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The annuus fibrosus (AF) and nucleus pulposus (NP) of the intervertebral disc (IVD) work in conjunction to dissipate spinal loads. In this study we have isolated the contribution of the NP to the overall response of the disc and investigated the effect of extreme structural changes to the disc on the mechanical behaviour. Linear stiffness, overall load range, hysteresis area and total energy were used to evaluate the impact of these changes on the spine and surrounding structures. Six porcine lumbar isolated disc specimens were tested in 6 DOFs with a 400 N compressive axial preload at low strain rates in three conditions: intact (IN), after total nucleotomy (NN) and after the injection of bone cement into the nuclear void (SN). The latter two conditions, NN and SN, were chosen to emulate the effect of extreme changes to the NP on disc behaviour. When comparing with intact specimens, significant changes were noted primarily in axial compression-extension, mediolateral bending and flexion-extension. NN and SN cases demonstrated significant increases in linear stiffness, overall load range and total energy for mediolateral bending and flexion-extension compared to the intact (IN) state. SN also demonstrated a significant increase in total energy for axial compression-extension, and significant decreases in the elastic contribution to total energy in all axes except flexion-extension. These changes to total energy indicate that surrounding spinal structures would incur additional loading to produce the same motion in vivo after structural changes to the disc. [ABSTRACT FROM AUTHOR]

Posterolateral corner knee injuries are clinically significant, and often require surgical reconstruction. The optimal knee brace following posterolateral corner reconstructions has not yet been determined via clinical nor biomechanical study. We sought to evaluate the stiffness of six types of knee braces to determine the ideal brace type for reducing varus forces, which may have clinical utility for posterolateral corner knee reconstruction rehabilitation. Six different groups of knee braces underwent mechanical testing: cruciate braces, cruciate braces with a valgus bend, medial unloaders, articulating sleeves, hinged braces, and tri-panel immobilizers. Each brace was fitted to the same fiberglass leg model and was secured to the testing apparatus. Force was applied under four-point bending to generate a varus moment about the artificial knee. The stiffness in Newtons per millimeter (N/mm) of each brace was calculated from the slope of the force-displacement curve. The cruciate brace with a valgus bend had the highest average stiffness at 192.61 N/mm (SD 28.53). The articulating sleeve was the least stiff with an average stiffness of 49.86 N/mm (SD 8.99). Stiffness of the cruciate brace was not statistically different compared to cruciate valgus (p = 0.083) or medial unloader (p = 0.098). In this experimental design, a cruciate brace with a valgus bend was shown to have the highest overall stiffness, while an articulating sleeve had the lowest stiffness. Future work will investigate whether this translates into clinical performance. [ABSTRACT FROM AUTHOR]

Empirical joint contact mechanics measurement (EJCM; e.g. contact area or force, surface velocities) enables critical investigations of the relationship between changing joint mechanics and the impact on surface-to-surface interactions. In orthopedic biomechanics, understanding the changes to cartilage contact mechanics following joint pathology or aging is critical due to its suggested role in the increased risk of osteoarthritis (OA), which might be due to changed kinematics and kinetics that alter the contact patterns within a joint. This article reviews and discusses EJCM approaches that have been applied to articulating joints such that readers across different disciplines will be informed of the various measurement and analysis techniques used in this field. The approaches reviewed include classical measurement approaches (radiographic and sectioning, dye staining, casting, surface proximity, and pressure measurement), stereophotogrammetry/motion analysis, computed tomography (CT), magnetic resonance imaging (MRI), and high-speed videoradiography. Perspectives on approaches to advance this field of EJCM are provided, including the value of considering relative velocity in joints, tractional stress, quantification of joint contact area shape, consideration of normalization techniques, net response (superposition) of multiple input variables, and establishing linkages to regional cartilage health status. EJCM measures continue to provide insights to advance our understanding of cartilage health and degeneration and provide avenues to assess the efficacy and guide future directions of developing interventions (e.g. surgical, biological, rehabilitative) to optimize joint's health and function long term. [ABSTRACT FROM AUTHOR]

The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL). Each specimen was tested in a spinal loading simulator that separately applied axial rotation, flexion-extension and lateral bending. In each test condition, displacement controlled angular motion was applied in both directions at a speed of 2 deg/s until a resulting moment of 1.5 Nm was achieved. The measured ranges of motion (ROM) of the C1-C2 segments were compared for each test condition using nonparametric Friedman tests. The destabilized state had significantly more C1-C2 motion (p < 0.05) than the intact state in all cases, and all constructs greatly reduced this motion. C2 pedicle screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension as well as axial rotation and no statistically significant difference was detected in lateral bending. C2 translaminar screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension and no statistically significant difference was detected in axial rotation or in lateral bending. Data from the current study suggested that constructs using the novel C1PA clamp would provide as good, or improved, biomechanical stability to the C1-C2 segment compared with constructs using C1LM screws. [ABSTRACT FROM AUTHOR]

This biomechanical study evaluates the performance of a solid titanium-alloy intra-medullary (IM) clavicular screw in torsion and cantilever bending in cadaveric clavicle specimens with simulated simple oblique and butterfly wedge midshaft fractures. Thirty-two fresh-frozen male clavicles were sorted into six experimental groups: Torsion Control, Torsion Simple Oblique Fracture, Torsion Butterfly Wedge Fracture, Bending Control, Bending Simple Oblique Fracture, and Bending Butterfly Wedge Fracture. The experimental groups were controlled for density, length, diameter, and laterality. All other samples were osteotomy-induced and implanted with a single 90 mm × 3 mm clavicle screw. All groups were tested to physiologically relevant cutoff points in torsion or bending. There were no statistically significant differences in the performance of the oblique and butterfly wedge fracture models for any torsion or bend testing measures, including maximum torsional resistance (p = 0.66), torsional stiffness (p = 0.51), maximum bending moment (p = 0.43), or bending stiffness (p = 0.73). Torsional testing of samples in the direction of thread tightening tended to be stronger than samples tested in loosening, with all groups either approaching or achieving statistical significance. There were no significant differences between the simple oblique or the butterfly-wedge fracture groups for any of the tested parameters, suggesting that there is no difference in the gross biomechanical properties of the bone-implant construct when the IM clavicle screw is used in either a simple midshaft fracture pattern or a more complex butterfly wedge fracture pattern. [ABSTRACT FROM AUTHOR]

Objectives: Stability of bone splitting sternotomy is essential for normal healing after open cardiac surgery. Mechanical vibration transmittance may offer a means for early detection of separation of bone (diastasis) in the sternotomy and prevent further complications. This article describes the technical implementation and validation of vibration analysis-based prototype device built for measuring sternal bone connectivity after sternotomy.Methods: An in-house built measurement system, sternal vibration device, consisting of actuator, sensor, and main controller and signal acquisition unit was designed and manufactured. The system was validated, and three different test settings were studied in mockups (polylactide rods in ballistic gel) and in two human sternums: intact, stable wire fixation, and unstable wire fixation with a gap mimicking bone diastasis. The transmittance of vibration stimulus across the median sternotomy was measured.Results: The validation showed that the force produced by the actuator was stable, and the sensor could be calibrated to precisely measure the acceleration values. The vibration transmittance response to material cut and sternotomy was evident and detectable in the 20 Hz to 2 kHz band. The transmittance decreased when the connectivity between the sternal halves became unstable. The trend was visible in all the settings.Conclusion: Technical solutions and description of validation process were given. The device was calibrated, and the vibration transmittance analysis differentiated intact and cut polylactide rod. In the sternum, intact bone, wire fixation with exact apposition, and with a gap were identified separately. Although further studies are needed to assess the accuracy of the method to detect different levels of diastases, the method appears to be feasible. [ABSTRACT FROM AUTHOR]

In recent years, steerable catheters have been developed to combat the effects of the dynamic cardiac environment. Mechanically actuated steerable catheters appear the most in the clinical setting; however, they are bound to a number of mechanical limitations. The aim of this research is to gain insight in these limitations and use this information to develop a new prototype of a catheter with increased steerability. The main limitations in mechanically steerable catheters are identified and analysed, after which requirements and solutions are defined to design a multi-steerable catheter. Finally, a prototype is built and a proof-of-concept test is carried out to analyse the steering functions. The mechanical analysis results in the identification of five limitations: (1) low torsion, (2) shaft shortening, (3) high unpredictable friction, (4) coupled tip-shaft movements, and (5) complex cardiac environment. Solutions are found to each of the limitations and result in the design of a novel multi-steerable catheter with four degrees of freedom. A prototype is developed which allows the dual-segmented tip to be steered over multiple planes and in multiple directions, allowing a range of complex motions including S-shaped curves and circular movements. A detailed analysis of limitations underlying mechanically steerable catheters has led to a new design for a multi-steerable catheter for complex cardiac interventions. The four integrated degrees of freedom provide a high variability of tip directions, and repetition of the bending angle is relatively simple and reliable. The ability to steer inside the heart with a variety of complex shaped curves may potentially change conventional approaches in interventional cardiology towards more patient-specific and lower complexity procedures. Future directions are headed towards further design optimizations and the experimental validation of the prototype. [ABSTRACT FROM AUTHOR]

In developing countries, the access of amputees to prosthetic devices is very limited. In a way to increase accessibility of prosthetic hands, we have recently developed a new approach for the design and 3D printing of non-assembly active hand prostheses using inexpensive 3D printers working on the basis of material extrusion technology. This article describes the design of our novel 3D-printed hand prosthesis and also shows the mechanical and functional evaluation in view of its future use in developing countries. We have fabricated a hand prosthesis using 3D printing technology and a non-assembly design approach that reaches certain level of functionality. The mechanical resistance of critical parts, the mechanical performance, and the functionality of a non-assembly 3D-printed hand prosthesis were assessed. The mechanical configuration used in the hand prosthesis is able to withstand typical actuation forces delivered by prosthetic users. Moreover, the activation forces and the energy required for a closing cycle are considerably lower as compared to other body-powered prostheses. The non-assembly design achieved a comparable level of functionality with respect to other body-powered alternatives. We consider this prosthetic hand a valuable option for people with arm defects in developing countries. [ABSTRACT FROM AUTHOR]

The aim of this study was the dynamic biomechanical evaluation of a ready-to-use oil-based calcium phosphate cement paste implanted to augment intramedullary nail fixation of a three-part humeral head fracture model. Fractures in the osteoporotic bone are often fractures of the proximal humerus. Secondary fracture displacements due to cut-out in osteoporotic bone have been observed in up to 13% of cases. Procedures have been developed to augment fracture fixation with polymethylmethacrylate to increase stability, but there are still unsolved challenges relating to its material-specific properties. Calcium phosphate cement could be a biological alternative in the augmentation of osteoporotic fractures because of its more favourable material properties. Fracture fixation was performed on eight pairs of human cadaveric bones to stabilize a standardized three-part humeral head fracture model by implantation of the Targon® PH (Braun-Aesculap AG, Tuttlingen, Germany) intramedullary nail and insertion of three head screws and two bicortical shaft screws. The procedure was randomized, and one bone of each pair received calcium phosphate cement augmentation. Custom-made cannulated screws with an open lateral slot facilitated augmentation, making it possible to cement the threaded portion of the screw (1-mL calcium phosphate cement/screw). After the calcium phosphate cement had hardened, the humeri were subjected to dynamic axial loading. Load was progressively increased, monitored by ultrasound-based motion analysis, and total deformation was recorded. Load testing continued until implant failure. The augmented group withstood significantly more cycles before implant failure. The average initial stiffness showed a significant difference between the two study groups. Ultrasonic sensor technology was used to measure angular displacement during testing and a significant difference was found. Calcium phosphate cement offers a potential alternative to implant augmentation in the treatment of osteoporotic humeral head fractures. Future studies are required to confirm these observations clinically in vivo. [ABSTRACT FROM AUTHOR]

In golf, the trunk and pelvis kinematic variables are often related to measures of performance due to the highly complex and multi-joint movements involved in swings. However, it is unclear how specific body segments or joints contributed to the golf performance parameters. Therefore, the purpose of this study was to identify the key joints, including those of the upper and lower trunk, that are associated with golf performance parameters, such as X-Factor and pelvis motion. A motion capture system was used to obtain three-dimensional kinematics of golf swings performed by 10 low handicap male golfers. Based on regression analysis, right knee adduction, right shoulder external rotation and left elbow extension in ball address to top of the backswing and left knee adduction and lower trunk right bending with left rotation in top of the backswing to end of follow-through were presented as predictor variables for the X-Factor. For pelvis movement, a greater number of joint angles were associated with pelvis posterior tilt during backswing and pelvis motion to target with right rotation during downswing/follow-through. This study provides fundamental details of the movement mechanisms of major joints, as well as their relationships with performance parameters. Such understanding can be combined with training to improve the golfing skill and prevent possible injuries. [ABSTRACT FROM AUTHOR]

Driver drowsiness is a significant cause of fatal crashes every year in the world. In this research, driver's drowsiness is detected by classifying surface electromyography signal features. The tests are conducted on 13 healthy subjects in a driving simulator with a monotonous route. The surface electromyography signal from the upper arm and shoulder muscles are measured including mid deltoid, clavicular portion of the pectoralis major, and triceps and biceps long heads. Signals are separated into 30-s epochs. Five features including range, variance, relative spectral power, kurtosis, and shape factor are extracted. The Observer Rating of Drowsiness evaluates the level of drowsiness. A binormal function is fitted for each feature. For classification, six classifiers are applied. The results show that the k-nearest neighbor classifier predicts drowsiness by 90% accuracy, 82% precision, 77% sensitivity, and 92% specificity. [ABSTRACT FROM AUTHOR]

Gait analysis has demonstrated to efficaciously support clinical investigations. The patterns of the outcome variables (joint angles, moments and powers) are characterized by an intrinsic and extrinsic variability. Particularly, extrinsic variability is induced by operator-dependent differences in markers' placement, with errors propagating non-linearly to alter outcome variable patterns. The aims of this study are (1) to consider a specific gait analysis protocol named LAMB and provide a description of its procedures, (2) to experimentally assess the between-operator and within-operator variability induced by operator-dependent marking of required anatomical landmarks and (3) to evidence how such inaccuracies propagates to the gait analysis kinematic and kinetic outcome variables. Six expert gait analysis operators performed LAMB anatomical landmarks marking on three healthy adult participants; moreover, one operator repeated three times the marking on one participant. The participants then performed a set of locomotor tasks including stair negotiation and heel- and toe-walking. An anatomical calibration approach let to register each marking and to compute, starting from one single raw data set, a set of outcome variables for each marking/operator. The between-operator variability of gait analysis outcome was assessed in terms of mean absolute variability to quantify offsets and minimal correlation coefficient to quantify patterns' similarity. The results evidence average minimal correlation coefficient ranging from 0.857 for moments to 0.907 for angles and average mean absolute variability accounted for few degrees in angular variables (worst between-operator mean absolute variability is 7.3°), while dynamic variables mean absolute variability, relative to the variable range, was below 5% for moment and below 10% for powers. The variability indexes are comparable to those related to previously published protocols and are independent from the considered task, thus suggesting that the LAMB is a reliable protocol suitable for the analysis of different locomotor tasks. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop an objective method for the elastic characterisation of pre- and post-transitional moduli of left anterior descending (LAD) porcine coronary arteries.Methods: Eight coronary arteries were divided into proximal, middle and distal test specimens. Specimens underwent uniaxial extension up to 3 mm. Force-displacement measurements were used to determine the induced true stress and stretch for each specimen. A local maximum of the stretch-true stress data was used to identify a transition point. Pre- and post-transitional moduli were calculated up to and from this point, respectively.Results: The mean pre-transitional moduli for all specimens was 0.76 MPa, as compared to 4.86 MPa for the post-transitional moduli. However, proximal post-transitional moduli were significantly greater than that of middle and distal test specimens (p < 0.05).Conclusion: Post-transitional uniaxial properties of the LAD are dependent on location along the artery. Further, it is feasible to objectively identify a transition point between pre- and post-transitional moduli. [ABSTRACT FROM AUTHOR]

A finger prosthesis consisting of a Cobalt-chromium (CoCr) proximal component and an Ultra-high-molecular-weight-polyethylene (UHMWPE) medial component (both mounted on hydroxyapatite coated stems) was evaluated to 5,000,000 cycles in an in vitro finger simulator. One “test” prosthesis was cycled through flexion-extension (90°–30°) with a dynamic load of 10 N, whilst immersed in a lubricant of dilute bovine serum. Additionally, a static load of 100 N was applied for 45 s every 3000 cycles to simulate a static gripping force. A second “control” prosthesis was immersed in the same lubricant to account for absorption. Gravimetric and Sa (3D roughness) measurements were taken at 1,000,000 cycle intervals. Micrographs and Sa values revealed negligible change to the CoCr surfaces after 5,000,000 cycles. The UHMWPE also exhibited no distinctive Sa trend, however the micrographs indicate that polishing occurred. Both the CoCr and UHMWPE test components progressively decreased in weight. The CoCr control component did not change in weight, whilst the UHMWPE component gained weight through absorption. To account for the disparity between surface and gravimetric results, the hydroxyapatite coatings were examined. Micrographs of the test stems revealed that the hydroxyapatite coating was partially removed, whilst the micrographs of the control stems exhibited a uniform coating.

In developing countries, prosthetic workshops are limited, difficult to reach, or even non-existent. Especially, fabrication of active, multi-articulated, and personalized hand prosthetic devices is often seen as a time-consuming and demanding process. An active prosthetic hand made through the fused deposition modelling technology and fully assembled right after the end of the 3D printing process will increase accessibility of prosthetic devices by reducing or bypassing the current manufacturing and post-processing steps. In this study, an approach for producing active hand prosthesis that could be fabricated fully assembled by fused deposition modelling technology is developed. By presenting a successful case of non-assembly 3D printing, this article defines a list of design considerations that should be followed in order to achieve fully functional non-assembly devices. Ten design considerations for additive manufacturing of non-assembly mechanisms have been proposed and a design case has been successfully addressed resulting in a fully functional prosthetic hand. The hand prosthesis can be 3D printed with an inexpensive fused deposition modelling machine and is capable of performing different types of grasping. The activation force required to start a pinch grasp, the energy required for closing, and the overall mass are significantly lower than body-powered commercial prosthetic hands. The results suggest that this non-assembly design may be a good alternative for amputees in developing countries. [ABSTRACT FROM AUTHOR]

Assembly of a femoral head onto the stem remains non-standardized. The literature shows altering mechanical conditions during seating affects taper strength and lower assembly load may increase fretting corrosion during cyclic tests. This suggests overall performance may be affected by head assembly method. The purpose of this test was to perform bench-top studies to determine influence of peak force magnitude, load rate, and compliance of the system's support structure on initial stability of the taper. Custom manufactured CoCrMo femoral heads and Ti-6Al-4V taper analog samples were assembled with varying peak force magnitudes (2-10.1 kN), load rates (quasi-static vs impaction), and system compliance (rigid vs compliant). A clinically-relevant system compliance design was based off of force data collected during a cadaver impaction study. Tensile loads were then applied to disassemble the taper and quantify initial taper stability. Results indicated that taper stability (assessed by disassembly forces) increased linearly with assembly force and load rate did not have a significant effect on taper stability. When considering system compliance, a 42%-50% larger input energy, dependent on assembly force, was required in the compliant group to achieve a comparable impaction force to the rigid group. Even when this impaction force was achieved, the correlation between the coefficient, defined as distraction force divided by assembly load, was significantly reduced for the compliant test group. The compliant setup was intended to simulate a surgical scenario where patient and surgical factors may influence the resulting compliance. Based on results, surgical procedure and patient variables may have a significant effect on initial taper stability. [ABSTRACT FROM AUTHOR]

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury. [ABSTRACT FROM AUTHOR]

While many femoral neck fractures can be reliably treated with surgical intervention, Pauwels III femoral neck fractures in the young adult population continue to be a challenging injury, and there is no consensus on optimal treatment. As such, there are past and ongoing biomechanical studies to evaluate the fixation provided by different constructs for this inherently unstable fracture. While many investigations rely on cadavers to evaluate the biomechanical performance of a construct, significant inter-subject variability can confound the analysis. Biomechanical femur analogs are being used more frequently due to more consistent mechanical properties; however, they have not been stringently evaluated for morphology or suitability for instrumentation. This study sought to determine the variability among composite femoral analogs as well as consistently create a Pauwels III injury and instrument the analogs without the need for fluoroscopic guidance. In total, 24 fourth-generation composite femoral analogs were evaluated for femoral height, neck-shaft angle, anteversion, and cortical thickness. A method was developed to simulate a Pauwels III fracture and to prepare three different constructs: an inverted triangle of cannulated screws, a sliding hip screw, and a hybrid inverted triangle with cannulated screws and a sliding hip screw. Radiographs were utilized to evaluate the variation in implant position. All but one of the morphological parameters varied by <1%. The tip-to-apex distance for all sliding hip screw hardware was 18.8 ± 3.3 mm, and all relevant cannulated screw distances were within 5 mm of the adjacent cortex. All screws were parallel, on average, within 1.5° on anterior-posterior and lateral films. Fourth-generation composite femora were found to be morphologically consistent, and it is possible to consistently instrument the analogs without the use of fluoroscopy. This analog and hardware implantation model could serve as a screening model for new fracture repair constructs without the need for cadaveric tissues or radiologic technology. [ABSTRACT FROM AUTHOR]

A novel clinically practical upper limb model is introduced that has been developed through clinical use in children and adults with neurological conditions to guide surgery to the elbow and wrist. This model has a minimal marker set, minimal virtual markers, and no functional joint centres to minimise the demands on the patient and duration of data collection. The model calculates forearm supination independently from the humerus segment, eliminating any errors introduced by poor modelling of the shoulder joint centre. Supination is calculated by defining the forearm segment twice, from the distal and proximal ends: first, using the ulna and radial wrist markers as a segment defining line and second using the medial and lateral elbow markers as a segment defining line. This is comparable to the clinical measurement of supination utilising a goniometer and enables a reduced marker set, with only the elbow, wrist, and hand markers to be applied when only the wrist and forearm angles are of interest. A sensitivity analysis of the calculated elbow flexion-extension angles to the position of the glenohumeral joint centre is performed on one healthy female subject, aged 20 years, during elbow flexion and a forward reaching task. A comparison of the supination angles calculated utilising the novel technique compared to the rotation between the humeral and forearm segments is also given. All angles are compared to a published kinematic model that follows the recommendations of the International Society of Biomechanics. [ABSTRACT FROM AUTHOR]

In short-track speed skating, the three-dimensional kinematics of the lower extremities during the whole skating cycle have not been studied. Kinematic parameters of the lower extremities during skating are presented as joint angles versus time. However, the angle-time presentation is not sufficient to describe the relationship between multi-joint movement patterns. Thus, angle-angle presentations were developed and used to describe interjoint coordination in sport activities. In this study, 15 professional male skaters' full body motion data were recorded using a wearable motion capture system during short-track speed skating. We investigated the three-dimensional kinematics of the lower extremities and then established the interjoint coordination between hip-knee and knee-ankle for both legs during the whole skating cycle. The results demonstrate the relationship between multi-joint movements during different phases of short-track speed skating. This study provides fundamentals of the movement mechanism of the lower extremities that can be integrated with physiotherapy to improve skating posture and prevent injuries from repetitive stress since physiological characteristics play an important role in skating performance. [ABSTRACT FROM AUTHOR]

Finite element models of an isolated vertebral body cannot accurately predict compressive strength of the spinal column because, in life, compressive load is variably distributed across the vertebral body and neural arch. The purpose of this study was to develop and validate a patient-specific finite element model of a functional spinal unit, and then use the model to predict vertebral strength from medical images. A total of 16 cadaveric functional spinal units were scanned and then tested mechanically in bending and compression to generate a vertebral wedge fracture. Before testing, an image processing and finite element analysis framework (SpineVox-Pro), developed previously in MATLAB using ANSYS APDL, was used to generate a subject-specific finite element model with eight-node hexahedral elements. Transversely isotropic linear-elastic material properties were assigned to vertebrae, and simple homogeneous linear-elastic properties were assigned to the intervertebral disc. Forward bending loading conditions were applied to simulate manual handling. Results showed that vertebral strengths measured by experiment were positively correlated with strengths predicted by the functional spinal unit finite element model with von Mises or Drucker-Prager failure criteria ( R2 = 0.80-0.87), with areal bone mineral density measured by dual-energy X-ray absorptiometry ( R2 = 0.54) and with volumetric bone mineral density from quantitative computed tomography ( R2 = 0.79). Large-displacement non-linear analyses on all specimens did not improve predictions. We conclude that subject-specific finite element models of a functional spinal unit have potential to estimate the vertebral strength better than bone mineral density alone. [ABSTRACT FROM AUTHOR]

Treatment of distal tibia shaft fractures using intramedullary nailing requires stable fixation of the distal fragment to prevent malunion. Angular stable locking for intramedullary nails pledge to provide increased mechanical stability. This study tested the hypothesis that intramedullary nails with angular stable interlocking screws would have increased construct stiffness, reduced fracture gap movement and enhanced fatigue failure compared to nails with conventional locking having the same diameter. Biomechanical experiments were performed on 24 human cadaveric tibiae which obtained a distal fracture and were fixed by three different techniques: conventional locking with 8- and 10-mm-diameter nails and angular stable locking with 8-mm nails. Stiffness of the implant-bone construct and movement of the fragments were tested under axial loading and torsion. The constructs were tested to failure under cyclic fatigue loading. Analysis of variance and Kaplan-Meier survival analysis were used for statistical assessment. Axial stiffness of the 10-mm nail was about 50% larger compared to both 8-mm nail constructs independent of the type of locking mode (p < 0.01). No differences were found in axial performance between angular stable and conventional locking neither under static nor under cyclic testing conditions (p > 0.5). Angular stability significantly decreased the clearance under torsional load by more than 50% compared to both conventionally locked constructs (p = 0.03). However, due to the larger nail diameter, the total interfragmentary motion was still smallest for the 10-mm nail construct (p < 0.01). Although the 10-mm nail constructs survived slightly longer, differences between groups were minor and not statistically significant (p = 0.4). Our hypothesis that angular stable interlocking of intramedullary nails would improve mechanical performance of distal tibia fracture fixation was not confirmed in a physiologically realistic loading scenario. Whether minor mechanical advantages provided by angular stability of the locking screws would improve biological tissue response cannot be concluded from this biomechanical study. [ABSTRACT FROM AUTHOR]

Three-dimensional image-based strain measurement in whole bones allows representation of physiological, albeit quasi-static, loading conditions. However, such work to date has been limited to specimens postmortem. The main purpose of this study is to verify the efficacy of deformable image registration of post-euthanasia strain to characterize the in vivo mechanical behavior of rat vertebrae. A micro-computed tomography-compatible custom loading device was used to apply 75 N load to a three-level caudal motion segment of a healthy rat. Loaded and unloaded micro-computed tomography scans were acquired in vivo and post-sacrifice. A micro-computed tomography-based deformable image registration algorithm was used to calculate vertebral strains live and post-euthanasia. No significant difference was found in the in vivo strains (-0.011 ± 0.001) and ex vivo strains (-0.012 ± 0.001) obtained from the comparisons of loaded and unloaded images (p = 0.3). Comparisons between unloaded-unloaded and loaded-loaded scans yielded significantly lower axial strains, representing the error of the method. Qualitatively, high strains were observed adjacent to growth plate regions in evaluating the loaded-unloaded images. Strain patterns in the loaded-loaded and unloaded-unloaded scans were inconsistent as would be expected in representing noise. Overall, live and dead loaded to unloaded comparisons yielded similar strain patterns and magnitudes. Point-wise differences in axial strain fields also supported this observation. This study demonstrated a proof of concept, suggesting that post-euthanasia micro-computed tomography-based strain analysis is able to represent the in vivo quasi-static behavior of rat tail vertebrae. [ABSTRACT FROM AUTHOR]

Cases of fretting and corrosion at the taper junction have been reported in large metal-on-metal bearing combinations, and more recently, this concern has included metal-on-polyethylene bearing combinations. Many of these patients have been revised due to adverse local tissue reaction secondary to taper corrosion. This taper corrosion-related adverse local tissue reaction seems to be a multifactorial issue and difficult to assess. The aim of this study was to look at one potential variable, the impaction behavior (impaction force, number of blows, etc.) of orthopedic surgeons, and understand how this can affect the locking strength of tapers. A group of experienced orthopedic surgeons were asked to use their typical surgical approach to impact a femoral head onto a hip femoral stem using an Operating Room (OR)-simulated test setup. Impaction parameters such as impaction force, velocity, and energy, as well as the number of impacts, were characterized and applied in a bench-top study used to evaluate the effect of these parameters on the initial stability of the taper junction. High variation was found in the surgical impaction parameters, but overall it was determined that increased impaction force correlated to superior stability of the taper junction. [ABSTRACT FROM AUTHOR]

Press-fit acetabular shells used for hip replacement rely upon an interference fit with the bone to provide initial stability. This process may result in deformation of the shell. This study aimed to model shell deformation as a process of shell stiffness and bone strength. A cohort of 32 shells with two different wall thicknesses (3 and 4 mm) and 10 different shell sizes (44- to 62-mm outer diameter) were implanted into eight cadavers. Shell deformation was then measured in the cadavers using a previously validated ATOS Triple Scan III optical system. The shell-bone interface was then considered as a spring system according to Hooke's law and from this the force exerted on the shell by the bone was calculated using a combined stiffness consisting of the measured shell stiffness and a calculated bone stiffness. The median radial stiffness for the 3-mm wall thickness was 4192 N/mm (range, 2920-6257 N/mm), while for the 4-mm wall thickness the median was 9633 N/mm (range, 6875-14,341 N/mm). The median deformation was 48 µm (range, 3-187 µm), while the median force was 256 N (range, 26-916 N). No statistically significant correlation was found between shell stiffness and deformation. Deformation was also found to be not fully symmetric (centres 180° apart), with a median angle discrepancy of 11.5° between the two maximum positive points of deformation. Further work is still required to understand how the bone influences acetabular shell deformation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to characterize the effect of a group of variables on frictional torque generated by acetabular components as well as to understand the influence of test model. Three separate test models, which had been previously used in the literature, were used to understand the effect of polyethylene material, bearing design, head size, and material combinations. Each test model differed by the way it simulated rotation of the head, the type of frictional torque value it reported (static vs. dynamic), and the type of motion simulated (oscillating motion vs. continuous motion). It was determined that not only test model may impact product ranking of fictional torque generated but also static frictional torque may be significantly larger than a dynamic frictional torque. In addition to test model differences, it was discovered that the frictional torque values for conventional and highly cross-linked polyethylenes were not statistically significantly different in the more physiologically relevant test models. With respect to bearing design, the frictional torque values for mobile bearing designs were similar to the 28-mm diameter inner bearing rather than the large diameter outer liner. Testing with a more physiologically relevant rotation showed that frictional torque increased with bearing diameter for the metal on polyethylene and ceramic on polyethylene bearings but remained constant for ceramic on ceramic bearings. Finally, ceramic on ceramic bearings produced smaller frictional torque values when compared to metal on polyethylene and ceramic on polyethylene groups. [ABSTRACT FROM AUTHOR]

Using the unilateral pedicle screw fixation was thought to decrease the stiffness of the fixed segments. Various prospective, randomized studies were performed to determine whether unilateral pedicle screw fixation provides the necessities of bilateral fixation in one- or two-segment lumbar spinal fusion. In this study, four different unilateral pedicle screw fixation systems were evaluated to determine which one best approximated an intact spine with respect to biomechanics and kinematics. The four groups included an intact group, a unilateral facetectomy group with no fixation, a unilateral semi-rigid pedicle screw fixation group with a poly-ether-ether-ketone rod, and a unilateral dynamic pedicle screw fixation group. The bone mineral densities of all specimens were measured and specimens were matched with groups randomly. Flexion, lateral bending, and axial rotation tests were performed to compare the groups. For the flexion, lateral bending, and axial rotation tests, the best biomechanical outcomes were in the control group. The unilateral facetectomy group had the poorest performance and was not stable enough, compared with the control group. The dynamic and semi-rigid groups showed performance closer to that of the control group. The biomechanical responses of these two groups were also in good agreement, showing no significant statistical differences. Based on these test results, it is concluded that the unilateral dynamic and semi-rigid pedicle screw fixations can be used to provide stability to the vertebrae. [ABSTRACT FROM AUTHOR]

Clinical results of the PyroCarbon proximal interphalangeal joint replacement are inconsistent with various complications reported. To address this, in vitro testing was conducted using finger joint simulators. Two PyroCarbon proximal interphalangeal prostheses were tested in a lubricant of dilute bovine serum to 5 × 106 cycles of flexion–extension (90°–30°) with dynamic forces of 10 N applied. At intervals of 3000 cycles testing ceased and a static load of 100 N was applied to simulate gripping. In addition, two ‘control’ prostheses were immersed alongside the test prostheses to account for lubricant absorption. Wear and roughness averages (Ra) were measured every 1 × 106 cycles. Minimal wear for all of the components was measured with a negligible increase in Ra for most of the components. One condyle of one component increased in Ra over the 5 × 106 cycles with a value above the recommended 50 nm. Unidirectional marks were visible on the condyle from micrographs, consistent with an abrasive wear mode. [ABSTRACT FROM AUTHOR]

Bioactive coatings are frequently used to improve the osseointegration of the metallic implants used in dentistry or orthopaedics. Among different types of bioactive coatings, hydroxyapatite (Ca10(PO4)6(OH)2) is one of the most extensively used due to its chemical similarities to the components of bones and teeth. In this article, production and characterization of hydroxyapatite films deposited on Ti6Al4V alloy prepared by magnetron sputtering were reported. Besides, SiC was deposited on substrate surface to study the interlayer effect. Obtained coatings were annealed at 600 °C for 30 and 120 min in a mixed atmosphere of N2 + H2O vapours with the heating rate of 12 °C min−1. The effects of SiC interlayer and heat treatment parameters on the structural, mechanical and corrosion properties were investigated. After heat treatment process, the crystalline hydroxyapatite was obtained. Additionally, cell viability tests were performed. The results show that the presence of the SiC interlayer contributes a decrease in surface roughness and improves the mechanical properties and corrosion performance of the hydroxyapatite coatings. Biological properties were not affected by the presence of the SiC interlayer. [ABSTRACT FROM AUTHOR]

Cyclic flexure and stretch are essential to the function of semilunar heart valves and have demonstrated utility in mechanically conditioning tissue-engineered heart valves. In this study, a cyclic stretch and flexure bioreactor was designed and tested in the context of the bioresorbable elastomer poly(glycerol sebacate). Solid poly(glycerol sebacate) membranes were subjected to cyclic stretch, and micromolded poly(glycerol sebacate) scaffolds seeded with porcine aortic valvular interstitial cells were subjected to cyclic stretch and flexure. The results demonstrated significant effects of cyclic stretch on poly(glycerol sebacate) mechanical properties, including significant decreases in effective stiffness versus controls. In valvular interstitial cell-seeded scaffolds, cyclic stretch elicited significant increases in DNA and collagen content that paralleled maintenance of effective stiffness. This work provides a basis for investigating the roles of mechanical loading in the formation of tissue-engineered heart valves based on elastomeric scaffolds. [ABSTRACT FROM AUTHOR]

Aim: Maneuvering manual wheelchairs is defined by changes in momentum. The amount of effort required to maneuver a wheelchair is dependent on many factors, some of which reflect the design and configuration of the wheelchair., Objective: The objective of this study was to measure the work required to propel a manual wheelchair configured with three weight distributions, three drive wheels and four casters., Methods: A novel wheelchair-propelling robot was used as the test platform to measure work while traversing two surfaces using three different maneuvers which were defined to highlight different kinetic energies and energy loss mechanisms., Results: Overall, propulsion cost decreased with an increase in load on the drive wheels. Pneumatic drive wheels exhibited lower propulsion costs compared to a solid tire. Two casters, a 4″ dia × 1.5″ and a 5″ dia × 1″, exhibited better overall performance compared to 5″ dia × 1.5″ solid and 6″ dia × 1″ pneumatic casters., Discussion: The results indicate that drive wheel load and types of drive wheels and casters impact propulsion cost and their influences differ across maneuvers and surfaces. The approach is well suited to assess equivalency in components and configurations. Assessment of performance equivalency would empower clinicians and users with important knowledge when selecting components., (© The Author(s) 2020.)

Introduction: Wearable limb-socket displacement sensors may help patients and prosthetists identify a deteriorating socket fit and justify the need for repair or replacement., Methods: A novel sensor using an inductive sensing modality was developed to detect limb-to-socket distances. Key detection elements were a coil antenna placed in the socket wall and a magnetic composite sheath worn over the outside of the prosthesis user's elastomeric liner. The sheath was a nylon or cotton prosthetic stocking coated with a polyurethane composite. The polyurethane composite contained embedded iron particles (75 wt%)., Results: Brushing γ-glycidoxypropyltriethoxysilane onto the sheath fabric, coating it first with unfilled polyurethane and then iron-filled polyurethane, enhanced bonding between the sheath and the composite and overcame mechanical degradation problems. A γ-glycidoxypropyltriethoxysilane-rich fumed silica layer applied to the outside of the sheath reduced friction and improved durability. Field testing demonstrated less than a 3% signal degradation from four weeks of field use., Conclusions: The developed wearable displacement sensor meets durability and performance needs, and is ready for large-scale clinical testing., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In short-track speed skating, the three-dimensional kinematics of the lower extremities during the whole skating cycle have not been studied. Kinematic parameters of the lower extremities during skating are presented as joint angles versus time. However, the angle-time presentation is not sufficient to describe the relationship between multi-joint movement patterns. Thus, angle-angle presentations were developed and used to describe interjoint coordination in sport activities. In this study, 15 professional male skaters' full body motion data were recorded using a wearable motion capture system during short-track speed skating. We investigated the three-dimensional kinematics of the lower extremities and then established the interjoint coordination between hip-knee and knee-ankle for both legs during the whole skating cycle. The results demonstrate the relationship between multi-joint movements during different phases of short-track speed skating. This study provides fundamentals of the movement mechanism of the lower extremities that can be integrated with physiotherapy to improve skating posture and prevent injuries from repetitive stress since physiological characteristics play an important role in skating performance.

Three-dimensional image-based strain measurement in whole bones allows representation of physiological, albeit quasi-static, loading conditions. However, such work to date has been limited to specimens postmortem. The main purpose of this study is to verify the efficacy of deformable image registration of post-euthanasia strain to characterize the in vivo mechanical behavior of rat vertebrae. A micro-computed tomography-compatible custom loading device was used to apply 75 N load to a three-level caudal motion segment of a healthy rat. Loaded and unloaded micro-computed tomography scans were acquired in vivo and post-sacrifice. A micro-computed tomography-based deformable image registration algorithm was used to calculate vertebral strains live and post-euthanasia. No significant difference was found in the in vivo strains (-0.011 ± 0.001) and ex vivo strains (-0.012 ± 0.001) obtained from the comparisons of loaded and unloaded images (p = 0.3). Comparisons between unloaded-unloaded and loaded-loaded scans yielded significantly lower axial strains, representing the error of the method. Qualitatively, high strains were observed adjacent to growth plate regions in evaluating the loaded-unloaded images. Strain patterns in the loaded-loaded and unloaded-unloaded scans were inconsistent as would be expected in representing noise. Overall, live and dead loaded to unloaded comparisons yielded similar strain patterns and magnitudes. Point-wise differences in axial strain fields also supported this observation. This study demonstrated a proof of concept, suggesting that post-euthanasia micro-computed tomography-based strain analysis is able to represent the in vivo quasi-static behavior of rat tail vertebrae.