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Orthopedic surgeons endure high physical stresses when performing surgery, as large forces and torques are applied commonly. Occupational risks are consequently higher when compared to other surgical disciplines. One example is the reaming of the acetabula during total hip arthroplasty, using customized instruments. This surgery may predispose the surgeon to overuse-related wrist pathology. In this study, torques acting along the reaming tool were measured, and the resulting forces applied to the orthopedic surgeons' wrists were estimated based on the measured torque data from hip reaming. Different reamer sizes and tool velocities were analyzed to determine how both parameters may influence the torques applied at the surgeon's wrist. Using a highly standardized setup, torques were measured while the reamer was pushed into the acetabula to remove cartilage. Maximum torques and stoppage torques at blocking of the reamer were compared between feed rates and reamer sizes. Peak values of the maximum torques along the reamer axis averaged 1.5-1.8 Nm. No significant difference between maximum torques and reamer sizes was found. A significant difference in maximum torques was noted between feed rates with a large effect (p = 0.010; η 2  = 0.214) and a large interaction effect (p = 0.017; η 2  = 0.186). Based on this experimental setup, it can be hypothesized that the impulsive behavior of the torque when the milling tool reaches the subchondral lamella could potentially contribute to wrist pathology. These preliminary data warrant further study. Consequently, torque limiters should be implemented in reamers to minimize the risk of occupation-related pathology to the wrist., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Colonoscopy is a commonly-performed procedure to diagnose pathology of the large intestine. Perforation of the colon is a rare but feared complication. It is currently unclear how much force is actually required to cause such injury nor how this is altered in certain diseases. Our aim was to analyze the forces required to perforate the colon in experiments using porcine tissues., Methods: Using 3D printing technology, models of two commercially available colonoscope heads were printed under three configurations: straight (I), 90°- bent (L) and fully bent (U). Samples of porcine colon were assessed with the models and configurations under perpendicular and angular load application and these data compared to the maximum force typically exerted by experienced colonoscopists., Results: The force required for perforation was significantly lower for the I compared to the L of the larger colonoscope head configuration under angular loading (14.1 vs. 46.5 N). Similar differences were found for linear stiffness when loaded (I vs. L small when loaded perpendicular: 0.8 vs. 2.4 N/mm, I vs. L large when loaded angled 0.7 vs. 2.1 N/mm). The mode and site of failure varied significantly between the scopes, with delamination of the mucosa/submucosa below the sample (96%) for the I, blunt mucosa/submucosa/muscularis failure adjacent to the loading site (77%) for the L, and failure of all colon layers lateral to the loading site (59%) for the U configuration, respectively. Perpendicular and angulated loading resulted in similar load-deformation values. Maximum forces typically exerted by colonoscopists averaged 13.9-27.9 N, depending on the colonoscope model and head configuration., Discussion: The force required for colon perforation varies depending on the type mode of loading and is likely lower than the force an experienced colonoscopist would exert in daily practice. There is a real risk of perforation, especially when the end of the scope is advancing directly into the colonic wall. The given experimental setup allowed to obtain reliable data of the colon in a standardized scenario, forming the basis for further experiments., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Mechanical properties of the human scalp have not been investigated to a great extent with limited information available. The purpose of this study was to provide new baseline material data for human scalp tissue of various ages, which can be applied to experimental and constitutive models, such as in the area of impact biomechanics. This study used specimens from the left and right temporal, fronto-parietal and occipital regions of the human scalp. It investigated the tensile behavior of scalp tissue using tissues harvested from unfixed, fresh cadavers. These samples were subjected to an osmotic stress analysis and upon testing, cyclic loading followed by stretching until failure in a universal testing machine. Strain evaluation was conducted using digital image correlation in a highly standardized approach. Elastic modulus, tensile strength, strain at maximum load and strain to failure were evaluated computationally. No significant differences were observed comparing the tensile strength between males and females. In contrast to that, a sex-dependent difference was found for the elastic modulus of the occipital scalp region and for the elongation properties. Additionally, regional differences within the male group, as well as an age dependent correlation for females were found in the elastic modulus and tensile strength. Scanning electron microscope analyses have shown the ultrastructural failure patterns, indicated by damaged keratin plates, as well as partially disrupted and retraced collagens at the failure site. The novel data obtained in this study could add valuable information to be used for modeling purposes, as well as provide baseline data for simulant materials and comparisons of tissue properties following head injury or forensic investigations., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Blunt force impacts to the head and the resulting internal force transmission to the brain and other cranial tissue are difficult to measure. To model blunt force impact scenarios, the compressive properties resembling tissue elasticity are of importance. Therefore, this study investigated and compared the elastic behavior of gelatin, alginate, agar/glycerol and agar/glycerol/water simulant materials to that of porcine brain in a fresh and unfixed condition. Specimens, 10 × 10 × 10mm 3 , were fabricated and tested at 22°C, apart from gelatin which was conditioned to 4°C prior to testing. For comparison, fresh porcine brains were sourced and prepared to the same dimensions as the simulants. Specimens underwent compression tests at crosshead displacement rates of 2.5, 10 and 16mms -1 (equivalent to strain rates of 0.25, 1 and 1.6s -1 ), obtaining apparent elastic moduli values at different strain rate intervals (0-0.2, 0.2-0.4 and 0.4-0.5). The results of this study indicate that overall all simulant materials had an apparent elastic moduli similar in magnitude across all strain ranges compared to brain, even though comparatively higher, especially the apparent elastic moduli values of alginate. In conclusion, while agar/glycerol/water and agar/glycerol had similar apparent elastic moduli in magnitude and the closest apparent elastic moduli in the initial strain range (E 1 ), gelatin showed the most similar values to fresh porcine brain at the transitional (E 2 ) and higher strain range (E 3 ). The simulant materials and the fresh porcine brain exhibited strain rate dependent behavior, with increasing elastic moduli upon increasing loading velocities., (Copyright © 2017 Elsevier Ltd. All rights reserved.)