Tissue stresses and strain in trabeculae of a canine proximal femur can be quantified from computer reconstructions

A quantitative assessment of bone tissue stresses and strains is essential for the understanding of failure mechanisms associated with osteoporosis, osteoarthritis, loosening of implants and cell- mediated adaptive bone-remodeling processes. According to Wolff's trajectorial hypothesis, the trabecular architecture is such that minimal tissue stresses are paired with minimal weight. This paradigm at least suggests that, normally, stresses and strains should be distributed rather evenly over the trabecular architecture. Although bone stresses at the apparent level were determined with finite element analysis (FEA), by assuming it to be continuous, there is no data available on trabecular tissue stresses or strains of bones in situ under physiological loading conditions. The objectives of this project were to supply reasonable estimates of these quantities for the canine femur, to compare trabecular-tissue to apparent stresses, and to test Wolff's hypothesis in a quantitative sense. For that purpose, the newly developed method of large-scale micro-FEA was applied in conjunction with micro-CT structural measurements. A three-dimensional high-resolution computer reconstruction of a proximal canine femur was made using a micro-CT scanner. This was converted to a large-scale FE-model with 7.6 million elements, adequately refined to represent individual trabeculae. Using a special-purpose FE-solver, analyses were conducted for three different orthogonal hip-joint loading cases, one of which represented the stance-phase of walking. By superimposing the results, the tissue stress and strain distributions could also be calculated for other force directions. Further analyses of results were concentrated on a trabecular volume of interest (VOI) located in the center of the head. For the stance phase of walking an average tissue principal strain in the VOI of 279 strain was found, with a standard deviation of 212 microstrain. The standard deviation depended not only on the hip-force magnitude, but also on its direction. In more than 95% of the tissue volume the principal stresses and strains were in a range from zero to three times the averages, for all hip-force directions. This indicates that no single load creates even stress or strain distributions in the trabecular architecture. Nevertheless, excessive values occurred at few locations only, and the maximum tissue stress was approximately half the value reported for the tissue fatigue strength. These results thus indicate that trabecular bone tissue has a safety factor of approximately two for hip-joint loads that occur during normal activities.     

Tissue stresses and strain in trabeculae of a canine proximal femur can be quantified from computer reconstructions

A quantitative assessment of bone tissue stresses and strains is essential for the understanding of failure mechanisms associated with osteoporosis, osteoarthritis, loosening of implants and cell-mediated adaptive bone-remodeling processes. According to Wolff's trajectorial hypothesis, the trabecular architecture is such that minimal tissue stresses are paired with minimal weight. This paradigm at least suggests that, normally, stresses and strains should be distributed rather evenly over the trabecular architecture. Although bone stresses at the apparent level were determined with finite element analysis (FEA), by assuming it to be continuous, there is no data available on trabecular tissue stresses or strains of bones in situ under physiological loading conditions. The objectives of this project were to supply reasonable estimates of these quantities for the canine femur, to compare trabecular-tissue to apparent stresses, and to test Wolff's hypothesis in a quantitative sense. For that purpose, the newly developed method of large-scale micro-FEA was applied in conjunction with micro-CT structural measurements. A three-dimensional high-resolution computer reconstruction of a proximal canine femur was made using a micro-CT scanner. This was converted to a large-scale FE-model with 7.6 million elements, adequately refined to represent individual trabeculae. Using a special-purpose FE-solver, analyses were conducted for three different orthogonal hip-joint loading cases, one of which represented the stance-phase of walking. By superimposing the results, the tissue stress and strain distributions could also be calculated for other force directions. Further analyses of results were concentrated on a trabecular volume of interest (VOI) located in the center of the head. For the stance phase of walking an average tissue principal strain in the VOI of 279 strain was found, with a standard deviation of 212 microstrain. The standard deviation depended not only on the hip-force magnitude, but also on its direction. In more than 95% of the tissue volume the principal stresses and strains were in a range from zero to three times the averages, for all hip-force directions. This indicates that no single load creates even stress or strain distributions in the trabecular architecture. Nevertheless, excessive values occurred at few locations only, and the maximum tissue stress was approximately half the value reported for the tissue fatigue strength. These results thus indicate that trabecular bone tissue has a safety factor of approximately two for hip-joint loads that occur during normal activities.     

Mechanical properties of metaphyseal bone in the proximal femur

We used a three-point bending test to investigate the structural behavior of 123 rectangular flat plate specimens harvested from the metaphyseal shell of the cervical and intertrochanteric regions of five fresh/frozen human proximal femora. For comparison purposes, 36 specimens of similar geometry were also fabricated from bone of the femoral diaphysis. All specimens were oriented in either the local longitudinal or transverse directions. The mean longitudinal elastic modulus was 9650 +/- 2410 (SD) MPa and demonstrated a 24% decrease from that measured for the diaphysis (12500 +/- 2140 MPa) using the same testing technique. However, the transverse elastic moduli did not differ significantly between the proximal (5470 +/- 1720 MPa) and diaphyseal (5990 +/- 1520 MPa) specimens. The globally averaged values for the ultimate tensile strengths of the metaphyseal shell were 101 +/- 26 MPa in the longitudinal and 50 +/- 12 MPa in the transverse directions. These compared with diaphyseal values of 128 +/- 16 MPa and 47 +/- 12 MPa, respectively. While these differences were largely due to the reduced density of the proximal specimens, a slight decrease in transverse anisotropy for the proximal specimens was also noted by comparing the ratio of longitudinal to transverse moduli (1.76) and tensile strength (2.02) to the diaphyseal values (2.09 and 2.71, respectively). Use of these data should lead to improved performance of analytical models for the proximal femur, and thus help focus increased attention on the structural contribution of trabecular bone to the strength and rigidity of the proximal femur.     

Microtensile measurements of single trabeculae stiffness in human femur

In this paper, the authors perform microtensile tests of single trabeculae excised from a human femur head. One of the main issues of this work is to establish some experimental procedures for preparing and testing the specimens. The use of a well-characterized microtensile apparatus allows for a low intraspecimen dispersion of the measured stiffness. Tensile/compressive tests were chosen because they appear less sensitive to errors in the cross-sectional area measurements with respect to bending tests. By these considerations, some tensile/compressive tests of plate-like trabecular specimens have been carried out. Typical stiffness values are 74.2+/-0.7Nmm(-1) for tensile tests, and 58.9+/-0.6Nmm(-1) for compressive test. Another compressive test performed on a shorter specimen yielded a stiffness value of 148.3+/-5.3Nmm(-1). The maximum applied load was about 0.5N. Rough measurements of specimens sizes yielded a Young's modulus value ranging from 1.41 to 1.89GPa.     

Electrical properties of chloride transport across theNecturus proximal tubule

Summary The chloride conductance of the basolateral cell membrane of theNecturus proximal tubule was studied using conventional and chloride-sensitive liquid ion exchange microelectrodes. Individual apical and basolateral cell membrane and shunt resistances, transepithelial and basolateral, cell membrane potential differences, and electromotive forces were determined in control and after reductions in extracellular Cl^–. When extracellular Cl^– activity is reduced in both apical and basolateral solutions the resistance of the shunt increases about 2.8 times over control without any significant change in cell membrane resistances. This suggests a high Cl^– conductance of the paracellular shunt but a low Cl^– conductance of the cell membranes. Reduction of Cl^– in both bathing solutions or only on the basolateral side hyperpolarizes both the basolateral cell membrane potential difference and electromotive force. Hyperpolarization of the basolateral cell membrane potential difference after low Cl^– perfusion was abolished by exposure to HCO ₃ ^– -free solutions and SITS treatment. In control conditions, intracellular Cl^– activity was significantly higher than predicted from the equilibrium distribution across both the apical and basolateral cell membranes. Reducing Cl^– in only the basolateral solution caused a decrease in intracellular Cl^–. From an estimate of the net Cl^– flux across the basolateral cell membrane and the electrochemical driving force, a Cl^– conductance of the basolateral cell membrane was predicted and compared to measured values. It was concluded that the Cl^– conductance of the basolateral cell membrane was not large enough to account for the measured flux of Cl^– by electrodiffusion alone. Therefore these results suggest the presence of an electroneutral mechanism for Cl^– transport across the basolateral cell membrane of theNecturus proximal tubule cell.     

Investigations on the reliability of determiningan individual's age from the proximal femur

In the context of individual identifications the reliable determination of age is important. It has been suggested that the femur is appropriate for reliably determining age and excellent results were indeed claimed but calculated errors of estimation were often missing in the studies. In order to check the reliability and validity for forensic diagnostics, two independent investigators who were not informed of the actual age of the femur specimens evaluated x-ray views of 90 femurs according to methods described in the literature. The results of the two investigators differed by maximally 5 years in 64.4% of all cases examined; the average error of estimation amounted to 10.1–17.0 years. Only one-seventh of all cases examined could be precisely grouped into the 5-year class. Deviations of more than 15 years occurred in nearly one fourth of all cases. In particular, individuals over 50 years of age were estimated as being much younger. We must therefore conclude that the method under examination is only appropriate for rough estimations of age. A more accurate estimation within a five-year interval is only rarely possible.     

Patient-specific finite-element analyses of the proximal femur with orthotropic material properties validated by experiments

Patient-specific high order finite-element (FE) models of human femurs based on quantitative computer tomography (QCT) with inhomogeneous orthotropic and isotropic material properties are addressed. The point-wise orthotropic properties are determined by a micromechanics (MM) based approach in conjunction with experimental observations at the osteon level, and two methods for determining the material trajectories are proposed (along organs outer surface, or along principal strains). QCT scans on four fresh-frozen human femurs were performed and high-order FE models were generated with either inhomogeneous MM-based orthotropic or empirically determined isotropic properties. In vitro experiments were conducted on the femurs by applying a simple stance position load on their head, recording strains on femurs' surface and head's displacements. After verifying the FE linear elastic analyses that mimic the experimental setting for numerical accuracy, we compared the FE results to the experimental observations to identify the influence of material properties on models' predictions. The strains and displacements computed by FE models having MM-based inhomogeneous orthotropic properties match the FE-results having empirically based isotropic properties well, and both are in close agreement with the experimental results. When only the strains in the femoral neck are being compared a more pronounced difference is noticed between the isotropic and orthotropic FE result. These results lay the foundation for applying more realistic inhomogeneous orthotropic material properties in FEA of femurs.     

The fixion proximal femur nailing system: biomechanical properties of the nail and a cadaveric study

The treatment of choice for early mobilization of hip fracture is surgery, which traditionally employs side plates and screws or intramedullary nails. We examined the biomechanical properties of a new proximal femoral nail system. The new expandable Fixion proximal femur nailing (PFN) system, made of stainless-steel alloy, consists of a nail, a peg and an anti-rotation pin. Upon positioning, the nail and peg are expanded to their maximal diameter. The current biomechanical study investigated: nail bending strength and stiffness, fatigue properties and hip peg strength. A cadaveric study that determined the effect of the expandable peg on the femoral head included subsidence testing, pull and torsion testing and intra-osseous pressure (IOP) measurements before and after expansion. Biomechanical properties of the new nail met ASTM F384 guideline requirements. The cadaver study yielded equivalent results for the pullout test between the peg and the hip screw, but found the peg superior in the torsion strength test. IOP during peg insertion and expansion was substantially lower than the threshold pressure that causes avascular necrosis. The biomechanical tests found the new system to be safe and able to provide good abutment of the nail to the bone. We conclude that the Fixion PFN system proved to be an effective proximal femur fracture fixation device.     

Critical evaluation of known bone material properties to realize anisotropic FE-simulation of the proximal femur

PURPOSE: In a meta-analysis of the literature we evaluated the present knowledge of the material properties of cortical and cancellous bone to answer the question whether the available data are sufficient to realize anisotropic finite element (FE)-models of the proximal femur. MATERIAL AND METHOD: All studies that met the following criteria were analyzed: Young's modulus, tensile, compressive and torsional strengths, Poisson's ratio, the shear modulus and the viscoelastic properties had to be determined experimentally. The experiments had to be carried out in a moist environment and at room temperature with freshly removed and untreated human cadaverous femurs. All material properties had to be determined in defined load directions (axial, transverse) and should have been correlated to apparent density (g/cm(3)), reflecting the individually variable and age-dependent changes of bone material properties. RESULTS: Differences in Young's modulus of cortical [cancellous] bone at a rate of between 33% (58%) (at low apparent density) and 62% (80%) (at high apparent density), are higher in the axial than in the transverse load direction. Similar results have been seen for the compressive strength of femoral bone. For the tensile and torsional strengths, Poisson's ratio and the shear modulus, only ultimate values have been found without a correlation to apparent density. For the viscoelastic behaviour of bone only data of cortical bone and in axial load direction have been described up to now. CONCLUSIONS: Anisotropic FE-models of the femur could be realized for most part with the summarized material properties of bone if characterized by apparent density and load directions. Because several mechanical properties have not been correlated to these main criteria, further experimental investigations will be necessary in future.     

Lung auscultation recordings from normal sheep and from sheep with well-defined respiratory tract pathology

Increased audibility of normal lung sounds is commonly caused by hyperventilation after exercise and during hot weather. Tachypnoea is common in toxaemic and septicaemic conditions, but there may be no adventitious sounds. Moderate to pronounced coarse crackles are readily identified in advanced cases of ovine pulmonary adenocarcinoma, but auscultation findings do not correspond well to the distribution of lesion(s) revealed at necropsy. Auscultation does not detect pleural abscesses (up to 10 cm diameter). Marked attenuation of normal lung sounds results from marked fibrinous pleurisy and extensive unilateral pyothorax. Pleural frictions rubs are not heard in cases of marked fibrinous pleurisy associated with pleural abscesses. Rumen contraction sounds are often superimposed upon lung sounds. Auscultation of the ovine chest alone does not allow the clinician to determine the presence of all superficial lung pathology nor accurately define its distribution. Ultrasonography provides more accurate information regarding the nature and extent of superficial lung pathology in sheep.     

Trabecular bone ontogeny in the human proximal femur

Ontogenetic changes in the human femur associated with the acquisition of bipedal locomotion, especially the development of the bicondylar angle, have been well documented. The purpose of this study is to quantify changes in the three-dimensional structure of trabecular bone in the human proximal femur in relation to changing functional and external loading patterns with age. High-resolution X-ray computed tomography scan data were collected for 15 juvenile femoral specimens ranging in age from prenatal to approximately nine years of age. Serial slices were collected for the entire proximal femur of each individual with voxel resolutions ranging from 0.017 to 0.046 mm depending on the size of the specimen. Spherical volumes of interest were defined within the proximal femur, and the bone volume fraction, trabecular thickness, trabecular number, and fabric anisotropy were calculated in three dimensions. Bone volume fraction, trabecular number, and degree of anisotropy decrease between the age of 6 months and 12 months, with the lowest values for these parameters occurring in individuals near 12 months of age. By age 2-3 years, the bone volume, thickness, and degree of anisotropy increase slightly, and regions in the femoral neck become more anisotropic corresponding to the thickening of the inferior cortical bone of the neck. These results suggest that trabecular structure in the proximal femur reflects the shift in external loading patterns associated with the initiation of unassisted walking in infants.     

A fossil hominoid proximal femur from Kikorongo Crater, southwestern Uganda

The external morphology of a fragmentary right proximal femur from southwestern Uganda is described here. Discovered in the Kikorongo Crater of Queen Elizabeth National Park in 1961, this specimen was informally assigned to Homo sapiens (although never described) and tentatively dated to the late Pleistocene. However, because aspects of the external morphology of the femur align the fossil with the African great apes, we suggest that the Kikorongo femur may be the first postcranial fossil of the genus Pan. Like the African apes, the Kikorongo specimen lacks both an obturator externus groove and an intertrochanteric line. It has a short femoral neck with a circular cross section, and a narrow and deep superior notch. Using resampling statistics and discriminant function analysis, the Kikorongo femur clustered with the genus Pan, as opposed to Gorilla or Homo. However, if the specimen is from Pan, it would be large for this taxon. Furthermore, features that clearly distinguish the external morphology of Plio-Pleistocene hominin proximal femora from African ape femora, such as the shape of the femoral neck in cross section and femoral neck length, have converged in Holocene humans and African apes. Unfortunately, the internal morphology of the femoral neck of the Kikorongo fossil was not discernable. Although we hypothesize that the Kikorongo femur is from the genus Pan, there is such variability in the proximal femora of modern humans that, although it would be an unusual human, it remains possible that this fossil represents H. sapiens.     

Comparison of micro-level and continuum-level voxel models of the proximal femur

Continuum-level finite element (FE) models became standard computational tools for the evaluation of bone mechanical behavior from in vivo computed tomography scans. Such scans do not account for the anisotropy of the bone. Instead, local mechanical properties in the continuum-level FE models are assumed isotropic and are derived from bone density, using statistical relationships. Micro-FE models, on the other hand, incorporate the anisotropic structure in detail. This study aimed to quantify the effects of assumed isotropy, by comparing continuum-level voxel models of a healthy and a severely osteoporotic proximal femur with recently analyzed micro-FE models of the same bones. The micro-model element size was coarsened to generate continuum FE models with two different element sizes (0.64 and 3.04 mm) and two different density–modulus relationships found in the literature for wet and ash density. All FE models were subjected to the same boundary conditions that simulated a fall to the side, and the stress and strain distributions, model stiffness and yield load were compared. The results indicated that the stress and strain distributions could be reproduced well with the continuum models. The smallest differences between the continuum-level model and micro-level model predictions of the stiffness and yield load were obtained with the coarsest element size. Better results were obtained for both continuum-element sizes when isotropic moduli were based on ash density rather than wet density.     

内蒙古和林格尔土城子农业人群与林西井沟子游牧人群股骨中部的生物力学对比

肢骨的形态结构可以反映人类进化、古代人群的生存适应性活动和生存环境等重要信息。基于“骨骼功能适应”和“杠杆原理”,有学者对不同生计方式的古代人群下肢股骨开展了大量的研究工作,但是,国内外尚未有关于农业人群和游牧人群股骨之间差异性研究的报道。本文选取两个具有代表性的古代人群,即内蒙古和林格尔土城子戍边农业人群和内蒙古林西井沟子游牧人群进行对比研究。通过对股骨骨干中部横断面生物力学分析发现,农业人群股骨粗壮度与游牧人群之间具有显著差异。前者的平均粗壮度较大,后者女性组下肢骨的活动强度明显较小,这可能与游牧人群经常从事骑马活动而下肢骨活动强度相对较少有关。农业人群股骨指数的变异范围均大于游牧人群,这可能与前者男性的士兵身份有关;同时,也提示土城子男性组股骨所反映的行为活动信息并不代表真正意义上的纯农业人群下肢骨行为模式,而是一种农业和士兵行为的混合模式。在性别分工上,井沟子组的男女性均从事骑马活动,两侧股骨受力较为一致,在两侧不对称性程度和骨干横断面形状上的男女差异不大;男性股骨的粗壮度要明显大于女性,这与井沟子组男性还从事一定的狩猎行为有关。与游牧人群女性较为纤细的股骨不同,土城子组女性作为典型的农业人群代表,其下肢骨整体的活动强度较大,几乎与同组的男性和井沟子组男性相当,组内的性别差异相对较小;骨干横断面形状的显著性差异说明,土城子组内部男性和女性的行为活动方式存在明显的性别分工。本文研究结果说明农业人群女性的下肢骨活动强度较大,在行为活动方式上,戍边农业人群具有更为明显的性别分工。     

Validation of subject-specific automated p-FE analysis of the proximal femur

Background: The use of subject-specific finite element (FE) models in clinical practice requires a high level of automation and validation. In Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688–3699] a novel method for generating high-order finite element (p-FE) models from CT scans was presented and validated by experimental observations on two fresh frozen femurs (harvested from a 30 year old male and 21 year old female). Herein, we substantiate the validation process by enlarging the experimental database (54 year old female femur), improving the method and examine its robustness under different CT scan conditions.Approach: A fresh frozen femur of a 54 year old female was scanned under two different environments: in air and immersed in water (dry and wet CT). Thereafter, the proximal femur was quasi-statically loaded in vitro by a 1000 N load. The two QCT scans were manipulated to generate p-FE models that mimic the experimental conditions. We compared p-FE displacements and strains of the wet CT model to the dry CT model and to the experimental results. In addition, the material assignment strategy was reinvestigated. The inhomogeneous Young's modulus was represented in the FE model using two different methods, directly extracted from the CT data and using continuous spatial functions as in Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688–3699].Results: Excellent agreement between dry and wet FE models was found for both displacements and strains, i.e. the method is insensitive to CT conditions and may be used in vivo. Good agreement was also found between FE results and experimental observations. The spatial functions representing Young's modulus are local and do not influence strains and displacements prediction. Finally, the p-FE results of all three fresh frozen human femurs compare very well to experimental observations exemplifying that the presented method may be in a mature stage to be used in clinical computer-aided decision making.     

Densitometric, morphometric and mechanical distributions in the human proximal femur

With the prevalent use of DXA-measured BMD to assess pathologic hip fractures and its recently reported lack of reliability to predict fracture or account for efficacy of anti-resorptive therapy, it is reasonable to assess whether variations in the primary and secondary tensile and compressive trabecular microstructure can account for variations in proximal femur strength in comparison to DXA-measured BMD. To that end, microstructural and densitometric measures of trabecular bone specimens, from discrete sites within the proximal femur, were correlated with their mechanical properties. We hypothesize that accounting for regional variations in trabecular microstructure will improve predictions of proximal femur strength and stiffness compared to bone density measured by DXA. Forty-seven samples (seven donors) from seven distinct sites of human proximal femur underwent DXA and muCT imaging and mechanical testing. The results revealed significant variations in BMC, morphometric indices and mechanical properties within the proximal femur. This work has demonstrated that the mechanical performance of each sub-region is highly dependent on the corresponding trabecular microstructure. BMD measured by DXA at standard regions of interest cannot resolve the variations in trabecular density and microstructure that govern the mechanical behavior of the proximal femur. This work suggests that a quantitative Singh index that uses high resolution QCT to monitor the trabecular microstructure at specific sub-regions of the proximal femur may allow better predictions of hip fracture risk in individual patients and an improved assessment of changing bone structure in response to pharmacological interventions.     

Concept and development of an orthotropic FE model of the proximal femur

PURPOSE: In contrast to many isotropic finite-element (FE) models of the femur in literature, it was the object of our study to develop an orthotropic FE "model femur" to realistically simulate three-dimensional bone remodelling. METHODS: The three-dimensional geometry of the proximal femur was reconstructed by CT scans of a pair of cadaveric femurs at equal distances of 2mm. These three-dimensional CT models were implemented into an FE simulation tool. Well-known "density-determined" bony material properties (Young's modulus; Poisson's ratio; ultimate strength in pressure, tension and torsion; shear modulus) were assigned to each FE of the same "CT-density-characterized" volumetric group.In order to fix the principal directions of stiffness in FE areas with the same "density characterization", the cadaveric femurs were cut in 2mm slices in frontal (left femur) and sagittal plane (right femur). Each femoral slice was scanned into a computer-based image processing system. On these images, the principal directions of stiffness of cancellous and cortical bone were determined manually using the orientation of the trabecular structures and the Haversian system. Finally, these geometric data were matched with the "CT-density characterized" three-dimensional femur model. In addition, the time and density-dependent adaptive behaviour of bone remodelling was taken into account by implementation of Carter's criterion. RESULTS: In the constructed "model femur", each FE is characterized by the principal directions of the stiffness and the "CT-density-determined" material properties of cortical and cancellous bone. Thus, on the basis of anatomic data a three-dimensional FE simulation reference model of the proximal femur was realized considering orthotropic conditions of bone behaviour. CONCLUSIONS: With the orthotropic "model femur", the fundamental basis has been formed to realize realistic simulations of the dynamical processes of bone remodelling under different loading conditions or operative procedures (osteotomies, total hip replacements, etc).