Similar Fracture Patterns in Human Nose and Gothic Cathedral.

This study proposes that the bony anatomy of the human nose and masonry structure of the Gothic cathedral are geometrically similar, and have common fracture patterns. We also aim to correlate the fracture patterns observed in patients' midface structures with those seen in the Gothic cathedral using computational approach. CT scans of 33 patients with facial fractures were examined and compared with computer simulations of both the Gothic cathedral and human nose. Three similar patterns were found: (1) Cracks of the nasal arch with crumpling of the vertical buttresses akin to the damage seen during minor earthquakes; (2) lateral deviation of the central nasal arch and collapse of the vertical buttresses akin to those due to lateral forces from wind and in major earthquakes; and (3) Central arch collapse seen as a result of collapse under excessive dead weight. Interestingly, the finding of occult nasal and septal fractures in the mandible fractures with absence of direct nasal trauma highlights the possibility of transmission of forces from the foundation to the arch leading to structural failure. It was also found that the structural buttresses of the Gothic cathedral delineate the vertical buttresses in the human midface structure. These morphologic similarities between the human nose and Gothic cathedral will serve as a basis to study the biomechanics of nasal fractures. Identification of structural buttresses in a skeletal structure has important implications for reconstruction as reestablishment of structural continuity restores normal anatomy and architectural stability of the human midface structure.

Investigation of mechanical strength and structure of corneal graft-host junction.

Dehiscence is a common complication of corneal transplant surgery involving separating the graft from the host eye. The present article aims to investigate fundamental insights into the mechanical and structural aspects of the graft-host junction (GHJ) of a graft that survived in a patient for 13 years after penetrating keratoplasty (PK). Additionally, it adopts the sutur retention strength (SRS) test procedure defined in ISO:7198-2016 and aims to provide a comprehensive test protocol to study the biomechanics of the GHJ in extracted PK buttons. A 9 mm corneal button with GHJ was extracted from a 46-year-old patient who underwent PK 13 years back. The strength of the GHJ was quantified using the SRS test. Corresponding control results were obtained from the SRS tests of a corneoscleral button with no history of any refractive procedure. Birefringence, histological, and scanning electron microscopy (SEM) imaging were used to visualize the microstructural details of the GHJ. The strength of the GHJ was observed to be ten times lower than the native cornea. Histopathological features, such as fragmented Bowman's layer, and fibrosis with a clear demarcation line between host and graft tissue, were observed at the GHJ, suggesting a weak bond across the GHJ. The low strength of the GHJ in PK indicates the high susceptibility of the GHJ towards wound dehiscence.

Design, Kinematics and Gait Analysis, of Prosthetic Knee Joints: A Systematic Review.

The aim of this review article is to appraise the design and functionality of above-knee prosthetic legs. So far, various transfemoral prosthetic legs are found to offer a stable gait to amputees but are limited to laboratories. The commercially available prosthetic legs are not reliable and comfortable enough to satisfy amputees. There is a dire need for creating a powered prosthetic knee joint that could address amputees' requirements. To pinpoint the gap in transfemoral prosthetic legs, prosthetic knee unit model designs, control frameworks, kinematics, and gait evaluations are concentrated. Ambulation exercises, ground-level walking, running, and slope walking are considered to help identify research gaps and areas where existing prostheses can be ameliorated. The results show that above-knee amputees can more effectively manage their issues with the aid of an active prosthesis, capable of reliable gait. To accomplish the necessary control, closed loop controllers and volitional control are integral parts. Future studies should consider designing a transfemoral electromechanical prosthesis based on electromyographic (EMG) signals to better predict the amputee's intent and control in accordance with that intent.

Three-dimensional irradiance and temperature distributions resulting from transdermal application of laser light to human knee-A numerical approach.

The use of light for therapeutic applications requires light-absorption by cellular chromophores at the target tissues and the subsequent photobiomodulation (PBM) of cellular biochemical processes. For transdermal deep tissue light therapy (tDTLT) to be clinically effective, a sufficiently large number of photons must reach and be absorbed at the targeted deep tissue sites. Thus, delivering safe and effective tDTLT requires understanding the physics of light propagation in tissue. This study simulates laser light propagation in an anatomically accurate human knee model to assess the light transmittance and light absorption-driven thermal changes for eight commonly used laser therapy wavelengths (600-1200 nm) at multiple skin-applied irradiances (W cm-2 ) with continuous wave (CW) exposures. It shows that of the simulated parameters, 2.38 W cm-2 (30 W, 20 mm beam radius) of 1064 nm light generated the least tissue heating -4°C at skin surface, after 30 s of CW irradiation, and the highest overall transmission-approximately 3%, to the innermost muscle tissue.

Estimation of Lumbar Spine Loading of Low Back Pain Participant During Lifting Using an Open Source Musculoskeletal Model.

Biomechanical modeling of spinal load during lifting in OpenSim has the potential for rehabilitation and clinical assessment. In the literature, several spinal models have been developed and validated with movement data from healthy individuals. Although these models are valid for predicting spinal load in healthy individuals, it is unknown whether these models are applicable for people with chronic low back pain (CLBP). This study aims to compare the application of the lifting full body (LFB) model between a healthy participant and a participant with CLBP. The participants performed the lifting activity, and the motion capture data was used to analyze how an open-source model predicts the loading of the lumbar spine. Peak spinal loading at L5/S1 joint was estimated as 3.9 kN for the healthy participant and 3.1 kN for the CLBP participant. The results suggest that a longer duration of lift and lower lumbar range of motion reduces lumbar spinal loading.

Investigation of microstructural failure in the human cornea through fracture tests.

Fracture toughness of the human cornea is one of the critical parameters in suture-involved corneal surgeries and the development of bioengineered mimetics of the human cornea. The present article systematically studied the fracture characteristics of the human cornea to evaluate its resistance to tear in the opening (Mode-I) and trouser tear mode (Mode-III). Tear experiments reveal the dependency of the fracture behavior on the notch size and its location created in the corneal specimens. The findings indicate lamellar tear and collagen fiber pull-out as a failure mechanism in trouser tear and opening mode tests, respectively. Experimental results have shown a localized variation of tear behavior in trouser tear mode and indicated an increasing resistance to tear from the corneal center to the periphery. This article demonstrated the complications of evaluating fracture toughness in opening mode and showed that the limbus was weaker than the cornea and sclera against tearing. The overall outcomes of the present study help in designing experiments to understand the toughness of the diseased tissues, understanding the effect of the suturing location and donor placement, and creating numerical models to study parameters affecting corneal replacement surgery.

A Review on Damage and Rupture Modelling for Soft Tissues.

Computational modelling of damage and rupture of non-connective and connective soft tissues due to pathological and supra-physiological mechanisms is vital in the fundamental understanding of failures. Recent advancements in soft tissue damage models play an essential role in developing artificial tissues, medical devices/implants, and surgical intervention practices. The current article reviews the recently developed damage models and rupture models that considered the microstructure of the tissues. Earlier review works presented damage and rupture separately, wherein this work reviews both damage and rupture in soft tissues. Wherein the present article provides a detailed review of various models on the damage evolution and tear in soft tissues focusing on key conceptual ideas, advantages, limitations, and challenges. Some key challenges of damage and rupture models are outlined in the article, which helps extend the present damage and rupture models to various soft tissues.

A Biomechanical Evaluation of a Novel Airbag Bicycle Helmet Concept for Traumatic Brain Injury Mitigation.

In this study, a novel expandable bicycle helmet, which integrates an airbag system into the conventional helmet design, was proposed to explore the potential synergetic effect of an expandable airbag and a standard commuter-type EPS helmet. The traumatic brain injury mitigation performance of the proposed expandable helmet was evaluated against that of a typical traditional bicycle helmet. A series of dynamic impact simulations on both a helmeted headform and a representative human head with different configurations were carried out in accordance with the widely recognised international bicycle helmet test standards. The impact simulations were initially performed on a ballast headform for validation and benchmarking purposes, while the subsequent ones on a biofidelic human head model were used for assessing any potential intracranial injury. It was found that the proposed expandable helmet performed admirably better when compared to a conventional helmet design-showing improvements in impact energy attenuation, as well as kinematic and biometric injury risk reduction. More importantly, this expandable helmet concept, integrating the airbag system in the conventional design, offers adequate protection to the cyclist in the unlikely case of airbag deployment failure.

What can artificial intelligence and machine learning tell us? A review of applications to equine biomechanical research.

Artificial intelligence (AI) and machine learning (ML) are fascinating interdisciplinary scientific domains where machines are provided with an approximation of human intelligence. The conjecture is that machines are able to learn from existing examples, and employ this accumulated knowledge to fulfil challenging tasks such as regression analysis, pattern classification, and prediction. The horse biomechanical models have been identified as an alternative tool to investigate the effects of mechanical loading and induced deformations on the tissues and structures in humans. Many reported investigations into bone fatigue, subchondral bone damage in the joints of both humans and animals, and identification of vital parameters responsible for retaining integrity of anatomical regions during normal activities in all species are heavily reliant on equine biomechanical research. Horse racing is a lucrative industry and injury prevention in expensive thoroughbreds has encouraged the implementation of various measurement techniques, which results in massive data generation. ML substantially accelerates analysis and interpretation of data and provides considerable advantages over traditional statistical tools historically adopted in biomechanical research. This paper provides the reader with: a brief introduction to AI, taxonomy and several types of ML algorithms, working principle of a feedforward artificial neural network (ANN), and, a detailed review of the applications of AI, ML, and ANN in equine biomechanical research (i.e. locomotory system function, gait analysis, joint and bone mechanics, and hoof function). Reviewing literature on the use of these data-driven tools is essential since their wider application has the potential to: improve clinical assessments enabling real-time simulations, avoid and/or minimize injuries, and encourage early detection of such injuries in the first place.

Specimen-specific fracture risk curves of lumbar vertebrae under dynamic axial compression.

Underbody blast attacks of military vehicles by improvised explosives have resulted in high incidence of lumbar spine fractures below the thorocolumbar junction in military combatants. Fracture risk curves related to vertical loading at individual lumbar spinal levels can be used to assess the protective ability of new injury mitigation equipment. The objectives of this study were to derive fracture risk curves for the lumbar spine under high rate compression and identify how specimen-specific attributes and lumbar spinal level may influence fracture risk. In this study, we tested a sample of three-vertebra specimens encompassing all spinal levels between T12 to S1 in high-rate axial compression. Each specimen was tested with a non-injurious load, followed by a compressive force sufficient to induce vertebral body fracture. During testing, bone fracture was identified using measurements from acoustic emission sensors and changes in load cell readings. Following testing, the fractures were assessed using computed tomographic (CT) imaging. The CT images showed isolated fractures of trabecular bone, or fractures involving both cortical and trabecular bone. Results from the compressive force measurements in conjunction with a survival analysis demonstrated that the compressive force corresponding to fracture increased inferiorly as a function of lumbar spinal level. The axial rigidity (EA) measured at the mid-plane of the centre vertebra or the volumetric bone mineral density (vBMD) of the vertebral body trabecular bone most greatly influenced fracture risk. By including these covariates in the fracture risk curves, no other variables significantly affected fracture risk, including the lumbar spinal level. The fracture risk curves presented in this study may be used to assess the risk of injury at individual lumbar vertebra when exposed to dynamic axial compression.

Occlusion of the lumbar spine canal during high-rate axial compression.

BACKGROUND CONTEXT: While burst fracture is a well-known cause of spinal canal occlusion with dynamic, axial spinal compression, it is unclear how such loading mechanisms might cause occlusion without fracture. PURPOSE: To determine how spinal canal occlusion during dynamic compression of the lumbar spine is differentially caused by fracture or mechanisms without fracture and to examine the influence of spinal level on occlusion. STUDY DESIGN: A cadaveric biomechanical study. METHODS: Twenty sets of three-vertebrae specimens from all spinal levels between T12 and S1 were subjected to dynamic compression using a hydraulic loading apparatus up to a peak velocity between 0.1 and 0.9 m/s. The presence of canal occlusion was measured optically with a high-speed camera. This was repeated with incremental increases of 4% compressive strain until a vertebral fracture was detected using acoustic emission measurements and computed tomographic imaging. RESULTS: For axial compression without fracture, the peak occlusion (Omax) was 29.9±10.0%, which was deduced to be the result of posterior bulging of the intervertebral disc into the spinal canal. Omax correlated significantly with lumbar spinal level (p<.001), the compressive displacement (p<.001) and the cross-sectional area of the vertebra (p=.031). CONCLUSIONS: Spinal canal occlusion observed without vertebral fracture involves intervertebral disc bulging. The lower lumbar spine tended to be more severely occluded than more proximal levels. CLINICAL SIGNIFICANCE: Clinically, intermittent canal occlusion from disc bulging during dynamic compression may not show any radiographic features. The lower lumbar spine should be a focus of injury prevention intervention in cases of high-rate axial compression.

Effect of sitting posture on pelvic injury risk under vertical loading.

Underbody blast (UBB) attacks on military vehicles can result in severe pelvic injuries to the vehicle occupants. The aim of this study was to evaluate the biomechanical responses of the pelvis to UBB-like vertical loading in different seated postures. High-rate axial loading were performed on six defleshed human cadaveric pelves, whilst a three-dimensional finite element model of a human pelvis was created and used to simulate the high-rate loading with the model responses validated against experimental measurements. Three pelvic orientation corresponding to normal, upright, and relaxed seated postures, along with three different sacral slope angles representing the range of relative pelvis and sacrum positions known to exist across the population, were studied. The results showed that a decrease in posterior pelvic tilt slightly reduced the severity of sacral fracture, while an increase in sacral angle extended the region of anterior sacral fracture but reduced the extent to which the dorsal sacrum fractured. Across all seated postures, the predicted fractures of the ischial tuberosity, ischium, pubic rami and sacrum coincided with the typical pelvic fracture patterns observed in UBB events. The present study suggests that adopting an upright initial seated posture prior to an UBB event may reduce the risk of pelvic injuries.

Load response of an osseointegrated implant used in the treatment of unilateral transfemoral amputation: An early implant loosening case study.

BACKGROUND: Osseointegrated implants for transfemoral amputees facilitate direct load transfer between the prosthetic limb and femur; however, implant loosening is a common complication, and the associated implant-bone loads remain poorly understood. This case study aimed to use patient-specific computational modeling to evaluate bone-implant interface loading during standing and walking in a transfemoral amputee with an osseointegrated implant prior to prosthesis loosening and revision surgery. METHODS: One male transfemoral amputee with an osseointegrated implant was recruited (age: 59-yrs, weight: 83 kg) and computed tomography (CT) performed on the residual limb approximately 3 months prior to implant failure. Gait analyses were performed, and the CT images used to develop a finite element model of the patient's implant and surrounding bone. Simulations of static weight bearing, and over-ground walking were then performed. FINDINGS: During standing, maximum and minimum principal strains in trabecular bone adjacent to the implant were 0.26% and -0.30%, respectively. Strains generated at the instant of contralateral toe-off and contralateral heel strike during walking were substantially higher and resulted in local trabecular bone yielding. Specifically, the maximum and minimum principal strains in the thin layer of trabecular bone surrounding the distal end of the implant were 1.15% and -0.98%, respectively. INTERPRETATION: Localised yielding of trabecular bone at the interface between the femur and implant in transfemoral amputee osseointegrated prosthesis recipients may present a risk of implant loosening due to periprosthetic bone fracture during walking. Rehabilitation exercises should aim to produce implant-bone loading that stimulates bone remodelling to provide effective bone conditioning prior to ambulation.

The influence of rotator cuff tears on muscle and joint-contact loading after reverse total shoulder arthroplasty.

Rotator cuff tears are known to affect clinical outcome of reverse total shoulder arthroplasty (RSA). This study aimed to use computational modelling to quantify the effect of rotator cuff tear severity on muscle and joint forces after RSA, as well as stresses at the glenosphere, base-plate, fixation screws, scapula, and humeral components. A multi-body musculoskeletal model of the glenohumeral joint was developed comprising the scapula, humerus and nine major upper limb muscles. Simulations of abduction and flexion after RSA were performed in the case of the intact rotator cuff and tears to (i) supraspinatus; (ii) supraspinatus and infraspinatus, and (iii) supraspinatus, infraspinatus and subscapularis. The intact and supraspinatus deficient rotator cuff resulted in the largest calculated muscle forces, glenohumeral joint contact forces and implant stresses. Peak glenohumeral joint forces during flexion were lower than those during abduction in all cases; however, substantially more posterior joint shear force was generated during flexion than abduction. A tear involving the supraspinatus and infraspinatus reduced glenohumeral joint forces by a factor of 8.7 during abduction (603.1 N) and 7.1 during flexion (520.7 N) compared to those in the supraspinatus deficient shoulder. RSA with an intact or supraspinatus deficient rotator cuff produces large glenohumeral joint forces that may increase base-plate failure risk, particularly during flexion when posterior shear forces are largest. Infraspinatus tears after RSA greatly reduce glenohumeral joint compression and may ultimately reduce joint stability. Future research ought to focus on experimental validation of subject-specific muscle recruitment strategies and joint loading after RSA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Cortical and Trabecular Bone Fracture Characterisation in the Vertebral Body Using Acoustic Emission.

The ability to rapidly detect localised fractures of cortical and/or trabecular bone sustained by the vertebral body would enhance the analysis of vertebral fracture initiation and propagation during dynamic loading. In this study, high rate axial compression tests were performed on twenty sets of three-vertebra lumbar spine specimens. Acoustic Emission (AE) sensor measurements of sound wave pressure were used to classify isolated trabecular fractures and severe compressive fractures of vertebral body cortical and trabecular bone. Fracture detection using standard AE parameters was compared to that of traditional mechanical parameters obtained from load cell and displacement readings. Results indicated that the AE parameters achieved slightly enhanced classification of isolated trabecular fractures, whereas the mechanical parameters better identified combined fractures of cortical and trabecular bone. These findings demonstrate that AE may be used to promptly and accurately identify localised fractures of trabecular bone, whereas more extensive fractures of the vertebral body are best identified by load cell readings due to the considerable loss in compressive resistance. The discrimination thresholds corresponding to the AE parameters were based on calibrated measurements of AE wave pressure and may ultimately be used to examine the onset and progression of vertebral fracture in other loading scenarios.

A computational study of the EN 1078 impact test for bicycle helmets using a realistic subject-specific finite element head model.

In the present study, the free fall impact test in accordance with the EN1078 standard for certification of bicycle helmets is replicated using numerical simulations. The impact scenario is simulated using an experimentally validated, patient-specific head model equipped with and without a bicycle helmet. Head accelerations and intracranial biomechanical injury metrics during the impacts are recorded. It is demonstrated that wearing the bicycle helmet during the impact reduces biomechanical injury metrics, with the biggest reduction seen in the metric for skull fracture.

Feasibility of using computer simulation to predict the postoperative outcome of the minimally invasive Nuss procedure: Simulation prediction vs. postoperative clinical observation.

The Nuss procedure is the most minimally invasive and commonly used surgical correction for pectus excavatum (PE) by using a prebent pectus bar to elevate the deformed chest wall. However, there are some complications associated with this procedure such as postoperative pain as well as surgical uncertainties because of human judgment. It is therefore important to understand the biomechanical effect of the pectus bar on PE thoraces undergoing an operation to alleviate the postoperative pain as well as to improve surgical outcome. The current study incorporated the finite element method (FEM) to simulate the entire Nuss procedure including the flipping process of the pectus bar on a preoperative PE patient-specific thorax model, in conjunction with comparison against the postoperative CT scans. The mid-sagittal sternovertebral elevation was found to be within 5.32 mm, whereas the transverse sternal deviations ranged from 1.59 to 3.02 mm. The average discrepancy between the predicted contour and postoperative CT contour was approximately 3%. On a different note, the stress and strain distributions largely concurred with reported findings. High bilateral stress was seen to occur at the back of ribs near the vertebral column, and particularly over the second to fifth ribs, whereas the greatest strain was found to be confined to the regions of costal cartilages. It is evident that the FEM is a feasible and robust approach in predicting the outcome of the mechanical surgical procedure. This contributes to the future development of a predictive tool incorporated in surgical planning to enhance surgical management of PE.

Effect of helmet liner systems and impact directions on severity of head injuries sustained in ballistic impacts: a finite element (FE) study.

The current study aims to investigate the effectiveness of two different designs of helmet interior cushion, (Helmet 1: strap-netting; Helmet 2: Oregon Aero foam-padding), and the effect of the impact directions on the helmeted head during ballistic impact. Series of ballistic impact simulations (frontal, lateral, rear, and top) of a full-metal-jacketed bullet were performed on a validated finite element head model equipped with the two helmets, to assess the severity of head injuries sustained in ballistic impacts using both head kinematics and biomechanical metrics. Benchmarking with experimental ventricular and intracranial pressures showed that there is good agreement between the simulations and experiments. In terms of extracranial injuries, top impact had the highest skull stress, still without fracturing the skull. In regard to intracranial injuries, both the lateral and rear impacts generally gave the highest principal strains as well as highest shear strains, which exceed the injury thresholds. Off-cushion impacts were found to be at higher risk of intracranial injuries. The study also showed that the Oregon Aero foam pads helped to reduce impact forces. It also suggested that more padding inserts of smaller size may offer better protection. This provides some insights on future's helmet design against ballistic threats.

Face shield design against blast-induced head injuries.

Blast-induced traumatic brain injury has been on the rise in recent years because of the increasing use of improvised explosive devices in conflict zones. Our study investigates the response of a helmeted human head subjected to a blast of 1 atm peak overpressure, for cases with and without a standard polycarbonate (PC) face shield and for face shields comprising of composite PC and aerogel materials and with lateral edge extension. The novel introduction of aerogel into the laminate face shield is explored and its wave-structure interaction mechanics and performance in blast mitigation is analysed. Our numerical results show that the face shield prevented direct exposure of the blast wave to the face and help delays the transmission of the blast to reduce the intracranial pressures (ICPs) at the parietal lobe. However, the blast wave can diffract and enter the midface region at the bottom and side edges of the face shield, resulting in traumatic brain injury. This suggests that the bottom and sides of the face shield are important regions to focus on to reduce wave ingress. The laminated PC/aerogel/PC face shield yielded higher peak positive and negative ICPs at the frontal lobe, than the original PC one. For the occipital and temporal brain regions, the laminated face shield performed better than the original. The composite face shield with extended edges reduced ICP at the temporal lobe but increases ICP significantly at the parietal lobe, which suggests that a greater coverage may not lead to better mitigating effects.

Investigation of the relationship between facial injuries and traumatic brain injuries using a realistic subject-specific finite element head model.

In spite of anatomic proximity of the facial skeleton and cranium, there is lack of information in the literature regarding the relationship between facial and brain injuries. This study aims to correlate brain injuries with facial injuries using finite element method (FEM). Nine common impact scenarios of facial injuries are simulated with their individual stress wave propagation paths in the facial skeleton and the intracranial brain. Fractures of cranio-facial bones and intracranial injuries are evaluated based on the tolerance limits of the biomechanical parameters. General trend of maximum intracranial biomechanical parameters found in nasal bone and zygomaticomaxillary impacts indicates that severity of brain injury is highly associated with the proximity of location of impact to the brain. It is hypothesized that the midface is capable of absorbing considerable energy and protecting the brain from impact. The nasal cartilages dissipate the impact energy in the form of large scale deformation and fracture, with the vomer-ethmoid diverging stress to the "crumpling zone" of air-filled sphenoid and ethmoidal sinuses; in its most natural manner, the face protects the brain. This numerical study hopes to provide surgeons some insight in what possible brain injuries to be expected in various scenarios of facial trauma and to help in better diagnosis of unsuspected brain injury, thereby resulting in decreasing the morbidity and mortality associated with facial trauma.