bone properties in mouse models of osteogenesis imperfecta, osteoporosis, osteoarthritis, Duchenne muscular dystrophy, and diabetes. However, recent disappointing clinical trial outcomes of induced myostatin inhibition in diseases with significant neuromuscular wasting and atrophy reiterate complexity and further need for exploration of the translational application of myostatin inhibition in humans.

Biomechanical Influence of Treatment Table Axis Location on Axial Rotation of Lumbar Spine

Various treatment devices or tables have been developed for generating axial rotation of the lumbar spine during spinal mobilization. However, the effects of the design of such treatment devices on the axial rotation of the lumbar spine have not been thoroughly investigated. In this study, the influences of the location of the treatment table rotational axis on the biomechanical behaviors of the lumbar spine were investigated for spinal mobilization using finite element analysis. The axial rotation of spinal mobilization with a supine posture on a treatment table was simulated. The sacrum was rotated by 10° along the axial rotation axis. The initial axis location was around the posterior edge of the nucleus pulposus of the L5–S intervertebral disc. The axis location was varied in the posterior direction from 0 to 200 mm in increments of 50 mm. Changes in the spine biomechanics, such as the intersegmental rotation, intradiscal pressure, and stresses on the ligaments and fibers of the annulus fibrosus, were investigated. Upon movement of the rotation axis towards the posterior direction, (1) the rotation angle along the lateral bending direction increased, (2) the intradiscal pressure increased, (3) the stresses on fibers of the annulus fibrosus and ligaments increased, and (4) the facet joint forces increased. Based on these findings, we conclude that careful consideration of the rotation axis location is important and necessary in the development of treatment beds for spinal manipulation.

A Moving Contact of Articulation Enhances the Biosynthetic and Functional Responses of Articular Cartilage

Biomechanical influences play a fundamental role in the structural, functional, and biosynthetic properties of articular cartilage. During physiologic joint loading, the contact area between two surfaces migrates due to the primary and secondary motions of the joint. It has been demonstrated that a migratory contact area plays a critical role in reducing the coefficient of friction at the cartilage surface. However, a detailed analysis of the influences that a migratory contact area plays on the structural, functional, and biosynthetic properties remain to be explored. In this study, bovine cartilage explants were placed in a biotribometer. Explants were subjected to compression and shear forces of migratory contact area, namely moving contact (MC) articulation, or stationary contact area, namely stationary contact (SC) articulation. Free swelling explants were used as control. In a separate study, bovine cartilage-bone grafts were used for frictional testing. On histologic analysis, the SC group had evidence of surface fibrillations, which was not evident in the MC group. Compared to the SC group, the MC group cartilage explants had increased chondrocyte viability, increased lubricin synthesis, and comparable proteoglycan synthesis and release. MC articulation had reduced coefficient of friction as compared to SC articulation. MC articulation led to reduced surface roughness as compared to SC articulation. In conclusion, a migratory contact area can play an important role in maintaining the structural, function, and biosynthetic properties of articular cartilage. This study provides further evidence of the importance of migratory contact area and in vitro assessment of natural joint movement, which can be further evaluated in the context of cartilage homeostasis and disease.

Biomechanical influence of the surgical approaches, implant length and density in stabilizing ankylosing spondylitis cervical spine fracture

Ankylosing spondylitis cervical spine fractures (ASCFs) are particularly unstable and need special consideration when selecting appropriate internal fixation technology. However, there is a lack of related biomechanical studies. This study aimed to investigate the biomechanical influence of the pattern, length, and density of instrumentation for the treatment of ASCF. Posterior, anterior, and various combined fixation approaches were constructed using the finite element model (FEM) to mimic the surgical treatment of ASCFs at C5/6. The rate of motion change (RMC) at the fractured level and the internal stress distribution (ISD) were observed. The results showed that longer segments of fixation and combined fixation approaches provided better stability and lowered the maximal stress. The RMC decreased more significantly when the length increased from 1 to 3 levels (302% decrease under flexion, 134% decrease under extension) than from 3 to 5 levels (22% decrease under flexion, 23% decrease under extension). Longer fixation seems to be more stable with the anterior/posterior approach alone, but 3-level posterior fixation may be the most cost-effective option. It is recommended to perform surgery with combined approaches, which provide the best stability. Long skipped-screwing posterior fixation is an alternative technique for use in ASCF patients.

The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis

PurposeTo investigate the biomechanical influence of differential loading of suture strands (torque) on the fixation strength of knotted and knotless all-suture anchors.MethodsThe biomechanical strength of 48 all-suture anchors was evaluated for 4 conditions in polyurethane foam blocks: (1) 12 knotted all-suture anchors loaded proportionately, (2) 12 knotted all-suture anchors with 1 suture strand bearing 50% of total force (partial torque), (3) 12 knotted all-suture anchors with 1 strand fixated and the other loaded (full torque), and (4) 12 knotless all-suture anchors with the loop kept open via a fixed rod. Force for 1 mm and 2 mm of displacement and ultimate failure load were assessed.ResultsFor 1 mm of displacement, groups 2, 3, and 4 showed significantly lower forces than group 1 (all P < .001), with no statistically significant difference between groups 2 and 3 (P = .516); for 2 mm of displacement, all groups showed significantly lower forces than group 1 (P < .001), which positively correlated with applied torque. No differences in the mean ultimate loads observed between testing groups 1, 2, and 4 were noted, with 93.3 ± 3.8 N, 91.4 ± 4.7 N, and 92.6 ± 5.6 N, respectively; however, group 3 exhibited a significantly lower mean ultimate load (62.3 ± 1.7 N) than all other groups (P < .001).ConclusionsThe ultimate failure load of knotted and knotless all-suture anchor fixation was partially affected by loading differentials between strands in this validated foam block model. Differential loading of knotted all-suture anchor fixation presented greater initial displacement when compared with symmetrically loaded knotted all-suture anchors. Despite an initial increase in displacement, knotless all-suture anchors showed similar ultimate failure loads to knotted all-suture anchors with strands loaded equally.Clinical RelevanceThe role of suture strand loading imbalance on anchor fixation is variable and should be considered during placement and fixation of the repair constructs in a clinical setting.

Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study

Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group (p = 0.037) with no changes during the intervention period (p = 0.997). Within a single session, running stability decreased over the course of the 15-min run (p = 0.012) without differences between both groups (p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.

Unsupervised Machine Learning Approach for Identifying Biomechanical Influences on Protein-Ligand Binding Affinity

Drug discovery is incredibly time-consuming and expensive, averaging over 10 years and $985 million per drug. Calculating the binding affinity between a target protein and a ligand through Virtual Screening is critical for discovering viable drugs. Although supervised machine learning (ML) can predict binding affinity accurately, models experience severe overfitting due to an inability to identify informative properties of protein-ligand complexes. This study used unsupervised ML to reveal underlying protein-ligand characteristics that strongly influence binding affinity. Protein-ligand 3D models were collected from the PDBBind database and vectorized into 2422 features per complex. Principal Component Analysis (PCA), t-Distributed Stochastic Neighbor Embedding (t-SNE), K-Means Clustering, and heatmaps were used to identify groups of complexes and the features responsible for the separation. ML benchmarking was used to determine the features’ effect on ML performance. The PCA heatmap revealed groups of complexes with binding affinity of pKd<6 and pKd>8 and identified the number of CCCH and CCCCCH fragments in the ligand as the most responsible features. A high correlation of 0.8337, their ability to explain 18% of the binding affinity’s variance, and an error increase of 0.09 in Decision Trees when trained without the two features suggests that the fragments exist within a larger ligand substructure that significantly influences binding affinity. This discovery is a baseline for informative ligand representations to be generated so that ML models overfit less and can more reliably identify novel drug candidates. Future work will focus on validating the ligand substructure’s presence and discovering more informative intra-ligand relationships.

Parametric study of anterior percutaneous endoscopic cervical discectomy (APECD)

Anterior percutaneous endoscopic cervical discectomy (APECD) is a common treatment for cervical spondylotic radiculopathy (CSR). In this study, the effects of various channel diameters and approach angles on cervical vertebrae on postoperative outcomes in APECD surgery were explored. A finite element model of intact cervical C3-C7 was constructed and then modified to obtain six surgical models. Range of motion (ROM) and intradiscal pressure (IDP) were calculated under different conditions of flexion (Fle), extension (Ext), lateral bending, and axial rotation. During Fle and bending to the left (LB), the ROM was closer to the intact model when the angle of approach was 90°. During bending to the left (LB) and rotation to the left (LR), the ROM changed considerably (43.2%, 33.7%, respectively) where the angle of approach was 45°. As the surgical channel diameter increased, the extent of the change in ROM compared with the intact model also increased. IDP decreased by 48% and 49%, respectively, compared with the intact model at the C5-C6 segment where the angle of approach was 45° and 60° during Fle, while it changed little at 90°, by less than 10%. The IDP was increased noticeably by 117.6%, 82.1%, and 105.8%, for channel diameters of 2, 3 and 4 mm, respectively. And declined noticeably during LB and LR (LB: 27.1%, 27.1%, 38.5%; LR: 37.4%, 35.5%, 48.7%). The results demonstrated that the shorter the surgical path, the smaller surgical diameter, the less the biomechanical influence on the cervical vertebra.

Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis

BackgroundThe treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However, the biomechanical influence of the use or non-use of the proximal screws of buttress plates on vFNFs stability remains unclear. This study aims to analyse the biomechanics of buttress plate fixation with or without the use of proximal screws through finite element analysis (FEA) to further understand this approach.MethodsWe built five vFNFs (Pauwels angle 70°) finite element models treated using three cannulated screws (CS group) or three cannulated screws plus a locking buttress plate (buttress group). In the buttress group, use or non-use of proximal screws was carried out on two types of plates (4-hole & 6-hole). The following seven parameters were analysed to compare biomechanical properties of the five models: the stiffness; the maximal stress of the plate system (plate and screws), CSs and bone (MPS, MCS, MBS); the maximal displacement of internal fixations (plate system & CSs) and bone (MIFD, MBD); and the maximal relative displacement of interfragments (MID).ResultsCompared with CS model, the buttress models exhibited improved biomechanical properties, with increased stiffness and decreased MCS, MBS, MIFD, MBD and MID. The models fixed using buttress plates combined with a proximal screw showed greater stiffness (+ 3.75% & + 8.31% vs + 0.98% & + 4.57%) and MPS (795.6 & 947.2 MPa vs 294.9 & 556.2 MPa) values, and smaller MCS, MBS, MIFD, MBD and MID (− 3.41% to − 15.35% vs − 0.07% to − 4.32%) values than those using the same length plates without a proximal screw.ConclusionsBased on the FEA results, buttress plates can improve construct mechanics, help to resist shear force and prevent varus collapse; under the modelling conditions, the use of a proximal screw on buttress plate may be a key technical feature in improving anti-shearing ability; additionally, this screw may be essential to reduce stress and prevent re-displacement of cannulated screws and fracture fragments.