Low-velocity nail penetration response of muscle tissue and gelatin.

Quantitative estimation of soft tissue injuries due to penetration of sharp objects is a challenging task for forensic pathologists. The severity of injury depends on the force required to penetrate the tissue. This study focuses on investigating the amount of force required to penetrate porcine muscle tissue and gelatin simulants (10 % wt) to mimic human muscle tissue when subjected to sharp objects like nail at velocities below 5 m/s. A custom-made experimental setup was used to examine the influence of penetration velocity and nail diameter on penetration forces. Images captured by a high-speed camera were used to track the position and velocity of the nail. A finite element (FE) model was established to simulate the penetration behavior of the tissue and gelatin. The FE simulations of the nail penetration were validated through direct comparison with the experimental results. In tissues as well as in the simulant, penetration forces were seen to increase with increasing nail diameter and velocity. Porcine muscle tissue showed 23.9-46.5 % higher penetration forces than gelatin simulants (10 % wt) depending on nail diameter and velocity; the difference being higher for higher nail diameter and velocity. The ranges of maximum penetration forces measured were 8.6-59.1 N for porcine muscle tissue and 6.8-34.9 N for gelatin simulant. This study helps to quantify injuries caused by sharp nails at low velocities and offers insights with potential applications in injury management strategies and forensic studies.

Computational assessment of leg response to extreme loadings using a detailed finite element model.

This study focuses on evaluating the response of the Total Human Model for Safety™ lower extremity finite element model under blast loading. Biofidelity of the lower extremity model was evaluated against experiments with impact loading equivalent to underbody blast. The model response was found to match well with the experimental data for the average impactor speeds of 7 and 9.3 m/s resulting in an overall correlation and analysis rating of 0.86 and 0.82, respectively. The model response was then used to investigate response for antipersonnel mine explosion where the numerical setup consists of a charge mass of 40 g trinitrotoluene placed at a depth of 50 mm below the heel. The explosion was modeled using Multi Material-Arbitrary Lagrangian Eulerian method. The model was subjected to the graded input in terms of variation in standoff distance and mass of explosive to investigate the sensitivity of the model. The model found sensitive to the threat definition and predicted an increase of 110% in peak fluid-structure interaction force with 20% reduction in its time to peak and 29% increase in peak calcaneus axial force with a reduction of 33% in its time to peak when explosive mass varied from 40 g to 100 g. The location of the explosive below the foot was discovered to have significant effect on the injury pattern in near-field explosion. A comparative study suggested that the model predicted similar response and damage pattern compared to experimental data.

Strain-rate-dependent material properties of human lung parenchymal tissue using inverse finite element approach.

Automobile crashes and blunt trauma often lead to life-threatening thoracic injuries, especially to the lung tissues. These injuries can be simulated using finite element-based human body models that need dynamic material properties of lung tissue. The strain-rate-dependent material parameters of human parenchymal tissues were determined in this study using uniaxial quasi-static (1 mm/s) and dynamic (1.6, 3, and 5 m/s) compression tests. A bilinear material model was used to capture the nonlinear behavior of the lung tissue, which was implemented using a user-defined material in LS-DYNA. Inverse mapping using genetic algorithm-based optimization of all experimental data with the corresponding FE models yielded a set of strain-rate-dependent material parameters. The bilinear material parameters are obtained for the strain rates of 0.1, 100, 300, and 500 s-1. The estimated elastic modulus increased from 43 to 153 kPa, while the toe strain reduced from 0.39 to 0.29 when the strain rate was increased from 0.1 to 500 s-1. The optimized bilinear material properties of parenchymal tissue exhibit a piecewise linear relationship with the strain rate.

Alternating Layers of Morselized Allograft and Injectable Ceramic Bone Graft Substitute in Acetabular Reconstruction: A Novel 'Sandwich' Technique.

Background: Impaction of morselized allograft is an appealing procedure for addressing the bone defects. However, concerns remain about its suitability for massive defects. We used a novel "sandwich" technique by impacting the morselized allograft in layers with an intervening layer of injectable bone graft substitute for restoring bone defects during acetabular reconstruction in total hip arthroplasties. Methods: From August 2015 to June 2017, 17 revisions, 4 rerevisions, and 3 complex primary total hip arthroplasties were operated by this novel technique. Postoperatively, serial X-rays were evaluated at regular intervals. Clinical and functional outcomes were assessed by the Harris hip score. To examine if introducing an injectable bone substitute into allograft stock increased its load-bearing capability, simulated mechanical testing using Synbone samples was conducted in the laboratory. Results: The mean Harris hip score significantly improved from 54.6 preoperatively to 86.8 at the latest follow-up. Graft incorporation was seen in all the cases. There was no evidence of component migration or loosening as compared to the X-rays at 3 weeks and 3 months in all the cases. With revision of component as end point, the survivorship was 100% at 82 months. The mechanical testing reported a higher capability of allograft samples when compared to those without bone substitutes. Conclusions: Our data confirms that the use of the "sandwich" technique is a reliable option for major acetabular reconstruction. Early weight bearing is a significant value addition, and short-term results confirm good clinical and functional outcome. Longer follow-up is necessary to assess the status of the construct in the long term.

Lower Extremity Response to Blast Loading: A Computational Study.

This study has investigated the response of the Total Human Model for Safety (THUMS) lower extremity finite element model under blast loading. Response of the model was estimated in simulated underbody blast (UBB) loading using floorplate impact velocities of increasing severity. Correlation and analysis (CORA) ratings suggested a good match between numerical response and available experimental data. The model response was then investigated in an antipersonnel landmine explosion. The model was found stable in the nearfield blast and sensitive to the threat definition. The lower extremity injury was predicted when detonation occurred below the heel. The model predicted major injuries localized to the hindfoot and midfoot with minimal damage to the forefoot, consistent with the findings in the literature. The damage to the individual bones of the foot was measured in terms of percentage change in mass and element eroded.

Development and validation of risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD).

There has been a systematic review of studies that used FEA in dental sciences, but no adequate risk of bias (RoB) analysis technique has been developed. Therefore, the development and validation process of RoB in studies using the finite element analysis in dentistry (ROBFEAD) tool is described. In the first phase of development, the scope of the tool and possible modifications were covered, and validation was done in the second phase. The developed tool comprised 6 domains and a total of 22 guiding questions in these domains. This article proposes the development and validation of ROBFEAD, a tool for measuring RoB in finite element research in dentistry.

Reporting guidelines for in-silico studies using finite element analysis in medicine (RIFEM).

BACKGROUND: To the best of our knowledge, there are no reporting guidelines for design, conduct and reporting of Finite Element studies in health sciences. We intend to propose specific and detailed guidelines for reporting these studies. METHOD: After recognizing the need to have uniform guidelines for reporting of finite element analysis in medicine and dentistry, a group of 5 researchers working on FEA as their research area met in the summer of 2020 and drafted the methodology for the development of such guidelines. Each researcher individually made a list of major headings required for reporting these studies and met again in September 2020 to finalize the domains. Subsequently, sub headings and details were charted. The draft list of items for reporting the guidelines were presented to a larger team of 15 experts and some changes were further made based on their inputs. RESULTS: The guidelines entail seven major domains and their sub-domains, including parameters for model structure, segmentation, mesh structure, force application and model validation, etc. This checklist aims to improvise the reporting and consistency of FEA studies. CONCLUSION: We hope that the usage and adoption of these guidelines by the scientific community would result in more thoughtful and uniform documentation. Also, the confidence in the results would be enhanced through model reproducibility, reusability and accountability. The proposed guidelines were named as 'Reporting of in-silico studies using finite element analysis in medicine' and the term 'RIFEM' was used as acronym.

Effects of miniplate anchored Herbst appliance on skeletal, dental and masticatory structures of the craniomandibular apparatus: A finite element study.

OBJECTIVE: To analyze the stress distribution in the hard and soft tissue structures of craniomandibular complex during mandibular advancement with miniplate anchored rigid fixed functional appliance (FFA) using Finite Element Analysis (FEA). MATERIAL AND METHODS: The virtual model consisting of all the maxillofacial bones (up to calvaria), the mandible and temporomandibular joint (TMJ) was generated using the volumetric data from pre-treatment CBCT-scan of a growing patient. The masticatory muscles, other soft tissues, Herbst appliance and plate geometry were modelled mathematically. Force vectors simulating muscle contraction at rest and advanced mandibular positions, with protraction force of 8N were applied. The final model was imported into ANSYS for analysis after assigning material properties. RESULTS: The maximum von Mises stress of 11.69MPa and 11.96MPa magnitude was observed in the region of pterygoid plates and at the bone-miniplate interface respectively, with the mandibular advancement of 7mm. Stress patterns were also noted at the condylar neck. The stress values observed in the medial and lateral pterygoid muscles were of 10.42MPa and 4.16MPa magnitude, respectively. Stress was noted in the bucco-cervical region of the upper posterior teeth, but negligible change was seen on the lower anterior teeth and periodontal ligament. CONCLUSION: Miniplate Anchored Herbst Appliance brought about Class II skeletal correction in growing children as it was accompanied by minimal changes in the inclination of the lower incisors. Soft tissue structures like pterygoid muscles and discal ligaments exhibited increased stress whereas masseter muscle displayed reduction in stresses.

Prediction of lower extremity injuries in car-pedestrian crashes - real-world accident study.

OBJECTIVE: This study focusses on injury prediction capabilities of the THUMS (Total HUman Body Model for Safety) finite element human body model (FE-HBM) in real world car-pedestrian crashes. METHODS: Ten cases of car-pedestrian crashes with incidence of lower extremity injuries were reconstructed using sequence of multi-body tools and finite element tools. Multi-body simulations were used to obtain relevant impact conditions like vehicle speed, pedestrian location etc. which were later used as initial conditions in finite element simulations. Estimated injury from the FE simulation were compared with the clinical records of victim. RESULTS: The severity and location of injuries were correctly predicted in 8 out of 10 crashes that were considered. However, in remaining two cases injuries were under-predicted, and strain didn't reach the failure threshold level. CONCLUSION: This study demonstrates that THUMS HBM well predicts pedestrian injuries in real-world crashes. However, a similar study with comprehensive crash site data and medical records of victims will enhance the confidence in results.

Characterisation of human diaphragm at high strain rate loading.

Motor vehicle crashes (MVC׳s) commonly results in life threating thoracic and abdominal injuries. Finite element models are becoming an important tool in analyzing automotive related injuries to soft tissues. Establishment of accurate material models including tissue tolerance limits is critical for accurate injury evaluation. The diaphragm is the most important skeletal muscle for respiration having a bi-domed structure, separating the thoracic cavity from abdominal cavity. Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending upon the mechanisms of the causative trauma. A major step to gain insight into the mechanism of traumatic rupture of diaphragm is to understand the high rate failure properties of diaphragm tissue. Thus, the main objective of this study was to estimate the mechanical and failure properties of human diaphragm at strain rates associated with blunt thoracic and abdominal trauma. A total of 23 uniaxial tensile tests were performed at various strain rates ranging from 0.001-200s(-1) in order to characterize the mechanical and failure properties on human diaphragm tissue. Each specimen was tested to failure at one of the four strain rates (0.001s(-1), 65s(-1), and 130s(-1), 190s(-1)) to investigate the effects of strain rate dependency. High speed video and markers placed on the grippers were used to measure the gripper to gripper displacement. Engineering stresses reported in the study is calculated from the ratio of force measured and initial cross sectional area whereas engineering strain is calculated from the ratio of the elongation to the undeformed length (gauge length) of the specimen.The results of this study showed that the diaphragm tissues is rate dependent with higher strain rate tests giving higher failure stress and higher failure strains. The failure stress for all tests ranged from 1.17MPa to 4.1MPa and failure strain ranged from 12.15% to 24.62%.

Repositioning the knee joint in human body FE models using a graphics-based technique.

OBJECTIVE: Human body finite element models (FE-HBMs) are available in standard occupant or pedestrian postures. There is a need to have FE-HBMs in the same posture as a crash victim or to be configured in varying postures. Developing FE models for all possible positions is not practically viable. The current work aims at obtaining a posture-specific human lower extremity model by reconfiguring an existing one. METHODOLOGY: A graphics-based technique was developed to reposition the lower extremity of an FE-HBM by specifying the flexion-extension angle. Elements of the model were segregated into rigid (bones) and deformable components (soft tissues). The bones were rotated about the flexion-extension axis followed by rotation about the longitudinal axis to capture the twisting of the tibia. The desired knee joint movement was thus achieved. Geometric heuristics were then used to reposition the skin. A mapping defined over the space between bones and the skin was used to regenerate the soft tissues. Mesh smoothing was then done to augment mesh quality. RESULTS: The developed method permits control over the kinematics of the joint and maintains the initial mesh quality of the model. For some critical areas (in the joint vicinity) where element distortion is large, mesh smoothing is done to improve mesh quality. CONCLUSIONS: A method to reposition the knee joint of a human body FE model was developed. Repositions of a model from 9 degrees of flexion to 90 degrees of flexion in just a few seconds without subjective interventions was demonstrated. Because the mesh quality of the repositioned model was maintained to a predefined level (typically to the level of a well-made model in the initial configuration), the model was suitable for subsequent simulations.

Fracture of the outer metallic head of the bipolar hip prosthesis: an unusual bearing surface failure.

Fracture of the bearing surface is an infrequent cause of failure of a hip arthroplasty. Although well documented with ceramic heads, fracture of the metallic head is much rarer. We report a case of a fracture of the outer metallic head of a modular cemented bipolar hemiarthroplasty 2 years after the index procedure. Over time, the outer head lost its intended motion and assumed a vertical position. We hypothesized that this position caused asymmetrical loading with stress concentration at the poles, compounded by repeated impingement between the skirted inner cobalt-chromium (Cr-Co) head and the outer stainless steel head of this particular prosthesis. These were supported by the finite element studies. In addition, scanning electron microscopy and energy dispersive x-ray studies showed metallurgical defects that seemed to have initiated and/or accelerated the fracture. Although rare, this mode of failure calls for increased awareness, periodic follow-up, and quality control.

Effect of active muscle forces on knee injury risks for pedestrian standing posture at low-speed impacts.

OBJECTIVES: The objective of the present study is to investigate the effect of muscle active forces on lower extremity injuries for various impact locations and impact angles for a freely standing pedestrian. METHODS: FE simulations have been performed using a validated lower extremity FE model with active muscles (A-LEMS). In all, nine impact orientations have been studied. For each impact orientation, three different pre-impact conditions of a freely standing pedestrian, representing a cadaver, and an unaware and an aware braced pedestrian, have been simulated. Stretch-based reflexive action was included in the simulations for an unaware pedestrian. RESULTS: Strains in knee ligaments and knee joint kinematics have been compared in each impact orientation to assess the effect of muscle activation. It is observed that strain in knee ligaments is dependent on impact locations and angles and the MCL is the most vulnerable ligament. Further, due to muscle effects, except when the impact is on the knee, peak strain values in all the ligaments are lower for an unaware pedestrian than either for a cadaver or for a fully braced pedestrian. CONCLUSIONS: It is concluded that active muscle forces significantly affect the knee kinematics and consequently reduce strains in knee ligaments.