This study aims to determine the pull-out strength, stiffness and failure pull-out energy of cement-augmented, cannulated-fenestrated pedicle screws in an osteoporotic cadaveric thoracolumbar model, and to determine, using synthetic bone samples, the extraction torques of screws pre-filled with cement and those with cement injected through perforations. Radiographs and bone mineral density measurements from 32 fresh thoracolumbar vertebrae were used to define specimen quality. Axial pull-out strength of screws was determined through mechanical testing. Mechanical pull-out strength, stiffness and energy-to-failure ratio were recorded for cement-augmented and non-cement-augmented screws. Synthetic bone simulating a human spinal bone with severe osteoporosis was used to measure the maximum extraction torque. The pull-out strength and stiffness-to-failure ratio of cement pre-filled and cement-injected screws were significantly higher than the non-cement-augmented control group. However, the cement pre-filled and cement-injected groups did not differ significantly across these values (p=0.07). The cement pre-filled group had the highest failure pull-out energy, approximately 2.8 times greater than that of the cement-injected (p<0.001), and approximately 11.5 times greater than that of the control groups (p<0.001). In the axial pull-out test, the cement-injected group had a greater maximum extraction torque than the cement pre-filled group, but was statistically insignificant (p=0.17). The initial fixation strength of cannulated screws pre-filled with cement is similar to that of cannulated screws injected with cement through perforations. This comparable strength, along with the heightened pull-out energy and reduced extraction torque, indicates that pedicle screws pre-filled with cement are superior for bone fixation over pedicle screws injected with cement.

Quantifying the risk of falling (falls risk) would be helpful in treating people with gait disorders. The gait sensitivity norm (GSN) is a stability measure that correlates well to risk of falling in passive dynamic walkers but has not been evaluated on humans or human-like walking models. We assessed the correlation of GSN to risk of falling in a neuromusculoskeletal (NMS) walking model. Specifically, we evaluated the correlation of GSN to the actual disturbance rejection (ADR) of the model and the sensitivity of this relationship to gait parameter, Poincaré section selection and steady state variability correction. Statistically significant results at p<0.05 were obtained for some of the gait indicators evaluated at the point in the gait cycle where they were most variable. The correlation between GSN and ADR was sensitive to gait indicator and Poincaré sections evaluated but not to steady state variability correction. The current work suggests some simple steps to reduce the sensitivity of GSN to arbitrary and subjective factors. Overall, the findings support the potential of GSN to be a clinically applicable measure of falls risk. Further study is required to identify methods to more definitively select the various factors within the GSN calculation and to confirm its ability to predict falls risk in human subjects.

BACKGROUND:

Optical spectroscopy can be used to assess the pathophysiological characteristics of diseased and injured biological tissue in vivo in a non-destructive way. It is often used in conjunction with a contact optical probe for the purposes of operating and sensing in a sterile field. Since the probe is often held by the hand of an investigator during data acquisition, any hand instability can affect the quality of acquired data and, hence, degrade the accuracy of diagnosis. This study was designed to quantitatively characterize these artifacts, and then propose an effective engineering solution to remove them.

METHODS:

Time-dependent diffuse reflectance spectra (Rd(λ,t)) were acquired from the normal cortex region of pediatric patients undergoing epilepsy surgery. They were acquired at a rate of 33Hz, and their range was 400 and 900nm. Two distinct ways of collecting data were tested: one with the fiber optical probe held by the surgeon's hand during data acquisition, and the other with the probe held by a specially designed probe holder. The probe holder was designed and constructed to minimize the variations in probe contact pressure and contact point for the full duration of any given investigation. Spectral data acquired using versus not using the probe holder were characterized and compared in the time, wavelength, and frequency domains, using both descriptive and inferential statistics.

RESULTS:

Hand motion manifested as strong random variations in Rd(λ,t) which impacted temporal and frequency characteristics of Rd(λ,t). The percentage standard deviation %STD of Rd(λ,t) acquired without probe holder could be as high as 60%, and they are significantly higher than those with probe holder at all wavelengths. This difference is especially prominent between 400 and 600nm. Rd(λ,t) acquired without the probe holder also processed a higher spectral power energy in the frequency domain than those with the probe holder. The correlation analysis revealed that the hand motions induced synchronistic variations in Rd(λ,t) between 600 and 800nm, but this synchronicity is not obvious between 400 and 600nm.

CONCLUSION:

The results of this investigation demonstrate the nature and the magnitude of hand motion induced artifacts in in vivo diffuse reflectance spectra and propose one potential solution (i.e., a probe holder) to remove them. These findings allow us to improve the quality of time-dependent, diffuse reflectance signals acquired to study the dynamic characteristics of biological tissues, like brain, in vivo.

Hydrocephalus includes a number of disorders characterised by clinical symptoms, enlarged ventricles (observable using neuroimaging techniques) and altered cerebrospinal fluid (CSF) dynamics. Infusion tests are one of the available procedures to study CSF circulation in patients with clinical and radiological features of hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analysed seventy-seven ICP signals recorded during infusion tests using four spectral-based parameters: median frequency (MF) and relative power (RP) in three frequency bands. These measures provide a novel perspective for the analysis of ICP signals in the frequency domain. Each signal was divided into four artefact-free epochs (corresponding to the basal, early infusion, plateau and recovery phases of the infusion study). The four spectral parameters were calculated for each epoch. We analysed differences between epochs of the infusion test and correlations between these epochs and patient data. Statistically significant differences (p<1.7×10(-3), Bonferroni-corrected Wilcoxon signed-rank tests) were found between epochs of the infusion test using MF and RP. Furthermore, some spectral parameters (MF in the basal phase, RP for the first frequency band and in the early infusion phase, RP for the second frequency band and in all phases of the infusion study and RP in the third frequency band and in the basal phase) revealed significant correlations (p<0.01) between epochs of the infusion test and signal amplitude in the basal and plateau phases. Our results suggest that spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.

Fluid-structure interaction (FSI) simulations using a patient-specific geometry are carried out to investigate the influence the length of elastic parent artery and the position of constraints in the solid domain on the accuracy of patient-specific FSI simulations. Three models are tested: Long, Moderate, and Short, based on the length of the elastic parent artery. All three models use same wall thickness (0.5mm) and the elastic modulus (5MPa). The maximum mesh displacement is the largest for the Long model (0.491mm) compared to other models (0.3mm for Moderate, and 0.132mm for Short). The differences of hemodynamic and mechanical variables, aneurysm volume and cross-sectional area between three models are all found to be minor. In addition, the Short model takes the least amount of computing time of the three models (11h compared to 21h for Long and 19h for Moderate). The present results indicate that the use of short elastic upstream artery can shorten the time required for patient-specific FSI simulations without impacting the overall accuracy of the results.

Accurate computer modelling of the fixation of unicompartmental knee replacements (UKRs) is a valuable design tool. However, models must be validated with in vitro mechanical tests to have confidence in the results. Ten fresh-frozen cadaveric knees with differing bone densities were CT-scanned to obtain geometry and bone density data, then implanted with cementless medial Oxford UKRs by an orthopaedic surgeon. Five strain gauge rosettes were attached to the tibia and femur of each knee and the bone constructs were mechanically tested. They were re-tested following implanting the cemented versions of the implants. Finite element models of four UKR tibiae and femora were developed. Sensitivity assessments and convergence studies were conducted to optimise modelling parameters. The cemented UKR pooled R(2) values for predicted versus measured bone strains were 0.85 and 0.92 for the tibia and femur respectively. The cementless UKR pooled R(2) values were slightly lower at 0.62 and 0.73 which may have been due to the irregularity of bone resections. The correlation of the results was attributed partly to the improved material property prediction method used in this project. This study is the first to validate multiple UKR tibiae and femora for bone strain across a range of specimen bone densities.

By characterizing anatomical differences in size and shape between subjects, statistical shape models enable population-based evaluations in biomechanics. Statistical models have largely focused on individual bones with application to implant sizing, bone fracture and osteoarthritis; however, in joint mechanics applications, the statistical models must consider the geometry of multiple structures of a joint and their relative position. Accordingly, the objectives of this study were to develop a statistical shape and alignment modeling (SSAM) approach to characterize the intersubject variability in bone morphology and alignment for the structures of the knee, to demonstrate the statistical model's ability to describe variability in a training set and to generate realistic instances for use in finite element evaluation of joint mechanics. The statistical model included representations of the bone and cartilage for the femur, tibia and patella from magnetic resonance images and relative alignment of the structures at a known, loaded position in an experimental knee simulator for a training set of 20 specimens. The statistical model described relationships or modes of variation in shape and relative alignment of the knee structures. By generating new 'virtual subjects' with physiologically realistic knee anatomy, the modeling approach can efficiently perform investigations into joint mechanics and implant design which benefit from population-based considerations.

The purpose of this study was to evaluate the effect of wheelchair mass, solid vs. pneumatic tires and tire pressure on physical strain and wheelchair propulsion technique. 11 Able-bodied participants performed 14 submaximal exercise blocks on a treadmill with a fixed speed (1.11m/s) within 3 weeks to determine the effect of tire pressure (100%, 75%, 50%, 25% of the recommended value), wheelchair mass (0kg, 5kg, or 10kg extra) and tire type (pneumatic vs. solid). All test conditions (except pneumatic vs. solid) were performed with and without instrumented measurement wheels. Outcome measures were power output (PO), physical strain (heart rate (HR), oxygen uptake (VO2), gross mechanical efficiency (ME)) and propulsion technique (timing, force application). At 25% tire pressure PO and subsequently VO2 were higher compared to 100% tire pressure. Furthermore, a higher tire pressure led to a longer cycle time and contact angle and subsequently lower push frequency. Extra mass did not lead to an increase in PO, physical strain or propulsion technique. Solid tires led to a higher PO and physical strain. The solid tire effect was amplified by increased mass (tire×mass interaction). In contrast to extra mass, tire pressure and tire type have an effect on PO, physical strain or propulsion technique of steady-state wheelchair propulsion. As expected, it is important to optimize tire pressure and tire type.

Dynamic implant cut-out is a frequent complication associated with surgical fracture fixation. In this in vitro study, we investigated the influence of the local trabecular bone microstructure on the rate and path of implant migration. Dynamic hip screws were implanted into six human femoral head specimens with a wide range of bone volume fractions. The specimens were subjected to image-guided failure assessment using physiological dynamic hip loading. Mechanical testing was used intermittently with high-resolution computed tomography scanning. A high correlation was found between the bone volume fraction and implant migration (R(2)=0.95). Profiles of the bone-implant interface were computed based on the positions of the screw and the femoral head. With a larger interface, the implant migration rate was smaller. The bone-implant interface was significantly smaller on the approximated screw migration path than if it had been on a straight line in loading direction. We thus hypothesize that implants migrate on a path of least resistance. This would indicate a relevant mechanism for targeted surgical intervention.

INTRODUCTION:

The strengthening effect of prophylactic internal fixation (PIF) with a bone plate at the radial osteocutaneous flap donor site has previously been demonstrated using the sheep tibia model of the human radius. This study investigated whether a finite element (FE) model could accurately represent this biomechanical model and whether stress or strain based failure criteria are most appropriate.

METHODS:

An FE model of an osteotomised sheep tibia bone was strengthened using 4 types of plates with unilocking or bicortical screw fixation. Torsion and 4-point bending simulations were performed. The maximum von Mises stresses and strain failure criteria were studied.

RESULTS:

The strengthening effects when applying stress failure criteria [factor 1.76-4.57 bending and 1.33-1.80 torsion] were comparable to the sheep biomechanical model [factor 1.73-2.43 bending and 1.54-2.63 torsion]. The strongest construct was the straight 3.5mm stainless steel unilocking plate. Applying strain criteria the strongest construct was the straight 3.5mm stainless DCP plate with bicortical screw fixation.

CONCLUSIONS:

The FE model was validated by comparison with the sheep tibia model. The complex biomechanics at the bone-screw interface require further investigation. This FE modelling technique may be applied to a model of the human radius and other sites.