Mechanical properties of fused sagittal sutures in scaphocephaly.

BACKGROUND: Craniosynostosis in newborns is caused by the premature closure of the cranial sutures leading to cranial vault deformity. It results in aesthetic imbalance and developmental disabilities and surgery is frequent during the first months of growth. Our study focused on scaphocephaly defined as the premature closure of the sagittal suture. We hypothesised that the effective mechanical properties of sutures were altered as compared to those of the parietal adjacent tissue considered as control. METHODS: The population consisted of seven males and four females (mean age 4.9 months). Sixteen suture samples and thirty-four parietal tissue samples were harvested during corrective surgery and investigated by using three-point bending tests to obtain the structure-stiffness of specimens. An energy model was used to derive the effective Young's modulus. A histological study complemented the experimental protocol. FINDINGS: Fused sutures were thicker than adjacent bone and the natural curvature of sutures did not influence the static mechanical response. The stiffness of stenotic sutures was significantly higher than that of the parietal bone. The effective Young's modulus of stenotic sutures was significantly lower than that of the parietal adjacent tissue. The parietal tissue showed a parallel bone architecture whereas the central stenotic tissue was disorganised with more vascularisation. INTERPRETATION: The stenotic suture differed in structural and mechanical terms from the adjacent bone during calvarial growth in the first year of life. Our study emphasised the alteration of effective tissue properties in craniosynostosis.

2D calculation method based on composite beam theory for the determination of local homogenised stiffnesses of long bones.

A calculation method using the finite element technique is presented. Its main objective was to determine strains, stresses and more particularly stiffnesses in any cross section of a tibia, thus enabling the localisation of tibial torsion in vivo. Each tibial cross section was considered to be a non-uniform cross section of a composite beam with arbitrary orientation of fibres. The determination of stresses, strains and stiffnesses within a composite beam cross section has been defined by solving a variational problem. The validation of this method was performed on a tibial diaphysis of which each cross section was assumed to be the cross section of a composite beam made of orthotropic materials with orthotropic axes of any orientation with respect to the principal axis of the bone. The comparison of the results, from our model and that of a three-dimensional one, was performed on each nodal value (strains, stresses) of the meshed cross section as it was impossible to obtain local stiffnesses by experimentation. The good agreement between the results has validated our finite element program. Actually, this method has enabled to treat directly 2D geometric reconstructions from CT scan images with a good accuracy to determine locally the homogenised mechanical characteristics of human tibia in vivo, and particularly to quantify torsional tibial abnormalities of children without approximation of the shape of the cross section and by calculating the real moment of inertia J. The importance of the fibre orientation with regards to the stiffness values has been emphasised. This 2D method has also allowed to reduce CPU time of the 3D modelling and calculation.

Assessment of hindfoot deformity by three-dimensional MRI in infant club foot.

In 12 infants aged under 16 months with unilateral club foot we used MRI in association with multiplanar reconstruction to calculate the volume and principal axes of inertia of the bone and cartilaginous structures of the hindfoot. The volume of these structures in the club foot is about 20% smaller than that in the normal foot. The reduction in volume of the ossification centre of the talus (40%) is greater than that of the calcaneus (20%). The long axes of both the ossification centre and the cartilaginous anlage of the calcaneus are identical in normal and club feet. The long axis of the osseous nucleus of the talus of normal and club feet is medially rotated relative to the cartilaginous anlage, but the angle is greater in club feet (10 degrees v 14 degrees). The cartilaginous structure of the calcaneus is significantly medially rotated in club feet (15 degrees) relative to the bimalleolar axis. The cartilaginous anlage of the talus is medially rotated in both normal and club feet, but with a smaller angle for club feet (28 degrees v 38 degrees). This objective technique of measurement of the deformity may be of value preoperatively.

Finite element analysis of the mechanical behavior of a scapula implanted with a glenoid prosthesis.

OBJECTIVE: The objective of the present study was to analyze the mechanical effect of some of the surgical variables encountered during shoulder arthroplasty using the finite element method. The effect of one eccentric load case, cement thickness and conformity has been investigated. DESIGN: A 3D finite element model of a healthy cadaveric scapula implanted with an anatomically shaped glenoid has been developed from computed tomography (CT) images. BACKGROUND: Glenoid component fixation can present the most difficult problem in total shoulder arthroplasty, loosening of this component remains one of the main complications. METHODS: The 3D finite element model was first validated by comparison with experimental measurements and by fitting of the mechanical properties of the cortical bone. Then the articular pressure location, the surface contact geometry and the cement thickness have been analyzed to observe their effect on stresses and displacements at the interfaces and within the scapular bone. RESULTS: The antero-posterior bending of the scapula was a notable feature and this was accentuated when an eccentric load was applied. The gleno-humeral contact area had a major role on the stress level in the supporting structures though but not on the global displacements. Varying the cement mantle modified stresses according to the load case and it essentially changed the latero-medial displacement of the cement relatively to the bone. CONCLUSIONS: This analysis provided an insight into the mechanical effects of an implanted scapula according to different parameters related to implantation technique. RELEVANCE: Results emphasized the role of some of the parameters a clinician may face. They demonstrated the importance of the humeral head centering in the horizontal plane. Conformity decreasing may involve drastic increase of stresses within structures and a thick cement mantle is not necessarily advantageous relatively to the stresses at the cement/bone interface.

In vivo determination of homogenised mechanical characteristics of human tibia: application to the study of tibial torsion in vivo.

OBJECTIVE: The study presents a method allowing the in vivo homogenised characteristics of the tibiae of children to be assessed. DESIGN: Studies have been performed on two groups of children: six normal children, aged from 5 to 16 yr, and on four children, aged from 8 to 11 yr with tibial deformities. We analysed the tibial transverse sections from CT scans performed on the left tibia of each child. BACKGROUND: Most tibial torsion studies have only been based on geometrical parameters. Our study integrated mechanical and geometrical considerations. METHODS: The finite element models and integration of mechanical properties were performed from CT scans. Then homogenised mechanical characteristics (tensile stiffness, flexural stiffness and torsional stiffness) were calculated. RESULTS: The homogenised mechanical characteristics decrease between 20 to 80% of the tibial length. The values increased with age for both groups of children. Children with abnormalities seem to have values of tibial rigidities comparable with those of normal tibiae. CONCLUSIONS: By considering the mechanical and geometrical properties of the tibia in our study, we showed that the bone stiffness of children is not altered with torsional deformities. RELEVANCE: Torsional tibial abnormalities of children are a frequent phenomenon which may have important consequences on gait and joints. The method developed could be used as an objective assessment of bone rigidities for analysing tibial disorders such as torsional abnormalities of varying severity.