Development of a simulation system for femoroacetabular impingement detection based on 3D images.

Image-based criteria have been adopted to diagnose femoroacetabular impingement (FAI). However, the overlapping property of the two-dimensional X-ray outlines and static and supine posture of taking computed tomography (CT) and magnetic resonance imaging images potentially affect the accuracy of the criteria. This study developed a CT image-based dynamic criterion to effectively simulate FAI, thereby providing a basis for physicians to perform pre-operative planning for arthroscopic surgery. Post-operative CT images of 20 patients with satisfactory surgical results were collected, and 10 sets of models were used to define the flexion rotation centre (FRC) of the three-dimensional FAI model. First, let these 10 groups of models simulate the FAI detection action and find the best centre offset, and then FRC is the result of averaging these 10 groups of best displacements. The model was validated in 10 additional patients. Finally, through the adjustment basis of FRC, the remaining 10 sets of models can find out the potential position of FAI during the dynamic simulation process. Rotational collisions detected using FRC indicate that the patient's post-operative flexion angle may reach 120° or greater, which is close to the actual result. The recommended surgical range of the diagnostic system (average length of 6.4 mm, width of 4.1 mm and depth of 3.2 mm) is smaller than the actual surgical results, which prevents the doctor from performing excessive resection operations, which may preserve more bones. The FRC diagnostic system detects the distribution of FAI in a simple manner. It can be used as a pre-operative diagnosis reference for clinicians, hoping to improve the effect and accuracy of debridement surgery.

Investigating the Effect of Design Parameters on the Mechanical Performance of Contact Wave Springs Designed for Additive Manufacturing.

Additive manufacturing (AM) enables design freedom to fabricate functionally graded wave springs designed by varying design parameters, which are not possible in traditional manufacturing. AM also enables optimization of the wave spring design for specific load-bearing requirements. Existing wave springs are manufactured by metal with constant dimensions (width and thickness of the strip, diameter) using customized traditional machines in which design variations are almost impossible. This study aims to investigate the effect of wave height, the overlap between the two consecutive coils, and the number of waves per coil on the mechanical properties, for example, load-bearing capacity, stiffness, and energy absorption of contact wave springs. Two designs, that is, rectangular and variable thickness wave springs, were chosen and the design of experiment was devised using Minitab software, resulting in 24 samples. HP MultiJet Fusion (MJF) printer was used to manufacture the samples for performing uniaxial compression tests up to 10 cycles and 90% of the compressible distance to study the variation in mechanical properties due to changes in parameters. Experimental and simulation results showed that variable thickness wave springs have better load bearing, stiffness, and energy absorption compared with the rectangular counterparts. In addition to that, the number of waves per coil and the overlap are directly proportional to the load-bearing capacity as well as stiffness of the wave springs, while the constant wave height is responsible for more uniformly distributed stresses throughout the coils. Load-bearing capacity was increased by 62%, stiffness by 37%, and energy absorption by 20% once the number of waves per coil is increased from 5 to 6 in rectangular wave springs. Overall, the parametric variations significantly affect the performance of wave springs; thus, designers can choose the optimized values of investigated parameters to design customized wave springs for specific applications as per load/stiffness requirements.

Biomechanical comparison of static and dynamic cervical plates in terms of the bone fusion, tissue degeneration, and implant behavior.

INTRODUCTION: Using an anterior cervical fixation device in the anterior cervical discectomy and fusion (ACDF) has evolved to various systems of static and dynamic cervical plates (SCP and DCP). Dynamic cervical plates have been divided into three categories: the rotational (DCP-R), translational (DCP-T), and hybrid (DCP-H) joints. However, little studies have been devoted to systematically investigate the biomechanical differences of dynamic cervical plates. MATERIALS AND METHODS: The biomechanical tests of load-deformation properties and failure modes between the SCP and DCP systems are implemented first by using the UHMWPE blocks as the vertebral specimens. The CT-based C2-C7 model simulates the strategies of cervical plate in ACDF surgery is developed with finite-element analyses. One intact, one SCP and two DCP systems are evaluated for their biomechanical properties of bone fusion and tissue responses. RESULTS: In the situation of biomechanical test, The mean values of the five ACDSP constructs are 393.6% for construct stiffness (p < 0.05) and 183.0% for the first yielding load (p < 0.05) less than those of the SCP groups, respectively. In the situation of finite-element analysis, the rigid-induced ASD is more severe for the SCP, followed by the DCP-H, and the DCP-R is the least. DISCUSSION AND CONCLUSIONS: Considering the degenerative degree of the adjacent segments and osteoporotic severity of the instrumented segments is necessary while using dynamic system. The mobility and stability of the rotational and translational joints are the key factors to the fusion rate and ASD progression. If the adjacent segments have been degenerative, the more flexible system can be adopted to compensate the constrained mobility of the ACDF segments. In the situation of the osteoporotic ACDF vertebrae, the stiffer system is recommended to avoid the cage subsidence.

Flexural Properties of Periodic Lattice Structured Lightweight Cantilever Beams Fabricated Using Additive Manufacturing: Experimental and Finite Element Methods.

Lattice structures are a type of lightweight structure that is more commonly being applied to engineering systems as a way to reduce mass and enhance mechanical properties. The cantilever beam case is one of the primary modes of loading in many engineering applications, where light-weighting is also crucial. However, lightweight lattice structured cantilever beams have not been investigated considerably due to design and manufacturing limitations. Therefore, the aim of this study was to investigate the response of four different lattice structured cantilever beams comprising of unit cells made from Schwarz-P, Schwarz-D, Gyroid, and Octet-truss structures fabricated using Multi Jet Fusion additive manufacturing technology. An investigation into the cross-sections of these structures leads to a conclusion that the beams made from such structures are non-prismatic in nature as a result of variation in cross-sections. This led to the development of equations for the moment of inertia of these structures, which helped in calculating symmetric and un-symmetric bending. These beams were subjected to cantilever loading until failure, which provided insights into flexural properties such as flexural stress, stiffness, and strain energy. Experimental results indicate that the surface-based structures, due to better surface-area-to-volume ratio, have better ability in transferring loads and hence perform better than the beam-based Octet-truss beam. The Schwarz-D beam had performed the best among all the beams, which is further supported in literature due to its stretch-dominated topology that results in higher values of modulus. The finite element analysis (FEA) findings also validate these findings in which the distribution of stresses can be seen to be better transmitted than the other structures. The FEA validation shows that the distribution of Von-Mises stress and their position in experimental tests and failure of these structures is also very close, which provides validation to the experimental setup and the testing of beams.

A Review of Critical Issues in High-Speed Vat Photopolymerization.

Vat photopolymerization (VPP) is an effective additive manufacturing (AM) process known for its high dimensional accuracy and excellent surface finish. It employs vector scanning and mask projection techniques to cure photopolymer resin at a specific wavelength. Among the mask projection methods, digital light processing (DLP) and liquid crystal display (LCD) VPP have gained significant popularity in various industries. To upgrade DLP and LCC VPP into a high-speed process, increasing both the printing speed and projection area in terms of the volumetric print rate is crucial. However, challenges arise, such as the high separation force between the cured part and the interface and a longer resin refilling time. Additionally, the divergence of the light-emitting diode (LED) makes controlling the irradiance homogeneity of large-sized LCD panels difficult, while low transmission rates of near ultraviolet (NUV) impact the processing time of LCD VPP. Furthermore, limitations in light intensity and fixed pixel ratios of digital micromirror devices (DMDs) constrain the increase in the projection area of DLP VPP. This paper identifies these critical issues and provides detailed reviews of available solutions, aiming to guide future research towards developing a more productive and cost-effective high-speed VPP in terms of the high volumetric print rate.

Biomechanical comparisons of dynamic fixators with rod-rod and screw-spacer joints on lumbar hybrid fixation.

BACKGROUND: Hybrid fixators with quite different joint design concepts have been widely to suppress adjacent segment degeneration problems. The kinematic and kinetic responses of the adjacent and transition segments and contact behaviors at the bone-screw interfaces served as the objective of this study. METHODS: The moderately degenerated L4/L5 and mildly degenerative L3/L4 segments were respectively immobilized by a static fixator and further bridged by the rod-rod (Isobar) and screw-spacer (Dynesys) fixator. The joint stiffness and mobility of the rod-rod system and the cable pretension of the screw-spacer system were systematically varied. FINDINGS: The flexion of the screw-spacer system provided higher mobility to the transition segment, reducing adjacent-segment problems. The cable pretension had a minor effect on the construct behavior. However, due to limited joint mobility, the rod-rod system showed higher constraints to the transition segment and induced more adjacent-segment compensations. The increased mobility of the rod-rod joint caused it to behave as a more dynamic fixator that increased adjacent-segment compensations at the transition segment. Comparatively, increasing the joint mobility showed more significant effects on the construct behaviors than decreasing the joint stiffness. Furthermore, increased constraint by the rod-rod joint induced higher stress and risk of loosening at the bone-screw interfaces INTERPRETATION: If the protection of the transition segment is the major concern, the rod-rod system can be used to constrain the intervertebral motion and share the higher loads through the fixator. Otherwise, the screw-spacer system is recommended in situations where higher loads onto the transition disc are allowable.

Difference analysis of the glenoid centerline between 3D preoperative planning and 3D printed prosthesis manipulation in total shoulder arthroplasty.

INTRODUCTION: Excessive version and inclination of the glenoid component during total shoulder arthroplasty can lead to glenohumeral instability, early loosening, and even failure. The orientation and position of the central pin determine the version and inclination of the glenoid component. The purpose of this study was to compare the differences in centerline position and orientation obtained using "3D preoperative planning based on the best-fit method for glenoid elements" and the surgeon's manipulation. MATERIALS AND METHODS: Twenty-nine CT images of glenohumeral osteoarthritis of the shoulder were reconstructed into a 3D model, and a 3D printer was used to create an in vitro model for the surgeon to drill the center pin. The 3D shoulder model was also used for 3D preoperative planning (3DPP) using the best-fit method for glenoid elements. The in vitro model was scanned and the version, inclination and center position were measured to compare with the 3DPP results. RESULTS: The respective mean inclinations (versions) of the surgeon and 3DPP were -2.63° ± 6.60 (2.87° ± 5.97) and -1.96° ± 4.24 (-3.21° ± 4.00), respectively. There was no significant difference in the inclination and version of the surgeon and 3DPP. For surgeons, the probability of the inclination and version being greater than 10° was 13.8% (4/29) and 10.3% (3/29), respectively. Compared to the 3DPP results, the surgeon's center position was shifted down an average of 1.63 mm. There was a significant difference in the center position of the surgeon and 3DPP (p < 0.05). CONCLUSION: The central pin drilled by surgeons using general instruments was significantly lower than those defined using 3D preoperative planning and standard central definitions. 3D preoperative planning prevents the version and inclination of the centerline from exceeding safe values (± 10°).

Supportless Lattice Structure for Additive Manufacturing of Functional Products and the Evaluation of Its Mechanical Property at Variable Strain Rates.

This study proposes an innovative design solution based on the design for additive manufacturing (DfAM) and post-process for manufacturing industrial-grade products by reducing additive manufacturing (AM) time and improving production agility. The design of the supportless open cell Sea Urchin lattice structure is analyzed using DfAM for material extrusion (MEX) process to print support free in any direction. The open cell is converted into a global closed cell to entrap secondary foam material. The lattice structure is 3D printed with Polyethylene terephthalate glycol (PETG) material and is filled with foam using the Hybrid MEX process. Foam-filling improves the lattice structure's energy absorption and crash force efficiency when tested at different strain rates. An industrial case study demonstrates the importance and application of this lightweight and tough design to meet the challenging current and future mass customization market. A consumer-based industrial scenario is chosen wherein an innovative 3D-printed universal puck accommodates different shapes of products across the supply line. The pucks are prone to collisions on the supply line, generating shock loads and hazardous noise. The results show that support-free global closed-cell lattice structures filled with foam improve energy absorption at a high strain rate and enhance the functional requirement of noise reduction during the collision.

A parametric investigation on traditional and cortical bone trajectory screws for transpedicular fixation.

BACKGROUND: Many studies have been conducted to compare traditional trajectory (TT) and cortical bone trajectory (CBT) screws; however, how screw parameters affect the biomechanical properties of TT and CBT screws, and so their efficacy remains to be investigated. METHODS: A finite element model was used to simulate screws with different trajectories, diameters, and lengths. Responses for implant and tissues at the adjacent and fixed segments were used as the comparison indices. The contact lengths and spanning areas of the inserted screws were defined and compared across the varieties. RESULTS: The trajectory and diameter had a greater impact on the responses from the implant and tissues than the length. The CBT has shorter length than the TT; however, the contact length and supporting area of the CBT within the cortical bone were 19.6%. and 14.5% higher than those of the TT, respectively. Overall, the TT and CBT were equally effective at stabilizing the instrumented segment, except for bending and rotation. The CBT experienced less adjacent segment compensations than the TT. With the same diameter and length, the TT was considerably less stressed than the CBT, especially for flexion and extension. CONCLUSIONS: The CBT may provide less stress at adjacent segments compared with the TT. The CBT may provide more stiffer in osteoporotic segments than the TT due to greater contact with cortical bone and a wider supporting base between the paired screws. However, both entry point and insertion trajectory of the CBT should be carefully executed to avoid vertebral breach and ensure a stable cone-screw purchase.

Design for Additive Manufacturing and Investigation of Surface-Based Lattice Structures for Buckling Properties Using Experimental and Finite Element Methods.

Additive Manufacturing (AM) is rapidly evolving due to its unlimited design freedom to fabricate complex and intricate light-weight geometries with the use of lattice structure that have potential applications including construction, aerospace and biomedical applications, where mechanical properties are the prime focus. Buckling instability in lattice structures is one of the main failure mechanisms that can lead to major failure in structural applications that are subjected to compressive loads, but it has yet to be fully explored. This study aims to investigate the effect of surface-based lattice structure topologies and structured column height on the critical buckling load of lattice structured columns. Four different triply periodic minimal surface (TPMS) lattice topologies were selected and three design configurations (unit cells in x, y, z axis), i.e., 2 × 2 × 4, 2 × 2 × 8 and 2 × 2 × 16 column, for each structure were designed followed by printing using HP MultiJet fusion. Uni-axial compression testing was performed to study the variation in critical buckling load due to change in unit cell topology and column height. The results revealed that the structured column possessing Diamond structures shows the highest critical buckling load followed by Neovius and Gyroid structures, whereas the Schwarz-P unit cell showed least resistance to buckling among the unit cells analyzed in this study. In addition to that, the Diamond design showed a uniform decrease in critical buckling load with a column height maximum of 5193 N, which makes it better for applications in which the column's height is relatively higher while the Schwarz-P design showed advantages for low height column maximum of 2271 N. Overall, the variations of unit cell morphologies greatly affect the critical buckling load and permits the researchers to select different lattice structures for various applications as per load/stiffness requirement with different height and dimensions. Experimental results were validated by finite element analysis (FEA), which showed same patterns of buckling while the numerical values of critical buckling load show the variation to be up to 10%.

Mechanical Performance of Lightweight-Designed Honeycomb Structures Fabricated Using Multijet Fusion Additive Manufacturing Technology.

Cellular structures including three-dimensional lattices and two-dimensional honeycombs have significant benefits in achieving optimal mechanical performance with light weighting. Recently developed design techniques integrated with additive manufacturing (AM) technologies have enhanced the possibility of fabricating intricate geometries such as honeycomb structures. Generally, failure initiates from the sharp edges in honeycomb structures, which leads to a reduction in stiffness and energy absorption performance. By material quantity, these hinges account for a large amount of material in cells. Therefore, redesigning of honeycomb structures is needed, which can improve aforementioned characteristics. However, this increases the design complexity of honeycombs, such that novel manufacturing techniques such as AM has to be employed. This research attempts to investigate the optimal material distribution of three different topologies of honeycomb structures (hexagonal, triangular, and square) with nine different design configurations. To achieve this, higher amount of material was distributed at nodes in the form of fillets while keeping overall weight of the structure constant. Furthermore, these design configurations were analyzed in terms of stiffness, energy absorption, and the failure behavior by performing finite element analysis and experimental tests on the samples manufactured using Multijet fusion AM technology. It was found that adding material to the edges can improve the mechanical properties of honeycombs such as stiffness and energy absorption efficiency. Furthermore, the failure mechanism is changed due to redistribution of material in the structure. The design configurations without fillets suffer from brittle failure at the start of the plastic deformation, whereas the configurations with increased material proportion at the nodes have larger plastic deformation zones, which improves the energy absorption efficiency.

The Effect of Functional Gradient Material Distribution and Patterning on Torsional Properties of Lattice Structures Manufactured Using MultiJet Fusion Technology.

Functionally graded lattice structures have attracted much attention in engineering due to their excellent mechanical performance resulting from their optimized and application-specific properties. These structures are inspired by nature and are important for a lightweight yet efficient and optimal functionality. They have enhanced mechanical properties over the uniform density counterparts because of their graded design, making them preferable for many applications. Several studies were carried out to investigate the mechanical properties of graded density lattice structures subjected to different types of loadings mainly related to tensile, compression, and fatigue responses. In applications related to biomedical, automotive, and aerospace sectors, dynamic bending and rotational stresses are critical load components. Therefore, the study of torsional properties of functionally gradient lattice structures will contribute to a better implementation of lattice structures in several sectors. In this study, several functionally gradient triply periodic minimal surfaces structures and strut-based lattice structures were designed in cylindrical shapes having 40% relative density. The HP Multi Jet Fusion 4200 3D printer was used to fabricate all specimens for the experimental study. A torsional experiment until the failure of each structure was conducted to investigate properties of the lattice structures such as torsional stiffness, energy absorption, and failure characteristics. The results showed that the stiffness and energy absorption of structures can be improved by an effective material distribution that corresponds to the stress concentration due to torsional load. The TPMS based functionally gradient design showed a 35% increase in torsional stiffness and 15% increase in the ultimate shear strength compared to their uniform counterparts. In addition, results also revealed that an effective material distribution affects the failure mechanism of the lattice structures and delays the plastic deformation, increasing their resistance to torsional loads.

Gender differences in femoral trochlea morphology.

PURPOSE: This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. METHODS: Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross-section were also analyzed to determine the differences in the depth of the trochlear groove. RESULTS: The absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. CONCLUSION: Male subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. LEVEL OF EVIDENCE: III.

Design and application of personalized surgical guides to treat complex tibial plateau malunion.

Intra-articular corrective osteotomy can be used to restore the anatomic position of knee surfaces for tibial plateau malunion (TPM) but precise restoration is not easy. The personalized surgical guide (PSG) might improve the TMP outcomes. This study developed a two-staged PSG method to provide registration and drill the bone for subsequent osteotomy. The tests were performed to compare the accuracy the proposed PSG and the conventional guide (Anterior cruciate ligament guide, ACLG). The results showed that the PSG provides better accuracy (0.50 ± 0.19 mm) than the ACLG (1.58 ± 0.67 mm). The results show the PSG method is a feasible alternative to the conventional ACLG procedure.

How do lateral hinge and distraction affect three-dimensional rotation in open wedge high tibial osteotomy?

BACKGROUND: Open-wedge high tibial osteotomy (OWHTO) has extensively been used for the correction of medial knee osteoarthritis. The proximal tibia is osteotomized and distracted to enable the rotation of tibial fragments around the lateral hinge. Both, wedge inclination on the medial side and saw progression near the lateral cortex determine the hinge orientation. This study focused on the interaction between hinge orientation and distraction sites on the coronal, sagittal, and horizontal planes of the distracted plateau. METHODS: Three parameters of wedge inclination, saw progression, and distraction site (i.e., posterior, middle, and anterior) were systematically varied. Using a three-dimensional (3D)-printing technique, the osteotomized tibiae were manufactured as the specimens for the in vitro experiments. In total, 27 variations (3 × 3 × 3) were tested. After distraction, the specimens were scanned by computed tomography and spatially registered with the original tibia to compare the 3D angles of the distracted plateaus. RESULTS: Coronal rotation is the main purpose of OWHTO; therefore, all the values of the coronal angles were positive and significantly higher than the other two. The sagittal and horizontal angles had relatively similar values. Distraction in the middle site seems to have the least impact on sagittal rotation. Large angles of hinge orientation show the superior ability in adjusting the sagittal rotation than small angles. However, the larger the horizontal angles the greater the wedge inclination. CONCLUSIONS: The wedge inclination, saw progression, and distraction site constitute a complex mechanism that affects 3D rotations of the distracted plateau. The coronal angles are sensitive to hinge orientation and distraction site. The intraoperative planning of manipulating hinge orientation is an effective method to adjust sagittal rotation. A large angle of wedge inclination is an indicator of horizontal rotation, and it should be carefully mitigated to reduce the risk of cracking in the lateral hinge.

How do osteotomy and distraction affect distraction angles of opening wedge high tibial osteotomy?

BACKGROUNDS: Trigonometric formulae have been derived to correlate the distraction angle (height) and tibial specifications. However, the assumption-induced simplifications are inherent in the formulae such as the rigid tibia and the specific orientations of cutting plane and lateral hinge. This study aimed to evaluated the accuracy of the trigonometric formulae. METHODS: The 3D printed tibiae were used as the specimens for which the hinge orientations and distraction sites were systematically varied. Hinge orientation was determined by wedge inclination of the bone saw into the medial tibia and saw progression near the lateral cortex. The specimens were distracted at different distraction sites to measure the distraction angles that were compared with literature formulae. FINDINGS: In cases of the same distraction height, the wedge inclination, saw progression, and distraction site had various impacts on the coronal angles, indicating that the ideal formula should consider these parameters. Averagely, the predicted angles of the literature formulae were 15% higher than the testing results. The differences in these results may be attributed to the deformable property of the specimen material, non-ideal hinge orientation, and differences in distraction sites. Saw progression and distraction site had greater impacts than wedge inclination on the distraction angle. INTERPRETATION: Variations in three surgical indices constitute a complicated mechanism that affects the 3D hinged rotation of the distracted plateau. The non-middle distraction further deforms the tibial rotation and reduces the accuracy of the trigonometric formulae. The trigonometric formulae might underestimate the distraction angle; thus. Appropriate corrections are necessary for clinical application.

Traditional and cortical trajectory screws of static and dynamic lumbar fixation- a finite element study.

BACKGROUND: Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) were shown to provide equivalent pull-out strengths of a screw. CBT utilizing a laterally-directed trajectory engaging only cortical bone in the pedicle is widely used in minimal invasive spine posterior fusion surgery. It has been demonstrated that CBT exerts a lower likelihood of violating the facet joint, and superior pull-out strength than the TT screws, especially in osteoporotic vertebral body. No design yet to apply this trajectory to dynamic fixation. To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization. METHODS: A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison. RESULTS: The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking. CONCLUSIONS: Modeling the effects of TT and CBT fixation in a full lumbosacral model suggest that dynamic TT provide slightly superior stability compared with dynamic CBT especially in bending and rotation. In dynamic CBT design, large diameter screws might avoid issues with loosening and cracking.

Concentrated stress effects of contoured and non-contoured high Tibial osteotomy plates: A finite-element study.

BACKGROUND: The TomoFix plate has been extensively used in high tibial osteotomy surgery to stabilize the distracted tibial bones. However, distal pain related to plate irritation was considered one of the most relevant complications for this fixation device. This study aimed to correlate reports of distal pain with the profiles of the distracted tibia and initial plate and plate contour. METHODS: This study used the finite-element method to investigate the profile-, distraction-, and contour-induced effects on stress distribution of the distal tibia-plate contact. The associations of two tibia profiles (normal and concave), distraction angles, and two plate profiles (contoured and non-contoured) were discussed in this study. The areas and stresses of the distal tibia-plate contact were chosen as comparison indices. FINDINGS: Before weight-bearing, the non-contoured plates of the normal and concave tibia profiles consistently showed less contact area at the distal tibia-plate region. Consequently, the physiological loads make the non-contoured plate subject to more concentrated bone stresses and thus may induce more pain at the distal tibia-plate region than a contoured plate. When the distraction angle decreases, the tibia-plate gap increases. Prior to fixation, the tibia-plate gap can be evaluated by the profiles of the distracted tibia and non-contoured plate by use of anteroposterior radiograph and computer-aided simulation. INTERPRETATION: In the situations of a lower distraction angle or a large tibia-plate gap, the use of a plate bender or a lag screw is recommended in order to contour the plate for reducing the concentrated stress at the distal tibia-plate region.

Comparison between different screening strategies to determine the statistical shape model of the pelvises for implant design.

BACKGROUND AND OBJECTIVES: The statistical shape model (SSM) of numerous bones has been used to determine the anatomical representative of the population- or race-specific design for periarticular implants. Whether to include size- and profile-mismatched bones in the SSM calculation is debatable. Therefore, the objective of this study was to characterize the screening strategies for the mismatched bones to improve the SSM calculation. METHODS: The bone database used in this study consisted of 20 pelvises. A systematic four-staged SSM calculation was used to evaluate the accuracy of the predicted SSM shape among the four size- and profile-screening strategies. Additionally, the surface-smoothing effects on the SSM results were investigated. Two comparison indices were used in terms of profile difference and surface smoothness. RESULTS: Significant variations in size and profile existed for the collected bones. By normalizing the aspect ratio of all bones, exclusion of the size-mismatched bones reduced the maximum and root mean square (RMS) error values of the profile difference by 18.9% and 17.5%, respectively. After further excluding the profile-improper bones, normalization reduced the RMS profile difference by 24.1% compared with the non-normalized strategy. Exclusion of the size-improper bones for non-normalized strategy would have reduced the RMS profile difference by 15.4%. After smoothness, the RMS profile difference of SSM was only 6.1% higher than that of the non-smoothness SSM. CONCLUSIONS: The four-stage calculation showed that the most favorable strategy was to normalize bones to the same aspect ratio and exclude improperly shaped bones. The model permitted inclusion of the original characteristics of the bones and preserved their shapes and excluded only significantly improper bones. After SSM calculation, the smoothed process provided satisfaction in quality with a statistically insignificant loss in bone morphology for population- or race-specific designs of implants.