Search

Background: The most important issue in the assessment of fracture healing is to acquire information about the restoration of the mechanical integrity of bone. Many researchers have attempted to monitor stiffness either directly or indirectly for the purpose of assessing strength, as strength has been impossible to assess directly in clinical practice. The purpose of this study was thus to determine the relationship between bending stiffness and strength using mechanical testing at different times during the healing process., Methods: Unilateral, transverse, mid-tibial osteotomies with a 2-mm gap were performed in 28 rabbits. The osteotomy site was stabilized using a double-bar external fixator. The animals were divided into four groups (n=7/group/time point; 4, 6, 8 and 12 weeks). A series of images from micro-computed tomography of the gap was evaluated to detect the stage of fracture healing and a 4-point bending test was performed to measure stiffness and strength. Relative stiffness and strength values were also acquired from calculation of ratios relative to those of the non-osteotomized contralateral bones., Findings: Formation of cortex and medullary canal at the gap was seen in the 12-week group and would represent the remodeling stage. In addition, the relationship between stiffness and strength remained almost linear until at least 12 weeks. However, stiffness recovered much more rapidly than strength., Interpretation: Strength was not fully restored until the later stages of fracture healing. However, the current study demonstrated that stiffness could be monitored as a surrogate marker of strength until at least the remodeling stage., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The annual occurrence of hip fracture due to osteoporosis as of 2002 had reached 120,000 in Japan. The increase has been very rapid. From a biomechanical perspective, hip fractures are thought to be caused in real settings by different directions of loading. Thus, clarification of the loading directions under which the proximal femur is most vulnerable to fracture would be helpful for elucidating fracture mechanics and establishing preventive interventions. The purpose of the current study was to clarify the influence of loading direction on strength and fracture site of the proximal femur using the CT-based nonlinear FE method to determine loading directions under which the proximal femur is most vulnerable to fracture. Contralateral femora were analyzed in 42 women with hip fracture (mean age, 82.4 years), comprising 20 neck fractures and 22 trochanteric fractures. Within 1 week after fracture, quantitative CT of the contralateral femur was performed in each patient and 3-dimensional FE models were created. One stance loading configuration (SC) and four different fall loading configurations (FC) were assigned. Nonlinear FE analysis was performed. Differences in fracture loads depending on differences in loading direction were analyzed and correlations among fracture loads in different loading directions were assessed. Next, fracture sites were also analyzed. Mean predicted fracture load in the SC was 3150 N. Mean fracture loads were 2270 N in FC1, 1060 N in FC2, 980 N in FC3, and 710 N in FC4. The correlation between predicted fracture loads in SC and those in each FC was significant with a correlation coefficient of 0.467-0.631. Predicted fracture sites in the SC appeared at the subcapital region in all patients and were categorized as neck fracture. However, trochanteric fractures occurred in all fall configurations except FC1. In FC1, a significant correlation was seen between real fracture type and predicted type. The current investigation could contribute to the acquisition of useful knowledge allowing the establishment of more efficacious means of preventing hip fractures.

Hip fractures are the most serious complication of osteoporosis and have been recognized as a major public health problem. In elderly persons, hip fractures occur as a result of increased fragility of the proximal femur due to osteoporosis. It is essential to precisely quantify the strength of the proximal femur in order to estimate the fracture risk and plan preventive interventions. CT-based finite element analysis could possibly achieve precise assessment of the strength of the proximal femur. The purpose of this study was to create a simulation model that could accurately predict the strength and surface strains of the proximal femur using a CT-based finite element method and to verify the accuracy of our model by load testing using fresh frozen cadaver specimens. Eleven right femora were collected. The axial CT scans of the proximal femora were obtained with a calibration phantom, from which the 3D finite element models were constructed. Materially nonlinear finite element analyses were performed. The yield and fracture loads were calculated, while the sites where elements failed and the distributions of the principal strains were determined. The strain gauges were attached to the proximal femoral surfaces. A quasi-static compression test of each femur was conducted. The yield loads, fracture loads and principal strains of the prediction significantly correlated with those measured (r=0.941, 0.979, 0.963). Finite element analysis showed that the solid elements and shell elements in undergoing compressive failure were at the same subcapital region as the experimental fracture site.

Background: The purpose of this study was to investigate the effects of lengthening frequency on mechanical environment in limb lengthening., Methods: Tensile forces were continuously monitored using a load sensor attached to a unilateral external fixator. Twenty patients were monitored. Ten patients were with acquired femoral shortening, and five of them underwent quasi-continuous lengthening of 1440 steps per day, and the other five received step lengthening twice a day. The other 10 patients were with achondropalsia. Five of them underwent the same quasi-continuous lengthening, and the other five received the same step lengthening. The circadian change and the daily course of the tensile forces were assessed and compared between quasi-continuous lengthening and step lengthening., Findings: As for circadian change, an acute increase in the force took place simultaneously with each step of lengthening in the step-lengthening group, but very little change of the baseline force level was seen during quasi-continuous lengthening. As for daily course of the tensile force, it increased almost linearly in both lengthening frequency groups in the initial stage of lengthening. No significant difference of the average force increment rate in this phase was recognized between the quasi-continuous and step lengthening groups irrespective of the etiologies., Interpretation: The lengthening frequency greatly affected the circadian change of the tensile force, but did not affect the increment rate of the force in the linear phase.

A technique was developed to create a reproducible femoral neck fracture in vitro using 5-month-old JW/CSK series male rabbits. Force attenuation of a newly developed damping material was also evaluated using this model. Ten pairs of the femora with smaller deviations in length and weight were harvested and cleaned of soft tissue. Either a right or left of each pair of the specimens was randomly selected and put into either the control or the experimental group, both of which contained equal numbers of the right and left femora. The specimens were attached to an L-shaped plate and embedded in a resin from the proximal diaphysis to the distal end so as to maintain a consistent position of the femora. They were mounted and fixed on a pedestal slanted in the coronal plane at 20 degrees. The impact load testing was conducted using an impact mallet dropped from a height of 3 cm. The impact load was applied onto the femoral head. To the specimens in the experimental group, attenuated impact forces were loaded through the damping material, but those in the control group were subjected to forces directly transmitted without the material. All the impact testing was performed in a temperature and humidity controlled chamber. All of the femoral specimens exposed to the direct impact forces (controlled group) sustained fracture at the neck. The fracture line passed from the base of the femoral head laterally and to the calcar area just proximal to the minor trochanter medially. The location of each fracture line was almost identical among the specimens. None of the specimens that were exposed to the impact force through the damping material (experimental group) sustained fracture macroscopically and roentgenographically.

Objective: To monitor pin clamp motion using a displacement sensor over time during weight bearing and to investigate whether this method could contribute to quantitative assessment of the mechanical properties of fracture healing., Methods: Patients with a shaft fracture of the tibia were monitored, all of whom were in the stage of dynamization. The hifixator equipped with a ball bearing mechanism was used as a dynamic external fixator. The displacement was recorded versus time during stamping with weight bearing of the patients. The displacement curve had an oscillatory component synchronized with touch down and lift up of the foot, a time-dependent component expressed by shifting of the baseline, and an irreversible component during a non-weight bearing period after stamping. The three components were analyzed with a simple Voigt model., Results: In all patients, both the amplitude of the oscillatory component and the time-dependent component expressed as retardation time decreased as fracture healing proceeded, and by the time of fixator removal the irreversible component had disappeared., Conclusions: The monitoring method could quantitatively evaluate viscoelastoplasticity of the healing fracture site., Relevance: Until now, there has been few method for assessing the viscoelastic property of the healing fracture site in vivo. Although the method described here involves some assumptions and approximations, it was able to quantitatively assess the viscoelasticity of the healing fracture site.