Effectiveness of pedicle screw inclusion at the fracture level in short-segment fixation constructs for the treatment of thoracolumbar burst fractures: a computational biomechanics analysis

When treating thoracolumbar burst fractures (BF), short-segment posterior fixation (SSPF) represents a less invasive alternative to the traditional long-segment posterior fixation (LSPF) approach. However, hardware failure and loss of sagittal alignment have been reported in patients treated with SSPF. Including pedicle screws at the fracture level in SSPF constructs has been proposed to improve stiffness and reliability of the construct. Accordingly, the biomechanical performance of the proposed construct was compared to LSPF via a computational analysis. Pedicle screws at fracture level improved the performance of the short-segment construct. However, LSPF still represent a biomechanically superior option for treating thoracolumbar BF.     

Effect of pedicle screw diameter on screw fixation efficacy in human osteoporotic thoracic vertebrae

The selection of an ideal screw size plays a crucial role in the success of spinal instrumentation as larger diameter screws are thought to provide better fixation strength but increase the risk of pedicle failure during insertion. On the other hand, smaller diameter screws are with lesser risk of pedicle breakage but are thought to compromise the stability of the instrumentation. By investigating the relationship between screw diameter and the pullout strength of pedicle screws after fatigue loading, this study seeks to find quantitative biomechanical data for surgeons in determining the most ideal diameter size screws when performing surgical implementations on osteoporotic vertebrae.Twenty-seven osteoporotic (BMD ranged: 0.353–0.848 g/cm²) thoracic vertebrae (T3-T8) were harvested from 5 human cadavers. Two sizes of poly-axial screws (5.0 mm × 35 and 4.35 mm × 35) were implanted into each pedicles of the vertebrae by an experienced surgeon. Specimens were randomly distributed into control group, fatigue group of 5000 and 10,000 cycles with peak-to-peak loadings of 10–100 N at 1 Hz. Each specimen was then axial pullout tested at a constant rate of 5 mm/min. The ultimate pullout strength (N) & stiffness (N/mm) were obtained for analysis.The results showed that although the larger diameter screws achieved superior pullout strength immediately after the implantation, both sizes of screws exhibited comparable pullout strengths post fatigue loading. This indicates that the smaller diameter screws may be considered for surgical techniques performed on osteoporotic vertebrae for reduced risk of pedicle breakage without sacrificing fixation strength.     

Finite element analysis of Stryker Xia pedicle screw in artificial bone samples with and without supplemental cement augmentation

A validated, using in vitro biomechanical testing, finite element model was used to evaluate the affects of (1) cement augmentation and (2) an intact posterior cortex in osteoporotic bone. The presence of augmentation and/or a posterior cortical cortex increased the stabilization of the pedicle screw 2–5 fold. Placement of cement influenced failure load and toggle; with distal placement having the largest increase in failure load and decrease in cephalad–caudad toggle. The presence of posterior cortex caused a decrease in the amount of toggle, a proximal shift of the center of rotation and an increase in the maximum failure force.     

Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: a biomechanical analysis

Abstract

Posterior pedicle fixation technique is a common method for treating thoracolumbar burst fractures, but the effect of different fixation techniques on the postoperative spinal mechanical properties has not been clearly defined, especially on adjacent segments. A finite element model of T10-L2 with moderate T12 vertebra burst fracture was constructed to investigate biomechanical behavior of three posterior pedicle screw fixation techniques. Compared with traditional short-segment 4 pedicle screw fixation (TS-4) and intermediate long-segment 6 pedicle screw fixation (IL-6), mono-segment 4 pedicle screw fixation (MS-4) provides a safer surgical selection to prevent the secondary degeneration of adjacent segments in the long-term.     

Effect of screw position on load transfer in lumbar pedicle screws: a non-idealized finite element analysis

Angled screw insertion has been advocated to enhance fixation strength during posterior spine fixation. Stresses on a pedicle screw and surrounding vertebral bone with different screw angles were studied by finite element analysis during simulated multidirectional loading. Correlations between screw-specific vertebral geometric parameters and stresses were studied. Angulations in both the sagittal and axial planes affected stresses on the cortical and cancellous bones and the screw. Pedicle screws pointing laterally (vs. straight or medially) in the axial plane during superior screw angulation may be advantageous in terms of reducing the risk of both screw loosening and screw breakage.     

An approximate model for cancellous bone screw fixation

This paper presents a finite element (FE) model to identify parameters that affect the performance of an improved cancellous bone screw fixation technique, and hence potentially improve fracture treatment. In cancellous bone of low apparent density, it can be difficult to achieve adequate screw fixation and hence provide stable fracture fixation that enables bone healing. Data from predictive FE models indicate that cements can have a significant potential to improve screw holding power in cancellous bone. These FE models are used to demonstrate the key parameters that determine pull-out strength in a variety of screw, bone and cement set-ups, and to compare the effectiveness of different configurations. The paper concludes that significant advantages, up to an order of magnitude, in screw pull-out strength in cancellous bone might be gained by the appropriate use of a currently approved calcium phosphate cement.     

Stress analysis of a centrally fractured rib fixated by an intramedullary screw

The stress on an intramedullary screw rib fixation device holding together a centrally fractured human rib under in vivo force loadings was studied using finite element analysis (FEA). Validation of the FEA modelling using pullout from porcine ribs proved FEA to be suitable for assessing the structural integrity of screw/bone systems such as rib fixated by a screw. In the human rib fixation investigation, it was found that intramedullary bioresorbable Bioretec screws can fixate centrally fractured human ribs under normal breathing conditions. However, under coughing conditions, simulation showed Bioretec fixating screws to bend substantially. High stresses in the screw are mainly the result of flexion induced by the force loading, and are restricted to thin regions on the outside of the screw shaft. Stiffer screws result in less locally intense stress concentrations in bone, indicating that bone failure in the bone/screw contact regions can be averted with improvements in screw stiffness.     

Estimation of conditions evoking fracture in finger bones under pinch loading based on finite element analysis

A finger finite element (FE) model was created from CT images of a Japanese male in order to obtain a shape-biofidelic model. Material properties and articulation characteristics of the model were taken from the literature. To predict bone fracture and realistically represent the fracture pattern under various loading conditions, the ESI-Wilkins-Kamoulakos rupture model in PAM-CRASH (ESI Group S.A., Paris, France) was utilized in this study with parameter values of the rupture model determined by compression testing and simulation of porcine fibula. A finger pinch simulation was then conducted to validate the finger FE model. The force-displacement curve and fracture load from the pinch simulation was compared to the result of finger pinch test using cadavers. Simulation results are coincident with the test result, indicating that the finger FE model can be used in an analysis of finger bone fracture during pinch accident. With this model, several pinch simulations were conducted with different pinching object’s stiffness and pinching energy. Conditions for evoking finger bone fracture under pinch loading were then estimated based on these results. This study offers a novel method to predict possible hazards of manufactured goods during the design process, thus finger injury due to pinch loading can be avoided.     

Material properties of the placenta under dynamic loading conditions

Trauma during pregnancy especially occurring during car crashes leads to many foetal losses. Numerical modelling is widely used in car occupant safety issue and injury mechanisms analysis and is particularly adapted to the pregnant woman. Material modelling of the gravid uterus tissues is crucial for injury risk evaluation especially for the abruption placentae which is widely assumed as the leading cause of foetal loss. Experimental studies on placenta behaviour in tension are reported in the literature, but none in compression to the authors' knowledge. This lack of data is addressed in this study. To complement the already available experimental literature data on the placenta mechanical behaviour and characterise it in a compression loading condition, 80 indentation tests on fresh placentae are presented. Hyperelastic like mean experimental stress versus strain and corridors are exposed. The results of the experimental placenta indentations compared with the tensile literature results tend to show a quasi-symmetrical behaviour of the tissue. An inverse analysis using simple finite element models has permitted to propose parameters for an Ogden material model for the placenta which exhibits a realistic behaviour in both tension and compression.     

Twist buckling of veins under torsional loading

Veins are often subjected to torsion and twisted veins can hinder and disrupt normal blood flow but their mechanical behavior under torsion is poorly understood. The objective of this study was to investigate the twist deformation and buckling behavior of veins under torsion. Twist buckling tests were performed on porcine internal jugular veins (IJVs) and human great saphenous veins (GSVs) at various axial stretch ratio and lumen pressure conditions to determine their critical buckling torques and critical buckling twist angles. The mechanical behavior under torsion was characterized using a two-fiber strain energy density function and the buckling behavior was then simulated using finite element analysis. Our results demonstrated that twist buckling occurred in all veins under excessive torque characterized by a sudden kink formation. The critical buckling torque increased significantly with increasing lumen pressure for both porcine IJV and human GSV. But lumen pressure and axial stretch had little effect on the critical twist angle. The human GSVs are stiffer than the porcine IJVs. Finite element simulations captured the buckling behavior for individual veins under simultaneous extension, inflation, and torsion with strong correlation between predicted critical buckling torques and experimental data (R² = 0.96). We conclude that veins can buckle under torsion loading and the lumen pressure significantly affects the critical buckling torque. These results improve our understanding of vein twist behavior and help identify key factors associated in the formation of twisted veins.     

Numerical investigations of rib fracture failure models in different dynamic loading conditions

Rib fracture is one of the most common thoracic injuries in vehicle traffic accidents that can result in fatalities associated with seriously injured internal organs. A failure model is critical when modelling rib fracture to predict such injuries. Different rib failure models have been proposed in prediction of thorax injuries. However, the biofidelity of the fracture failure models when varying the loading conditions and the effects of a rib fracture failure model on prediction of thoracic injuries have been studied only to a limited extent. Therefore, this study aimed to investigate the effects of three rib failure models on prediction of thoracic injuries using a previously validated finite element model of the human thorax. The performance and biofidelity of each rib failure model were first evaluated by modelling rib responses to different loading conditions in two experimental configurations: (1) the three-point bending on the specimen taken from rib and (2) the anterior–posterior dynamic loading to an entire bony part of the rib. Furthermore, the simulation of the rib failure behaviour in the frontal impact to an entire thorax was conducted at varying velocities and the effects of the failure models were analysed with respect to the severity of rib cage damages. Simulation results demonstrated that the responses of the thorax model are similar to the general trends of the rib fracture responses reported in the experimental literature. However, they also indicated that the accuracy of the rib fracture prediction using a given failure model varies for different loading conditions.     

Simulation of the behaviour of the L1 vertebra for different material properties and loading conditions

Three-dimensional finite element models of the thoracolumbar junction (T12–L2) and isolated L1 vertebra were developed to investigate the role of material properties and loading conditions on vertebral stresses and strains to predict fracture risk. The geometry of the vertebrae was obtained from computed tomography images. The isolated vertebra model included an L1 vertebra loaded through polymethylmethacrylate plates located at the top and bottom of the vertebra, and the segment model included T12 to L2 vertebrae and seven ligaments, fibrous intervertebral discs and facet joints. Each model was examined with both homogeneous and spatially varying bone tissue properties. Stresses and strains were compared for uniform compression and flexion. Including material heterogeneity remarkably reduced the stiffness of the isolated L1 vertebra and increased the magnitudes of the minimum principal strains and stresses in the mid-transverse section. The stress and strain distributions further changed when physiological loading was applied to the L1 vertebra. In the segment models, including heterogeneous material properties increased the magnitude of the minimum principal strain by 158% in the centre of the mid-transverse section. Overall, the inclusion of heterogeneity and physiological loading increased the magnitude of the strains up to 346% in flexion and 273% in compression.     

Finite element analysis of different loading conditions for implant-supported overdentures supported by conventional or mini implants

The effect of implants’ number on overdenture stability and stress distribution in edentulous mandible, implants and overdenture was numerically investigated for implant-supported overdentures. Three models were constructed. Overdentures were connected to implants by means of ball head abutments and rubber ring. In model 1, the overdenture was retained by two conventional implants; in model 2, by four conventional implants; and in model 3, by five mini implants. The overdenture was subjected to a symmetrical load at an angle of 20 degrees to the overdenture at the canine regions and vertically at the first molars. Four different loading conditions with two total forces (120, 300 N) were considered for the numerical analysis. The overdenture displacement was about 2.2 times higher when five mini implants were used rather than four conventional implants. The lowest stress in bone bed was observed with four conventional implants. Stresses in bone were reduced by 61% in model 2 and by 6% in model 3 in comparison to model 1. The highest stress was observed with five mini implants. Stresses in implants were reduced by 76% in model 2 and 89% increased in model 3 compared to model 1. The highest implant displacement was observed with five mini implants. Implant displacements were reduced by 29% in model 2, and increased by 273% in model 3 compared to model 1. Conventional implants proved better stability for overdenture than mini implants. Regardless the type and number of implants, the stress within the bone and implants are below the critical limits.     

Stress distribution in cylindrical and conical implants under rotational micromovement with different boundary conditions and bone properties: 3-D FEA

Factors related to micromovements at bone-implant interface have been studied because they are considered adverse to osseointegration. Simplifications are commonly observed in these FEA evaluations. The aim of this study was to clarify the influence of FEA parameters (boundary conditions and bone properties) on the stress distribution in peri-implant bone tissue when micromovements are simulated in implants with different geometries. Three-dimensional models of an anterior section of the jaw with cylindrical or conical titanium implants (4.1 mm in width and 11 mm in length) were created. Micromovement (50, 150, or 250 μm) was applied to the implant. The FEA parameters studied were linear vs. non-linear analyses, isotropic vs. orthogonal anisotropic bone, friction coefficient (0.3) vs. frictionless bone-implant contact. Data from von Mises, shear, maximum, and minimum principal stresses in the peri-implant bone tissue were compared. Linear analyses presented a relevant increase of the stress values, regardless of the bone properties. Frictionless contact reduced the stress values in non-linear analysis. Isotropic bone presented lower stress than orthogonal anisotropic. Conical implants behave better, in regard to compressive stresses (minimum principal), than cylindrical ones, except for nonlinear analyses when micromovement of 150 and 250 μm were simulated. The stress values raised as the micromovement amplitude increased. Non-linear analysis, presence of frictional contact and orthogonal anisotropic bone, evaluated through maximum and minimum principal stress should be used as FEA parameters for implant-micromovement studies.     

Stress analysis of a complete maxillary denture under various drop impact conditions: a 3D finite element study

Complete maxillary dentures are one of the most economic and easy ways of treatment for edentulous patients and are still widely used. However, their survival rate is slightly above three years. It is presumed that the failure reasons are not only due to normal fatigue but also emerge from damage based on unavoidable improper usage. Failure types other than long-term fatigue, such as over-deforming, also influence the effective life span of dentures. A hypothesis is presumed, stating that the premature/unexpected failures may be initiated by impact on dentures, which can be related to dropping them on the ground or other effects such as biting crispy food. Thus, the behavior of a complete maxillary denture under impact loading due to drop on a rigid surface was investigated using the finite element method utilizing explicit time integration and a rate-sensitive elastoplastic material model of polymethylmethacrylate (PMMA). Local permanent deformations have been observed along with an emphasis on frenulum region of the denture, regardless of the point of impact. Contact stresses at the tooth–denture base were also investigated. The spread of energy within the structure via wave propagation is seen to play a critical role in this fact. Stress-wave propagation is also seen to be an important factor that decreases the denture's fatigue life.     

Finite element analysis to characterize how varying patellar loading influences pressure applied to cartilage: model evaluation

A finite element analysis (FEA) modeling technique has been developed to characterize how varying the orientation of the patellar tendon influences the patellofemoral pressure distribution. To evaluate the accuracy of the technique, models were created from MRI images to represent five knees that were previously tested in vitro to determine the influence of hamstrings loading on patellofemoral contact pressures. Hamstrings loading increased the lateral and posterior orientation of the patellar tendon. Each model was loaded at 40°, 60°, and 80° of flexion with quadriceps force vectors representing the experimental loading conditions. The orientation of the patellar tendon was represented for the loaded and unloaded hamstrings conditions based on experimental measures of tibiofemoral alignment. Similar to the experimental data, simulated loading of the hamstrings within the FEA models shifted the center of pressure laterally and increased the maximum lateral pressure. Significant (p < 0.05) differences were identified for the center of pressure and maximum lateral pressure from paired t-tests carried out at the individual flexion angles. The ability to replicate experimental trends indicates that the FEA models can be used for future studies focused on determining how variations in the orientation of the patellar tendon related to anatomical or loading variations or surgical procedures influence the patellofemoral pressure distribution.     

The contribution of the glenoid labrum to glenohumeral stability under physiological joint loading using finite element analysis

The labrum contributes to passive glenohumeral joint stability. Cadaveric studies have demonstrated that this has position and load dependency, which has not been quantified under physiological loads. This study aims to validate subject-specific finite element (FE) models against in vitro measurements of joint stability and to utilise the FE models to predict joint stability under physiological loads. The predicted stability values were within ± one standard deviation of experimental data and the FE models showed a reduction in stability of 10–15% with high, physiological, loads. The developed regression equations provide the first representation of passive glenohumeral stability and will aid surgical decision-making.     

辣椒OSCA基因家族的全基因组鉴定及不同胁迫条件下表达分析

钙通透性阳离子通道蛋白(OSCA)在渗透胁迫感应中发挥重要的作用.本研究利用辣椒(Capsicum an-nuum L.)全基因组信息,鉴定出14个OSCA基因(CaOSCA),染色体定位及同源性分析表明,它们分别位于1、2、4、6、7、8、9、12号染色体上,亚细胞定位预测表明其编码产物均位于质膜上.系统进化树分析这...