A new device to quantify regenerate torsional stiffness in distraction osteogenesis.

We present a newly developed torsional stiffness measurement device with the potential to quantitatively assess the in vivo torsional stiffness of bone regenerate during distraction osteogenesis. We describe the form and function of this device and its application in a model of regenerate consolidation. The device was able to produce data to assess stiffness of the regenerate with an accuracy between +/- 3 and +/- 9% for material stiffness ranging between 0.1 and 2.4 Nm/o and with a precision of +/- 3.6%. This method provides advantages over similar methods of bone fracture healing assessment with guaranteed maintenance of bone axis, minimized risk of bone misalignment during the bone healing process and a close relation to the functional loading pattern in torsion of bones such as tibia and femora.     

Effects of chair restraint on the strength of the tibia in rhesus monkeys

To determine the effects of the relative inactivity and unloading on the strength of the tibias of monkeys, Macaca mulatta, we used a non-invasive test to measure bending stiffness, or EI (Nm2), a mechanical property. The technique was validated by comparisons of in vivo measurements with standard measures of EI in the same bones post-mortem (r2 = 0.95, P < 0.0001). Inter-test precision was 4.28+/-1.4%. Normative data in 24 monkeys, 3.0+/-0.7 years and 3.6+/-0.6 kg, revealed EI to be 16% higher in the right than left tibia (4.4+/-1.6 vs. 3.7+/-1.6 Nm2, P < 0.05). Five monkeys, restrained in chairs for 14 days, showed decreases in EI. There were no changes in EI in two chaired monkeys that lost weight during a 2-week space flight. The factors that account for both the decreases in bone mechanical properties after chair restraint at 1 g and lack of change after microgravity remain to be identified. Metabolic factors associated with body weight changes are suggested by our results.     

Rigidity of microtubules is increased by stabilizing agents

Microtubules are rigid polymers that contribute to the static mechanical properties of cells. Because microtubules are dynamic structures whose polymerization is regulated during changes in cell shape, we have asked whether the mechanical properties of microtubules might also be modulated. We measured the flexural rigidity, or bending stiffness, of individual microtubules under a number of different conditions that affect the stability of microtubules against depolymerization. The flexural rigidity of microtubules polymerized with the slowly hydrolyzable nucleotide analogue guanylyl-(alpha, beta)- methylene-diphosphonate was 62 +/- 9 x 10(-24) Nm2 (weighted mean +/- SEM); that of microtubules stabilized with tau protein was 34 +/- 3 x 10(-24) Nm2; and that of microtubules stabilized with the antimitotic drug taxol was 32 +/- 2 x 10(-24) Nm2. For comparison, microtubules that were capped to prevent depolymerization, but were not otherwise stabilized, had a flexural rigidity of 26 +/- 2 x 10(-24) Nm2. Decreasing the temperature from 37 degrees C to approximately 25 degrees C, a condition that makes microtubules less stable, decreased the stiffness of taxol-stabilized microtubules by one-third. We thus find that the more stable a microtubule, the higher its flexural rigidity. This raises the possibility that microtubule rigidity may be regulated in vivo. In addition, the high rigidity of an unstabilized, GDP-containing microtubule suggests that a large amount of energy could be stored as mechanical strain energy in the protein lattice for subsequent force generation during microtubule depolymerization.     

A new device to control mechanical environment in bone defect healing in rats

Mechanical conditions have a significant influence on the biological processes of bone healing. Small animal models that allow controlling the mechanical environment of fracture and bone defect healing are needed. The aim of this study was to develop a new animal model that allows to reliably control the mechanical environment in fracture and bone defect healing in rats using different implant materials. An external fixator was designed and mounted in vitro to rat femurs using four Kirschner-wires (titanium (T) or steel (S)) of 1.2mm diameter. The specimens were distracted to a gap of 1.5mm. Axial and torsional stiffness of the device was tested increasing the offset (distance between bone and fixator crossbar) from 5 to 15mm. In vivo performance (well-being, infection, breaking of wires and bone healing) was evaluated in four groups of 24 Sprague-Dawley rats varying in offset (7.5 and 15mm) and implant material (S/T) over 6 weeks. Torsional and axial stiffness were higher in steel compared to titanium setups. A decrease in all configurations was observed by increasing the offset. The offset 7.5mm showed a significantly higher torsional (S: p<0.01, T: p<0.001) and axial in vitro stiffness (S: p<0.001, T: p<0.001) compared to 15mm offset of the fixator. Although in vitro designed to be different in mechanical stiffness, no difference was found between the groups regarding complication rate. The overall-complication rate was 5.2%. In conclusion, we were able to establish a small animal model for bone defect healing which allows modeling the mechanical conditions at the defect site in a defined manner.     

Adjustable Stiffness,External Fixator for the Rat Femur Osteotomy and Segmental Bone Defect Models

The mechanical environment around the healing of broken bone is very important as it determines the way the fracture will heal. Over the past decade there has been great clinical interest in improving bone healing by altering the mechanical environment through the fixation stability around the lesion. One constraint of preclinical animal research in this area is the lack of experimental control over the local mechanical environment within a large segmental defect as well as osteotomies as they heal. In this paper we report on the design and use of an external fixator to study the healing of large segmental bone defects or osteotomies. This device not only allows for controlled axial stiffness on the bone lesion as it heals, but it also enables the change of stiffness during the healing process in vivo. The conducted experiments have shown that the fixators were able to maintain a 5 mm femoral defect gap in rats in vivo during unrestricted cage activity for at least 8 weeks. Likewise, we observed no distortion or infections, including pin infections during the entire healing period. These results demonstrate that our newly developed external fixator was able to achieve reproducible and standardized stabilization, and the alteration of the mechanical environment of in vivo rat large bone defects and various size osteotomies. This confirms that the external fixation device is well suited for preclinical research investigations using a rat model in the field of bone regeneration and repair.     

Ideal operating conditions for a variable stiffness transverse plane adapter for individuals with lower-limb amputation

Transverse plane shear stress between the prosthetic socket and residual limb often results in soft tissue breakdown and discomfort for individuals with lower-limb amputation. To better understand the effects of reduced transverse plane stiffness in the shank of a prosthesis, a second-generation variable stiffness torsion adapter (VSTA II) was tested with individuals with a transtibial amputation (n = 10). Peak transverse plane moments, VSTA II deflection, range of whole body angular momentum (WBAM), ground reaction impulse, joint work, and personal stiffness preference were evaluated at three fixed stiffness levels (compliant: 0.25 Nm/°, intermediate: 0.75 Nm/°, stiff: 1.25 Nm/°) at three walking speeds (self-selected, fast and slow: +/− 20% of self-selected, respectively) while straight-line walking and performing left and right turns. Residual limb loading decreased and VSTA II displacement increased for reductions in stiffness and both metrics increased with increasing walking speed, while ground reaction impulse and joint work were unaffected. The range of WBAM increased with decreased stiffness, which suggests an increased risk of falling when using the VSTA II at lower stiffness settings. Preference testing showed no significant result, but trends for lower stiffness settings when turning and walking at self-selected speeds were noted, as were stiffer settings when walking straight and at faster speeds. These results show that a device with rotational compliance like the VSTA II could reduce loading on the residual limb during straight walking and turning activities and that factors such as walking speed, activity type and user preference can affect the conditions for optimal use.     

Erythropoietin (EPO): EPO-receptor signaling improves early endochondral ossification and mechanical strength in fracture healing

Beyond its role in the regulation of red blood cell proliferation, the glycoprotein erythropoietin (EPO) has been shown to promote cell regeneration and angiogenesis in a variety of different tissues. In addition, EPO has been indicated to share significant functional and structural homologies with the vascular endothelial growth factor (VEGF), a cytokine essential in the process of fracture healing. However, there is complete lack of information on the action of EPO in bone repair and fracture healing. Therefore, we investigated the effect of EPO treatment on bone healing in a murine closed femur fracture model using radiological, histomorphometric, immunohistochemical, biomechanical and protein biochemical analysis. Thirty-six SKH1-hr mice were treated with daily i.p. injections of 5000 U/kg EPO from day 1 before fracture until day 4 after fracture. Controls received equivalent amounts of the vehicle. After 2 weeks of fracture healing, we could demonstrate expression of the EPO-receptor (EPOR) in terminally differentiating chondrocytes within the callus. At this time point EPO-treated animals showed a higher torsional stiffness (biomechanical analysis: 39.6+/-19.4% of the contralateral unfractured femur) and an increased callus density (X-ray analysis (callus density/spongiosa density): 110.5+/-7.1%) when compared to vehicle-treated controls (14.3+/-8.2% and 105.9+/-6.6%; p<0.05). Accordingly, the histomorphometric examination revealed an increased fraction of mineralized bone and osteoid (33.0+/-3.0% versus 28.5+/-3.6%; p<0.05). Of interest, this early effect of the initial 6-day EPO treatment had vanished at 5 weeks after fracture. We conclude that EPO-EPOR signaling is involved in the process of early endochondral ossification, enhancing the transition of soft callus to hard callus.     

Assessment of functional series elastic stiffness of human dorsiflexors with fast controlled releases.

The series elastic stiffness (SES) of the human dorsiflexors was investigated in vivo with the fast controlled release method in 8 subjects. The maximum moment of a voluntary contraction (66 +/- 17 Nm) was significantly higher than the maximum moment with electrical stimulation of tibialis anterior (34 +/- 16 Nm). At an ankle moment of 34 Nm produced with either voluntary or electrical stimulation, we found a significantly different SES of 219 +/- 54 and 149 +/- 54 Nm. rad(-1), respectively. It is proposed that this is due to the fact that, during voluntary contraction, more elastic tissue parallel with each other is involved, because of coactivation of the extensor hallucis longus, extensor digitorum longus, and tibialis anterior. This shows that, for a functional assessment of the SES of the dorsiflexors, one has to include the toe extensors, which is possible with the fast controlled release method. Additionally, our results demonstrated that the SES of the human dorsiflexors at moment levels up to about isometric maximum did not reach an asymptote at which the stiffness is independent of moment, i.e., the series elastic component of the dorsiflexors is during daily activities loaded for the greatest part in the nonlinear part of the stress-strain function.     

In vivo measurement of bending stiffness in fracture healing

Background  

Measurement of the bending stiffness a healing fracture represents a valid variable in the assessment of fracture healing. However, currently available methods typically have high measurement errors, even for mild pin loosening. Furthermore, these methods cannot provide actual values of bending stiffness, which precludes comparisons among individual fractures. Thus, even today, little information is available with regards to the fracture healing pattern with respect to actual values of bending stiffness. Our goals were, therefore: to develop a measurement device that would allow accurate and sensitive measurement of bending stiffness, even in the presence of mild pin loosening; to describe the course of healing in individual fractures; and help to evaluate whether the individual pattern of bending stiffness can be predicted at an early stage of healing.     

Evaluation of an electromagnetic position tracking device for measuring in vivo, dynamic joint kinematics

An electromagnetic position tracking device was evaluated to determine its static and dynamic accuracy and reliability for applications related to measuring in vivo joint kinematics. The device detected the position and orientation of small coiled sensors, maintained in an electromagnetic field. System output was measured against known translations or rotations throughout the measurement volume. Average translational errors during static testing were 0.1 +/- 0.04, 0.2 +/- 0.17, and 0.8 +/- 0.81 mm (mean+/-SD) for sensors 50, 300, and 550 mm away from the field generator, respectively. Average rotational errors were 0.4 +/- 0.31 degrees, 0.4 +/- 0.21 degrees, and 0.9 +/- 0.85 degrees (mean +/- SD) for sensors located at the same distances. Since we intended to use this system in an animal walking on a treadmill, we incrementally moved the sensors under various treadmill conditions. The effects of treadmill operation on translational accuracy were found to be negligible. The effects of dynamic motions on sensor-to-sensor distance were also assessed for future data collection in the animal. Sensor-to-sensor distance showed standard deviations of 2.6 mm and a range of 13 mm for the highest frequency tested (0.23 Hz). We conclude that this system is useful for static or slow dynamic motions, but is of limited use for obtaining gait kinematics at higher speeds.     

Stiffness behaviour of trabecular bone specimens

Trabecular bone specimens were tested by non-destructive technique with the purpose of investigating stiffness behaviour and optimizing stiffness determination. Cylindrical specimens (n = 25) were loaded repetitively (0.1 Hz, 30 cycles) by axial compression to 50% of predicted ultimate strength and finally compressed to failure. Analyses of single compression curves showed increasing stiffness (E') until a stress level about 50% of ultimate stress followed by decreasing stiffness. Curve fit analysis of the elastic part of the compression curve showed the best fit, when a second order polynomial was used (r = 0.94, p less than 0.001). The stiffness determined non-destructively at the 25% level of ultimate strength increased significantly to the tenth loading cycle followed by a steady state. The precision of stiffness determination as an average of five consecutive measurements at steady state was E' +/- less than 5% (95% confidence limits). A reproducibility test by repetition of the test sequence after 3 h rest showed qualitatively the same stiffness behaviour. The variation of stiffness determination between the two test sequences was +/- 27% at the first loading cycle falling to +/- 12% at steady state.     

Assessment of human locomotion by using an insole measurement system and artificial neural networks

A new method for measuring and characterizing free-living human locomotion is presented. A portable device was developed to objectively record and measure foot-ground contact information in every step for up to 24h. An artificial neural network (ANN) was developed to identify the type and intensity of locomotion. Forty subjects participated in the study. The subjects performed level walking, running, ascending and descending stairs at slow, normal and fast speeds determined by each subject, respectively. The device correctly identified walking, running, ascending and descending stairs (accuracy 98.78%, 98.33%, 97.33%, and 97.29% respectively) among different types of activities. It was also able to determine the speed of walking and running. The correlation between actual speed and estimated speed is 0.98, p< 0.0001. The average error of walking and running speed estimation is -0.050+/-0.747 km/h (mean +/- standard deviation). The study has shown the measurement of duration, frequency, type, and intensity of locomotion highly accurate using the new device and an ANN. It provides an alternative tool to the use of a gait lab to quantitatively study locomotion with high accuracy via a small, light and portable device, and to do so under free-living conditions for the clinical applications.     

Accuracy and reproducibility of bending stiffness measurements by mechanical response tissue analysis in artificial human ulnas

Osteoporosis is characterized by reduced bone strength, but no FDA-approved medical device measures bone strength. Bone strength is strongly associated with bone stiffness, but no FDA-approved medical device measures bone stiffness either. Mechanical Response Tissue Analysis (MRTA) is a non-significant risk, non-invasive, radiation-free, vibration analysis technique for making immediate, direct functional measurements of the bending stiffness of long bones in humans in vivo. MRTA has been used for research purposes for more than 20 years, but little has been published about its accuracy. To begin to investigate its accuracy, we compared MRTA measurements of bending stiffness in 39 artificial human ulna bones to measurements made by Quasistatic Mechanical Testing (QMT). In the process, we also quantified the reproducibility (i.e., precision and repeatability) of both methods. MRTA precision (1.0±1.0%) and repeatability (3.1±3.1%) were not as high as those of QMT (0.2±0.2% and 1.3+1.7%, respectively; both p<10⁻⁴). The relationship between MRTA and QMT measurements of ulna bending stiffness was indistinguishable from the identity line (p=0.44) and paired measurements by the two methods agreed within a 95% confidence interval of ±5%. If such accuracy can be achieved on real human ulnas in situ, and if the ulna is representative of the appendicular skeleton, MRTA may prove clinically useful.     

A force transducer to measure individual finger loads during activities of daily living.

A new six-degree-of-freedom force transducer has been manufactured, with the sensitivity to measure forces in the range +/-100 N and moments of up to +/-5 Nm. The transducer incorporates two mechanical components: shear forces and bending moments are measured via a strain-gauged tubular section whilst axial forces are transmitted to a cantilevered load cell. Both components are instrumented with 350 ohms strain gauge full bridge circuits and are temperature compensated. After calibration, measurement errors are less than +/-0.3 N for direct forces and +/-0.03 Nm for applied moments. In order to measure sub-maximal finger loads during activities of daily living, the transducer has been incorporated into several housings representing objects in domestic use: a jar, a tap, a key in a lock and a jug kettle.     

In vivo passive mechanical properties of the human gastrocnemius muscle belly

The purpose of the present study was to determine the in vivo passive mechanical properties, including the length below the slack length, of the gastrocnemius muscle (GAS) belly in humans. Transverse ultrasound images of the medial head of the GAS were taken in 11 subjects during passive knee extension from 80 degrees to 5 degrees with a constant ankle joint angle of 10 degrees (0 degrees is the neutral ankle position: positive values for dorsiflexion). The change in passive ankle joint moment (Mp), which is produced only by the GAS length change, was also measured during passive knee extension. The onset of Mp during passive knee extension was found to be 43+/-8 degrees (mean+/-SD) when the baseline of the Mp was set at the average Mp in the range of 55-60 degrees where the Mp was almost constant (SD<0.03 Nm). At this onset, the muscle fascicle length of the GAS (Lf) was 46+/-7 mm (slack length; Lfs). Lf at 80 degrees was 6+/-4 mm (13+/-6%) less than the Lfs, and Lf at 5 degrees was 12+/-5 mm (27+/-11%) greater than the Lfs. The passive force-resisting compression of the GAS did not produce a dorsiflexion moment in the joint angle range adopted. The passive ankle joint moment increased linearly with Lf (coefficient of determination (R2)=0.85-0.96), and the slopes of the relationships between Lf and Mp, and between the relative Lf to Lfs and Mp were 0.093+/-0.038 Nm/mm and 0.043+/-0.021 Nm/%Lfs. The findings of the present study can be implemented in musculoskeletal modeling, which would provide a more accurate evaluation of the passive mechanical properties of muscle during movement.     

Assessment of markers of bone formation under controlled environmental factors and their correlation with serum minerals in adult sheep as a model for orthopaedic research

Eighteen healthy skeletally mature (3 years old) ewes, with an average weight of 45 kg, of the Portuguese Churra da Terra Quente breed were used to evaluate the normal values of total and bone-specific isoform of alkaline phosphatase serum activities (ALP and BALP, respectively) and serum osteocalcin (OC) and their correlation with the serum minerals - calcium (Ca), phosphorus (P), magnesium (Mg) and ionized calcium (Ca(2+)). The sheep were maintained under controlled environmental conditions (constant diurnal photoperiod cycle and identical husbandry and feeding) for six weeks before the collection of the blood samples. The measurement of the total ALP and serum minerals was performed with automated biochemistry analysers using the BioMérieux kits, the serum electrolyte Ca(2+) Diametrics Medical, Inc specific cassettes and the BALP and OC METRATM kits from QUIDEL Corporation. The mean +/- standard deviation values obtained were: total ALP 90.17 +/- 85.72 U/L, BALP 15.0 +/- 5.44 U/L, ratio BALP/ total ALP 29.28 +/- 24.22, OC 13.02 +/- 1.87 ng/mL, Ca 2.57 +/- 0.37 mmol/L, P 2.13 +/- 0.42 mmol/L, Mg 1.04 +/- 0.13 mmol/L, Ca(2+) 1.29 +/- 0.04 mmol/L. Significant correlations were observed between the total ALP and Ca (r = 0.5939; P = 0.05) and OC and Ca (r = 0.5706; P = 0.05). Reference to the serum values of bone turnover parameters in sheep could be of great value in research and could provide complementary non-invasive information on the bone healing process, particularly with regard to obtaining an early prognosis of fracture healing.     

Modulation of bone ingrowth of rabbit femur titanium implants by in vivo axial micromechanical loading.

Titanium implants commonly used in orthopedics and dentistry integrate into host bone by a complex and coordinated process. Despite increasingly well illustrated molecular healing processes, mechanical modulation of implant bone ingrowth is poorly understood. The objective of the present study was to determine whether micromechanical forces applied axially to titanium implants modulate bone ingrowth surrounding intraosseous titanium implants. We hypothesized that small doses of micromechanical forces delivered daily to the bone-implant interface enhance implant bone ingrowth. Small titanium implants were placed transcortically in the lateral aspect of the proximal femur in 15 New Zealand White rabbits under general anesthesia and allowed to integrate with the surrounding bone for 6 wk. Micromechanical forces at 200 mN and 1 Hz were delivered axially to the right femur implants for 10 min/day over 12 consecutive days, whereas the left femur implants served as controls. The average bone volume 1 mm from mechanically loaded implants (n = 15) was 73 +/- 12%, which was significantly greater than the average bone volume (52 +/- 21%) of the contralateral controls (n = 15) (P < 0.01). The average number of osteoblast-like cells per endocortical bone surface was 55 +/- 8 cells/mm(2) for mechanically loaded implants, which was significantly greater than the contralateral controls (35 +/- 6 cells/mm(2)) (P < 0.01). Dynamic histomorphometry showed a significant increase in mineral apposition rate and bone-formation rate of mechanically stressed implants (3.8 +/- 1.2 microm/day and 2.4 +/- 1.0 microm(3).microm(-2).day(-1), respectively) than contralateral controls (2.2 +/- 0.92 microm/day and 1.2 +/- 0.60 microm(3).microm(-2).day(-1), respectively; P < 0.01). Collectively, these data suggest that micromechanical forces delivered axially on intraosseous titanium implants may have anabolic effects on implant bone ingrowth.     

A method for measuring joint kinematics designed for accurate registration of kinematic data to models constructed from CT data

A method for measuring three-dimensional kinematics that incorporates the direct cross-registration of experimental kinematics with anatomic geometry from Computed Tomography (CT) data has been developed. Plexiglas registration blocks were attached to the bones of interest and the specimen was CT scanned. Computer models of the bone surface were developed from the CT image data. Determination of discrete kinematics was accomplished by digitizing three pre-selected contiguous surfaces of each registration block using a three-dimensional point digitization system. Cross-registration of bone surface models from the CT data was accomplished by identifying the registration block surfaces within the CT images. Kinematics measured during a biomechanical experiment were applied to the computer models of the bone surface. The overall accuracy of the method was shown to be at or below the accuracy of the digitization system used. For this experimental application, the accuracy was better than +/-0.1mm for position and 0.1 degrees for orientation for linkage digitization and better than +/-0.2mm and +/-0.2 degrees for CT digitization. Surface models of the radius and ulna were constructed from CT data, as an example application. Kinematics of the bones were measured for simulated forearm rotation. Screw-displacement axis analysis showed 0.1mm (proximal) translation of the radius (with respect to the ulna) from supination to neutral (85.2 degrees rotation) and 1.4mm (proximal) translation from neutral to pronation (65.3 degrees rotation). The motion of the radius with respect to the ulna was displayed using the surface models. This methodology is a useful tool for the measurement and application of rigid-body kinematics to computer models.     

Plantarflexor muscle function in young and elderly women

Contractile properties of the ankle plantarflexor muscles were compared between groups of young (means = 26 y) and elderly (means = 82 y) women. The H-reflex muscle contraction in the elderly group was characterized by a significant slowing of torque generation, as compared to the young women (means for average rate of torque development were young = 0.16 Nm ms-1 +/- 0.02 (SE), elderly = 0.09 Nm ms-1 +/- 0.02, P less than 0.05). However, the proportion of the total motor unit pool activated by the reflex was similar for the young and elderly groups at 63% and 70%, respectively. Maximal voluntary isometric torques were significantly lower (71%) in the elderly (young means = 135.3 Nm +/- 9.3, elderly means = 39.2 Nm +/- 2.9, P less than 0.01). These results are consistent with, and extend, previous reports showing decreased strength and speed of contraction in elderly muscle. Given that the average body weight was similar for the young and elderly groups, it was concluded that the aged plantarflexor muscles exhibited considerable impairment in ability to generate stabilizing torques about the ankle joint.     

Evaluating the stability of fracture fixation systems: mechanical device for evaluation of 3-D stiffness in vitro]

Different fixation systems are used for fracture and defect treatment. A prerequisite for complication free healing is sufficient mechanical stability of the osteosynthesis. In vitro investigations offer the possibility of both analysing and assessing the pre-clinical fixation stability. Due to the complex loading environment in vivo, stiffness analysis should include a complete determination of the stiffness under standardised conditions. Based on a mathematical procedure to calculate the 3-D stiffness, a mechanical testing device for the 3-D loading of fixation systems was designed and integrated in the existing test set-up. The set-up consisted of a material testing machine to produce the necessary loads and an optical measurement device to detect the resulting inter-fragmentary movements. To validate the testing device, the 3-D stiffness matrices of different Ilizarov fixator configurations were determined and compared. The good reproducibility of the test was reflected in the small intra-individual variability of the stiffness components. A distinct direction dependence of the fixator stiffness was observed. Increasing the number of rings led to a stiffness increase of up to 50%, especially in bending. The presented testing device allows a complete standardised determination of the stiffness of different fixation systems. It considers the direction dependence of the stiffness and creates a prerequisite for a more direct implant comparison.